4912 Wasatch
TYPE OF PERMIT CITY'
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST liNE:
(714) 765 - 4626 .
CENSUS CODE: 555
QUARTER SECTION: 173
BUILDING PERMIT N.O. BlD2005-01581
DATE: 5/26/2005
JOB ADDRESS: 4912 E W ASA TCH DR
LEGAL DESCRIPTION: . N TR 7.426 LOT 23
APPliCANT: FRANK GARCIA
OWNER INFORMATION; CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
Wilnam Martin COAST ROOFING
.18DiamondGate 21681 IMPALA LANE
Aliso Viejo, CA 92656. HUNTINGTON BEACH, CA 926460000
.. BUSINESS PHONE: 714 968-3754 .
JOeDESCRIPTION:Tear off existing roof and replace wITh 19 squares of 30 year composition shingles.
VALUATION: 3,285.00 PROCESSED BY: MSM
OWNER-BUILDER DECLARATION
hereby affjrm,und~r penalty 9f Pl?rjury that I am exemPt rom the Cpntractor's ;License Law for ~he followng reason Sec. 7.031..5 Business and
Professions Code: any city or county which requires a ~per"mit to construct, alter, 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 lie-enred pursuant to the provisions of the Contractor's License Law (Chapter
9)(commen<?in9 with Section 7000 of Division 3 of the' Busfness and Profession:> Code) o~ that he is exempt therefrom and the-basis for the alleged
exemption._ Any violation of Section 7031.5 by any applicar\t for a permit subje?S t~ appliQant to a civil penalty of not more. than five hundr~ dollars
($500). . , .", '.'
o 1,_88 owner o.fproperty, or my'employees with wages as their SoIecomper~at'ion, will do the work, and the structure is ~t intended or ~ffered for
sale (Sec. 7044 l?usiness and ProfessiOns Code: The Contracto(s License ~w does not apply to an owner of property who builds or improves
thereon, and'who'doessuch work himself or herself or through his or, her own employees, provided that such improvements arenat 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 purpose of sale). ,! '. " "
o "I, a,s, the owner of the pr,~perty. .am exch,JsivE,31y contracling.with liCense~~~tracto:rs to construct the project (S@c.. 7044 Businl9ss and-Professions.
.Code: The Contractor's License Law does not apply to an owner of p,roperty'Who bUllds.or improves thereon, and who contracts for such projects with
a contractor(s) llcensed pursuant to the Contractor's License' law).
~D _.j am exempt under Sec. _ ,B & P.C. for.this reason:.
''Date: Owner:
I WORKER'S COMPENSATION DECLARATION
1 hereby affirm. under penalty of R~~ury on/? of the follOWing decla~tions: I
o Lhave and will maintain a' certifIcate of consent to self~ins-ure for worker'sco.mpensation, .
,as prov,ided for by Section 3700 of the Labor Code, for the performance of the 'rock for which
ih" permit is issued, .. ',' j'
I have and will maintain worker's compensation' insurance, as required by Section 3700 'of
e labor Code, for the-performance of tbe work for which this permtt is issued.; My worker's
Compensation insurance carrier and policy are: .
Carrier: STATE FUND POlicy Number. 1113190-04 .
This section need not be completed If the pennlt Is for 0"'; dred dollars ($1 OO} 0( less.
Q I certify that in the performance of the work for ich.this permit is issued, I shall. not "
empl9yany person in any manner so as ,to becom subject to the workers compensation laws
of Calif ami a,' arId agree that if I should become bjectJ6the wo' 's compensation
provisions of Section 3700 of the Labor Code, sh . wi mply with those provisions."
LICENSED CONTRACTORS DECLARATION
hereby afflTm under pen . .ofperjury that I am
licensed under provisions 0 h er g:(commencing
with SectiQn 7000) of Oi n f the Business and
Professions ode. ~
5/26/?005
Date:
NUMBER
450393
TYPE
EXPIRATION DATE
12/31/2005
C39
Date: 5/26/2005 Applicant:
WARN ING: FAILURE TO SECUR WO KER'S COMPENSATION COVERAGE IS
UNLAWFUL; AND SHALL SUBJECT EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINESUPTO ONE HUNDRED THOUSAND DOLLARS ($100,060), IN ADDlllON TO THE
COST OF COMPENSATION, DAMAGES ASPROVIDED. FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending ager.cyfor the
performance of the work for Which this permit is i$sued (See.309? ,Civ .C):
Lender's Information:' .
Construcion Types:
VN, ,
Fire Sorinklerecl?
NO
,',A
plication and state that the above information is correct.
ity. to enter upon the above mentioned property for
Fees paid for Permit:
Total:
160.61
Date: 5/26/2005
. Signature of Applicant or Agent .
l'he permit shall expire by limitation andbecQme null and void if the buiiding or
wQI"k has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to oommenc:e or continue work.
INSPECTION RECORD
.
. '. .lNSPE,CTlON. DATE INSPECTOR
Temporary.Power Pole
Plumbing (DrainiWaSle Pipe)
Electri<;al Ground I'lectrodelUfer
Setbacl<lFormslTrenclles (Footings) .
00 not install subfloor or pour floor slab until the .... .
following applicable items have been signed: .
Plumbing (Water Plpe.Sprinkler Valves)
Mechanical (Groundwork) . .
Electrical (Underground Condu it) .
Pre-slab (CompactlonlMembrane.Rernf. ... .
Underpinning (F'QOl' Joist/Girders) .
I 00 110t cover or conceal tile work below until the.
following applicable items. have been signed: ,
1st Floor Shear . . . . .C
FiR!sprinkler (Rough) .
2nd Flo . ^ I.
Roaf1Sheat . aphragrnlFramel ,~v~
Masonry (ReinfJBond BelllllPre-Grout) . .
Rough Plumbing (Top Out) . . i.
Rough Mechanical . .. '
lROugllEfectr -waUl .
Rough Electrical .
Framing (Only afier Plbg., Elee.. Meeh., and Fire)
Insulation ISoundlEnergy) .
00 not tape or plaster until the following applicable
ite,!,s have been signed: .. .' .
. DtyWall . .
Peneirations (fiR! Rated) Electrical .
Penetrations (FiR! Rated) Mechanical
Penetrations (FiR! Rated) Plumbing
Interior. Lath . . .
Exterior Lath . .. .
.. .. GI'NERAL ITEMS
Exterior Plaster (Brown Coat) . .
T -Bar Electric,,'
T -Bar Mechanical. ~
T -Bar Structural . . . . .
Sewer
Water Engineering Backflow
Water SArvice
FINAL INSPECTIONS Date' inspector . .
Electrical Final .
Plumbing Final .,
.
Mechanical. Final
Gas Test ...
. . . ..
Enginearing/Grading Final 165-5126 ,
..
. . - .
.Fire Dept. Final 7654040
Water Engineering 765-5268 . ,
Su.b ListlBusiness License T65-519 ,
Zoning 765-5139 .'
. Building Final *ast Inspection- Only eLloj - ..
fter Above Completel J~"tJ5v~{
PARTIAL INSPECTfor4s
. -
BuildinalhsDections
. Mechanical Inspections
Plumbina Insoections
. 'ElectricallnsDections