970-976 Lamark Ln.
CONTRACTOR INFORMATION:
PETRONELLA ROOFING CO Tl-IE
2626 NEWPORT BLVD
COSTA MESA, CA 926270000
. BUSINESS PHONE: 9493679727
JOB DESCRIPTION:lns~l! 25 squares ot "decove(with polyurethane foam" (lCBO# 5007) over one (1)'existir)9 layer of bUilt-up-roof on the attached
VALUATION: gara~e~d8roI!l0-976 Lamark. . , PROCESSED BY: MSM .
I OWNER-BUILDER DECLARATION.
I hereby affirm under penalty of perjury that I am exempt from the c.ontractor'~ Ucense Law for the following reason (Sec. 7031.5 BuSi ness and
Prof7ssions Cod~: any city or count~wh~h req~ires a permit tocons~ru~t, .alt~~ improve, demolish or r~~air any s,tructure, prior t~ its issuance, a15:o
requires the applicant for such permit to fIle a signed statement that he IsIlCensed pursuant to the proViSions of the Contractor's. LlCense.Law (Chapter
9}(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the'basis fo~ the alleged
exemption.. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a- civil penalty of not more than ,five.hundred dollars'
($500). '
01, as owner of property, or my employees with wages as their sole compensation, will do the work,and, the structure is not int~nded or offered for,
sale.(Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an ,ownerof property who builds or improves
thereon,-and who does such work himself or herself or through his or'her own employees, provided that such improvements are not i.ntended or
offered for sale. If, however, ttle 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). . '~. .
D I, as the Qwner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7.044 Business and Professions
Code: The Contractor's License Lawdoes not apply to'an oW!1er of propertywflo builds or improves thereon, and who contracts for such projects with
a contractor(s)'licensed pursuant to the Contractor's License Law). '
D. I am exempt under Sec.' , B & P .C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe~ury one of the following declarations:
D I have and will maintain a certificate of consent to self-insure 'for worker'scompensation,
as provided fo'r by Section 3700 of:the Labor {(ode, for1hepertormanceof the work forWhich
this, permit is issued. -; , , "
~\ ! Iha.ve a.nd will maintain worker's c.ompensation insurance, as required by~ection 3700 of 4/26/2005
Labor Code, for the performance of the work for which this permit is issued. My worker's. Date:
ensation 'insurance carrier and policy are: .' i
Carrier: STATE COMPENSATION INS CO Policy Number. 1594628 .
BUILDING. PERMIT NO.
BLD2005-Q1195
TYPE OF PERMIT
ReroQf
"...
.:!.,
CITY
DATE: 4/26/2005
JOB ADDRESS: 970 W LAMARK LN
LEGAL DESCRIPTJON: N TR 4001 LOT 192
APPLICANT: MIKE ROGERS
OWNER INFORMATION:
DaleW Athey
325 Convention Center Dr
Las Vegas, NV 89109.
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
.CENSUS CODE: 555
QUARTER SECTION: 77
ARCHITECT/ENGINEER INFORMATION:
I
This section need not be completed if the pennit is for one hun~red dollars ($1 00) -or less.
D ' I certify that in the perfolT1)ance of ~he \"lork for which this permit is issued; I shall not
employ any person _hi any manner so as to become subject to the worker's compensation laws
of California, and agree that if I. should become subject ,to th:e worker~s compe~sation
provisions of Section 3700 of the Lab Code, I shall fa hwith comply "liith those prov; .
Date: 4/26/2005 Applicant:
WARNING: FAILURE TO SECUR
UNLAWFUL, AND SHALL SUBJE AN EM PLOYER TO CRI NAL PENALTIES AND CI VIL
FINES UPTO ONE HUNDRED. OUSAND DOLLARS ($100,000), IN ADDI1l0N TO.THE
COST OF COMPENSATION, D,il; AGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR COD E, I NTEREST AND ATTORNEY'S FEES. .
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agencyfor'the
performance of the work for which this permit is issued (Sec.3097 .Civ.C):
Lender's Information: .
~J.
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 building construction,' and
~h ereb .\authorize.repreSentives of this city to enter upon the above mentioned property for
nsp [n purposes. .
~ Date' 4126/2005
. Signature f pplicant or Ag
The permit shall expire by limitation 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 coritinue work.
I
LICENSED CONTRACTORS DECLARATION.
I hereby affirm under penalty of perjury that. I am
licensed under provisions of chapter 9 (commencing
with .Section 7, 00 of Divsion 3 of the Business and
Professions C
NUMBER
460707
TYPE
TYPE
EXPIRATIONhll/
8/31/2005 .
C39
ASB
Construcion Types:
VN, ,
Fire Sprin~lered?
NO
. Fees paid for Permit:
Total:
213.98
INSPECTION RECORD'
-""""".."'"
FINAL INSPECTI,ONS Date In'specie,; "i
Electrical Final' - " ,
,
Plumbing Final , . , '
Mechanical Final ,
Gas Te,st
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
SU,b List/Business License 765-519
Zoning 765-5,139 .
Building Final !l:ast Inspection- Only r12.~ i//1..,,- .'
. ' Iter Above Complete)
PARTIAL INSPECTIONS
Buildinq Inspections
" INSPECTION . ' DATE INSPECTOR
Temporary Power Pole
Plumb! ng (DrainlWaste Pipe) , "
Electrical Ground Electrode/uter , , ,
Selback/FormsfTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed,
Plumbing (Water Plpe.Sprinkler Valves)
Mechanical (Grouildwork)
Electrical (Underground Conduit) ,
Pre-slab (CompactionlMembrane.Relnf.
, underpinning (Floor Joist/Girders)
Do not ,cover or conceal the woll< below until the
following applicable items have been signed:
1st Floor, Shear
Firesprinkler (Rough)
2nd Floor Shear " , '~~
Roof (Sheathlng/DiaphraamlFrame) (1..:;., ..# off' .J
Masonry (ReinfJBond BeamlPre-Grout)
,Ro'ugh Plumbing (Top Out), ,
Rough Mechanical ' ,
KOugn l::IectrlCallury ..all) ,', ,
Rough Electrical, , '
Framing (Only after Plbg" Elec.. Mech..,and Fire) "
Insulation (SoundlEnergy)
Do not tape or plaster until the.following applicable,
" items have been signed: ,,' , '
Drywall ,
Penetrations (Fire Rated) ElectriCal
Penetrations (Fire Rated) Mechanical . ' ,
Penetrations (Fire Rated) Plumbing
Interior Lath ' " ,
Exterior Lath ,
GENERAL ITEMS
Exterior Plaster (Brown Coal) , " ,
T -Bar Electrical. , '.
T -Bar Mechanical "
T .Bar Structural , ,
Sewer
Water Engineering Backflow , "
Waler service
Mechanical Inspections
Plumbinq Inspections
Electrical Inspections