553 S. Peralta Hills Dr.
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;;;;~;,?FPERMIT CITY
DATE: 8/5/2003
JOB ADDRESS: 553 S PERALTA HILLS DR
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8UllDJ~JG- Di\!rSION ~~;"
200 S. ANAHEIM P.t.'JD,
. (714) 765,.5.1#:\
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INSPECTION REOUEST LINE:
(7)4) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 168
BUilDING PiRi'iIlT NO, BlD2003-03062
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LEGAL DESCRIPTION:
P BK36 PG 10 PAR 3
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CONTRACTORINFORM,hoN:
PETRONELLA ROOFIN0/jO Tl-iE
2626 NEWPORT BlVO ~~ ~
COSTA MESA, CA926270<"'n
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BUSiNESS PHONE'. 949 3''>7,B72j'' . ,
JOB DESCRJPTlON:Tear off shake "and install 92 sqlJares of Mira Vj~~~g~i!~'Jj;~:.:s ~C30'# :32Q9hr~ducles POQ!_ house)
VALUATION:'. 38,000,00 . . ..;,:iIf ..,..", " "PROCESSED BY: oor;; . . .'
C ." . '. OWNER-I3lJ;;:i3E,~~Ct,p;RATION,;-'_ '-'-~ '. ,,~,",~_~_..::...~~-J
1 hereby affirm under penalty of perjUry that I am exempt fro~ ~n~.. C9(!t~~~t,~;r:;}Jc?n.,?e.Lav..', for t!ie Jo:,lc:..v~ng J7~~ol:; t~~,c. 7021.0 Bl.Is,u,esf> and
Professions Code~ any city or county which reqUIres a permit to c~ns:truc~, '~)'~*j; Impr~_'l\/e, demolish or:r"c:pair any !')tr!JCi.ure, prior to it::;. 1S$ua~1C€l, ai~c
r€:Ci-uires the applicant for such permit to file a signed stat"emei?t th~l heds:~j{))~.~~c!p:urfuant t();~he provi'!;;ior.e 07 the Contmctor's L:censeLaw (Chapter
9)(commencing with Section 7000 of DiVision 3 of ~he Bus!nes,s~_ndp'isfesskr-li.G,Mel or tb2tt~)~ 9,~enlpt-th'::ref~om al1d the baSIS Tor the all-aged
~;:C~~~ion.. .:Any violation ofSectio~7031.5 ~y any apPliCantf~r:af~'.~!t~st~;];~tS'I~e,_~p:PHC~r:} ~~.~'(.[vi:1~t~;~,;t~~~~_n~rm()r~ thall fi'!e hundred doliars
[1 '!, as owner ofproperty..or my employees with wages as !~(;,jrsoJ~'comJJ.:.i,:~'r~I::~i'!~ v:i.l:'do. t~ety..ork,al,;d P~e_stru,:i;reis not :at~"ded croffCi€:lj Tor
saJe{SeC,7044 Business and Professi(m$ Gode: The Contract0r's Ucef'!sci:t~~~; doi=:l.s lior ?p;;ly.i6'an"o,..t;i.~:(' Pf,p.r:):.'o..ltywhc b'Ji\ds or i~np~Qvcs
. - " __'_,' c_'':' _.-, :"",\.<"-._-'", ",- ,:,' ,'__, "_ ., ,'....-.'-"','-' ',' ""', -' <
thereon, and w~o d~s,sucn work himself_or herself or through ,hl~_-or:,~~",;:"\'.i~>i:~~:;:'tQyec~~_pr'J'1ided}r.a~-sut'.~~\!!~p:U..ie;ii::r.t5 i\re n6t lntende_d cr'
-effere1:J for sale. If1 however, the'building of_improvement is s6Jd,).vjt~:~/ie ',I~.,f?i?-)il1;:'l.et.iol1. the,~v"'l0er-t.uJk1:~;.,~vHl hav~ trl~ tlwdenof pr("'vj~g tn:!!,the
. di~r:o:t build or imprQve for the p_~ipose of sale). .~:~;.j;,<:L/.-,'-' ~/ V ",,:.'_, ' ":~~ ',';'-_ '::', i.\::,'", '_'" <~"~'"~,,',,,; - :.:
LJ" i. a~ ~he o\Yl"!er of the propertY, am exdU5ive~{ contrndir.g ~Vi~tr}:p~:~s;;,~I;i~;!1,~ri3~c;:, t.::l'Ct..ilStrcd1.!-'le-pfojece{q:8C: ./0-:1,4 8u!:,ji1~.,s'and,ProfeS$;oil~,
Ccce: The Contractor's LIcense Law does not apply, to anow;1er ,..-d p~b;:iCn~':#,h~;-;;iJj~,d~:~:-lih~mvp~ tlfler,enn, and.~-y.!!;;,) ((li,tr2.'.;t~~ fnr SL:(:h prcjt')o5 \~'tlh ~
r_~cntractor(~) licensed pursuant to the Contractor's Licens!3L:t'~~!:: '<-: .. '. ..~'". " "_ .,~' ,," .,',., <~'.,; . . ''_co '
_J '-j am exerr~pi under See; , B & P.C. forthjs .r0u~:,9W '.., --_~'~~~~_..-':';"'.__":.'~~...........-__._'i.,.,
DZ.tf::\ Owner:, "-<':>'."_":-'~:,'~;:'.S;-~"'_"""::: . "}:'" ,~"~..:.' ',,',J-..,.. _ ,,~; _ '
[ .' ,', WO~KER'SCOMPENSATIONA~LARAtIQf!-:.51Y!~~::~--,j1 r -t.!~NSED CO~TRA9.!~~?_D~CLAR...;~N-I/'
, !.!I~r~by af(;rm uno.er pe~al~ ,of perJ_~ry one of the tOilo.V..mo de?Jara}!:~~,~;':~f,?:;',:~-;.;I~" ,:', pC: _-"_'1; I t1':S~~b~ ~ffl;~m .~~y~:..pe0llt~'of-pe<rJL:~1 th;;;t };21;i .
LJI have and w:n maIntaIn a certificate of 001:50fn to seff-m~ure-'{<?~:W::(KGC~i':::a:TIp(;n$':;;!Ic.:;. ,. r l,cens~d ~~_?!,::, 'f)\Il:,>'~,n.~..pTc,'<?;:.'Iter 9 (co.T'men:...n(-:, .,-'
as prCVid. ed f ,y Section 3700 of theL-abo r Code, rorthe pCff..()r.....m...:a.,_..c.n...._~..(?...',::.'....'~.'O..f..t.{.~~'.::..y...O;',,-i.:J r ';I';r.j~~1 y..'lth Se?tiCp'''fOCD) 0 Z~ 1> f the 8usiness. aT',:!
thi~;Jer, :~lsisSlled. . " ..>><,'.:f;' -J. . I PrvfeS':;lo~sC 0' . '..-/ ,~
," nave and will maintain worker's compens'af(on inSurance, ..;;:S,req~Kre<! ~,~1~k,'{;tiC'n,170!) of i 8!5l200~ . "... _ --,-.... : ' ~ ..,.~,__
t.he LEmor C,ode, for the pE;l:rf6~niance of the \.vork fo~ wh!ch this'pf;:nn.,it'~:i:~_-.!-]i~: !\:lywork$r':;. ! Date: *:", C..;ntrad!r'"Jf^
Compensation insurancc:carrier and policy are: . .--<',-,;-11. I . ., "Y.
Ci::lrfier: STATE COMPE.NSATION INS CO Policy. Number. .1,~?ZOf:~{. i , ' . .Nl)M~ER EXPir;'J\T!ON DATE
This $~tio".need not be completed if the permit !s fer one hUl1dre~:dcll~~;;X$to~bffl:~'~,~ - /" , ~~~~7 C3sr e.;31j,io.04j'.~.._;.
o I certiiy that in the performance offue worklcr which this ~""'mii ;';;isiiJr:,hc;,jj,,"!i;~~o\ . '.. TYPE ",sa
employ -ar..,y'person in any m~nnel." 50. as to become.subject to).:.~<w..uO.J~.}.-.'..(;~,._C..:::f..;~.\~.'../:?.!~~c. h 1<1..'#81.. .
of Cel! ifOITlla, and agree that If I shou!d become su bject tq the wo:ker"~:'0ItiP~.;\?~t]i::;: ;;:.:, . r-
jXO:.isiOl1S of S. ection 3700 of the Lab~;; "rrthW;tl'f0ti'P!Y:~t~:b,,~~"'0". ~;')ns i 0.or--.n.ISitUcicn. Types:
,).t.: 815.'2003 Applicant _~{>., ;. '02:"-....L.;________! Fi,;S;rlnk!ered?
'NARNI~IG: FAILURE TO SECUR~VVORKER'S COMPENSATION ';;(lW;:~"GE iS~",',i":: .
UNLAWFUL AND SHALL SU.BJ~CT AN EMPLOYER TO CRIMINAUF::N;o,l.n:=SAtJeCIj{IL I
FINES UPTO ONE HUNDR~D THOUSAND DOLLARS ($106,eoo),jf~AbltTlPNT07ti,,, 'I
COSY OF COMPENSATION, DAMAGES AS PROVlDEDFOR!NSEC'j'IC;; 37q"91"'!J.ti; .',
LABOr<. COD~, INTEREST AND ATTORNEY'S FEES, ". >:', '; ,rit., , ,.".:,,:;:,7':.::')
[1""'"b~3~irm \lnde' pena~~c~~~;~~~t~:~~&~;~~I~;,:;:~W~1~;;--~:~~;::"~~~, ..' _____.m___'
-~~1-Tonna(lC$-.cT ifh.nr~C/rK--t6'nNtjlcrf c:iisP8'"01't Is"3suea (Sec.3Ll9i .Civ.C-j . - .;:. .), ..-
Le-nJer's fnformation: ' .
APPLICANT: PAUL GOMEZ
OWNloR INFORMATION:.
Michael 0 Carey
551 S Peralta Hills Dr
Anaheim, CA 92807
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ARCHITECT/ENGiNEER INFOF/:rvrA1!0N,
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I certify tha't I have read this appliCation and state that the above information is correct. I
agree tooomply' . /all city ordinances,and state laws relating to buDding cop$~ruction, and
her e representive~ of this city to enter upon the above mentionec' property for
ins se .
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Fees paid for Permit:
Total:
. 539.46
Date: 8/5/2003
ignature of Applicant or Agent
,The permit shallexpireb)i limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance, A
new permit is required to commence or continue work.
, INSPECTION RECORD '
.INSP,ECTION , DATE INSPECTOR
Temporaty'Power Pole ,
'Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/uter \
SetbacklFormsfrrenches ,(Footings)
Do not ,install subflooror pour floor slab 'Inlil the
following applicable items have be,,'; signed: ' "
, Plumbing (Water Pipe.Sprirllder Valves)
Mechanical (GrOUndwork) , " , , ' "
EIec:trical(Underground Conduit) " ,
Pre-sJab(CompactionlMembrane.Reint
Underpinning (FlOC!!' Joist/Girders)' "
Do not cover, or conceal too work below unlll the
following applicable items have been signed: '
1 st Floor Shear '
Firesprinkler (Rough) ,
'2nd Floor Shear , "
Roof (SheathinglDiaDhragmlFrame)'
Masonry (ReinfJBond BeamlPre-Grout) " '
Rciugh PIUnlbil1g{Top Out) , ,
Rough Mechanical' .. , ,
KOugO l:IectrlCaI II) ,
Rough Electrical '
Framing ,'(Only after Plbg" Elec" Mech" and Fire)
Insulation {SoundlEnergy} ,
Do not tape or plaster !In,til the fol/owing applicable ,
.items have been,.signed: .' '.'
Drvwall "
PlI\letratlons{Flre Rated) Electrical " '
Penetrations (Fire Rated) Mechani,cal
Penetrations (Fire Rated) Plumbing
Interior Lath ' ' , "
exterior Lath "
, , ' , GENERAL ITEMS ,
Exterior Plaster {Brown Coal} ,-
T -Bar Electrical, ,
T -Bar Mechanical
T -Bar Structural , ' ,
Sewer
Water Engineering Baek1low
Wat"r Service'
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FINAL INSPECTIONS -Date \:' "
Inspector
Electri,eal Final '" ,
Plumb,ng Final , , " ' .. ,
Mechanical Final' ,- I, , ,
Gas Test ' " "
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EnginooringiGradlng Final 765.0126 "
Fire Dept. Final 765-4040 , ','
Water Engineering 765-5268' , "
Sub List/Business License 765-519 , ,
Zoning 76,5-5139 ' , ',' , "
aul/dlng Final Itast insgectlon- Only ~/1(P161' ' ~'~
' , fter Ab ve Complete)
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Mechanicallnsoections
Plumbina Inspections
Electrical Inspections