500 Peregrine Pl.
--
-
, TYPE OF PERMIT
Reroof'
CITY
BUILDING DIVISION
200 S, ANAHEIM BLVD,
,(714) 765 - 5153
, INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: ,,434
QUARTER SECTION: 113
BUILDING PERMIT NO,
(~.
81..02004-00313'
,,'
DATE: 213/2004
JOB ADDRESS: 500 S PEREGRINE ST,
LEGALDESCRIPTION: N TR 1987 LOT 31
CONTRACTOR INFORM,'TION:
SANTIAGO ROOFING IN,C
, 417 ASSOCIATED RD #A215
BREA, CA 92621 0000 ',' ,
" 1. __',,'
BUSINESS PHONE: 714523-0440' ,
JOB DESCRIPTION:Replace eXisting shake with 50 year comp shingle, Incluces attachea garage, 26 squaree,
, VALUATION: 7,000,00 PROCESSED BY: CAL
I ' , OWNER.BUILDEll DECLARATION
t hereby affirm u1)der penalty of perjury. that I am exemptfrorn the Contractc_r':s, ~jcer1Se Law for the following rea~on {Sec. 7031.5 Business and
Professions. Cod e: aITt city or county Which requires a, permit to construct, a~!\ci'r,jinprove, demolish or repair any structure,_ prior to its isslJance, also
requires the appl1a:1nt for such permit t'o me a signed sta'tement t,hat he Is jjc'4n~.;1?ursuant. to the pro'visionsof the Contractor's License l~ (Ch~Pter
9)(commencing withSectjon 7000 of Divisiqn 3 of the Busihessand Profes3ibns (Jade) or t~t. h~ is exempt therefrom and the basis for the all~ed.. ....
~;;~\tion, Anyviolation of Seclion 7031 ,5 by any applicant for a permit sut!.eCl"lheapplicant to a dvUpana~y of not more than live hunared a?"ars
o .' I, as owner of property. or my emplQyees with wages as their sole cOIT!t:ensatiof), ~i11 dO,the work,. ~ndthe s~ructureisnot intended or offered fQr
. sale (Sec. 7044 BusineSs .and Professions Code: The Contractor's Ucensl~ l:aw does.nat apply to an owner of property who builds or improves,'-- ,
thereon, and who. does ,$uch work himself or herself or through his.or her ow:'. efliployees,provided that ~such improvements are natlntended or
offered fO~ ~Ie.: .If,'however,. the building, or improvement is sold:,\Yithone y.t'~rof"~lJlPletiar1' the owner-builder will ,have the burden of proving t~at he
did not budd ortmprove for the purpose of salel, . .'( . "'-.'~::'. . . " '. '
o . I, as the owner of the property, am exclusively contra cting with Iicense(~l ~corit"'cldars to construct the proJect (Sec. 7044 Business and Professions
Code: The'Contractor's License law does ,not apply to an owner.of property\vho builds or improves thereon, and who contracts for such projeCts with
~ontr:actor(s}licenSed,pursuant to the Contract~s Lice.nse Lav.:).' lso::'. .
U I am exempt under Sec, , ' "B & P.C. for this'teason: ;;
Date' OWner:'"
APPLICANT: DEBORAH ELIASUN
OWNER INFORMATION;
Thomas'T'Bressler' .
500 S Peregiine St
Anaheim, CA 92806
ARCHITECT/ENGINEER INFORMATION:
I
WORKER'S COMPENSATION DECLARATION ,_
I hereby affilin under penalty of perjury one of the following, declarations: 1,
o I have and Will maintain a certifici,Jte ot'consent to selfch1surefor workel!~ compensation>,"
as providecHor by Section 3700 of the' Labor Code, for the petformanoeot tt-.1ewol'k for Which
thIs per.,' IS issued. . . " . .' ',. "~,I ."
~ve and will main~in worker's compensation insurance, as required l,', Section 3700 of
'a~6r Code, for the perforrnance.ot'the work for which this perm'it is iss\.i.K!, My worker's' .
. pensatioli insurance carrier and pOlicy are: . . . .,.....; .,~
arrier: STATE COMPENSATION INS FUND Policy Number.285'D90;:2(jUq9~'
'. . " . '. . :'. .1:"~t>0: ~,t.~.:::::,
This section neEl!l not be oompletea if th, pannil Is for one hundred dollars (~1C~1 or"as.., ,,' '
o I certify that, in, the performance of the, work for. which this permit-Is iSS~(:d,:j":S~.IFnot
, employ any person in a ny manner so, as to become subject to .the. worke~s c':,~rTIp'en,sati6n'aws
of .california, anctagree'that if I 'should become. sUbject, to. the work.er's'9pmp,::ri~ation"":;'" ? ,_
provisions of Section, 3700 ofthe labor Code, allf ,rth 'th ~p~y ~it~~r~5,.~.~gYiSions. :~.O~~cion Tvpes:
Date: 2/312004 APplicant: "'~'"' "'~""':" "
WARNING: FAILURETO,SECUR RK '$ COMPENSATION COVERAGE IS'>"";'';!
, UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINALPENAc'tiES, I\N!iqVI(
FINES UP TOONE HUNDRED THOUSAND DOLLARS, ($100,000): IN ADCrnOl'J TO THE'} ,
COST OF COMPENSATION, DAMAGES AS PRaVIDEDFOR IN SEGTID:-.:, 3i0691"'j"HE;',(
LABORC9D E, INTEREST AND ATTORNEY'S FEES,;'''',' ,~.~;':' ' . '?', '<~ .',' ;:j,:
, CONSTRUCTION LENDING AGENCY
I hereby affirm .,urider penalty 'of. perjury that ther~js. ~ construction le,nd)nd:ai~1l9Y for ~e~" .
. pe,lTormance or the v{ork forwhidl this permitis issued (Sec.3097.Civ.C):
Lende(s Information: -
I
LICENSED CONTRACTORS DECLARATION
'1 hereby affirm under penaltyb perjUl:ythat "am
. licensed under provisions.o,f chapter 9'(comm~ncing
with Section 7000}.of.. Divsioli 3 of tt)e Business"and
::~ons (Dl (L ,', a~i;. "
Date: :\ .' Contractor
NUMBER . :EXPIRATIONDATE"
576276 8/31/2005
, TYPE C39
TYPE HIC
....,)
i c~rtify that I have read this' application and state that the ab,ove information is correct. I
, agree to comply with all city ordinances and stat~ laws relating to building construction, and
hereby authorize representives of thisd to enter upon ,the above mentioned property for
Inspection purpo ./
Fees paid for Permit:
Total:
167,29
Datt!: 2/3/2004
, n u e of Applicant or Agent , ' ,
The per tshall expire by limitation and become null and void if the building or
work has not passed fi 031 Inspection 365 days from the date of permit issuance. A
'new permit is required 10 commence or continue work.
INSPECTION RECORD
... DAT~ INSP~CTOR
. INSPECTION . .
Temporary Power Pole . . ..
Plumbing (DralnlWaste Pipe) >
Electrical Ground Electrode/Uter .
SetbacklFormsrrrenches (Footings) I.
. Do not install slJbflOor or pour floor slab until the
following applicable items have been Signed:
Plumbing (Water PlpeoSprinlder Valves) .
Mechanical (Groundwor'k) :. . .
Electrical (Ui1derground Conduit)
Pre-slab (Compaction/Membrane.Rein!.
Underpinning (ROot: Joist/Girders)
Do not cover or conceal the worK below until the .
following applicable items have,beensigned: .. ' ..
1st Flo,or Shear '. . ' .
Firesprinkler (Rough)' .
2nd Floor Shear . ., I
. ROof (Sll8al/lIng/OiaphragmlFrame) ry 194 iJA
Masonry (ReinfJBond BeamJPre-Grout)
Rough Plumbing (Top Out) , . . '
Rough Mechanical .
KOugn l:Iec;trical (ury wadi .
, Rough Electl'ical ..
Framing (Only alterPIIlg" EIEC" Meen" and Fire)
InSlJlation (SoundlEnergy)
Do not tape or plaster 'lJntil the following applicable
items have been signed: , " .. . .
Drywall .
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanic;al
P!!Oetrations (Fire Rated) Plumbing
",terlor Lath . .
Exterior Lath
. . GENERAL ITEMS
Exterior Plaster (Brown Coat) , ' .
T .Bar Electrical . .
T .Bar Mechanical . , ,
T .Bar, Structural :
Sewer .
Water Engineering BackflQw . .[
Water Service . .
~/
'yC'
FINAL INSPEOTIONS ).,. D~e, Inspector '
Electrical Final . ' . . ,.
Plumbing 'Final , .
Mechanical Final . .
Gas Test , .
.. .
Engineering/Grading Final 765-5126 .
Fire Cept. Final 765-4040 , .
, .
Water Engineering 765-5268 . . , '. .
Sub List/Business License 765.519 ,
Zoning 765-5.139 .
Building Final ~ast Inspection. Only 1;/'0'$" ~5'fc..-
fter Ab.oveCompJele)
PARTIAL INSPECTIONS .. '/
Buildina Inspections
, Mechanical Inspections
Plumbiria Inspections
'-
ElectricallnsDections
TYPE OF PERMIT.
Residential Remodel CITY
DATE: 12/2212004
JOB ADDRESS: 500 S PEREGRINEST
LEGAL DESCRIPTION: N TR 1987 LOT 31
t!f~;~~j~~J?2,\
" " -!HElM
j, .
.,
BUILDING DIVISION
200 S. ANAHEIM .sLVD.
(714) 765 - 5153
INSPECTION REQUESt LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER.SECTION: 113
BUILDING PERMIT NO. BLD2004-04477
APPLICANT: THOMAS BRESSLER
OWNER INFORMATION: CONTRACTOR INFORMA.T10N:
Thomas T Bre~ler
500 S Peregrine 8t
Anaheim, CA 92806
JOB- DE~CRIPTION:'New door. one window and drywall to existing,garage.
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 700.00 .-"
r OWNER-BUILDER DECLARATION :=J
I hereby affirm under penalty of perjury that I am exempt from the CC'lltractor;b UCF:!r1r..e Law.forJhe foHowing reason (SeG. 7031.5 Busjnes~ a;:d .
Professions Code: a~y city or CQuntywhich requireS81?ermTt to construd,al~~-;rih;pr0ve, dei'l')()lish or repair any str,uc:tufe, pr!c;r tcits iesuance. also
requires the applicant for such permit to file a signed statement that he is jf('e:H:.ed pl;rsuant to the proviSIons of the CcntraGt.or!s license ltilw,(Chapter
9)(commencing with Section 7000 of Division ~ of the Busines'S andProfessic;:s C~El) or that he'is exe'rr.pt therefrcmand tile-bC'l.!'>isfor ihe alleged "
exemption. Any violation, of Sectiqn, 7031.5 by any applicant for a perrr.i! SUbJ.~;:;ts the 8!=,plicant to a civil penalty of not lTiore thm'l tivehlmared dcllarq.
~~ . ... .. . . .
rxtJ, as owner of property, or myemployees with.wages as their sote c:om!J~:'hsCit,ion, wi:! do the work, and the strl,.lcture is not in,i~r,d"ed of'offered for
laIe (Sec. 70M'Business and Professions Code: The Contraetor'sl;censEl L~~\i does not apply to an owner of property wh? t..:uild~ cr imp;oves
thereon, and'who does such work himself or herself or through his or her owr;err';-ri0~lee8, provided that such i~.r:ovements (:'Ire not intended or
offered for sa'le. If, however, the buildiIJ9 or :mprovement is &old witn ':Ine yecl" of ccmpiet!on, the oWiler.hlJild~r will have tneburden of ~r~vinH that he
did not buildor improve for the purposP. ot-sale). '; '. . .' _. .' . '. .
o "I, a,s the owner oithe property, am ~xdtlslveiy contractirlg w;lh-!j'.;ens:;d (':~ntrabtor~ to constrLir.t the projed(Sec. 7044 Busin:ess a~d Professiqm
Cod~: The Contract"r's License Law does not apply to an owner of prop'?1y ,\-ho builds O( improves thereon, snd who oontr3cls fo: sud! r~!o.iects with
.8ontrac:tor(s) licensed plJrsual1t to the Cc etor's Lice. e Law). ) .
"~lam exemJ2! undei Sec. P :C. for . eas': ___~},
te:_ -;.,.l:- Ow -1::..:
WORKER' MPENSATiON DECLARATION. _,_~~ ~ ,'LICENSED C;:~jTRACro-;:;S-DECLARA:riCNJ
I hereby affirm under penalty 0 erjury one of the following declarations>. r:--I hereby aftir(rr under panal.t;y C'f perjury that I am
I ,have and will maintai .a c~rtificate'of oonsent \oselHnsureior WOrl\.er',:3;~Q-r;i~;6n!';atiG'1, I iicensed Ullder.lJfO'v1Sionsof chaoter 9 (comrn_eilc.in.g
as pl'ovlded fer by Sedlo 3700 of the labor Code. for ths perforrnanc-,E' of !::'~'~'~~ri; :c;r ~'lihlch with Section 7000) at Divsion 3 ofthe, Business and
this permit is issued. . Ii'. . Professior..s SOOb .
o j have and will' maintain worker'$ 'compehsation insl.!:rance,;lS l-equired c)';:';oct:on 3700 of I 1212:!12u04
the labor Code, for the performancecf the work for which this :')e'rmit 15 i~",u~!j-. MY"'.lorker's Date:
Compensaticn insurance carrier and policy are: . " ,
Carrier: -' . . Policy Number: ; . l' NUMBER
This seCtion need not be- Completed if the pem"!it ;5 fcrori; '~~mdre'd' dollars ($10c:,'N ie&s. ..' I TYPE
'Wf r' certify that in the performance of the work fo~ whir.h this per;itis i8Sueq,'I.. s~aH:-~ot I
~plqy. nr.y personinany manner so as to become subjeetto'~~le:\horKer's c(;'bpen~,<:!tion IS\vs
of,C~I.~cmia, a,nd ~greeJhat if'ls ,uld om subject t<?t~e 'o~:~~r'.s c.o.mpc~~~atiui1-", ,'-,. ~', .
proVISIons of Section 3700 of.the ,Go Sha.'.'.fortn OO:;~'~ ",tn tho". prw:s>ons. I eo~~tr~cion Tvoes:
Date: 12/22/2004 , Applicant: _. ~..~ ~__ Fire sprinklt;:red?
WARNING:. FAILURE TO SECUR. RKER'S <::OMPENSATIQN COVEI~':(;[JS ... . I'.
.UN.L. AWFUL, AND SHALL.SUBJ~ T . EMPLOYE.-R TO C.R1M.1N.f>...'.L PENAL'f.'.E._~A.;;"..[).... (.;] V.'L
FINESUPTO ONE HUNDRED OUSAND DOLLARS ($100,000), IN ADD'TIONTO THE I
COST OF COMPENSATION,.D AGES AS PROVIDED FOR IN.$E:CTION .j706T,F T.HE .
L:R CODE, INTERES~~s~;7u~i7~:~:~6i~G AGE~~~ . ~L:... ,.
I hereb~ affirm.u9oer pehaltyofp6:rjury that there_ !s:c,-,r:onstructi?lJ-kmding a:;~,:-t.:yf9r-ttJft..' :
r;~dorm.inte'of1H~'work f6'(~/hiGh tf\is pen:lit is iss'ued tSeC:309i.C-~v~(::': ..." ." ...- I
j:..~i1d&i's'{I;foli11ci'ijon: - '.. -- -- -- . - . r
PROCESSED BY: ENO
Contractor
EXPiRATION DATE
NO
c.-:'t
Date: '!2/2212004
Fees paid for Permit:
Total:
"
.196.19 "
Signature of Applicant or Agent
T e pe it shall expire bY limitation and become null and void if the',uiiding or
w k has not passed final inspection 365 days from the date of permit issu8!1Ce. A
w permit is. required to commence or continue work.
.',
"
INSPECTION RECORD
INSPECTION . . . DATE. INSPECTOR
Temporary Power Pole .. .
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer .
SetbacklFormsfTrenches (Footings)
Do not install subfloor or pour fl00r slab until the.
following applicable items have been signed:
Plumbing (Water Pipe;Sprinkler Valves) . .
Mechanical (Groundwork) , .'. . .
Electrical (Undergrollnd Conduit)
Pre-slab (Compaction/Membrane.Rei nt.
Underpinning (Floor Joist/Girders)
Do not cover or conceal.the work below until the
following applicable items have been signed:
1 st Floor Shear .
Firesprinlder (Rough)
2nd Floor Shear .
Roof (Sheathing/Diaphragm/Frame) . ,
Masonry (ReinfJBond BeimlPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical IDry Wall} .
Rough Elec1r1cal. .
Fra,ming (Only after Plbg.. Elee.. Mech. and Fire) '.
Insulation (SoundlEnergy) .
Do not tape or pfaster until the following applicable
items have been signed: '. .
Drywall . ,
Peneti'ations(Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plun'lbilig . .
Interior Lath . .
exterior Lath . .
. .. GENERAL ITEMS .
Exteri9l' Plaster (Brown Coat) .'
T .Bar Electrical' .
T .Bar Mechanical
T .Bar Structural '. . .
Sewer ....
Water Engineering Back.flow .
Water Service .
FINAL. INSPECTIONS. . Date Inspector
Electrical Final . . :
Plumbing Final '. . ..
Mechanical Final
Gas Test ". . . . .
Engineering/Grading Final 76505126 ". .
Fire Dept. Final 7654040 .
.
Water Engineering 765.5268
Sub List/Business License 765-519 . .
, .
Zoning 765-5139 .
Building Final ~ast Inspection' Only 7-/-<>)" -:Z:I Leo
fter Above Complete) c7
I
PARTIAL INSPECTIONS
'Buildina Inspections
Mechanical Inspections
Plumbina . Inspections
Electricallospections
~. .
/
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500 5. Peregrine 5t.
Anaheim CA 92806
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