1757 Landfair
TYPE OF PERMIT C I.TY.
Reroof
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
IN.SPECTION REOUESTUNE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 138
BUILDING PERMIT NO. BLD2005-o0758
DATE: 3/21/2005
JOB ADDRESS: 1757 N LANDFAIR ST
LEQAL DESCRIPTION: N TR 5623 LOT 64
APPLICANT: RANDY FREEMAN
OWNER INFORMATION:
Donald R Evans
. 1757 N Landfair St
Anaheim, CA 92806
CONTRACTOR INFORMATION:
FREEMAN ROOFING
12357 ARALIA DR
CHINO, CA 917100000
BUSINESS PHONE: 714 80t-2998
JOB DESCRIPTION:Tear off existing ma'terial, install 24 squares of 30 year composition shingles and ass plyv.JQod,
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 7,000.00
I OWNER.BUlLDER DECLARATION
I hereby affirm under penatty of perjury that I am exempt from the Contrad.o(~'Ucense Law for the following reason (Sec. 7031.5 Business and
. Professions COde: any dty or county which requires a permittoconstruct; aftt~r, improve, demo,UShor repair any structure, prior to its issuance; also
requireS the appncantfo.rsuch permit to file a signed statement that he is Ibnsed pursuant tathe provisions of the Contractor's License Law (Chapter
9)(commencingwith Section 7000 of Division.3 of ttle Business and P~ofessic.{r,-s Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5_by any applicant for a permit subJ~cts the appliCant to a civil penalty of not more than fiv~ hundred dollars
($500). . ,. ,
D. I, as owner of property, or my employees with wages as U'eir sole comp~t:lsation, will db the wor:k, and the structure is not intended or offered for
sale {Sec. 7044 Business and Professions Code: The Contractor's License.L~*'does not app1yto'an owner of property Who builds or improves
~hereon, and who does s~d1 work'.himself or herself or through his or her oWfI,empfoyees, provided that" such improvements are not intended or
offere,d for sale, If, however, the building or improvement is sold with one yei-:r of completion, the owner-builder will have the burden of proving that he
didnot build or improve for the pwpose of sale}. - _ _ ,.
o I, as the owner of the property, am exdusively contracting with licensed &Ji:itractors to construct the project (Sec. 7044 Business and Professions
Code: The ContraQtor's License law does not apply to an owner of propertY'}/ho builds or improves thereon, and who contracts for suCh projects with
~ontractor{s) 'ice~ed pursuant to the Contractor's License law). .
U lamexemptunderSec., . ,B&P.C.forthisreason:
. Date: Owner:
I WORKER'S COMPENSATION DECLARATION
, I hereb.yaffirm under. penalty of perjury one of the foJ/owing declarations:
o I have and will maintain a certificate ofoonsent to self-insure for worker::~ conlPensation,
as provided for by Section 3700 of the laoor Code, for the periorman-ce of th~ work for which
this permit is issued. . !
~ J have and will m.aintain worker's compensatic:n insurance, as required b~{Section 3700 of 3/21/2005
the labor Code, for the performance of the work for which this permit Is issued. .Myworker's Date:
Compensation -insurance ca-rrier.and policy are: .
Carrier: STATE COMPENSATION FUND Policy Number. 0002128-2Q03
PROCESSED BY: ENO
J
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am .
licensed under provisiOns of chapter 9 (commencing
with Section 70 of Divsion3 of e, Business' and
Pl'Ofessio C
Contractor
This section need not be completed if the pennit.is for one hundred dollars ,($1 00: !=r less.
'I\:A. I ~ertify that in .the perf9rrnance of the work for which this permit is issued! I shall not .
~ploy any person in any manner so a become subject to the worker's cCjl1pensation laws
of Califo1'flia, and agree that if I shout b ome subject to the wo er's, comP"",hsation
provisions of Section 3700 ofth b , I shaR forth . h co with tha"J,E:l: provisions.
NUMBER
752855
TYPE
E1<PIRATION DATE
8/31/2006
C39
Date: 3/21/2005 Applicant:
. WARNING: FAILURE TO SECUREW
-UNLAWFUL, AND SHALL SUBJECT EMPLOYER TO CRIMINAL.PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED TH Ol,i SAND DOLLARS ($100,000), IN ADDI1l0N TO THE
.COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF ,HE
. LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
ConstrLlcion Types:
VN, ,
Fire SprinkJered?
NO
I hereby ?ffirm tln.dp-r !,"*,n<'llty 1')( ru:rjury-th:3t fh!:'!"e Jsa_c0nstr'.!ction!er..ding.~"C"';."'~~:.fr}! the
performance ofthework for which this permit is issued-(Sec.3097.Civ.C):
lender's Information: .
r certify that J h~ve read this application and state that the above information is correct. I
agree to Iy with all city-ordinaocesand state laws relating to buU'ding construction, and
h eby, t rize representives of this . to enter upon the abov.e mentioned property for
pur $eS.
Date: 3/21/2005
Fees paid for Permit:
Total:
235.53
Signature of Applicant r Agent
The ermi shall expire by limitatIon and become null and void if the building or
wor has not passed final inspection 365 days from the date of permit issuance. A
new permitis required to commence or continue work.
INSPECTION RECORD
'.. INSPECTION DATE ' INSPECTOR
Temporary Power Pole ' ,
Plumbing (DralnlWaste Pipe) , ,
Electrical Ground Electrode/uter '
SetbacklFormsrrrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Plpe.Sprinkler Valves) ,
MectianiCaI (Groundwork) . ,
Electrical (Underground Conduit) . . ',. "
P~-slab (CompactionlMembrane.Reinf.1
Underpinning (Floor Joist/Girders)
Do not cover',or conceal.the work below until the
following applicable items have been signed: '
1st Floor Shear
Firesprinlder (Rough) , .
2nd Floor Shear ; ,
Roof (Sheathing/Diaphragm/Frame). . ~/,if IY7
Masonry (ReinfJBOnd BeamJPre-Grout) v .
Rough Plumbing (Top Out) ',.
Rough Mechanical . .
Rough l:IectrlCallOry Wall) .
Rough Electrical
Framing (Drily after Plbg., Elec.. Mech:. and Fire) .
, Insulation (SoundlEnergy)
, Do not tape or plaster until, th.. following applicable . .
items have been signed: ' "
Drywall , . ,',
.Penetratloll$ (Fi~ Rated) Electrical
Penetrations (FI~ Rated) Mechanical.
Penetrations (Fire Rated) Plumbing I
Interior Lath
Exterl!)r Lath '.
. GENERAL ITEMS '.
Exterior Plaster (Brown Coal)
T -Bar Electrical . '. , .
T.Bar Mechanical ' :
T .Bar Structural . ,
Sew.r . . .
Water Engineering Backfiow
Water Service .
FINAL INSPECTIONS Date Inspector
Electrical Final '
Plumbing Final .
Mechanic,j( Final ' ,
Gas Test ,"
Engineering/Grading Fina,1765-6126
Fire Dep.t. Final 765-4040 .
Water Engineering 765.5268 . . '
Sub List/Business License 765-519
Zoning 765:5139 ' .
.
Building Final ~astlnspection' Only 4-/f,ilr-- P:-U, ' If "
, , fter Above Complete)
PARTIAL INSPECTIONS
BUildinq'lnspections
Mechanicallnsoections
Plumbina Insoections
Electricallnsoections.