7157 E. Mockingbird Way
BUI~ING",ERMIT NO.
BLD2004.03909
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BUILDING DIVIS!ON
200 S. ANAHEIM BLVD.
(714) 765.5153
INSPECTION REQUESTLINE: .
(714)765-4626 .
CENSUS. CODE:
QUARTER SECTION: 210
TYPE OF PERMIT
Reroof
DATE: 10/22/2004
JOB ADDRESS: 7157 E MOCKINGBIRD WAY
LEGAL DESCRIPTION: N TR 8464 LOT 27
APPLICANT: FREDDIE VA2QUE2. d
OWNER INFORMATION: CONTRACTOR INFORMfttION: ARCHITECT/ENGINEER INFORMATION:
T~omas. Kilbarger FIRST QUALITY ROOFIN(>
7157 E Mockingbir~ Way 906 S FIGUEROA ST ,
Anaheim, CA 92807 SANTA ANA: CA 92704 oeJa
BUSINESS PHONE: 714 77,;'~375
JOB DESCRIPTION: Tear off and re-roof 34.squares of Monier Duralite Tile, 5) lb. ICBO#2656
VALUATION: 12,750.00 i'" PROCESSED BY: EMA
I OWNER.BUIL:DERDECLARATlON ~
I hereby affirm"under penalty of perjury that I am exempt from the. Contrf=~or~r,<I;icense L.aw for the following ,reason (Sec. 7031.5 Business and
Professions Code: a ny city or county which requires a permit to constru'ct, a ItUt,' improve,. demolish or repa ir any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that he iSlicci;$€d punH',ant to the proVisions of the ContraCtor's-Li~ense Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Prof~ss;',::;-fs' Code) or that he is exempt therefrom and the basis,for the -alleged
exemption. Any violation of Section 7031.5 by any applicant tor a permit "c;ub/~c!s the applicant to a civil penalty of not more than five hundred dollars
($500)... . . ..... \ . . .' .. .
o I, as owner of property, or my employees with wages as,-their sol~'Q:~rnp~!n,<;ation, will do the work, and the structure is notintended or offered for
sale.(Sec~ 7044 Business and Professions Code: TheContractor's License U~w does not apply to an owner of prope~y who builds or irnprQves
thereon, and who does s'uch work himself or herself orthrough his or h~:-owt~lamr..loyees. plOvidecl that such improvements are not ,k'l~ended or.
offered for sale. If. however, the build ing" or improvement is sold with on.eve~:r of completion, the owner-builder will have"il'1e burden.of proving that he
did.notbuild or improve for the purposeo(sale). --;. r. '.' ",
o t, as the owner of the property; a~ exdusively contracting with licensed ,~ont.ractors to construct the projecqSec. .7044 BusineSsand Professions
Code: The Contractor's License Law does not .apply to an owner of propertyi.~ho build3 or fmproves thereon, ant;! who contracts for such projects with
jLqon~ractor(s) licensed pursuant to the ContraCtor's License Law). _._' '\".._.__ .
U I am exempt under Sec. ,B & P.C.'forthis reason: _
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
\ hereby affirm under penalty of perjury one of the following ller;laratk.ns:
o I have and will maintain a certificate of consent to setf-insure for wcrker<. compensation,
as provided for bySedion 3700 of the Labor Code, fer the performance of th~,:wGrk forwhich
this ~rmit is is~ued. , . . 1.
~h. ave and will maintain WOrker's. compensation i.nsurance, as reQU.irea: :JY.:...S9ctiun 3700 of
L bor"Code; for the performance of the work for which this permit is issuek Mywcrk9r's
ompensation insurance carrier and policy are: '_
rrier: ~ STATE FU ND Policy Number: 16,~?137 _':j'i: ._
" . - . ~;::-"" -, -, :
Thi_s section ne'ed not be completed if the pennit is for one hundred dOI!,3r:~:t$ipo) :?r~ess.
. D I certify that in the Performance of the work for whic,h this permit isj~Ue(~.I"~hall not
employ .any personjn any manner so as to become subject to the wbrke'~s cO:~Tipensation laws
of Califomia, and agree that if I should become subject to the worker's Gompei$ation
provisions of Section 3700 of the labor Code, I all forthwith com 'ly_wiif1ttx.se provisions.
I
Date: 10/22/2004 Applicant:
WARNING: FAILURE TO SECURE ORKE S COMPENSATION OVERJ'.. ,EiS
UNLAWFUL, AND SHALL SUBJECT AN EM LOYER TO CRIMINAL PENALilES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN .ADDltION ro THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION ,706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. '
I, . CONSTRUCTION LENDING AGENCY. ). .
! ":<:1;,..:':",'/,aff!!T'!'I--u:1de,"ptl:l~!ty.-{;:f-i'>.)rjur/ th;:! ~h.:rc -~,:;,a t:(,';;<):"\::Gt;(_"j1er,.ji:';;".i.lgl,O.-(':;:~.'fDr.tr;b'--:--
performance of the work fO'r whicti this permit is issued (Sec.3097.Civ.C):
lender's Information:
_,
.i
J I LICENSED CONTRACTORS DECLARATION i
~ I hereby affirm under penalty of perjury that I nm
licensed under provisions of chapter 9 (commencing
With Section lOOO)'of DivSion 3 of the 8tJsine sand
Professions Code..
10/22/2004
Date:
NUMBER
776969
TYPE' .
TYPE
TYPE.
.EXPIRATION DATE
4130/2006
C39.
C27
HIC
Construcion Types:
VN, ,
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I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordin'ances and stat~ laws relating 'to building construction, and
hereby authorize ~epre,sentives"of this city to enter upon the above mentioned property for
inspecti n pur~ s.
Fees paid for Permit:
Total:
310.83
Date: 10/22/2004
\ Signature 0 Applicant or A nt
The. rmit s all expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of per mil issuance. A
new permit is required to comme.nee or continue work.
INSPECTION RECORD
. INSPECTION . .1, DATE. INSPECTOR
. .
Temporary Power Pole . .
Plumbing (Drain/Waste Pipet
Electrical Ground Electrode/uter . . .'
SetbacklFormsfTrenches (Footings). . .
Do not install subfloor.or pour floor slab until the
following applicable items have been signed: .
Plumbing (Water Pipe.Sprinkler Valves)
PJiechanical (Groundwork) '.
Electrical. (Underground Conduit)
Pre-slab (CompactionlPJlembrane.Rei nt.
Underpinning (Floor Joist/Girders)
Do not cover or con~al the work below until the
following applicable items ,have been signed:' . .' .
1 st Floor Shear' . . .
Firesprinkler (Rough)
Znd Floor Shear . ,/
RQof (Sheathing/Diaphragm' Frame) ..' .
Masonry (ReinfJBond Beam/Pr...Gl'll\It) '. . . .
Rough Plumbing (Top Out) . .
Rough Mechanical .
ROugh ElectrICal (Dry Wall)
Rough Elllcirical
. Framing . {OnJyafter PJbg.. Elec.. r..lech -and Fire)
Insulation (SoundlEnergy) .
00 not tape or plaster until the following applicable
items have been signed:, ' . . .
Drywall .
.Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbil19
Interior Lath ".
Exterior Lath
: . GENERAL ITEMS. '. .
Exterior Plaster (Brown Coat)
T -Bar Electrical
T-Bar. Mechanical.
T.Bar 'Structural .
Sewer' . .'
Water Engineering Backflow '
Water Service
FINAL INSPECTIONS I Date lilspectQr
Electrical Final. . .
Plumbing Final .
: .
- .
Mechanical Final
Gas Test .
.Engineering/Grading Final 765-5126
Fire O,!pt. Fina17654040 . .
Water Engineering 765-5268 .
Sub List/Business License 765.519
Zoning 765-5139 / . :
Building Final ~ast Inspection. Onfy I;J--'t;~, ,H :..,.
fter Above Completel
..
PARTIAL INSPECTIONS
Buildina Inspections..
Mechanical Inspections
'.
. Plumbina Inspections
Electrical Inspections