1975 W. Lullaby Ln.
TYPE OF PERMIT CITY
Reroof
BUILDING DIVISION
200 S. ANAHEIM BLVD,
(714) 765 - 5153
INSPECTION REOUESTLlNE:
(714) 765' 4626
CENSUS CODE: 434
QUARTER SECTION: 42
BUILDING PERMIT NO, BLD2004-02593
DATE: 6128/2004
JOB ADDRESS: 1975 W LULLABY LN
. LEGAL DESCRIPTION: N TR 2031 LOT 45
APPLICANT: RAFAEL MUNOZ
OWNER INFORMATION:
Rafael M Munoz
1975 W Lullaby Ln
Anaheim, CA 92804
JOB DESCRIPTION;ear off.and install 22sq, ~Comp shingles- 40year;
VALUATION: 3,300.00 PROCESSED BY: DOR
I .OWNER-BUILDS(OECLARATION .
. I hereby affirm, under penalty of perjury that I am exempt from-the Contractc:/o License'Law for the following reason (Sec. 7031.5 Business arid
Professions Code: any dtyor county which requires a permit to c'ons~ruct, a~rer. Tmprove, demolish OT repair any stn.:cture, prior to its !ssuanc13, also
requires the ~pplicantfor such permit to -file a,signed statement that he is Iic,f}nsed pursuant to the provisions of the Contractor's License law (Chapter .
9)(commencing with Section 7000 of Division. 3 of the Business cinel Profe$ihr:s Code) or tht:lt he is' exsrTlPttherefrom and the basis for the alleged , '
exemption. MY violation of Section 7031.5 by any applicant for a p~r;"it ~t.J.~~ecisthe applic..=mt to a dvU ppnaity of riot more tha n five hundred dollars
($500). :; . . .
rJ<J I, eas owiler of property, (J.r my employees with wages as their SOle COi\:".~/,n. sBtjon, will dO'.the work, and the structure is' not inte. ndecfor offered for'
sale (Sec, 7044 Business and, Professions Code: The Contractor's Ucense, I:.aw does not apply to an owner of,property who buildS or improves,
thereon, and wh'o doeS such work himself or herself or through his or her :J...h emptoyees, provided that such in1prove~nts are not in~c:ndt..>d or
offe~e" for sale. If, however, the building or improvement 'is sold with one yp:,1" of completion, the owner-builrler wUlhave the burden of preYing that he
did :not buUdor improve for the purpose 'of sale): 1 . . .
o I~as the owner ofthe.property,am exdusively contracting with Iicensetir...ontractors to construct the project (See. 7044 Business and Professions
Code,=-- TheContracfor's License Law does not apply to an owner of propert'i'\'Vho builds or improvE;!s thereon, 'and who contracts for slJch ,projects with
j!ontractor(s) licensed pursuant to the Contracto~'s License Law).'~ '~i.'; (. ,'.
. ,'am exempt under Sec. , & .C. far t .s' reason: _~:
ate: ~~. ,." OWner: Y - ~..!;~
WORKER'S COM ENSATION DECLA,RATlON __
. I hereby affirm under penalty of perjury one of the following declarations: .
tJ Ihaveand will maintain a cert}ficate o.f oonsent to self-lns"'r~ for workc;\ compel;1sation,
as provided for by Section 3700 ofthe labor Code, for the performanCE> of lii:e workror whidl
'this permit is issued. .' .
o I have and will maintainworker's_ compensation insurance, as requirect,~'J Section 3700 of 6/28/2004
. ,the labor Code, for the performance of the work for which this permit is isstcd: Mywo(ker's Date:
Compensation insurance carrier and policy are:
Carrier: Policy Number.
CONTRACTOR INFOR.M\TION:
ARCHITECT/ENGINEERiNFORMA TION:
LICENSED CONTRACTORS DECLARATION
J h,ereby affirm under penalty of perjury-that I,am
licensed 'uriderprovisionsof Chapter 9 (commencing
\'1{ith,Section 7000) of Divsion 3 of the Business and
Pro,fessions Code,
Contracfor
NUMBER
EXPIRATION DATE
This secti~n need not be completed if the penni! is for one hundred dollars ($10)) <if less.
o I ce'rt./fy that in the perfonnance of'the work for which this permit is i~l;r.4:),.s~all not
employ any perscm in any manner so as to become subject to the WQo<eYs\..(\jllpensatlon laws
of California, and agree that if I should become subject to'theWOrker~sc6m~-chsation. .' .
provisions of Section 3700 of the Labor Code, I shalf forthwith complY. wl1b.t!l)Se'l'tbyisions.
"<"C ','." '_.':,
Date: 6/28/2004. . APPIi~nt: ^. I?~j' 0z,....;:v,;>5..
WARNINGr FAILURE TO SECURE WORKER'S COMPENSATION CO)il;f];",E!'1S. . .
UNLAWFUL, AND SHALL SUBJECT AN ElvlPLOYER TO CRIMINAtPSW,"-T)ES AND CIVIL
FINES UP TO ONE HUNDRED TIiOUSAND DOLLARS ($100,000),:INAi}PiTION)TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR .iNSEc:ffbr'::,~7060FTHE
LABOR CODE, INTEREST AND ATTORNEY'S FEES, . . . .' , " :'
I CONSTRUCTION LENDING AGENCY _
I hereby affirm under penalty of perjury that there is a construction'lendinaa;;ency:f1Jr the
c-:=rforlT'~""i~ qfthe_work f"rwhir:h this n!:,rmit is.-jsSl)ed ISe("'~ ?097.r.i".c)::'2 ~~ ~.:"'_~..~__.
Lender's l(\formation:
TYPE
Construcion Types:
VN, ,
Fire, Sprinklered?
NO
,
:,:,-t
I certify that I haVe read this application and state thatthe above information is correct. ,
agree to oomply with all city ordinances and state laws relating to bu~ding cc;nstruction, and
hereby authorize representives of-this dty to enter upon.theabove mentioned property for
j1~ection purposes. .. .
.'S RA~j 0:rz.u-:::i.",'7 Da1,,: 6/28/2004
--- .. Signature of Applicallt or Agent
The permit shall expire by Iiinitationand become null and void if th~ building or
work has. notpassed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work. .
Fees paid fO~ Permit:
. Total:
124.85
INSPECTION RECORD
INSPECTION I. DATE. INSPECTOR
Tell1pofary Power Pole . .
. Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer . .
SelbacklFo..n'lsfTrenches (Footings) . ..
Do not install sub floor or pour floor slab until the.
following applicable items have been signed:
Plumbing (Water Pipe'.Sprinkler Valvesl . "
Mechanical (Groundworkl , 1
Electrical (Underground Conduit) . .'
Pre-slab,(CompactionlMembrane.Rei nt. . '
Underpinning (Floor Joist/Girders) .
. Do not cover or conceal the work below until the,
fOllowing applicable items have been signed:
1st Floor Shear , .
FireSprinkler (Rough) .
2nd Floor Shear. . . ~ A'
Roof (Sheathing/Diaphragm/Frane), . '//"Y/,I-;.
Masonry (ReinfJBond BeanlPr&;Grout) .. , ..........
R(lugh Plumbing (Top Out) , Ie./'
Rough Mechanical I.,
Rough.l:lectrical (ury wall) . . ..
RQugh Electrfcal ' .
Framing" - -- (Only after Plbg.,-Elec.: Mech. and F"ire)
Insulation (SoundlEnergy) ,
Do not tape or'plaster until the following applicable
items have been signed: . . . .:
DryWall .
Penetrations (Fire Rated) Electrical
!'enetrations (Fire Rated) Mechanical' .
PenetrationS (Fire Ra\ed) Plumbing ,
Interior Lath
Exterior Lath .
!. .. GENERAL ITEMS
. Exterior Plaster (BroIvn Coat)
T -Bar Electrical .
T-Bar Mechanical . , . .
T -Bar Structural "
Sewer, . .
Watllr Engineering Backflow ' , .
Wat"r l:ervice " .
.
FINAL. INSPECTIONS . Date Inspector
Electrical Final . .. '
Plumbing Final , ,
,
Mechanical Final ' . ..
Gas Test . .
.
Engineering/Grading Final 765-5126 .
Fire Dept. Final 765-4040 . ,
Water Engineering 765-5268 . , ,
Sub List/Business License 765-519 . .
Zoning 165-5139 . . .
Building Final ~ast Inspection- Only. ..,1 fer- -\L ~~
fter Above Completel ' "'If
PARTIAlINSPECTlb;(is " .
BuildinQ Inspections'
Mechanicalli'lspectioi'ls
PlumbinQ Inspections
'Electrical inspections