201 E. Susanne St.
CITY
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BUILDING DIVISION
200 S. ANAHEIM BLVD. .
(714) 765 - 5153 .
INSPECTION REQUEST LINE:
(714) 765. 4626
CENSUS CODE: 434
QUARTER SECTION: 85
BUILDING PERMIT NO. .l:l~~2005-00030
TYPE OF .PERMIT
Reroof
,...--'
DATE: 1/6/2005
JOB ADDRESS: 201 E SUSANNE ST
LEGAL DESCRIPTION: N TR1245 LOT 44
CONTRACTOR INFORM!,TION:
VANCE ROOF CO OF HjLLERTClN
. . ,
7241/2 S ANAHEIM BLVD'
ANAHEIM, CA .92805000, .
BUSINESS PHO'NE: 7149~:3-6775
JOB DESCRIPTION:'Tear 'off existing and instaJl19 squares of 20 year COlTIp~~_~ition shingles,
, . . . I .
VALUATION: 4,500.00 .,' PROCESSED BY: EMA
I. . OWNER.BUILDERDECLARATION .
I hereby affirm under penalty of perjury that' am exempt from the Contractrr's License taw for the following reason_(Sec. 7031.5 Business and
Professions Code: any dty or. county which requires a permit to construct, ~jer; improve; demolish Qr repair any structure, prior to its issuance: also
requires the applicant for sUch,permit to file a signed stateme~t that heis lic~iilsed' pursuant to the provision~. of the Contractor's License Law (Chapter
9)(commencing with Section 7O'O'O'_of Division 3 of the Business and Profess"~s Code) or that he is exe~pt ~hel"Elfromand the basis for the alleged
exemption. Af'!y violation:of Section 70'31.5 by ~ny applicant fora permit suhJects the applicant to.a dvil. pena\ty of not mor~ than five hundred dollars
($500). . . '. ". .' . .
o ,I; as. owner of property, or my employees with wa'ges a$ their Sole com~"er~s,:ation, will'do the work, and the structure is notintended o (offered for
sale (~ec. 70'44 Business and Professions Code: The Contractor's,License ~':a"I;does rlot apply to an owner of property who builds or improves
thereon, ,and who does such work himself or herself or through his or her 0...<n'~en1ployees, provided that such improVements are not intended or
offered for sale. If, howElver, the'building or improvement is sold with one YE;ar'_ofcompletion, the owner-builder will have the burden of proving tha~ he
did not build or improve for the purpose of sale). ' , .
D I, as the owner of the property, am exdusively cont~cting'with licenseo'-ccntracl:ors to con$truct the project (Sec. 7044 Business and Professions
Code: :The Contractor's License Law does not apply to an owne(of property'.vho builds or improves-thereon,. and whq oontractsfor suCh projects with
~ontractor(s),licensed ,pursuant to t~e Contractor's License Law). --, ~
U I am exempt under Sec. ,B & P.C. for this reason: I
.Date: Owner: . .
I WORKER'S COMPENSATION DECLARATION
I hereby affirm uhder penalty .of.pe~uryone of the following declarations,: ;c--- ,
D' I have and Will majntain.-a certific.ate of consent' to self-insure for worke:-;s compensation,
as prov.id for by Section 3700 of the Labor Code, for the performance of ti:e work forwtlich.
this mit isis~ued. _ ' ,
I have and will maintain-worker's compensation insurance, as required ray Section 3700 of
the labor Code, for the performance of the work for whieh this permit is issC:~d. Myworker's
Compensation, insurance carrier and policy are:' ,
Carrier: STATE FUND PQlicy Nu"mber:. 046000~190
APPLICANT: GEORGE'PRINCE
OWNER INFORMA TIOj\J: .
Lupe T Moreno
201 E Susanne SI
Anaheim, CA 92805
ARCHITECT/ENGINEER INFORMATION:
,....
_----.J
LICENSED CONTRACTORS DECLARATION
I herepy affirm ,un~er penalty of perjury thatJ..a'Tl
licensed under provisions of chapter 9 (commencing
with Se.ction 7000) of O'ivsiOn 3 of the essand
Professions Code:- .
:~.
1/6/2005
Date: .'
This ~ection neet;t not be completed if the pennit is for one hundred dollars ($10:;) or less.
o I. certify that in the perform~mce Qfthe work for which this pe'rmitis bsu;;'d,1 shall not
employ any person inany manner sq as to become subject to the worker'$ cJmpensation laws
of Califomia, and agree'that if I should become subject to the worker's comi-'Cr:sation
provisions of Seetio,,:! 3700' of the Labor Code, I shall forthwith comply wjt)) f se provisions.
Date: 1/6/2005 '. Applicant: . . .
WARNING: FAILURE TO SECUREWORKE C~PENSATION COVERAGE IS .
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINALP~N>kTIES AND CIVIL
FINES UPTO ONE HUNDR.ED THOUSAND DOLLARS ($100,000j,'INADr,1TI0N TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTJC" 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .
CONSTRUCTION LENDING AGENCY'
I hereby affirm underpenalty of perjury that there is a constructiQn lending auency for the
performance of the work for which this permit is issued (Sec.3097..civ.C): I' -
Lef:C;:;-n, ij,fU'lll1ⅈ)(j:-- - -.- - - ' - -. -..
NUMBER
255373
TYPE
TYPE
TYPE
EXPIRATION DATE.
1/31/2005
C39
C2
HIC
Construcion Types:
VN,
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city.ordinances and state laws relating, to bu~lding ccnstruction, and
hereby authorize representives of this dty to enter upon the above mentioned property for
inspect,ion purposes.
Date: 1/6/2005
Fees paid for Perr'!"it:
Total:
160.61
ignature of Applicant or Agent ,
The permit sl1a11 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.
"
'INSPECTION RECORD
INSPECTION 'DATE INSPECTOR
Temporary Power Pole'
Plumbing (DrainlWaste Pipe) " "
, Eklclrical Ground,Electrode/uter ' '
SetbacklFormsfTrenches (Footings)
Do not install subfloor or pqllr floor slab until the
following applicable items have been signed: "
Plumbing (Water Pipe.Sprinh;ler Valves) ,
Mechenicill (Groundwork) , ,,' ,
Eklclrical (Underground Conduit) , , , '
Pre-slab (CompactionlMi!Illbrane.Reinf.: ,
Underpinning (Floor Joist/Girders)
Do not cover or conceal the wori< below until the ,
:following applicable items have been signed~ ,
15t Floor Shear ,
Firesprinlder (Rough) , "
2nd Floor Shear " ' , '
Roof (&liIathinalDiaohragmlFrame) , ~ " '11~VI/.
Masonry TAiinf./Bond !leamlPre-GrolIt)
Rough,Plumbing (Top Out)
Rough Mechanical
Rougn l:IectrlCaI(llI'y wall) ,
Rough Electrical
Framing (Only after Plbg., EJec.. M~cli.. and Fire) I,
Insulation (SoundlEriergy) , ,:
Do not tape or plas,ter until the following applicable
items have been signed: . , ' " ,
Drywall ,,' , " ' " '
Penetrations (Firil Rated) Electrical " '
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interio,r Lath, .0
,
Exterior Lath " , , , ,
0 GENERAL ITEMS
Exterior Plaster (Brown Coat) , , "
T -Bar Electrical ,
T -Bar ,Mechanical '
T ,Bar Structural , ,
Sewer, ,
Water Engineering ,Backflow ' ,
Water Service ' ,
FINAL INSPECTIONS J . ..Date
electri,cal Final '<
Plumbing Final
Mechanical F.mil '
Gas Test
Engineering/Grading Final 76505126
Fire Dept. Final 765-4040
Water Engineering''765.5268
Sub List/Business License'765-519
Zoning 765-5139
Building Final (Last Inspection- Only ,
, After Above Complete)
, PARTIAL INSPECTIONS
Buildina Inspections
Inspector,
"
Mechanicallnsoectiol1s
C'/
Plumbina InsDections
, ElectricallnsPElctions