125 S. Westchester Dr.
BUILDING PER;~4-03613 . . 'lf5Jjl;;TiJ:~~~"
;:::O~~F PERMe~ ~1%fcMT~IH ElM
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JOB ADDRESS: 125 S WESTCHESTE ~ -------~~~~f;;~/
LEGAL DESCRIPTION: ,P BK 149 PG 16 PAR 2 ' '
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPE;CTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 5
CONTRACTOR INFORMATION:
SALINAS VALLEY ROOrrG IN C
1 PRESTON ST .
SALINAS, CA 93901 0000 I '
, ,BUSINESS PHONE: 831 75y,9400
JOB DESCRIPTION:Tearoff exlstin9 & rerool65 sq with BUR lor Building #1., " '
VALUATION: 9,750.00 PROCESSED BY: EMA
, , ' , ,OWNER-BUILDERIDECLARATlON " , '
I hereby affirm under penalty of perjury that' am exempt from the Contractor~ License law for the fullowing reason (Sec. 7031.5 Business and .
Professiori~ Code: any dt}ior countY~hich requires a permit to construct, al'ip;r, improve. demolish or repair' arlY structure. prior to its issu'ance, also .
require~ the applicant fOf such permit to file a Signe,d statement that he is li.cfr~dpursuant to the ProVl,"SIOns oHhe, Con.tractor's license law (Chapter
9)(col!'mencing with ~ection 7000 of ~ivision ,3 of the Business and Profes;stt~S Code) or that he is exempt therefrom and the basis for the alleged .
exemption. Any violation'of Section 7031.5 by any applieantfor a permitsuprccts th, e applicant to a dvil penalty a! not more than five hundred dollars
~~ ' , "',. , ,
o I,?s owner of property, 'or my employees with wages as their sole com~t' .nsation. will do. the-work, and thestructure is notintended or offered for
. sale (Sec. 7044 Busine:ssand Professions Code: The Contractor'::. license ~-, w'does not.applyto an owner of property who buildsar improves
thereon, and who does such work himself or herself or through his or her OV':> , employees, provided that such improvementsare not intended or . ._
o~ered fo~ sale.. If, h9wever. the building or improvement is sold with one Y;;"1~,of rompletlon, the o:wne~-buuder wnl have the bur~en of proving tl-1at he.
did not budd or Improve for the pu'rpose of sale). "T:
o i,.as the o~ne, r of the propertY, am exclusively contracting with licensed~.,~'. n, tractors to, construct_the prolect(Sec. 7044 'Business and profe, ssiohs
Code: ihe q:ontractor's License Law does not apply to an OWl1er of propert~..i. ~hCl builds'or improves' thereon, and who oontracts for such projects with
~ontractor(s) licensed "pursuant to the Contractor's licenSe law), . t.: . .
U lam exempt under Sec. ,8&P.C.forthis'reason: __J
Date: OWner: ;}
I WORKER'S COMPENSATION DECLARATION it.
I hereby affirm under pen_alty of perjury one of the fo!lowing declarations: ~
o I.have and will maintain a'certificate of ronsent to self-insure for workerS compensation,
a~(oVjded for by' Section 3700' of,the-Labor Gode, for the penoi'mance oftl1e work for which
thi . permit is issued.' . .' . . . :i'
1 have and will maintain wc:rker's compensation insurance, as ,required L::/ Section 3700 of
the labor Code, for the performance of the work for which this. permit is lssui;d. Myworker's
Compensation insurance carrier and policy are: .
Carrier: REFER TO CSLB Policy Number.
This section need not be completed if the pennit is for one hundr~ dollars ($1 ~.q', ~ less. .
o I, certify that in the performance of the work for which this permit is i$Su\;~:)'shaU- not
employ any person in any manner so as to become subject to theworke(s C:,"1rripensation laws
of Califomia, and agree that if Ishoujd become subject to' the worker's cqmp~ri;Sation
provisions of Section 3700' of the labor Code, I shan forthwith comply wHh tt~5e'provjsions.
ApPLICANT: JEFF LORONO
OWNER INFORMATION:
Dahl # Lindborg
30110 Crown Valley Pkwy
Laguna NigueJ, CA 92677
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION
1 hereby C1ffirm under penalty of perjury that 1 am
licensed under provisions of chapter g.(commencing
with Section 7000) of Divsion 3 of the Business and
:1;:;;:nst:!eiJdl.4' 1--r--
Date: . 1/('( Contractor
NUMBER EXPIRATION DATE
',-793987 ' 4/30/2005
TYPE C39 '
Date: 9124/2004 Applicant:
WARNING: FAILURE TO SECURE WORK
UNLAWFUL, AND SHALL SUBJECT AN E OYER TO CRIM INAL PEN.A'LTII;S AND CIVIL
FINES UP TO ONE HUNDRED 'THOUSAND DOLLARS ($100,000), 1~i'Ao.dIl10NTO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OFTHE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. ," ,"
I ' CONSTRUCTION LENDING AGENCY;;:":: ,'r
.1 her~b~affirfTIunder pena~y of perjury that t~ere is aconstr.ucti<:m J~ridi4t#, ~;1:etfP>,for the>_ .
- veffvl'(:t6ifye otthe"\ovolk.,or~wh1Cii.-trirS-pe'tnlit-i$ISSUeo (Sec. 30::;, :(,iv:-CJ:'/_'.~ '~~'.~;~~.- -~
Lender's Informatibn:
;.'-"
Construcion Types:
VN, ,
Fire Sprinklered?
NO
_.-,.L_,_'._~._,~.._;~
'-,
I
. 1 certify that I have read this application and state that the above information is correct. I
agree to romply with all city ordinances and state laws relating to building construction, and
hereby authorize.representives of this City to enter upon the above mentioned property, for
inspedjon purposes.
Date: 9/24/2004
Fees paid for Permit:
Total:
427.94
ign ture of Applicant or Agent
The permi all expire by limitation and become null and void ifthc building'or
work has not passed final inspection 36!;; days from the date of permit issuance. A
new permit is required to commence or continue work.
INSPECTION RECORD
. . . INSPECTION . DATE. I INSPECTOR
'. Temporary Power Pole .
. Plumbing (DrairllWaste Pipe)
. Electrical Ground ElectrodelUfer
.
SetbacklFormslTrenches (Footings).
. Do not install subflqor or pour floor slab. until the
following applicable items have been signed:
. Plumbing (Water Pipe,Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Condu~) .
Pre-slab (Compaction/Membrane.Rei nt. .
Underpinning (Floor Joist/Girders) .
Do not cover or conceal the work below until the
following app.liGable items have been signed:"
1 st Floor Shear . . .
FireSprinkfer (Roligh) . .
2nd Floor Shear
Roof (S~athing/DiaphragmlFtame)
Masonry (ReinfJBond Beam/Pre.GlO\It)
. Rough plumbing (Top Out) .
. . Rough Mechaoical
. KOugh Electrical (Dry Wall)
Rough Elecirtcat
. Framing {Only after Plbg.: Elec.. Meen . .and Fire}
Insulation (SoundlEnergy) '.
00 not tape or plaster until the following applicable
items have been ~i9ned: '. ' ' '. '.
Drywall .... . . . :.
Penetrations (Fire Rated) Electrical
Penetrations {Fire Rated) Mechanical .
Penetrations (Fire Rated) Plumbil1\l
Interior Lath . . . . .
Exterior Lath . .
:'. . . GENERAL ITEMS
Exterior Pl;lster (Brown Coal) . .
T -Bar Electrical .
. T -Bar Mechanical . .
'T-BarStrUctural .
Sewer
Water Engineering' Backfl()w
Water Service '.
FINAL INSPECTIONS . Date . Inspector
Electrical Final .'
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-1i1.26 .
Fire Depl. Final 765-4040
Water Engineering 765-5268 .
Sub List/Business License"165-519
Zoning 765-5139 '.
Building Final ~astlrispection- Only .
fte' Above Completel- .
PARTIAL INSPECTIONS
Buildinq Inspections
Mechanicallnspec:tlons
Plumbinqlnspections
ElectricallnsDections
"
PERMIT EXPIRED
INSPECTION
. NOT' COMPLETEO
o A i- EJli12.1 b,_:f~_-
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