1501 N. Miller St.
CONTRACTOR If'.jFORMl,ION:
CRAWFORD ROOF COMPANY
25821 JAMON LN ,
MISSION VIEJO, CA 9269':0000
BUSINESS PHONE: 949/29',6100
JOB DESCRIPTION; Tear off and re-roof 130 squa'es of BUR '__
, VALUATION: 25,000.00 !; PROCESSED BY: EMA
I OWNER.BUILDERUECLARATION ~
I hereby affirm under penalty of perjury that I am exe,mpt from the Corrtractori=!: License Law for the following .reason' (Sec. 7031.5 Business and
Professions Code: any dty or county which requires a perm it to construct, a!r:~r. improve; demolis.h or r,epair any -structure, prior to ,its'issuance, also
requires :the applica nt fot such permit to file a signed statement that he is I!c.~li:sed- p~u~s.uant ,m the provisi,ons of the Contractcr'.'$ -Lie,ense Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business andProfessk1.lls ende) or !hat he'is exempt therefrom anJthe_ bcisis for the alleged
exemption. Any violation. of ~ecti.on 7031.5 by any applicant for d permit sub~~c::ts tile applicant t.o a c?vil pena!ty of not more. tha 'lfiye hUI1_dr~9. d6i.ll3r!') .
($500). . . . .. 't ..' ...' " .
D I, as owner .of property,.or my employees with wages as their sole COmt:1\i1s.ation, wHi de the work, and the structure,is not inten~ed or':)ff~red fo.r
sale (Sec. 7044 Business,and Professions Cade: The Cantractar's LicenseL~"\I daes nat applyta an .owner .of pi O"perty whaIJuilds orJmproves .
thereon, and who d.oes such work himself or herself or thraugh his .or her 'oll':..a-:::1plovees, prC'vided that such improvements,are not inte!lded .or
'.offered for sale, If, hawever, the building .or impravement is' said 'with one ye~r;of compietion, the cWller-huilderwill hel\'S the-burdefl.of proving that he
did not build or improve for the purpase of sale). r .--
o I, as the owner of the property,,-am exdusively contracting with 'iic;en5ed lbntractors to ~on::;truct-the project(Sec-. 7044 Bustness and Pl~fessians'
Cede: The Canti-actor's License Law dae.<; not apply ta an own8r .of property !r:;)O bui~ds orfmproves therean, a~d I,vhc. contrat;:.ts f',)r such project~; with
~antradar(s) licensed pursuant to the CQntractor's License Law). f: . . .
U I am exempt under Sec. , B & P.C. for this reasan: .___~_' '-', . .
Date: Owner: 'k=
I WORKER'S COMPENSATION DECLARATION -mh -_~-.-J LICENSED CONTi<ACTORS DECLARATION!
I hereby.affirm under penalty of perjury .one .of the following declaratiens:.-i; I hereby affirm under perlattyof perjury ,am
o I have and will maintain, acertificate of oonsent ta self-insure for worker',$'ccmpen3atian, I!censed under provision3~fch t (corn
.as pravided for by Section~700 .of the labor Code, for tl1_e Performance ofttiJ. '.No&: for whiQ'1 with Section 70(0) iicn'" B
this pe(mit is issued. ". .. . . f' . I Professians Cod?,
~' have a.nej will ma~ntain worker's' compensation insurance, as required h~\\~ectic!13700 of 12/10/2004
tabor Code,for the perfarmance .of the work for which this permit is issu~;:. My worker'~' Date:
C mpensation insurance carrier and policy are: ;. I
Carrier: Policy Number.. 1613581
r::.-;... ~
BUILDING PERMIT No:>, BLD2004-04391
,
TYPE OF PERMIT 'C ITY
Reroof
DATE: 12/10/2004
JOB ADDRESS: 1501 N MILLER ST
LEGAL DESCRIPTION: KRAEMER TR LOT 2 BLK K POR OF LOT
APPLICANT: RICK CRAWFORD
OWNER INFORMATION:
Theodore L Ba~glia
4018 Temesca.l Ave
Norco, CA 92860
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE'
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 143
ARCHITECT/ENGINEER INFORMATION:
I
This section need not be completed if the permit is tOr one hundred dollars ($100):("A';-_i~s,
.0 I certify that in the perforrnance-ofthe ~ark far which this permit is !~ue'(~. i~hollnct
employ any person in any manner so as ta became subject to the warker's ;np~l1satian l<;Iws
'of Califainia, and agree that if I shauld became subjectta the warker's mpelsa:tibn
provisians of Se~tian3700.ofthe Labor Co I II fa h ith camp' ith U. ,\3-e'provisions,
NUMB~R
585465
TYPE ..
TYPE
.
Construcion Types:
VN, ,
Date: 12/10/2004 Applicant:
WARNING: FAILURE TO SEC EWO KER'S COM
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER T
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ( 100,000), IN ADDI.'iONTO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION';706pF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .
I CONSTRUCTION LENDING AGENCY
J hereh.y <:lffirlTl_ undA r penf-l'It'J__mperju::y.ttl'gt. thnt~ .Los a_cc-n,c:.tn ldit.!'1 ! end ino__~!.~.'r.'JY f('lr~thE'! ;;~._,.J~_:;;.i....:,-,-.__
performance .of the work for which this permit is issued (Sec,3097 .Civ.C):
Lender's Information: .
Signature of Applicant .or Agent.
he permit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
EXPIRATION DATE
1/3112006 .
HIC
C39
Fees paid for Perl11it:
Total:
752,43
. INSPECTION RECORD
INSPECTION . DATE INSPECTOR
Te.mporary Power Pole : .
Plumbing (DrainIWaste Pipe) .
Electrical Ground Electrode/Ufer
SetbacklFormsfTrenches (Footings)
Do not install subfloor or pour floor .slab unti Ithe
following applicable items have been signed:
Plumbing (Water Plpe.Sprinkler Valves) .
Mechanical (GroundWork).
. Electrical (Underground Condu it)
Pre-slab (Compaction/Membrane.Reinf.
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have be.en signed:
1 st Floor Shear -
Firesprinkler (Rough) .
2nd Floor Shear -
Roof (Sheathing/Diaphragm/Frame) ~_r1.K, -'~/I'4..
Masonry (ReinfJBond BeamlPre-Grout) . . /' T
Rough Plumbing (Top Out) . <.....-
Rough Mechanical .
Rough ElectrICal (Dry Wall)
Rough Electrical .
Framing (Only after Plbg., Elec.. Mech. and Fire)
Insulation (SoundlEnergy)
Do not tape or plaster until the. following applicable
items have been sigf.1ed: .
Drywall .,.
Penetrations (Fire Rated) Electrical .
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing .. .
Interior Lath. . ..
Exterior Lath
GENERAL ITEMS
Exterior PIa.ster (B/'l7Nn 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.$126
Fire Dept. Final 765-4040 . .. . ... .
Water Engineering 765.5268
Sub List/Business License 765.519
Zoning 765.5139 . .
Building Final ~ast.'nspection' Onlr /-6'''S -r-/~ /
fter Above Complete) .r'V
PARTIALINSPIOCTIONS V
Buildina InSDections
Mechanical Inspections .
Plumbina Inspections
Electrical Inspections