940 S. Mancos Pl.
---.:'::,"~:'~....,
BUILDING DIVISION.
200 S,ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE'
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 124
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BUILDING PeRMIT NO, 61..D2004-01307
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. TYPE OF P~RMIT
Rer<,o(
'DATE: 4/2112004
JOB ADDRESS: 940 S MANCOS pL
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LEGAL DESCRIPTION: N TR 3825 LOT 16
CONTRACTORINFORMA T!ON:
WHITNEY ROOFING
2950 W CENTRAL #25 ,
SANTA ANA, CA 92704 0000
BUSINESS PHONE: 714.434-')272
, JOB DE$CRIPTIONRe-roof - fear off existing at flat roof only and in'stall 8 sq. or 3UR.
comP2,~~~OO - ,
APPLICANT: ROBERT WHITNEY
.OWNER INFORMATION:
Angeloa' Adao
. 940 S Mancos PI
Anaheim, CA 92806
. ARCHITECT/ENGINEER INFORMATlpN:
Also install 16 sq. of 30 'yr. compo shingle over 1. Hayer of existing
VALUATION:.
L . OWNER-BUILDER r.ECLARATION
1 herebyaffirm under penalty of p~rjury that I am e,xemptfroni the Contractor's License Law for the following reason (Sec. '7:031.5 _Bus-iness' and
Professions Code: any dty or county which requires a permit to construct, ait€';;~mprove'- demolish or repairany structure, priortoits issuance, also
requ'ires the' applicant forSUch permit to file a signed statementthat he"islicet:/ecl pursu~:mt to'the provisions of the Contractor'sLiCense Law (Chapter
9)(comm~ncing wfth Sectio.n 7000 of Divisicin3of.t.t,e8u~iness and Profe~8!c~i,'s.codc}or that.he is-exemp.t)he~Jrom and thebasi~ for thealJeged.
exemption. Any violation-of Section 7031.5 by any ap;:>lic~~nt for' a 'permitsubj;;}:ts the applicar:'ltto a civil ~ri~ttyof not more tha~n<fivehundred dollars.
~~ '.. ..., .
o ,I; as owner af property, or my emplayees with wa_ges as. their sole cOnJpe::'sa"tion, will do the work, and the. stru<;'lure is '!;lot intc-nded Dr offered for
.sale (Sel:;. 7044 Business ~nd P-rofa'Ssions Code:, The Contractor's'l,icens'e L;:;;:;idoes not apply to. an owner of property who builds or improves
" thereon, and who. d~es_'SU:::tl work himselfor helSelf or through hi,S or her.o.wn '~mployees', provided t~t such. imp_rovemer.t~ are not intended or_ '
offered.for !X! fe, ff, however, the:building or,improvement is sold with one y~p:i;'of cornpletian, ~he owner-buHderwiJJ have the burde'n of proving that he
did not bui.ld-(:r improve for the purpose of sale). ", 'J- , ' " ',.' , ,- _ .
o 1" as' the owner of the property, am exdusl'IelY' contn:lding yvith licensed r,~~n tractors __to. construct the project (Seci 7044 Busin\?Ss.'and ProfeSsions
CQde: Tt:le C6ntracto.!,s Licen~ Law does not apply to a'n Owner ofpropertv~'~,:ho buUdscr lr'nproves'thereo;,\, -and who cOntracts fOT sllch pro.eets with
~",;oniraclor(s)-ncensed plJrsua'nt to the "Contractor's License Law). ' 1
LJ l,am.exempt under,'Sec. . B' & P.C. for this reason: _ ~_,~
Date: " Owner: .
.1 WORKER'S COMPEN5~IlQ!i!?1=CLARAT10N -~ .
1 hereby Clffirm under penalty of perjurtone af-the following declarations: :i .
.0 I have and will ma!ntai~'a cert(frcate of oonsent tose.lf-insure for wor:ke':-.s'>o;npe'nsatiol1,
as pravided f()r bY.Sed}on 3700 of the labor Code, for the petfarman~ Gf t!lt;.'i",o~(' for whiCh
this permit is issued.. . .' '. ~
01 have a ndwil! main'lairi worker'$' campensation insqran e, as required biSectia'n 3700 of
the ,=-abor Code,Jor the performance of the work for. whichthi ermit is issue~. Myworker's
Compensation .insurance carrier and policy are: ~
Carrier: STATE FUND - Policy Numb r. 285-0002""'1
. I
This section need not be"completed if the pennit i~ for one hundred UatS,l$100)!or less.
o '"certify-that in'the,perforrnance oftha Wark for whic this,per ,it is- i,$:i.uel,: shall not '
.'employ any person i.n any manner so as to. become s ct to the ..o~ker's:co~ilpensation laws
of Califamia, and agree that ,if I should become su to the we er's' comc.r:;-;.jsation '
provisions of Section 3700 of the Labor Code, a ith mply wit;, thc:36 provisions.
Date: 4/21/2004 APPlica,x. '-- 'x-H.: '-,
WARNING: FAILURE TO SECUREWORKE ~ NSATION C;bVE'R'\Gt'lS
UNLAWFUL, AND SHALL SUBJECT AN EM_ LOYER TO CRIMINALt'ENA[Ti~s A,NDCIVIL
.FINES UP TO ONE HUNDRED THOUSAND DOLLARS (~100.0(lO),Ji'i AQDF'ibN;ljO Tf:JE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEeTICN 3,06QF HIE
_LA,~OR CODE, INTEREST AND ATTORNEY'S FEES. . " .' .". .~. . _-I' .::. .
. L CONSTRUCTION LENDING AGENCY;!;, ,p'
I hereby affirrnunder penalty-of pe . that there is ,3 t?or'!strucWm ler\9,tng,a:~;0.C:yf61"t.he~
,'pertarm<:l!=l.9l3 of the work for which' this ermit is issued (Sec.,~097.Civ,.~):; -.t -'^~
Len,:;ler's Information: ">:,; %
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PROCESSED BY:, PMK
I
LICENSED CONTRACTORS
I hereby affirm under pe
licensed under provision
with Section 7(00) of vsio
Professio. s Code.
4121/200
Date:
NUMBER
406022
TYPE
. TYPE
EXPIRATION DATE
5/31/2005
C39
HIC
Construcion Types:
VN','" .
Fire Sp.rink/ered?
NO
ure of A lieant or'Agent'
The permit shall ex ire by Iimitaiion and become null and void if the building or
work has' not passed final inspection 3(;,5 days from the date of permit issuance. A
new permit is requirE!dto commence or continue work.
Date: 4/21/2004
Fees pai.d for Permtt:
Total:
0.50
I certify'that I have read thi
. agree to comply wit~ all
hereby authorize rep
, insPection purpo
.
INSPECTION RECORD'
. INSPECTION" .
, :Temporary PowerPole .
. Plumbing (DrainlWaste Pipe) .'
. Electril:al Ground. Elel:trodelUfei .
Setbac:kJFormsfTrenl:hes (Footings) .
Do not install subfloor. or pour f1oor,slab until the
following applicable items have ,been signed:
Plumbing (Waler Pipe.Sprinkler Valves)
Mechanical (GrOUndwork) .-
Electril:a1 (Underground Conduit) .
Pre-slab (Compac:tionfMernbr3l\l!.Reinf.
Underpinning (Floor JoistlGirders)
Do not <:over or <:oncealthework below untifthe
iollowing applicable. items.havebeen signed:
1 stFloor Shear'
. Firesprinkler (Rough) . '.' --:-- .
2nd Floor.Shear .'. .
Roof (ShealhiririlDiaphragmlFr;me). .'.
Masonry (ReinfJBond Be;mlPr.GroUt) v -v'
Rough Plumbing' (TQP Out)
RQugh Mel:hilnil:al. . : .
Rough E1ectric:a1 ilIf-:-
RQugh Elel:lril:al '. .
Framing. "(Only after. Plbg:, Elec::Mech.,.and Fire)
Insulallon(SQundlEnergy)- .
Do not tape or plaster until the fOllowing applicable
ilems have been signed: '. .' .. .
Drywall ..-. ,.
. Penetrallons (Fire Rated) Electrical
. Penetrallons(Fire Raled) Mechanical:
PenetratiQns (Fire Rated) PlumbIng
Interior. Lath --:-- --:--
Exterior Lath ' --:--. .
--:-- . GENERAL ITEMS
Exterior PIa$ler(Brown Coat) . '
'T-BarElectrical. .......
T -Bar Mechanical . .
T -Bar Structural.
Sewer .' .'
Watet Engineering Backflow
Water S;<rvice .
. QATE
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INSPECTOl'.
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FINAL INSPECTIONS Dat~ Inspector
Electrical Final, .' . . .
Plumbing Final, '" w,
Mechanical Final.'" . . .
Gas Test . .' .."
Engineering/Grading Final 765-5126 .' .
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Fire Dept, Final 765-4040 .
Water Engineering 765-5268
Sub List/Business License 765-519 '. .
Zoning 765'5139 . ,. I i Or
Building Final ~astlnspection. Only i'6{ th ( !~.
. .fter Above Complete) e..u.w..lk
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections
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, Plumbina Inspections
Electrical Inspections