336 S. Smokeridge Terrace
APPLICANT:
OWNER INFORMATION:. CONTRACTOR INfORM,.TION:
Ebrahim Basseri KING ROOFING
336 S Smokeridge Ter 1044 W ORANGE RD
Anaheim, CA 92807 SANTA ANA, CA 92708 OGoQ
. ..BUSINESS PHONE: 71454'1.0101
JOB DESCRIPTION;Remove shakes, inst eagle lite tile ICBO 4660, 23 squan:~
VALUATION; 7,000.00 I
I ... OWNER-BWLDER'O"CLARATION
I hereby' affirm under penalty of perjury that I am exetJ:lpt frO'lilt~e Gontradoi:S License Law for the following reason (Sec. 7031.5 Bl,.lsiness and
Professions Code: any dty or county whiCh requil'Bs a pe'r,;,itto construct, a:U:!r, improve, demolish or repa!ranystructure, prior to its isslJanc(:!, -also.
r~~~Jir~~s the~ppli~Bnt for ,SUdl permit t~ ~j~ a sign8,ds:at:=.n"lCnf.th::',: ~,,; i:'; i:('.:-rS~~~ PIJ(~~::'ln~ t'-) t~le..;:Ho:V;S:o~~'?f th: C:{'J:1tr3ct;r'? \ ic.~r;'~')L,t"" ,(C",iTjkr .
:J;,c.x,\r;H.:,rlc:ng y,qth St:cbon 7000 of DivlSlqrl 3 of (116 L;iU$:lless:~ ....:~' r" ~;;;~'.:::.'--:'r'" '.,. c-(\:.; c,; to' ,;;.,; ;\C,):s ,~,"i-,I1':;:;', ,_l,':;,~ :',,^',,', ::::,d :,h(~ C,,:.:..<: ~::t' !:',,; '.;_~::;(';;;
~:.,e:mption. ,6..':I'f viol<3tion of Section 7031.5 by onyapplicar.t for u p')m;;~ .sub)}cts th'3 app1:cElnt to a civil pen31ty of not rnGr'8 (I',.".:; f:vs i':'Jn:jI",)~ j:-,I~~'.r3
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BlJILDlNG PERMiT tiO. BLD2004-00114
TYPE OF PERMIT
Reroof .
DIiTE: .3/16/2004
JOB ADDRE~S: 336 S SMOKERIOGE TER
LEGAL DESCRIPTION: N TR 8783 LOT 29
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thr;. ')r)i"'i. ;~I'd who does such work himself or h<';ts~;:f();: 1:-'fOUgh
eUILDING DIVISION .
200 S. A"NAHEIM BLVD.
. (714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765- 4626
CENSUS CODE: 434
QUARTER SECTION: 180
ARCHITECT/ENGINEER INFORMATION:
CHARLES A JOHNSON JR
P.O. BOX 6284
GARDEN GROVE, CA 92846
PROcESSED BY: FAN
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L-1 ',;~S tiC ~W,G..)'r c; ttl,= property, am cxci'.tsi\ '--''y (XJ,',:Cc".JVi<J ,,', '~I..,'
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Owner:
. WORKER'S COMPENSATION DECLARATjON .,~ _--.J
I hereby affirm under penal!y of perjury one of the following declarations: .'1
o I have and W'iIlmaintlh a certificate of consent to self-insure for worker;' compen~ation,
'as provided for by Section 3700 of the L<3bor Code, for the performance '0ftl1;! work for.which
this permitis'issued,' , , . . " .
~I have a~ will maintain worker's compensation insur-ance, as required bl' Section 2700 of
the labor Code, for the performance of the work for which this permit is is:S~dJ. Myworker'$
Compensation insurance carrier and policy are: . . . ,
Carrier; STATE COMPENSATION FUND Policy Number. . 16277eS.j)1
This section neeCInol be completed if the pennit is for one hundred dollars ($100).or 'oSs.
o I certify that in the perfonnance o.f the work for which this pe(~itis'j_~~ed, !}~U ~t
erryploy any person in any manner sO a~ to become subject to t~ew.orker's compensation laws
of Califomi?, and. agree that if t should become ~bje " ,Olk:er's-sorlipensath?I1'.' , .
provisiQns of Section 3700 of tneLabor Code, ,I shall rtrnyith cq,IJlP_iY:W!tt(.thQse PJ:'ovisions,
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Date: 3/1612004 Applicant: .: ---::::>;::'
WARNING: FAILURE TO SECURE WORKER'S C0MPENSA;:iO}tc: ERAGE IS ,~...
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER To" CRIMINAL 8liNAL T1ESAliib CIVIL
FINES UP TO ONE HUNDRED lHOUSAND DOLLARS ($100,00Cl);}NAQDr:10iitTd[tfiE.
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIQtl3losqf'r'!'HE
LABOR CODE. INTEREST AND ATTORNEY'S FEES.. . :..}f"i ':'.
I . . . . CONSTRUCTION LENDING AGENc:Y ....
I hereby affirm under pena lty, of perjury that ,the-reo is ~ CO{l$tructi_onl-end jry,g):i(l(~ncy f"o~ th~
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Lendef's Information:
J certify that I have read this application and state that the above informatidn i;:t correct., I
agree to oomply with all city ordinances and state laws relating to buDding cor.~truction, and
hereby authorize representiv . 'ty nter upon the above mentioned property for
inspection purposes.
--
-~- Date: 3/1612004
Signature of Applicant or
The permit shallllxpire by limitation and become null and void if the :Juilding or
work has not passed final inspection 365 days from the date of permit issu,,"ce. A
new permit is required to commence or continue work.
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LICENSED CONTRACTORS DECLARATION J
I hereby affirm under penalty_of perjury that l,vn
licensed under provisions of chapter 9 (commeneing
with Section 7000) of Divsion e inessand
Professions Cod e.
311612004
. Date;
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Contractor
NUMBER
759061
TYPE
TYPE
EXPIRATION DATE
212812005
C39.
B
Construcion Types;
VN, ,
.
Fees ,paid for Permit:
Tolal;
0,70
INSPECTION RECORD'
'. INSPECTION: . DATE INSPECTOR.
Temporary Power Pole . .
Plumbing (DrainlWaSte Pipe) .
EleCtrical Ground ElectiodeiUfer .
Selbacl<lFcirmsfTrenches (Footings) '.
. .
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Plpe.Sprinkler Valves) .'
Mechanical (Groundwork) . .
Electrical (Underground Conduit)
Pre-slab (Cornpaction'Membrane.Reirif. '. '.
Underpi nning (Floor Joist/Gi mars) .
Do not cover or conceal tpe work below until the
following applicable items have bee,n signed:
1st Floor Shear . . . .
Firesprinkler (Rough) . .
2nd Floor Shear , . ,~ n' .'
Roof (Sheathill9'Diaphragmlframel ';> IdlA., u..J:
Masonry (ReinfJBond BeamlPre,Grout) \
Rough Plumbing (Top Out) .
Rough Mechanical . '.
Rough 8ectrlcal (ury Wall) . .
Rough Electrical
Framing (Only after Plbg:, Elec., rAeen,, and Fire) .
Insulation (SoundlEl1!!rgy)' '.
Do not tape or plaster' until the fonowing applicable
items have been signed: .
Drywall .'. . . .' .' .
Penetrations (Fire Rated) Electrical .
. Penetrations (File Rated) Mechanical
Penetrations (File Rated) Plumbing .
.Interior Lath . . . . .
Exterior Lath .
GENERAL ITEMS .
Exterior Plaster (Brown Coat)
T -Bar Electrical . .
T -Bar Mechanical
T -Bar Structural . .
Sewer .
Water Engineering BacldJow .
Water Service .
PERMIT EXPIRED
'. INSPECTiON
NOT COMPLETE!)
DATE:Jd~;;y=:{-()5 .
FINAL INSPECTIONS' Date . Im;pector
Electrical Final .
Plumbing Final .
Mechanical Final . . .
Gas Test . .
.
Engineerill9'Grading Final 765-5126 . . .
Fire Oepi. Final 765-4040 .. .
Water Engineering 765-5268 ..
Sub List/Business License 765-519 .'
Zoning 765-5139
Building Final Itast Insp~ction. Only .
fter Above Complete)
PARTIAL INSPECTIONS
Buildin9lnspections.
Mechanical Inspections
Plumbing Inspections
Electrical Inspections