1262 Placentia Ae.
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 111
BUILDING PERMIT NO. BLD2005-01778
DATE: 6/10/2005
JOB ADDRESS: 1262 N PLACENTIA AVE
LEGAL DESCRIPTION: N TR 1353 LOT 101
CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
PREMIER ROOFING & BUILDING CO INC
17501 NORWOOD PARK PL
TUSll N, CA 927800000
BUSINESS PHONE: 714573-0155
JOB DESCRIPTION: Tear off existing and raMroof 13 squares of 20 year composition shingles for garage only. Units 1.4
APPLICANT: JERRY BLANKS
OWNER INFORMATION:
Carmen F Gullo
17220 Newhope St #224
Fountain Valley, CA 92708
VALUATION: 2,000.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).
o I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-builder will have the burden of proving that"he
did not build or improve for the purpose of sale).
D I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of propertyw:lo builds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractor's License Law).
D I am exempt under Sec. , B & P .C. for this reason:
Date: Owner: '
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fallowing declarations:
D I have and will maintain a certificate of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
6 have and will maintain worker's compensation insurance, as required by Section 3700 of
e Labor Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
arrier: STATE FUND Policy Number. 1422159
PROCESSED BY: SAM
NUMBER
634404
TYPE
TYPE
EXPIRATION DATE
12/31/2005
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
D I certify that in the performance of the war. for which this permit is i ed, I shall not
employ any person in any manner so as to b orne subject to th ork cOlTlpensation laws
of Califomia, and agree that if I should bee e subject e er' ompensation
provisions of Section 3700 of the Labor C with those provisions.
B
C39
Date: 6/10/2005 Applicant:
WARNING: FAILURE TO SECU RKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJE N EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED T1-i SAND DOLLARS ($100,000), IN ADDIllON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
Construcion Types:
V N, ,
I certify that J ve read this application and state that the above information is correct. I
agree to com y with all city ordinances state laws relating to building construction, and
herebyauth rize representiv of is to enter upon the above mentioned property for
~ction urposes. , .
t::- Date: 6/10/2005
Signature of Icant or Agent
The p mit shall expire by limitation and become null and void if the building or
work has not passed Ii nal inspection 365 days Irom the date of permit issumce. A
new oermit is reauired to commence or continue work.
Fees paid for Permit:
Total:
160.61
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbackIFormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
followina applicable items have been signed:
Plumbin!! (Water PiDe/SDrinkler Valves) .
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathina/Diaphraam/Framel
Masonry (ReinfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Me<:. And Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable
items have been signed:
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Ex1erior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T -Bar Electrical
T -Bar Mechanical
T -Bar Structural
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS DATE INSPECTOR
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-5194
Zoning 765-5139 / /
Building Final (Last Inspection - Only iz1ls
After Above Complete) JA\30WSIL.. \
/
PARTIAL INSPECTIONS
Buildina InSDections
MechanicallnSDections
Plumbina InSDections
ElectricallnSDections