5999 E. Marsha Cr.
APPLICANT: RICK RON STADT ..(
OWNER INFORMATION: CONTRACTOR INFORMAhoN:
Michael E Selders RONSTADT ROOFING t
5999 E Marsha Cir 7916 GOLDEN STAR AVE.
Anaheim. CA 92807 RIVERSIDE, CA 92506 000 .
. BUSINESS PHONE: 951 780.6311
JOB DESCRIPTION:Tear off existing material replace plywood. intal! 32 sqllarep'of e~~.I~!;~e tlie at 5.5Ibs. ICBO# 4600.
VALUATION: 11,000.00 ~" PROCESSED BY: ENO
I OWNER-BUILDER-. 'ECLARATiON '
I hereby affirm under penalty of perjury that I am exempt from the Contractor',;,U~'I1~_~;Law for'tt)efollowing reason (Sec." 7031.5 Business. and..
Prof~sions Code: any dty or county which requires a,~ermit to construct,3~fi~;r.:l~ro:{e, dernollsh or repairar.ystructure, prior to it..c; tSsL..lanc~~.als.q .
requ ires the appticantfor such permit to file a signed su3.tement that he is lic&rGqd :pursuant to the provisi'Jr's of the Ccntracl()r'$ License Law (Chapter
9)(commencing with 'Section 7000 'of Division 3 of the Business and Proiessiej IS C~~)$1;.that he is 'exempttnercfrcm and th~ bc:srs for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit sub] -cts the::~{prlicant to a civil penalty of n:)t mo~€ tha n five hundred dehors.
($500). .' . . . . , . .'
[J !, as owner 9,f property.. or my employees with wages as'.their sole comp~ ::S3tiQn,.-,~in do. the work, and the st,r,ucluie ;s rot intended pr offered for
sale (Sec. 7044 Businessand Professions Code_: The Contractor's Licen~e l :I,-.Ld_ee3nt.t ~pply to an owner of pro Rf,':!rty who builds or improve~
thereon, and who does such work himself'or herself-or through his or her 0'.".: ,_Grr~i~vye'€s, Ptovided th&t ~uc~ imprcve'"'"1fJnts ~'re. not :nter1d~o.t.
offered for sale. If, however, the building or improvement is sold with one Y~F. __,\"jf 'xdt;'pIEltion, the cwner~bui'der-'tIillhave the /)unJen of provin'g ,Jhat he
did not build or improve for the purpose of sale). 1 ~:,
o 1, as the owner of the property, am exdusively contractzng with Iic~n$€:c! ( .mractoro:; t(,) C('Ilc::.truct tha proJecr (S~c. 7044 3USiOc$S 8."ld Prores':>lcns
Code: The Contractor's license Law does not apply to an owner of prope.-ty. '':-'3 bu~~ds O~ im,xo'lcs there:...n, arid wht. contract..; fer 5dro projects 'N1~f1
~;:ontractor(s) licensed pursuant to the Contractor's License Law). ; j
U !;"Im exempt under Sec. , B & P.C. for thiS r€a~on: ~~,I ~__ --=-_ ___._ __~ __, '
Date. 'Owner: ~ .
C WORKER'S COMPENSATION DECLARATiON - :_--':-_J I__L~ENSED CC~;:~~CTORS DECLARATiON]
I hereby afflnn !Jnder penalty of perjury one of the foliowing declarations: ,:' r I hereby affIrm IJlld:r penalty oj p~rjury in2t I at:'1
o I have and wi:! rnalntain a certificate of consent to self-insure for worker', ::Jrnpeqs:;lt:on, ! lIcensed under prOVISJCn~ of chapter 9 (corlmenc:ng
as provided. for by s.ection 3700 of the Labo.r CO,de, for the performance of U'<i. ....~:,:('....r',{ fc.r..W.hi<;h I W!tt') 8e.. tl:Jn TOO~D.' ion 3 f the Bess and
this permit is issued.. . . .; <. . ProfCSSi s ~ e. .
~l have and will maintain worker'~ compensation insurance, as ~equired b~, S_ict;Cf' :-::700 ofl 12/1/2004 . _- ....
me LabcrCQde, for the performance of the work for which this permit is is::'l;f;r~~_ll''Y ,wo;'ker's ! Dc:;te: .. Contractor' .
Compensation insurance carrier and policy are: i ,~~ . !.
Carrier: S1ATE FUND Policy Number: 28S.:00IJq'j-:087 . I NU BER
This section ~~ not be completed if the pe,!,"lt is for one hundred dollars {$10~;. }!.:?$s-::._1'~,~,51~~:~6
o I ~ertify that in.the performancebfthe work for which this permit Is iSSU3. A~hgll.ncI. . - .
employ any person in any manner'so as to becomeosubject to the worker's ce, ~5_e0s~tion laws I
of Califomia,and agree. that if 'should become subject to the worker's compE::' ;,li~!:Or. I
provisiqnsofSection3l00oft La . d Is allf ,tlWlthc p witht..~:uprc: lSI";"l~- ConstrucinnTvpes'
.. \IN, ,
Date: 12/1/2004 Appllcan _ Fire Spnnklered?
WARNING: FAILURE TO SEC EWORKER'SCOMPENSATlONCO c,C ,_=IS j
UNLAWFUL, AND SHALL SU JECT AN EMPLOYER TO CRIMINAL PE"Al IE;'; AND CIVIL
FINES UP TO ONE HUNDRED TIiOUSAND DOLLARS ($100,000), iN ADD' ON TO THE
COSt OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION {O'> OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. 0,
I CONSTRUCTION LENDING AGENCY _.__ '.:.-.,' . j
cc,.Lp,fir~~9X --Q:~nfQUln,d~ r J?2.fl9.!D'-..Pf.~U.YXY-,j~?tthet:e is~co~~~c::~l()~j_~r:cUnq _~::!. .~ 1"..".1 q~:1~~~~~~b--- ..__.__...'_'__.~..,_ "" ~ -.,.:_ :..
;,~.performance pLtheworkfo(whid,.lhis'.pe'rmiUs:issuetl(Sec.309?Civ.C): . \ ,,'^
t.entlei's'lnformation: '
BUILDING P.ERMIT NO: BL,02004",,4310
TYPE 0;= PERIVlIT C I TV
Reroof
DATE: 12/1/2004
JOB ADDRESS: 5999E MARSHA CIR
LEGAL DESCRIPTION: N TR 8679 LOT 19
BUILDING DIVISION
200'S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE:: 434
QUARTER SECTION: 192
ARCHITECT/ENGINEER INFORMATION:
Date: 12/1/2004
Sign' e of A lcant or Agen
e permit sh3l1 expire by limitation and become null andvoid if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new p-ermitis required to commence or continue work.
-,
...J
EXPIRATiON DATE
3/31/2005
C3S
NO
"-..
:';
Fees paid for Permit:
Total:
310.65
INSPECTION RECORD
. .
. . .
, " INSPECTION DATE ' INSPECTOR
, Temporary Power Pole
Plumbing (DralnlWaste Pipe) , .
EleCtrIcal GroUnd Electrode/lifer .
SetbacklFormsfTrenches (Footings)
00 riot install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves) ,
,Mechanical (Grour\dwork) ,
,Electrical (Underground Condu it)
Pre.slab (CompactionlMembrane.R8I nt.
Underpinning (Roar Joist/Gilders) :
00 not cover or conceal the work below until the
following applicable items have been signed: .
1st Floor Shear .
Fiiesprinkler(Rough) .
2nd Floor Shear . . ~
Roof (Shealhlng/Diapfuagm'Frane) /; -Z~
Masonry (ReinfJBond BeamlPre-Grout)
Rough Plumbing' (Top Out) . ,
Rough Mechanical . , .
Rough eectrlCaI II)
Rough Electrical
Framing (Only afterPlbg., EJec.. t...lech.. and Fire)
Insulalion(Soundl!:nergy) '., ' .
Do not tape or plaster until the following applicable .
items have been signed.: . . ',- .
Drywall, . . .
Penetrallons(Fire Rated) Electrical ,
Penetrations (Fire Rated) Mechanical
Penetraliolls (Fire Raled) Plumbing
Interior Lath ','
Exterior Lath
, , GENERAL ITEMS
Exterior Pl;Ister (BraN" Coat)
T .Bar Electrical
T .Bar Mechanical
T -Bar Structural , . ,
Sewer .
W;lter Engineering Backflow
Water Service .
.
FINAL INSPECTIONS' Date, . In"spector
Electrical Final, . . "
Plumbing Final ' . ' .. ,.
Mechanical.Final .
G;ls Test . .
.
Engineering/Grading Fimil765-5126
Fire Dept. Final 765-4040 ,
Water Engineering 765-5268 '. .
Sub List/Business License 765-519
Zoning 765-5139 '"
Building Final ~ast Inspection.,Only fA ."'~ . 14.;. ~
, ' , fter Above Complete I
PARTIAL INSPECTIONS
, Buildina Inspections
Mechanical Inspections ,
Plumbina Inspections,
, Electrical Inspections'