3255 E. Miraloma Ave. (4)
VALUATION: 85,000.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Ucense 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;s 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).
D I, as owner of property, or my employees with wages as their sole comp(lnsation, 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 owr"! 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). .
o 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 property who builds or improves thereon, and who contracts for such projects with
~ontractor(s) licensed pursuant to the Contractor's License Law).
U 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 following declarations:
o 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.
;B=1Jlave and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the performance of the work for which this permit is issued. My worker's
Compensation insurance carrier and policy are:
Carrier: BARRETT'S SELF-INSURED PLAN Policy Number. 3757286
BUILDING PERMIT NO. BLD2005-03029
TYPE OF PERMIT CITY
Reroof
DATE: 9/22/2005
JOB ADDRESS: 3255 E MIRALOMA AVE
LEGAL DESCRIPTION: TR 800 LOT A POR OF LOT INC POR
APPLICANT: CHERIE HAYES
OWNER INFORMATION:
LASCO INDU STRIES INC
3255 E MIRALOMA AVE
ANAHEIM, CA 928060000
CONTRACTOR INFORMATION:
BRONCO ROOFING, INC.
811 E LINCOLN AVE
ORANGE, CA 928650000
BUSINESS PHONE: 7146321057
JOB DESCR1PTION:Tear off existing and reroof 465 squares with capsheet; includes loading dock
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 144
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
This section need not be completed If the penn it Is tar one hundred dollars ($100) or less.
o I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the worker's compensation laws
of Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I rt-tlwith co WI those provisions.
Date: 10/25/2005 APPlicant~ ~
WARNING: FAILURE TO SECURE WORKER'S COMPENSA TION COVERAGE IS
UNLAWFUl:: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITlON TO THE
COST OF COMPENSATION, DAMAGES AS PROVI DED 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 ot the work for which this permit is issued (Sec.3097.Civ.C): '
Lender's Information:
I certify that I have read this application and state that the above information is correct. I
agree to oomply with all city ordinances and state raws relating to building construction, and
hereby authorize..represen~ives of .~ -:t} t~....., ,l.... .......v, , IRa absve mentioned property for
inspect~'on' po s.
.. Date: 10/25/2005
.:.- - Ig;,ature of Applicant or Agent
llte permit shall expire by 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.
LICENSED CONTRACTORS DECLARATION
1 hereby a irm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7. 000) ~~.' aLoi"O.' on"
Professions Code. .
10/25/2fi5\. ----=:->
Date: Contractor
-
NUMBER
344837
TYPE
EXPI RATION DATE
6130/2006
C39
Construcion Tvpes:
V N, ,
Fees paid for Permit:
Total:
2,733.20
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground ElectrodelUfer
SetbacklFormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler 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 J
Roof (Sheathlng/DlaphragmlFrame) IYI1Xllj Vrz,v (j;
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. 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
Ex1erlor Plaster (Brown Coat)
T-Bar Electrical
T-Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS DATE INSPECTOR
Elec1rlcal Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub ListlBusiness License 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only I<>f~ /~
Aller Above Complete)
, ,
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections
.1-
BUILDING PERMIT NO: BLD2004-03657
'"';
BUILDING DIViSION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 144
TYPE OF PERMIT
T ena.;t Improvement (Limited)
,_Co,. ,"
t~f:i:;'~~~~:~\
CITY Q1i~~J9~HEIM
\- .,>".~.".C'--""':':}l~,,)j ;/
. ~~f~1';t5}~/ .
DATE: 9/29/2004
JOB ADDRESS: 3255 E MIRALOMA AVE
LEGAL DESCRIPTION: TR 800 LOT A POR OF LOT INCPOR
APPLICANT: BILL FLOYD
OWNER INFORMATION:
Lasco Industries Ine
3255 E Miraloma Ave
Anaheim, CA 92806
JOB DESCRIPTION: Install head outs and relocate two spray booths.
VALUATION: 12,000.00
I OWNER-BUILDEr; DECLARATION
J hereby affirm unqer penalty of perjury that I am exempt from the Contractcr'.s: License Law for the following reason (Sec. 7031.5 Business and
PlOfessions Code: any dty or county which requires a permit to construct, ai~f:'r.-improve, demolish or repair any structure, prior to its issuance. also
requires the applicant for such permit to file a signed statementthat he is liCtrlsed pursuant to the p'rovisionsofthe Contractor's License Law (Chapter
9)(commencing with Section .1000 of Division 3 of the Business and Professi)l1s Code) or that he is exempt therefrom and the basis for the alleged
exemption. - Any violation of Section 7031.5 by any appacant for a permit sut~ects the applicant to a evil penalty of not more than five, hundred dollars'
~~ . I' . .
D I, as owner of property, or my employees with wages as their sole com~;~;nsation, will do the work; and the structure is not intended or offered for
sale (Sec. 7044 Business and'Professions Code;, The Contractor's licensE'! L.JW does not apply to an owner of property who builds or improves !
~hereon, and who does such work himself or herself or through his or:her 01/01:1 ~mployees, provided that such improvements are not intended or
offered for sale. If; however, the building or improvement is sold .with one Y6,ili" of oompletion, the owner-bu ilder will have the burden of proving,that he
did not build or improve for the purpose of sale),
o I, as the owner of the property, 'am exdusively contracting with Iicensed:contra-:tors to construct the.pr()j~ct (Se('~ .1044 Business and Professions
Code: The Contractor's License Law does not apply to an.owner of ,prop&,lty'Nho buUds or improves thereon', and who contracts fo~ such projects with
jLqontractor(s) licensed pursuant to the Contractor's I..icerise Law)~ - ' "
U I. ~111 eXl1mpt under Sec; '_ B & P .C, r this reason: _..,
j,gate: ..1l'1.ll!04 Owner:
WORKER'S COMPENSATION LARATION r
I hereby affirm under penalty of perjury one of the following declarations: . ,
D " have and will maintain a certificate-of consent to self-insure forwork.:>r\'s.compcilsation,
as pr ided for by Sedion 3700 of the Labor Code, for the performance of t!--9 work' for whidl
'thi rmit is'issued.' ';:
I have and will maintain worker's compensation insurance, as required ;-/, Sedion 3700 or
the Labor Code, for the-performance of the work for which this permit is issll~\d. My worker's
Compensation insurance carrier and policy are: '
Carrier: Policy Number.
CONTRACTOR INFORMATiON:
ARCHITECT/ENGINEER INFORMATION:
JAMES FOX
8060 TELEGRAPti RD.
DOWNEY, CA 90240
PROCESSED BY: MJF
LICENSED CONTRACTORS DECLARATION I
I hereby aff)rmunder penalty of perjury that I am
licensed under provisions of chapter'9 (commencing
Wittl Seclio.n 7000) of Divs,ion 3 of the Business and
Professions Cod e.
9/29/2004
Date:
Contractor
NUMBER
EXPIRATION DATE
ThiS section need not be completed lIthe pennit is for one hundred dolla," ($1 h) Or less.'
D I certify that in the performance of the work for Which this permit is i~U\!;1,! shall not
employ any person in any manner so as to become subject to the worker's, c~'mpensafion laws
of Califomia, and agree that if I should become 'subject to-the worker's .comp~~nsation
provisions of Section 3700 of the Labor Code', I shall f ith comply with tr:.)se provisions.
Date: 9/29/2004 Applicant:
WARNING: FAILURE TO SECURE WO KER'S COMPE SA ION COVEI4>,GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO IMINAL PENft;LTIES AND CIVIL
FINES UPTO ONE. HUNDRED 1l-iOUSAND DOLLARS ($100,000), IN ADQiTION TO THE
COST OF COMPIONSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY _
I hereby affirm under pena'lty of perjury that there is a construction lendin~ra(:ei1CY for the
performance of the work for which this permit is issued (Sec.3097.Civ.C)::
~,~I...Q-Pd-~r.',.-;.J.pfucl+'-l3-th!='<'---_ -'-_________ _ ____..__n . " _'-:"d-<
TYPE
Construcion Tvpes:
V N, ,
I certify that I hav~ read this a pplication and state that the above information is correct. 1
agree to comply with all city ordinances and" state laws relating'to building construction, and
hereby authorize repre tives of this citY to enter upon the above mentioned property for
. inspect n ses,
cJ--"-' Date. 9/29/2004
. . Signature of lieant or Agent
. The permit shall expire b Ii nation and become nuUandvoid 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 wor~
Fees paid for Permit:
Total:
147.83
INSPECTION RECORD
. INSPECTION . DATE. INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe) '.
Electrical Ground Electrode/uter
SetbacklFClrmslTrenches (Footings).
Do not install subflqor orpour floor slab untilthEl
following applicable items-have been signed:
Plumbing (WaterPipe.Sprinkler Valves)
Mecha'nical (GrOUndwork) . . '.
Electrical (Underground Condu~)
Pre-slab (CompactionlMembrane.Reinf.
Underpinning (Floor Joist/Girders) . .
Do not cover or conceal the work below until the '.
following applicable items have been signed: '.
1st floor Shear .
Firesprinlder (Rough) . - .
2nd Floor Shear II WJI
Roof (Sheathing/DiaphraamlFrame) ,
Masonry (ReinfJBond BeamJPr~lO\.It) /1
Rough Plumbing (Top Out)
Rough Mechallical
KOugn t:IectricallDry wall)
Rough Elecirical 107_0....0 [ jl t-w It'
Framing (Only -after Plbg". Elec.:Mech - and Fire} l.,y.qj ,iJZU/,?,
Insulation (SoundlEnergy)
Do not tape or plaste.r until the fallowing applicable
items have been signed:' '. - .
Drywall . . >/IZ/ o?
Penetrations (Fire Rated) Electrical . .
. Penetrations (Fire Rated) Mechanical
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 Backflow .
Water Service - .
I
FINAL INSPECTIONS
Electrical Flnal
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 76.504040.
Water Engineering 765-5268
Sub Li~t/Busi~ess License 7fi5-519 t1
Zoning 765-5139
Build.ing Final lLastlnspeclion. Only . 'I. 1 or ..' TJ-7..,. . :{..:
After Above Complete) '. P l/J r "'V le
Inspector
'J.
'.' PARTIAL INSPECTIONS
Buildina Inspections
7-N-or fflltJ< oltjo{":~67< f)~
Mechanicallnsl?ections
.
Plumbina Inspections
(j7& ~frO;r "c tJ(,~
Electricallnsoections