413 Vicki
APPLICANT: DAVE FIElY
OWNER INFORMATION: . CONTRACTOR INFORMA"fION:
Yanni N Phuoc PARAGON ROOFING
413 S Vicki Ln16542 POTTER CIR
Anaheim, CA 92804 .HUNTINGTON BEACH, CA ~2647 0000
. '. . I
. . .BUSINESS PHONE: 71HI;"r350,
JOB DESCRIPTION:Tear off wood shake and install 35 squares of 40 year C<)n~: shingl.,.
VAluATION: . . 9,000.00 ./1... PROCESSED BY: ODC
I OWNER-BUILDER I}ECLARATION . ~.
lhereby~ffirrn under penalty of perjury that I-am exempt from the Contractoi'.1license Law for the following reason (Sec.-7031.5 Business and- , 0.'.>"
profeSSions Code: any city or county which requires a pp.rmit to construct. aJtr1r.;mpro\l_e,'demolish.or repajr.any~tructur~,_ prior tciits iSsuance, also_.
requires th~ 8[:'plimntfor such permit to file a signed statement ~hat he i:;; lic.e:1'sc<Lpursuant to,theprovisioflsofthe Contractor's License Law (Chapter
9)(commencing with-Section 7000ofDivision 3, of 1he Bus!ness and Professk.hsCode) or tha't he is exempt therefrom, and the basis fodhe alleged
exef!1ption~ Any vivlation of Section 70?1.5 by'any appJicailtfora permit subJ pets the applicant to'a civil penalty of not more than five:' hundred.doll~r'S.
($500).. . ... ., .. .. ...
D. .J. as owner of property. or my employees with,wages astheif ~le c9mp{;nsation, Wiil do the work" andthe.structure.is not Intend ect ,or offered fOI~
s~re (Sec, 7044 Business and Professions Code: The Contractor's License L,~w does not apply to,an oWl1er of property who builds or improves_., :
the.re6n~ and.'who does such, wor~himself_or hemelf or through his or her ow~,emPloyees._ proVided-that such improvements. are, not ,intended, or ,_. .
offered for sale, If, however, the building or improvement is sold with one 'ye<:.l Of compl,etion;, the'owner-builder wllfhave the burden of proving that he
did not build or improve for the pUlpose of sale). ' _ . ~-, ,- , ,,', " ~,_ _., '.
0, i._ 'as the olJllner of the pr.operty. am .exdusively contracting with licensed f. 'ntractors to. construct the project (Sec.,7044 BUsiness a~ Professions.'
Cod~:,' Th~ <?on~ctor's License Law does not ~ppJy t? l?n owner of property/ho b u.ilds 9r improves thereon, ,and who t:;00tracts for suCh projects ~ith ,
p..Qontract,?r(s)i1censed pursuanqo,theContractor's'Lu::ensetaw). . J' ,,-' ., ,.: .. t f
U lamexemptunderS~c, - , ",B&P.C.forthisreason:. _'.;. ,'",- . .: " .'. ".' - .:' ". . . ~!
I Data: WOR~;:~ COMPENSATION DECLARATION -j .1 LICENSED CONTRACTORS DECLARATION J
Il'lereby affirm under penalty ofperjul)' on,e of the folloWing declarations: l! .. I hereby, affirm under pen~lty of perjuryth;~ll am _,
.0 lhave and will'maintain a certificate ofoonsent to self-insure for worker"J,compensation. licensed Onder provisions of chapter. 9 (com Cing
as providecf for by '3700.of the Labor Code, for the performance of tr.$ work for which witt) Section 7000 .of D' ioi13 ~i1e Bu I and
his permit i 'ed.. . . .. .' i} Professions C
e and will maintain worker's- compensation insurance, as required hv:'Section 3700 of 11/171 3.
the Labor :COOe,'for the performance of the work for which this permit is i$Su~~!j. Myworker's Date:
Compensation insurancecarrter and policY-are: '.
Carrier: STATE COMP . Policy Number. 157032S:m
BUILDING PERMIT NO. BlD2003.04465
. ,p':.;~'irr:-'::',~_,>~' ,
~;-",~,.."",'7;"'-<"~'~)" .
H /"",:~ .: ...;tt.&~"..\ .
I'":J' -, ){''''''1':I'';'''
~ !. "':'.:.hl~.'..'~~.- "~~:~.... ElM .
Iv ' '~~ r.. -:
, -~- i.
~ ~..!j.. .
:~~ .( /I. '
. 0" . J':)/
, ~E;-.-'~ .
TYPEOFPERMIT CITY
. Reroof
DATE: 11/17/2003
JOB ADDRESS:. 413 SVICiit"l.N
. ;. -
LEGAL DESCRIPTION~ N TR 6735 LOT 11
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765 - 5153. .
INSPEC<l'lON REQUEST LINE:
(714) 765: 4626
CENSUS CODE: 434
QUARTER SECTION: 20
ARCHITECT/ENGINEER INFORMATION:
, , This section need not be ~pJ~ted if the pennit is for one hundred doilars ($1Gll ~ less.
o .,1 ce'rtify, that in the perfonnange of the wqrk for which this permit is i~Li~~,_,_ ,~:~II, not'. '
.employ any person in any manner $0 as to become'subject to the worker'!i c"7'pensatiofl_'aws
ofCalifQmia,anc(agr.eethatiflshouldbecome,subject 6.theworker'scori!f.~t-sation . , .
provisions of Section 3700 of the Labor de, J shall fj rthw' mply, ~t;~~e'provisions.
NUMBER
726753
TYPE
TYPE
Consti"ucion' Types:
VN, .' .
Fire Sprtnklered?
. Date: 1111712003 . Applicant; ..
WARNING: FAILURE TO.SECURE WORKER'S COMPENSAT N COVEF.';GE;Il)c'
. UNLAWFUL, AND SHALL Sl!BJECrAN EMPLOYER TO CRIMINAl. PEN'P.':TlES.'AND CIVIL
FINES UPTOONE HUNDRED THOUSAND DOLLARS ($100,OQO),"INAD[,T10N}.0 THE.
COST OF COMPENSATION, DAMAGES As PROVIDED fOR IN SECTlo.,. 3706 Of.THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. '.'",...
I . Co.NSTRUCTION LEND!NG AGENCY,
I hereby' affirm under penalty of perjury that th.ere is a cor;.structior.I~l)ding:::..c;jet:.cyforl1e
;:>e(fOrIYldil~ Oiifle wvfr. iO," wnU::1l :nlS permit j:;; ;.5SUC-U \obe..;.;;slr.:ii-.tAif,(,}:" -- -'-----------~- .
. Lender's Informatio!1: ' .
EXPIRATION DATE
8/31/2004
C39.
HIC
NO
,'.'
Date: 11/1712003
195.65
Ignature of ppli
The permit sl}a11 e)tpire by Iim' . ion and become null and void ifthf.. building or
work has not passed final inspection 365 days from the date of penllit issuance. A
new permit is required to commence or continue work.
Fees. paid"for Permit:.
.Total:
INSPECTION
INSPECTION RECORD
. .
DATE
. .
Temporary Power Pole .'
Plurnbing (DrainlWaste Pipe)
,Electrical Ground Electrode/Ufer
Setl:>acklFormsfTrenches (Foo.tinllSl . '. .
Do not install subfloor or pour tlo.or slab until the
'.' following applicable Items have been signed: '.,
. Plumbing (Water Plpe.Sprinkler Valves)
MechaniCal (Groundwork) .
Electrical (Underground Condu it)
Pre,slab (CompactionlMembrane.Ret nt,
Underpinning (Roor Joist/Girders)
Do not 'cover or cOnceal the worK below until the
'following applicable items have been signed>
1st Floor Shear '
Firesprinkler (Rough) '.
2nd Floor Shear" '. '.'
, Roof (Sheathing/Diaphragm/Frame) /,t.;1'I,.<d~
Masonry (ReinfJBond BeamlPre-Grout) . r
Rou.gh Plumbing (Top Out)
Rough Mechanical'
Rougn t:fectncal (ury Walll
Rough Electrical
Framing (Only aner Plbg.. Elec.. Mech. and Fire)
Insulation (SoundlEnergy)
po. nDt tape Dr. plaster until tryefollDwing applicable
Items f:1;ave been Signed: .
Drywall .
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) p,fech;mical
Penetrations (Fire Rated) P1wnbing
Interior Lath- .
Exterior Lath
. .' GENERAL ITEMS
ExIeriot Plaster (Brown Coat). .
'. T -Bar .E1ectrical
. T -Bar Mechanical
T -Bar Structural, '.
Sewer.
.' Watei' Engineering Backflow
. Wat..r Service . .
.
.
.
,
.
INSPECTOR
.
.
'.
-
FINAL INSPECTIONS"
. Electrical Final
Date
Inspector
Plumbing Final
Mechanical Final
Gas Test
,-
A
,
.
Engineering/Grading Final T65-5126
Fire Dept. Final T654040
Water EngineeringT65-5268
Sub List/Business license 765-519
Zoning 765.5139
BuildingFinal CLast Inspection. Only
Alter Above Completel
. . PARTIAL INSPECTIONS
Buildinalnspections . .'. .'. .'. I '. .
~C;;;;~6:~~ kry?-L ~L-
. MechanicallnsD6ctions
i
.
.
.
Ph.imbina Insoections
- Electricallnsoections
..
Pc n,~ ;,' or
..L'f\iVI f.
EXPIReD
INSPECTION
NOT COMPLETED:
DATE: L
," .