312 S. Shields Ave.
BUILDING PERMIT NO. . BLD2004-04396
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765 - 5153
INSPECTION REQUEST LINE:
(714) 765- 4626
CENSUS CODE: 434
QUARTER SECTION: 20 .
~~~O~OFPERMIT CITY
DATE: 12/10/2004
JOB ADDRESS: . 312 S SHIELDS DR
LEGAL DESCRIPTION: N TR 2755 LOT 12
APPLICANT: GERARDO MEZA
OWNER INFORMATION:
SOCORRO. MEZA
312 S Shields Dr
Anaheim, CA92804 ,
JOB DESCRIPTION:Tear off existing material, install 30 squares of 50 yea, '=1' fiberglass shingles.
VALUATION: 3.000.00 L'
I OWNER-BUILDERQF.CLARATION
J hereby affirm under penalty of perjury that J am exempt from the Gontractof'r License Law for the following reason (Sec, 7031.5 Business an~
Professions Code: any city or county-w~jch requires a permit to construct,;ait*r, improve. demolish or repair any"structure,< pr:or to its~s$uance. also
requires the applicant for sudl permit to file a signed statement that he is licet-,sed pursuant to the provisions of the Contractor's license law"(Chapter
. 9)(commendng with Section 7000 of DiVision 3 of the Business arid Profess0\ts Code) or that he is exempt'the'refrom and the basis for the alleged '
exemption. Any violation ,of Section 7031.5 by any applicant for a permit subjkcts,the applicant to a,civ~ penalty af.not more than five hundred dollars
;,~O?)~s owner at'property, or my employees with wages a~ the_ir sol~ porn~tnsati-on, will do the work, ~nd the ~t~uc~ure is not intendedo.r offe~ed fo~
~e (Sec., 7044 Business and Professions Code: .The Contractor's'License Law does not apply to an owner of property who, build$or improves
thereon, and who does such work himself or herself or through hisor her owrl employees, provided that such improvements arenct: lntenc!edcr
offered for sale. If, however, the' building or improvement is sold with one_yedr of rompletion, the owner-builder will have th'; burden of pro\'ing that he
didnotbu~dorimproveforthe,purposeciLsale).,' t __' _ ' '_ _ ' '
o , I; as the ownei. ofthe property, am exdusively contracting' with licensed funtractors to'construct the project (Sec. 7044 Busines~ and Professions
Code: The Contractor's License Law does not apply to., an owner of 'property \ii ho builds Dr impro.ves, t~ereon, and, who. contracts fer such projec1:S with
Qontractor(s) licens'ed pursuantto the Con ct~r's License Law)", ' ',1" '
J I am' exempt under Sec. & P.C. r this reasan: J
Date:/7-IO- ?MOwn . '~...L
-...,,..
WORK R'S COM ENSATION DECLARATION'
I hereby affirm under' penalty of pe~ury ane af the following decJarations: :1
o I have. and will maintain a certificate of cor:-rsent to self.insure for workei"{fC. ompef'satior.,
as provided for by sedion 3700 of the,Labor Code,_ for the performat'}<;:.e of thq work fOT which
this permit is issued. ' ' ' ~ '
o i have and will maintain worker's compensation insurance, asrequire<i b~,A Section 3700 of
the Labor Code, for the performance of the work forwhich this permit is iSSt1e::L r~:y worker's
Compensation insurance carrier and policy are: l
Carrier: ' Policy Number:
This section need not be completed if the pemlit is for one hundred dollars ($1 00) ipf. jess.
gj I certify that in the performance of the yvork for Which this permit,is is3-U~I!i,':i shaH not
employ any person in,any mann r so. as to. b~ome subject to the worker's cO:T1pensationlaws
pf Califomia, and agree,t,hat if Is ld ecome bjed: to the worker's comPf~;1satiot:'
provisions .of Section 3700 of the Code sha" fOL~/ith camply with th~~? provisions.
Date: 12110/2004 Applicant'
WARNING: FAILURE TOSECU . KER'S CQMPENSATION COVERf.~GE IS
UNLAWFUL, AND SHALL SUBJ CT AN EMPLOYER TO CRIMINAL PENALnES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDI,DON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION ,706 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 ag~~nG1 '{Oi tl1e
OPrf_mman~ nUne,wark forwhidl 'this perlT)it i~ issuedJSec.3097.Civ.C): _~' ___~____
Lender's Information: '
CONTRACTOR INFORMATION:
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: ENO
---1
LICENSED CONTRACTORS DECLARATION
'hereby a irrn under penalty of perjurl that i am
licensed und~r provisions of chapter 9 (cammencing
with Section 70CO) of Dh.-sion 3 of the Business _and
Professions'Code. '
12/10/2004
Date:
Contractor:,
NUMBER
EXPIRATION DATE
TYPE
Construcion Tvpes:
VN" .'
Fire Sprinklered?'
NO
J certify that r have read this application atXJ state that the above Information h ccrrect. I
agree to .,c:omply with all city ordinances and state laws relating to bu~ding car-struction, and
. ereby, thoriZe r' re~ntiveZf this dty. to enter upon the above mentioned property far
I pe Ion purpo s.. . .
. . . . ~ Date. i2l10/2004
Signatu of Appli'cant or Agent ,
permit shall expire by limitation and become null and void if the buiiding or"
work has nOt passed final inSpection 365 days froin tI>e date of permit issuance. . A
. new permit is required to commence or continue work.
Fees paid for Permit: '
Total:
235.33
"
, I . EI
'.NSPECTI!JN DATE INSPECTOR
.
Temporary Power Pole PI
Plumbing (DraintWaste Pipe) Me
Electrical Ground Electrode/lifer'. '. . "
. SelbacklFormslTrenChes (Footings) . G
00 not install subfloor or pour floor slab until the. En
following applicable items have be'en signed: .
Plumbing (W;Iter Pipe.Sprinkler Valves) Fir
Mechanical (GrouridWork) . .' . W
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane.Reint. 5u
Underpinning (Floor Joist/Girders) . Zo
00 not cover or conceal the WOr1< below until tile Bu
following applicable items have been signed:
1. st Floor Shear ..' .
Firespnnkler (Rough) " '. . .' . ,
2nd Floor Shear . . ./),,, /. Bu
Roo{ (Sheathing/Diaphragm/Frame) 'L-U -D' 'fl". Ir,<.
Masonry (ReinfJBond BeamJPre-Grout) , / )
Rough Plilmbing(Top Out)... '----'"
Ro'ugh Mechanical , ,. .' '.
Rougn aectncaJ lOry Wall)
Rough Electrical . ' .
Framing (Only a~e' Plbg.. EIe,., Mach. and Fite) i
Insulation (SoundlEnergy) . Me
po nOllape or pla~ter until the following applicable ..'
Items.have :been Signed: .. . .
Drywall . .
Penetrations (Fire Rated) Electrical .
Penetrations (File Rated) Mechanical .
Penetralloris (Fire Rated) Plumbing .
Interior Lath . . .'
Exterjor Lath '0 , Plu
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T -Bar Electrical . . ,
T -Bar Mechanical . .
T -Bar Structural
Sewer
Water Engineering Backflow . . . .. Ele
Water Service
. INSPECTION RECORD
FINAL INSPECTIONS
ectri<;al Final
"mbing Final
chanical Final
as Test
gineering/Grading Final 765-5126 .
e DIIPl. Final 765-4040 .
ater Engineering 765,5268
b L.istlBusiness License 765-519
ning 765-5139
i1dingFinallLasllnspecliono Only'
After Above Complete)
Date
Inspector
~
PARTIAL INSPECTIONS
i1dina Insoections
chanicallnsoections
mbina Insoections
clrical Insoections