1776 W. Laurel Pl.
APPLICANT: STEVE 'JORDAN
OWNER INFORMATION: CONTRACTOR INFORMATION:
MauriciO Millan ROOFING BY DESIGN IN'~
1776 W Laurel PI 6104 OCASA DR ,
Anaheim., CA, 92801 MIRA LOMA. CA 9175200(<)
, , ' BUSINESS PHONE: 909 581.~367
JOB DESCRIPTION:Remove BUR, Instali 1/2" crupboard, OSB cn part, fiberq:i;sshingle on)he rest.
VALUATION: 4,800.00
I . OWNER-BUILDER ;lECLARATION
I hereby affirm under penalty of perjury that! am exempt from the Contr;3ctor'~. License law forthe" following reason (Sec. 7031".5 Business and
. Professions Code: any City or couritywhichrequires a permit to construct. alt~;r. improve. demoli&h or repair any structure. pridr to its issuance, also
reql!ires the applicanUorsuch permit to file.a signed statement thathe is licer.;sed l2:ursuant to the provisionsofthe Contractor's license law (Chapter
';9)(commencing with SeCtion 7000 of Division 3 of the Business and Professb"s Code).or that he is exempt therefrom and the basis for the alleged "
exemption. .A.J'r.f v:iOietic!1 of Section "1031.5 by ar~y appl!C2nt for 3 parmit s~bj~~>cts tl1e a pplicant to a civil penalty of not more_tha n five hundred dollars'
($500l. " .
o I, asowoer of property ,or my employees with W3@S as their sOle com~fnsa~i'on. will do the work, and the structure is oat, intended or offe~ed for
. sale (Sec~ 7044'Business and Professions Code: The Contra~.totfs Ucense liw does not apply to an owner of property who builds.or improves
thereon; and who' does sum w,ork l1imself or herself or through his or her owrl.)mployees. provided that such improvements are not intended or
offered for sale. If, however, the, building or improverr.ent is sold',with on eye:::'; of oomp.letion,__the <;lwner-bu"der wilt nave the burden of proving that he
did not build or.improve for the purpose of 'sale). .
o I, as the owner of the property,'am exd!,Jsively contracting with licensed "cjntractors ta'ccnstruct the project (Sec. 7044 Business and Professions
Code: The Contractor's:' License Law'c;loes not apply to an owner of.property ~':,hobtlijds or improves thereon, ano '\,''';10 contracts for sum, projects with'
~ontractor(s).Hcensed pursuanttoth~Contractor's Licensel$w). . "
U I am exempt under Sec.' .:. B & P.C. for thi:Heas~n:
Dare: eMme" '
,I WORKER'S COMPENSATION DECLARATIOrJ
I hereby affirm under penalty of perjury one of ,the following declarations:
o I have and wi,lI maintClina certificate of oonserifto self":,in~ure for worker's :"ompensation,
as provided for by Section 3700 of the LaborCode, for the pe'rformance of~h~ Yo,crk fo'rwhidl .
i- is perm,it is issued. ." ' : '
I have-and will maink:in workei-'s compensation insurance, a,~ required by SectIOn 3700 of
tl1 LaborGode, for the performance of the work for which this permit is, issu~~, 1V1yworker's
Compensation insUrance carrier and policy are: ..'
Carrier: STATE FUND' Policy Numb~r. 229-0026:::;7
This section need not be completed if the pennitls for one hundred dollors'($l QO) ,Or less.
o I certify that' in the perfor:mance bfthe work f~ .which this permit is:iSsued: Ish~_li 'not ,
employ any person in any mannerso,as to beeo e subje o.theworker's conl~n~ation: taws
of"calffomia,.arlctagr~e that if:' should become 1ect e worker's com~J-'$atl~n_ .
prOVisions of Section 3700 of the Labor 0 aH.~ ith con;Ply wi,~h t~9~e r>r?visions. . Construcion Types:
VN" ,
BUILDiNG PERMIT NO. BLD2004-00355
TYPE OFPERMIT C,ITY
Reroof
DATE: 216/2IJ04
JOB ADDRESS: 1776 W LAUREL PL
LEGAL DESCRJPTION; N TR 1591 LOT 136
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 ~ 5153
INSPECTiON REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 46
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: FAN
,
.J
,
LICENSED CONTRACTORS DECLARATION
I hereby. affirm under'penalty of perjury, that I am
licensed under proviso ns af ,pter 9 (commencing
witt)Section7000) . n .oftheBusinessarid
Professions ode.
, 216/2004
Date:
NUMBER
823060
'TYPE
Oate:.2I6/2oo4' Applicant: _,~~'-'.'.'-
WARNING: FAILURE,TOSECUREWORKER' CO PENSATIONPc.>YE.RAGE1S, .
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMIN~.L R~tT iE'S AND CIVIL'
FINESUPTO ONE HUNDRED 1l-IoUSAND DOLLARS ($100,OQd)., IN 'ilPDq'QN TO TH~'
COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IIfSECTI',)NF'.l;i;,gF THF,
LABOR CODE, INTEREST AND ATTORNEY'S FEES." ' %'.'c'"f.",' f<, ' .::,'
I CONSTRUCTION LENDING AGENCY+ '~' ,C'
I herebyaffirrrfunder penalty of perjury that there is a constructidn lendir.Jf~_ge':QY30fth_e._,
perfNma'lC"':ELof the work for whim this per.,.,lf i~ i!';c;l:~d ($p("~ ~'7..QLf~:'1 r.~~~""""':"'_"~.:\ ~i::..<. '--'.-". ,.,"
Lender's lnfonnation:' .
I.certify that lhave rea' this application and state that the above information is cOrrect. (
agree,tooomply with I-c:ity,.. r irfances anci,state laws relating to bu~ding conStruction, and
hereby authorize re ve of this citY to enter upon'the above mentioned'jJroperty. for
inspectio'n' rpo ,
Date: ?/6/2004
S nat of Applicant or Agent
The permit shall ex re by limitation and become null andvoid if tile building or
work h;1s nOt passed final Inspection 365 days from the date of permit issuance. A
new permit is required to commence or, continue work.
Con.tractor
EXPIRATION DATE
8/31/2005
C30
Fees paid for Permit:.
Total:
138.93,
INSPECTION RECORD
INSPECTION , DATE " INSPECTOR
Temporary Power Pole , ,
Plumbing (DrainlWaste Pipe) , "
Electrical Ground Electrode/uter ' " ,
SetbacklFormsfTrenches (Footings) ,
Do not install subflooror pour floor slab until the "
following applicable items have been signed:
Plumbing'(Water Ploe.Sprinkler Valves)
Mechanical (Groundwork), '
Electrical (Underground Conduit) , , ',' ,
Pre-slab (Compaction/Membrane.Reinf. ,
Underpinning (Aoor Joist/Girders) , "
Do not cover or conceal the work below until the
following applicabie items have been signed: ,
1 st Floor Shear "
Firesprinkler (Rough) "
2nd Floor Shear
Roof (Sheathing/DiaphragmlFrlme)
Masonry (ReinfJBond BeanlPre-Grout) , ,
Rouah Plumbing (Top Out) , "
Rough Mechanical , ,
Rough E1ectric;li (Dry Wall)
Rouah Electrical ' , ,
Framing (Only after Plbg.. Elec.. Mech.. and Fire)
Insulation (SoundlEnergy)
Do not tape or plaster until the following applicable
items have been signed: '..
Drywall ,
penetrations (Fire Rated) Electrical", ,
Penetrations (Fire Rated) Mechanical "
PenetratIons (Fire Rated) Plumbing , "
Interior, Lath ,
Exterior Lath
GENERAL ITEMS ' '
Exterior Plaster (Brown Coat) ,
T -Bar Electrical " ,
T -Bar Mechanical
T-Bar Structural ' ,
Sewer ' ' , "
Water Englneeri"g Backflow ,
Water Service
FINAL INSPECTIONS , Date , Inspector
Electrical Final I ' ,
" "
Plumbing Final
Mechanical Final " ' ,
Gas Test , ,
" , , "
EngIneering/Grading Final 765-5126 ,
Fire Dept. Final 765-4040 ,
" , ,',
Water Engineering 765-5268, ' , ,
Sub List/Business License 765-'519- ,
Zoning 765-5139 ,
Building Final ~ast Inspection' Only dulo4- c 1.,-,r
, ' fter Above Completel -
, PARTiAL INSPECTIONS
Buildina Insoections
"'~.e. ,
~"'(""1
Mechanicallnsoections
Plumbina Insoections
Electricallnsoections