1222 N. Placentia Ave.
~~O~?F PERMIT CITY
DATE: 2/3/2005
JOB ADDRESS: 1222 N PLACENTIA AVE
LEGAL DESCRIPTION: . N TR f353 LOT 94
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:.
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 111
BUILDING PERMIT NO. BLD2005-00316
APPLlCANT:PEDRO VILLASANA
OWNER INFORMATION:, CONTRACTOR INFORMI'.TION: ARCHITECT/ENGINEER INFORMATION:
PEDRO VILLASONA
. 1222 N. PLACENTIA AVE. . ,
ANAHEIM, CA 92806 . '.'. .
JOB DESGRIPTION:'lnstaIl1 layer of 27 squares of 20 year composition Shin~!~2S over 2 exi~ting layers.
VALUATION: 6,000.00
r- OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that,lam exempt from the Contracto(s Ucense Law tor the fqllowing reason (Sec. 7031.5 Bush'\ess a,nd
Professions Code: any dty or county whi9h requires a- permit to construct, aH:;i)-, :mprove, demolish or repa ir. any structure, prior to its issuance/also.
requires the applicant for such permit to file a signed statement that he'is lic~hood pursuant to the provisions of the Contractor's license Law (Chapter
9)(commencing 'with Se~tion 7000 of Division 3 of the Business and prcfess.bns Code) or that he is exempt therefrom and the b'asis for the alleged
exemption. Any violation of ,Section 7031.5 by any applicant for a perrl1itsul1,ects the applicant to a evil penalty of not more than: fiye hundred dollars
}!$ 0),. . ...,....
.1, as owne,r ofpro,perty. ,or my emproyees w. ith wag. es as their. sole comr~..,~..r-.$ation" will do the work., and the structure is. not intended_ or offered for
(Sec. 7044 Business-and Professions Gode: The Contractor's Ucense 1,'oW does not apply to an owner of property who builds or improves,
hereon, and who does s~dl work himself or helSelf,or through his or her 0\0\111 employees, provided that such improvements are not intended or.
offered for sale..,n. however, the building or improvement is sold with one Yf.~,lt of C':>mpletion, the owner-builder wiU have the burd~nof provIng that he
did not build 6rimprove fot the'purpose of sale). . ,:'.' . " .'
,0 .l,-ast.he owner' of the property, am exdusively contracting with !icensed:b.:.>ntractC",rs'to construct the proJect {Sec. 7044 BuSines!=> cmd Prof~ssions
COde: The Contr3ctor's license Law does not apply to a~ 0 ner ofpropert}:"who builos or improves thereon, and who contracts for sudl projects with
Ljontractor(s) fic,ensed pU,rsuan . 0 the ContractOJ:'~ . n awl. , '\)
-' I a exempt und"q'_?ec. . .,' B & P. . ,0 n:
Date - ,.CS-.:J' .Ower:. j'" _--'-__.
WORKER'S C PEN -"--:==1
I hereby affirm under penally of perjury one the following declarations: '.
o I have and will maintain a certificate csf oonsent to self-insure fol' worke:/~': cornpensa~ion,
as proyided for by Section 3700 of the.Labor Code, fdr the performance 9ftfje work ior which
thi~ permit is issued. . \
o "hayeand will maintain worker's compensation insurance, as, reqlJint'd t'y' Section 3700 of 2/3/2005
the Labor Cod'e,~,for thepelfonnance of the work for which this permit is issUrd. Myworker's . Date:
Compensation insurance carrier ,and policy are: i
Carri,er: . Policy Nu mber: 1
~hi section need not be compJetedifthe pennit is for one hundred dollar~ ($11)C~ or les.
, ,
I certify that in the ~rforrnance of the work for which this permit is !ssl);:d, I shall not
e lay any person in any manner so as to become'subjec to e worker'~ (".j)mpcnsation laws
of Califomla, and agree that if I should become subject to . orker' cory,p~nsatiol1 I
provisions of Section 3700 of the L~bor Code, I shall .... ,'y ~~-{i~~}:J~~ orovislons. 8o~strucion Types:
Date: 2/3/2005 . Applicant: . '. . ''','1 Fir"S~rinklered?
WARNING: FAILURE roSECURE ORKER' MP SATIONCQVc~GE IS .
UNLAWFUL, AND SHALL SlJBJEC AN OYER TO CRIMINALPe'''~'':' L TIES AND CIVIL
F.IN.. E.S....lJ P TO ONE H lJNDRED TIi. USAND DOLLARS ($1CO'OooJ."~'l.'. .'A. Q'..~I. nON 10 THE
.COSTOF COMPENSATION. DAMAGES AS PROVIDED FOR IN S5j;;JI9 3706 OF THF
LA,BOR CODE. INTEREST AND ATTORNEY'S FEES. ';;"", < .
L" ....,. , CO"!STRUCTION LENDING AGENCY ,) .
. .th~r~>r:?ffirm und~r p~nalty o~ perjury that there ,is 3 constryction:leIldir:~(?~ency for the
perfo~in~nce ,of the worK for which .this permit is issued (Sec.309? .Civ.C):'"' I
Lp.nC!:e~fl~rvrmatinn:
PROCESSED BY: MSM
['j:iCENSED CONTRACTORS DECLARATION I
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of.Divsio-n 3 Of the Busipess and
Professions Code.
'Contrador
NUMBER
. ExpiRATION DATE
TYPE
NO
- ,-----,,,-'-~.-._--_.----"
-
and state that the above 'information is correct... I
d e laws relating to'building co!istruction, and
. tenter l!.ponthe above mentioned property for
,
Fees ,paid for Permit:
Total:
235.43
Oat.>: 2/3/2005
'Signat pp' nt or -Agent
The permit shall e e by limitation and become null and void if the, building or
work has not sedfinaJ inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.:' .
INSPECTION RECORD
.
.'N.SPEC,TIO,,! . . DATE INSPECTOR
Temporary Power Pole . ..
Plumbing (DrainJWaste Pipe) . . '
Electrical Ground EI"ctrodelUfer , ' . , .
SetbacklFormsfTrenches (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 (CompactionlMembrane.Reinf. .
Underpinning (Roor Joist/Girders) . . "
, _Qo no~r,or conceal the woll< below until the . ,
folldwi pplicable .items have been signed:
1st Floor Sheilr ".. ,. , . "
Firesprinkler. (Rough) .
2nd Floor Shear 'A
ROof (Sheathing/Diaphragm/Frane) z!kJ/"", Kd, IL._
Masonry (ReinfJaond SeanlPre-Grout) I ()(J .. ,
Rough Plumbing (Top Out)
Rough Mechanical . ,
Rougn aectrlCallurv vvall) .
Rough Electrical . ,
Framing , (Only after Plbg" Elec.. Mech.. and Fire)
Insulation (5oundlEnergy) , . .
DQ'not tape or plaster until the followingapplicabie,
items have been signed: . ' - : -
Drywall , . .
PenetratlOll$ (Rre Rated) Electrical . '
PenetraliOll$ (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Latn . .,
Exterior Lath
. GENERAL ITEMS'
Exterior plaster (Brown Coal)
T -Bar. Electrical
T -Bar MechanIcal . '
T -Bar Structural ..
Sewer . --c-
Water Engineering Backflow -
Water Service .
FINAL INSPECTIONS ' Date Inspector
Electrical Final . ,
Plumbing Finai '
Mechanical Final
Gas Test: .
Engineering/Grilding Final 765-5126 . ..
Fire Dept. Final 765-4040 - ' .
Water Engineering 765-5268 '. '
SUb List/Business License 765-519 . .
'. .
Zoning 765;5139 " I . I
Building Final ~ast Inspection- Only. "JIP/~ V1A/"
fter Above Complete) .
PARTlAL,INSPECTIONS.
Buildina Inspections,
,Mechanical 'Inspections
Plumbina Inspections
, Electrical Inspections