188 N. Paseo Robles
BUILDING PERMIT NO.BLD2005.00200
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CITY 1~ 1 ;:,~:tfi:HEIM
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BUILDING DIVISiON
200 S. ANAHEIM-BLVD.
(714) 765.5153 '
INSPECTION REQUESnINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 191
TYPE OF PERMIT
Reroof
DATE: 1/24/2005
JOB ADDRESS: 188 N PASEO ROBLES
LEGAL DESCRIPTION: N TR 7470 LOT 47
CONTRACTOR INFORMtl1l0N:,
WEST PAC HOOFING ,1,
234 AVENIDAS CASR!LLO ':'8
SAN CLEMENTE. CA 926::~\l000
BUSINESS PHONE: 9494"2-3201
JOB DESCRIPTION: Tear off eX;sling and re-roof 24 squares of 30 yea'r COmiXfsltion shingles.
,
VALUATION: 5,300.00 i
I OWNER.BUILDER~1ECLARATION
I hereby affirm under penaf!,y of perjury tl:1at I 'am exempt _from the Contracf.or'~:'UcenS:e Law for the follOWing reason {Sec. 7031.5 Business and'.
Professions Code: any dty or county which requires a permit to construct, aJt~,r;_ impccve, demolish or repair any structure, prior to its issuance, also'
requires the applicant for suet.; permit to file a signed statement that he" is I!CerpgdPprs~nt to the provisions of the Contractor's LiCense Law (Chnpter.
9)(commencing with Section 7POO of Division 3 of the -Business and Profes~jl.~:;~ COd9) 6~ that he is exempt-therefrom and.~he basis,fo(the alleged
exemption. Anyviolation of Section 7031.5 by_any applicant for a permit s:;Dj:_!0ts the: applicant to z: dvU penalty of nOt more than fivehunctred dollars
~Q?,)~s owner of ~o~rty"or my ~mPIOyees ~ith wages as their sole ~omp{1Sati~n, wW do the Wb~k,' and the structure is' not inte.nded or offered tor
$alo (Sec. 7044 Business and Professions Code: The Contr2ctor's Uc~nse Lt..v CSf!.s :'let apply to an owner of pr~perty ~h(; build.s or improves
thereon, and who does such work himself or herself' .or through his or her oVin),emploYddS. provided that such improvements are n.ot intef')ded or. .'
OffBf.ed for sale. 'If, however, the building or improvement is sold with on~ yea""'oT cor'f,p!etion, the owner-:builder will have the burden of Proving f~!athe
did root build or improve for the purpose of -Sale), t' ' .
o ',as the'owner of the property, am exdusively contracting with lic~n.sed 4>1:-:'nictcfs tocor.struc1 the project (See. . 7044 8:usirless (:Ind Professions
Code: _ The Contractor's License L9w does not apply to an owner of property \.~:bo Cl1ilds or improVf~s thereon, arid who contracts for such projects with
~jontracto:(s) licensed pursuant to the Contractor's Ucense Law).. .' Ii _ . "
- I am .exempt under Sec. _ , B & P.G. for this reason: _~, ']1'
Date: Owner: i.__
r . WORKER'S COMPENSATION DECLARATION' .,,'i' .
I hereby affirm. under penalty of perjury one of the folloWing declarations: ;
o I have ar.d' will' maintain a ,certificate of oonsent to self.insure fer wo:ker's ~'(li11pensation, '
as provided for bv Section 3700 of the Labor Code, for the performance-of the\...'(\fh: for which
!j'thiS ermit is issued. . . i:
, have and will ~ain.tain Ifo!orker's compensation insuranc'e~ a's required 'by"\3edir:1O 3700 of
Labor Code, for the performance of the work for which this permit is iss,uel.'; M'J'Norker's
ompensation insurance carrier'and polic.y are: . ,,':
Carrier:, NO EMPLOYEES Policy Number. EX.EMPTi ,
This sactiorineed not be completed if the permit is for one hundred dollars ($100J.~~ 1~3.
0, I certify th~J!nthe perforrna~ce of the work for which this permit is issued!"', $h3i!.,~d' .
employ any person in any manner 50 as to become subject to the worker's:co'!'"pensation laws I
of California, and agree' that If I should become subject-to the worker's comper,~ation .
piovisionsof Section 3700 of the Labor Code, I shall forthwith'c 'piX with t~"$i3 provisions. .
APPLICANT: ED SEFNER
OWNER INFORMATION:
. Kerry Fielder
188 N PaseoRobles
Anaheim Hills, CA 92807
ARCHITECT/ENGINEER INFORMATION:,
PROCESSED BV: SAM .
,
J
LICENSED CONTRACTORS DECLARATIC?R:J
I hereby affirm under.pe(lalty of perjury that I am
licensed under provisions of chapter 9 (comi.1encing
with Section 7000) of Divsion 3 of the Business and
Professions Code.
'X::
1/24/2005
Date:
Contractor
NUMBER
673299
TYPE
, TYPE
EXPIRATiON DATE
6130/2005
C39
HIC
Date, 1/24/2005 Applieqnt: ,
WARNING: FAILURE TO SEC ' ORKER'S MPENSATION COVERAGE is ',' .
UNLAWFUl" AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALl:;~S AND CIVIL
FINES UP TO ONE HUNDRED 1HOUSAND DOLLARS ($100,000), IN ADDI:;i:jN 10 THE
, COST OF COMPENSATION, DAMAGES AS PROViDED FOR IN SECTION,:1lO6 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
,..}
I _ CONSTRUCTION LENDING AGENCY __
_ _ Jh'Z"!eby-:a"ifirrn_ unda:l)'')e.'la It~~ of pecjur'f .t\".sUb.er:e" is,a.con~~n..:ctfon-'!fi'odla~t 2gdC\(..~_!.Dr__~he
performance of the work for which this permit is issued (Sec. 3097 .CIv.C): .
- Lender's Information: .
Construeion Types:
VN, ,
FirE1 Sorinklered?
NO
'-~.-.'-'
I certify that I have read this application and state that the above information is correct. I
agree to oomply with all city ordinances. and state laws relating to building construction. and
hereby authorize representives 0 this city to enter-upon the above mentioned property for
i spection pur ses.
Date: 1/24/2005
Fees paid for Permit:
Total:
235.36
Sign ure 0 pplicant or Agent. . .
The 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. .
,,' INSPECTION' . EI
, PATE INSPECTO~
Temporary Power Pole PI
Plumbing (OrainlWaste Pipe) .
electrical Ground Electrode/uter . , . '. ..' Me
SetbacklFormsrrrenches (Footings) , . Ga
.
Do not install subfloor or pour floor slab until the E
following applicable items haye been Signed:
plumbing (Water Pipe.Sprinkler Valves) Fi
Mechanical (GroundwQrk) , . Wa
Electrical (UndergrOUnd CondUit)
Pre"!llab (compaction/Membrane.Keim.] . Su
Underpinning (Floor JoistlGirders) . Zo
Do not cover or conceal the work below until the , Bu'
following ilPplicable items have been sign"d: ,
1st Floor Shear ' '
Firesprlnkler (Rough) "
2nd Floor Shear ' . ~ () ./ Su
RoOf (Sheathlng/OlaphragmlFr.me) -
Masonry (Reinf.JSond BeamlPre-GroIit)
Rough Plumbing (Top Out).
Rough Mechanical . , ....
1 ROugn t:IectrlCllIlllrY wall)
,Rough Electrical ,. '. . .'
Framing (Only after PI~., Elec" MeCh...and Fire)
Insulation (SoundlEnergy) , . .
po not tape or pla~ter until the following applicable , Me
.tems have been signed: '. .;~;
Drvwall . '
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated). Mechanical .
Penetrations (Fire Rated) Plumbing .'
Interior Lllth .. . . .' ,
Exterior 1.ath Plu
GENERAL ITEMS .
Exterior Plaster (Brown Coat)
T -Bar Electrical " '.
T.BarMechanical ' , .
T -Bar. Structural . . .
Sewer . ' .
Water Engineering Backflow . . Ele
" :i!>ter Service
INSPECTION RECORD
FINAL INSPECTIONS'
ectrical Final
umbingFin,,1
chanical Final
s Test'
ngineering/Grading FinaI7!;$-5126
re Dept. Final 7654040
ter Engineering 765,,5268
b,LlstlBusinessLicense 765,51
nlng 765-5139,
Jldilig Final ILast Inspection. Only
Alter Above Complete)
PARTfAL INSPECTIONS
i1dina Inspections
,Date
InSPector
.
chanicallnspections
mbina Inspections
ctrical Inspecti~ms ,