1231 Shelli
BUILDING PERMIT NO. BLD2005-03084
TYPE OF PERMIT CITY
Reroof
DATE: 912712005
JOB ADDRESS: 1231 S SHELLI DR
LEGAL DESCRIPTION: N TR 2990 LOT 6
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 15
APPLICANT: AL SOUZA
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECTIENGINEER INFORMATION:
FREDERICK M DANIELSON M R ROOFING SERVICE INC
1231 S SHELLI DR 10657 STANFORD
ANAHEIM, CA 92804 GARDEN GROVE, CA 928400000
BUSINESS PHONE: 714636-5679
JOB DESCRIPTION:Tear off existing and reroof 22 squares with 30-year composition shingles
VALUATION:
4,900.00
PROCESSED BY: JNJ
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor'l:f License Law for the following reason (Sec. 7031.5 BUSiness and
Professions Code: any city or county which requires a permit to construct, alte'r, 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 Professio.'1s 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 subjocts 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 thelr sole compensatlon, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License LeLw does not apply to an owner of property who builds or improves
thereon, and who does such work himself or helSelf 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 pu rpose of sale).
o l, 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
a contractor(s) licensed pursuant to the Contractor's License Law).
o I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe~ury one of the following declarations:
o I have and will maintain a certificate of consent to self-insure fO.( worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of ths; work for which
this perm it is issued.
~ J have 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. Myworker's
Compensation insurance carrier and policy are:
Carrier: STATE FUND Policy Number. 0002399-05
This section need not be completed if the pennit is for 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 California, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I shall 'fort ith comply with those provisions.
Date: 9/27/2005 Applicant: -~
WARNING: FAILURE TO SECUREWORKER'S COMPENS ION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED lHOUSAND DOLLARS ($100,000), IN ADDITION 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 constructlon lendingage!icy for the
performance of 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. ,
agree to oomply with all city ordinances and state laws relating to building construction, and
hereby authorize repressn ives of this city to enter upon the above mentioned property for
inspection purposes.
Date: 9/27/2005
Signature of pplicant or Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed fi nal inspection 365 days from the date of permit issuMCe. A
new permit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty ot perjury that I am
licensed under provisions of chapter 9 (commenCing
with Section 7000) of Divsio 3 of the Business and
Professions Cod) tfl
9/27/2005 "It.
Date: r---
NUMBER
765080
TYPE
Construcion Types:
VN, ,
Contractor
EXPIRATION DATE
6/3012007
C39
Fees paid for Permit:
Total:
244.87
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
SetbackIFormslTrenches (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 Relnf.)
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 (Sheathing/Diaphragm/Frame) tt-2%5" 11. /J/LJ!><"Ji
Masonry (Reinf./Bond BeamJPre-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
Exterior Lath
GENERAL ITEMS
Ex1erior 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 '1>/51> g2>~P"6
After Above Complete)
PARTIAL INSPECTIONS
Building InsDections
MeChanical InsDections
Plumbing Inspections
Electrical Inspections