1179 Lombard Dr.
TYPE OF PERMIT CITY
Reroof
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BUILDING DIVISION
200 S, ANAHEIM BLVD,
(714) 765.5153
INSPECTION REQUt:ST LINE:
(714) 765. 4626
CENSUS CODE: 434
QUARTER SECTION: 51
''j
,BUILDING PERMIT NO, BL02005-00674
OA TE: 3/1 0/2005
JOB ADDRESS: 1179 N LOMBARD DR A
LEGAL DESCRIPTION: N TR 3635 LOT 3
APPLICANT: PAUL POWDERLY
OWNER INFORMATION:
~.enjamin V Rodriguez
PO Box 4962
Orange, CA 92863
CONTRACTOR INFORM!> nON:
ROYAL ROOFING CO
8111 W COMMONWEALTH ),VE
BUENA PARK, CA 90621 0000
, BUSINESS PHONE, 71452'-0100 ' ,
JOB DESCRIPTION:Tearoff existing composition shingles, instal.142 squares ~Jt 30 year composition shingles.
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 5,990,00
I OWNER-BUILOERQECLARATION
I hereby affjrmunder penalty of perjury-that I am exempt from the Contractor'X U!;ense Law for the following reason (Sec. 7031.5 Businel:>:s, and
Professions Code: any dty or county which requires.a permit t() construct; alti,':", improve, demolish or repair any structure., prior to its issuan.ce, aiso
requires the applicant for suchperrrut to file a signed statement that he is Ilceqsed pursuant to the provisions of the Contractor's License law (Chapter
9)(commencing with Section 7000 of Division 3 of the Busines's aQ.dPrOfeS&icr,E:. Code) Qr that he is exempt ti1emfrom and the basis for the alleged
ex~mption. Any violation of Section 7031.5 by any applicant for a permit Sl!bj~~d:: the-a-nplican1 to.a civil nsnalty of not mr,re than five hundrM dollC?!r;;;
($500).' " " ,
o l, as owner of pror::e:rty; or my 's'!lployees with wages a5 their sole comp;'l-\":1::l:tion, will do the work, "clod the structure is not intendeP or offered fer
sale {Sec. 7044 Business and Profe:ssions Code: -fhe Contractor's lice:1se L'~I,-'.' does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through ilLs or her O\.....ri;.;.~np:oVE:ies,. provided that such improvements are not intended or _
offeredfol' sale. IL however,.the. buildh""\g 0\ ir.rloiiOVe::!rnent'is soid with one ye~'rof oompfetior1, the oymer-builder will have the burden of proving .that he
did not build or improve for the purpOse of sale). '. .
01, as the owner of the oroperty, am exdusively contrading with Jicen$ed'~Jttractor~,.-to construct the project\Sec. 7044 Busirlb."',S and Professions:
Code: The Contractor's License Law'does not apply to an owner or prcp:=-rtywIY.-' bLiildS or.irrtproves thereon, and who <X>iltr~cts for sum projects with
~~ontrador(s) licensed pUi"suant ~o \ne Contractor's License Law). . .
U / am exempt under Sec. ,8 & P.C. for this reason~ __~~__.
Date: Owner: .
c::::: WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one0t the- follolA-ingdeclarations:
o !"havE' and will maintain a certjficate.c1 conrerit to SE;llf-insure for w.)rker'~.::cmper.sation,
as provided for by Section 3100 of the Labor Cede, for thepenormancc of :hf-: .....erk for whicM
, s permit is fssued.
I have and will maintain worker's. compens.ation insurance, as required bj.3cctil')n 3700 of
the or Code, for the performance of the work for whictlthis permit is iSSUE?~t Mywork:er's
ompensation insurance carrier and policy are: . I
Carrier: ACORD Policy Number: WC050101C400002
PROCESSED BY, IN,J
-.J
-~':' '~
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3/1 0/2005
Date:
NUMBER
678705
TYPE
TYPE
TYPE
Date: 3/10/2005 Applicant
WARNING: FAILURE TO SECU EWO R'SCOMPE
UNLAWFUL, AND SHALL SUBJ CT AN EM OYER TO CR INALFiONAUES AND 'CIVIL
FINES UP TO ONE HUNDRED OUSAND DOLLARS ($100,000), INADDI.;1CN TO THE
COST OF COMPENSATION, 0 MAGES AS PROVIDED FOR IN SECTi'ON 0706 OF THE
LABOR CODE, INTEREST AND ATlORNEY;S FEES,
CONS RUCTION LENDING AGENCY..
I h_erE)Qt_af!lrn:U.!!2de.r..P?Df.!ltyqf-p~ jl!l}'_tJ:i~lJt:tere is a c~{:w.ructi.on lend.iOQ aQ>' j;CY f~.;, th~
- pert-orrnance ot lhe work for which this permit is issued {Sec. 3097 .Civ.C):
Lender's Information:
Construcion Types:
VN"
Fire Spnnklered?
NO
"
Date: 3/10/2005
Fees paid for Permit:
Total:
384,87
.' Signature of Appl n or Agent.
The permits expire by limlla and become null and void if the building or
war has not passed finalJnspection 3&5 days from the date ot permit issuance, A
new ermit is re'quired to Commence or continue work..
INSPECTiON RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole ' , ' , , " ,
Plumbing (DrainlWaste Pipe)
Electrical Ground ElectrodelUfer ' ' ' ,
SelbacklFormslTrenches, (Footings) "
Do not install subfloor or pour floor slab until the
following applicable It~ms Have been signed: '
Plumbing (Water Pipe.sprinkler Valves) ,
Mechanical (Groundwork) " , ,
Electrical (Underground Conduit)
Pre-sJab (Compaction/Membrane.Reinf. ,
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below, unt,l the
following applicable items have been signed: ,
1st Floor Shear ,
Firesprinkler (Rough) ,
2nd, Floor Shear ' ' " ' ' , A
Roof athlmi'lDiaphragmlFrame) m ,k,( //V,
Masonry (RelntJBond Beam/Pre-Grout)
Rough Plumbing (Top Out), ,
Rough'Mechanical ' , ,
Rough l:Iectrlca/ (ury wall/ " ,
Rough Electrical
Framing, (Only after Pltig.; Elec.. r..Jech.. ana Fire? , ,
Insulation {SoundlEnergy) , , ,
Do not tape or plaster untif 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 , , ,
Water Service'
FINAL INSPECTIONS ,Date Inspector
Electrical Final ,
Plumbing Final ,
" ,
Mechanical Final "
, ,
, Gas Test ,
. ' ,
,Engineering/Grad,ing Final 765.5126 ' ' ,
Fire Dept. Final 765-4040 ,
, , " ,
Water Engineering 765-5268 ,
Sub L1st/Busine,ss License 765-519 , ' , '" ' "
Zoning 7,65-5139 , ;
s'uilding Final hLa$t Inspection-Only \I.. ' f\ I /i
, , fler Above Complete) 1;Jf~-~
PARTIAL INSPECTIONS
BuildinQlnspections
"
MechanicallnSDections
Plumbina Inspections'
, Electrical Inspections