1121 Lombard Pl.
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 60
BUILDING PERMIT NO. BLD2005-01422
DATE: 5/16/2005
JOB ADDRESS: 1121 W LOMBARD PL
LEGAL DESCRIPTION: N TR 3635 LOT 8
APPLICANT: KYLE LEWIS
OWNER INFORMATION:
Bobby K Hanada
PO Box 3086
Fullerton, CA 92834
CONTRACTOR INFORMATION:
LEWIS & SONS CONSTRUCTION INC
310 S MAPLE ST #E
CORONA, CA 928820000
BUSINESS PHONE: 909273'0901
JOB DESCRIPTIO!'J:Tear off existing r<;>ol and replace with 42 squares of 30 year composition shingles.
ARCHITECT/ENGINEER INFORMATION:
VALUATION:
8,775.00
PROCESSED BY: MSM
OWNER-BUILDER DECLARATION .
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Business and
Professions Cooe:, any city or county which require:? a permit to construct, alte-r, improve, demolish or repair any structure, prior to its issuance; also
requires the app6cantfor such permit to file a signed statement that he is licensed pursuant to the provisions of. the Contractor's License Law (Chapter
9)(commencing wit/1 SeGtion7000 of Division 3 of the Business and Professions Cpde) or that he is exempt therefrom and the basis for the,alleged
exemption. Any violatipn of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars
-~ . . . . . .. .
D' I, as owner of property, or my ~mploy'ees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 .Business and Professions Code: The Contractor's License Law does not app.lyto an. owner of property who build~ or improves
thereon, 'and who does such work himself or hem.elf or through his or her own employees, provided'that such improvements are not intended or
offered for sale. 11, however, the building or improvemeritis sold with one year_'Of completion, the owt:1er-buHder will haVS'-the burden of proving that he
did not build or'imprqve for the purpose of sale). ,I,' . ',', . .
D I, as tt1e owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions
Code: ,The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such :projects with.
a cOhtractor(s) licelnsed pursuant to the Contractor's License, Law). '
~ lam exempt.und~rSec, " B & P.C. for this reason:
Date: Owner:
I
WORKER'S .COMPENSATION DECLARATION
I he'reby affirrT! under penaltY of perjury one of the following d6CI?rations:
D I,have and will maintain a certificate of consent to self-insure for worker's compensation,
as provided for by Section. 3700 of,the Labor Code, for the performance of the work for which
~hi permit is iSsued.:' . . '.
, ;1 have and will maihtain worker's c<?mpensation.insura. nee, as required.by S. ection 3700 of
e Labor Code, -for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are: .
Carrier: EXEMPT Policy Number. EXEMPT
~i section need not be completed if the pennit Is for ne hundred dollars ($100) or less. .
1_ certify that in the perfonnance of the work hich this permit is issued: I shall ,not
m loy-any_person i'n any manner so as to bee subject to the worker's. com'pensation. laws
0: California, and agree that if I should becom j to the worker's compensation
provisions of Section 3700 of the Labor 0 e I forthwith comply with tho~e provisions.
511612005
Date:
NUMBER
416525
TYPE B
TYPE C39
Contractor
EXPIRATION DATE
4/30/2006
Date: 5/16/2005 Applicant.
WARNING: FAILURE TO SECUR. ORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJE 'T AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED.THOUSAND DoLLARS ($100,000), IN ADDI1lON TO THE
CO.ST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm tinder penalty-_cf perjury that t,here is a construction lending agency for the
performance of the work for which this permit is'issued (Sec. 3097 .Civ .C):
.Lender's Information:
Construcion Types:
V N, ,
Fire Sprinklered?"
NO
I certify that I have ad t s application and state that the above informatio.n is correct. I
agree to comply w' all ty ordinances and state laws relating ,to,building construction, an~ .
hereby author e pre ntives of this city to enter upon the above mentioned property for
insp 'on pu 0 s.
Date: 5/1612005
Fees paid for Permit:
Total;
385,15
Ignature of Applicant or Agent .
The per tshall expire by limitation and become null and void if the building or
work has not passed fi nal inspection 365 days from the dlite of permit issuance. A
new permit is requiredto commence or continue work. .
INSPECTION RECORD
INSPECTION . DATE ' INSPECTOR
Temporary Power Pole
Plumbi ng (DrainlWaste Pipe) .'
Electrical Ground Electrode/Ufer
SetbacklFcirmslTrel1ches (Footings)
Do not install subfloOr or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork) .
Electrical (Underground Conduit) , .
Pre-slab (CompactionlMembrane.Keinf.
Underpinning (Roar Joist/Girders)
Do not cover or conceal the work belOW until toe
following applicqble items have been signed: ,
1st,Floor Sliear
Firesprinkler (Rough) .
2nd Floor Shear . {
Roof (Sheathing/Diaphragm/Frame) ~-\~.c& '
Masonry (ReinfJBOnd Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical -
Rough ElectrICal III) ..
Rough .Electrieal ' ,
Framing (Only afterPlbg., EJec.. Mecti.. aM Fire) .
Insulation (SoundlEnergy)
Do not tape or plaster until the following applicable
items have been"s!gned: .'
Drywall . . .
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath . . .
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T -Bar Electrical
T -Bar Mechanical
T -Bar Structural " .
Sewer .
Water Engineering Backflow
WAter Service
FINAL INSPECTIONS Date Inspector
Electrical Final .
Plumbing Final . .
Mechanical Final . ,
Gas Test . ,
Engineering/Grading Final 765-5126 '.
Fire Dept. Final 765-'1D40
Water Engineering 765-5268 ' .
Sub List/Business LIcense 765.519 .
.
Zoning 765-5139 . . .
Building Final ~astlnspection. Only S~al .....s0,{. ,L
. fter Above Complete) , .v:'" -'~
PARTIAL INSPECTIONS,
Buildina Inspections
Mechanical Inspections
Plumbina Inspections,
Electrical Inspections '