520 W. Victor
BUILDING PERMIT NO. .BLD2004-00808
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CITY ".(t4%~"""~~HEIM
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5,153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 60
APPLICANT: BRAD FAUBERT
OWNER INFORMATION:, CONTRACTOR INFORMflj'ION:
Renate Holloway STAR COLiRSE'ROOFIN,}CO
520 W Victor Ave 24981 HON AVE ..(
Anaheim. CA 92801 , LAGUNA HILLS, CA 92552'(;000
JOB DESCRIPTION:Tear off com~and install 24 squares of 30 year GAF shi":le"
VALUATION:' 3,600.00 :, PROCESSE;DBY: ODC
I " OWNER-BUILDER,DECLARATION ' 1
. I hereby affirm under penalty of perjury that I am exp.mptfrom the COntractor'$Ucense law for the following reason (Sec. -7031.5 BUsiness and .
Professions Cod~: any city or county which requires a. permit to C?ilstrucl, .e~:y, imr,rovf!,demoUsh or repair a~wstructure, prior to its issuance, also
requires the. applicant forsuch.perm!tto file a signed statement the:it he is tjc:fi'(;~ed_pursuarlt to the prc:ivisionsofthe .Gt;.lOtractor's license L~w (Chapter
9)(comli1encing with Section 7000 of Division 3 of the Business and Profess:;,jils Code) or that he is exempt therefrom. and the basis for the alleged
exemption., Any violation of 8ectiol"\703',1.5 by any' applipant for a pern~it SjjbJi~cts the aprlicant to a civil penalty'of not more than five hundred dollars
~~.. ,', I ' " '
o I, as'oWner of property, or my employees with ,wages as their sole compt~IlSatiorl. wiiJ do the work, and the structure iS"not in1ended or offerer:! tor
sale.{Sec. 7044.Businessand Professions Code: The Contractor's UC'3nsc i...~w does not appfyto an owner of prope!ty whQ builds or Improves'
thereon, and who does:suChwork himself'or helSelf or through his or her c'virJ/Jm:J1oy.ess, provided that such improvements are not intended or
offered for sale. if, however, the bUilding -or improvement'is sold with one yttIr I)f completion, the owner-budder will have the burdfm of proving that he
did not build or improve for the purpose of sale). . . \ . .
. 0 tas-the_ ow'ner of the property; am exdusively contracting with /icensdd'l~}n~raC(Qrstocor.struct the project (S~c. 7044 Bu~inflss and ProfessionS
'Code:'The Contractor:s, Li~nse law does not ,apply to an owner CJf prop~rt:.:t'i-,o. buildc or i1nprnves thereoh, and vthe ccntrads for such pro~ectS With.
i!-Qontract:or(s) licehsed pursuant tathe Contractor's License .Law). ,if . . ", . "
U lamexemPtun<lerSec. ,B&P.CAorthisreason: _.1L_'~___'4_' ... . ..' '.'
Date: Owner: . . . j
I WOA.KER'S COMPENSATION DECLARATION ~f - -.-J
I hereby affirm under enarty of periury one of the following declarntiQns:' , . . .
o I have a .11l1"l&intain a certificate of consent to self-Ins Lire forworker':~ COI1-IPBr'lsc>:tion,
as pravi ~ for by Section 3700 of the Labor Code, forthe performance of th-~" ~~-I.)rk for whim
'. rmit is issued. . <
0- I hav~ and-will maintai0 wo-rk.er's compensation' Insurance; as required b{);6Cti0!1 3i"OG of . 3/
the labor Code, for the' performance of the.work for which this permit is',jsst.ic,:i. Mywor!<er's .D
Co.mpensation insurance Cc:irrier and policy are: " . . \.
Carrier: STATE FUND. Policy Number. 1379'163':U2
TYPE OF PERMIT
Reroof
DATE: 3/23/2004
JOB 'ADDRESS: 520 W VICTOR AVE
LEGAL DESCRIPTION: . N TR 1326 LOT 3'9
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This s~tion need net be completed if the permit is for orye. hundred doll~s ($1"i/ ~:lesS: ,
o I certify that in the perfonnance'of the' work for w' t~e1mit-is-i.s'me"!~~t' sha,ll not
: employ any person in any mahner so as to b , esubject to,the wor~el:;;- ~(';~. ation JCiWS
of.Califomia. and ~gree 'that ,if I should. orne subje.ct~,q.tK~_"worl<e~'s cor:1~' .n . ,
provisions of ~.~tion 3790 Of.the La~~han-rQn'hw~th co ~"'-l1l,-p'rOVjSions.
'Date: 3/23/2004 Applresn . ' , -41.' .: ' '
"WARNING: FAILURE TO SECUR ,MPENSATlON COVE""G& IS
UNLAWFUL: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENA: TieS AND CIVIL
, FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ~Pii'll9N TOTHE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEcue.!,; 1106 OF THE
. LABOR CODE, INTEREST AND ATTORNEY'S FEES. ' "r,~ ;<':':
I CONSTRUCTION LENDING AGENCY', r':i:
I hereoy affIrm under penalty of perJury that there IS a constructton lendiug ~'}';mG)- J0r the
~performan~ o~ th~ work for which this permit is issued (See. 3097 .~iv .C). I -_
- LeiU;ti:I::> lIlionl1,:1i;:;n. - -. "-
Date: 3123/2004
re of Applicant or Agent
The peril'll 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.
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTQB.8.0 TION
'. I here yaffir~ r penalty of pErJury t ':.. am
lIcensed Unde~::...P1~,' .~ 9 (comme:n.c;r
WIth SectiQff1~) of Dlvsion 3 of!h 8lJsin nd
Profes '-&;.s--Code.
NUMBER
532778
TYPE
'rYPE
EXPiRATION DATE
613012004
C39'
HIC
Construcion Types:
VN, ,
Fire.Sorinklered?
NO
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Fe~ paid for Permit:
Total:
G.50
INSPECTION RECORe
: INSPECTIoN DATE INSPECTOR
Temporary I'ower Pole . .'.
I'lumbing (DrainlWaste I'ipe) . . .
.' 'Electrical Ground Electrode/Uter .
SetbacklFormslTrencl!es {Fpotings) . . '.
Do not install subtlpor or pour floor slab until the
followirig applicable'ilems have been signed:
I'lumbing (Water I'ipe.Sprinkler Valve,,) .
~hanical (Groundwork)
Electrical (Underground Condu it) . .
Pre-slilb (~ompactionlMembrane,Reinf. .
'. Underpinning (Floor JoiSt/Girders)
Do not cover orconnea) lhe. worl< bel ow . u'nlU the
. fqllowing applicable. items have been signed: .
1st Floor Shear
Fi",sprinkler . (Rough) .
2nd Floor Shear .
Roof (SheathinglDiap/lragm'Frane) .. . . .
Masonry (ReinfJBond Bearn/l're.!3IO\iI) ..'
Rough Plumbing (Top Out) . .
Rough Mechanical .
Rough Bectrlcal (Dry Wall) '. . .
. Rough.Electrical .
Framing . (Only afterPlbg.."Elec. Mech. and Fire)
Insulation (SoundlEnergy) '.
. Do 'not tape or plaster untiltne following applicable .
. -!temshave been signed: '
. Drywall: .
I'enetrations (Fire Rated) Electrical . .
I'enetrations (Fire Rated) Mechanic;al . .
Penetrations (Fire Rated) I'lumbing . .
Interior Lath . . .
Exterior Lath . .
. .' . . GENERAL ITEMS
Exterior Plaster (B/XlIWn Coat)
T-Bar.Electrical .
T -Bar Mechanical . .' .
T -Bar Structura.1 . . '.
Sewer ,
'. Water Engineering.Backflow . . .
Water Service
FINAL INSPECTIONS . [late Inspector
Eleelrieal Final
Plumbing Final . r '.
.... Mechanical Final .
. .
.: Gas Test
Engineering/Grading Final 765:5126 . . . .
. Fire Dept. Fina1765-4040
.'. Water Engineering 765-5268
Sub List/Business License 765.5t9.< . .
." Zonirig 765-51 ~9 '. . .
. '.
Building Final ~astlnspection- Only . 3-1-~ . ....... ;b,if.lhl
Iter Above Complete) . ~-
PARTIAL. ,,'!SPECTIONS .
Buildina Inspections
Mechanical Inspections
PlumbinQ Inspections
Electrical Inspections