130 W. Winston Rd.
TYPE OF pERMIT CITY
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ElM
BUILDING DIVISION
.200 S,ANAHEIM BLVD,
(714) 765 . 5153
INSPECTION REOUESTlINE:
(714) 765.4626
CENSUS CODE: 434
QUARTER SECTION: 86
BUILDING PERMIT NO. BLD200S-01872
DATE: 6/2012005
JOB ADDRESS: '130 W WINSTON RD
LEGAL DESCRIPTION: TR ?637 LOT 4 AND 5
APPLICANT: RON SELL
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECTIENGINEER INFORMATION:
Due Le SELL ROOFING COMPAN'Y
642 Desert Canyon Rd 18032 LEMON')
B$a, CA 92821 , YORBA LINDA, CA 92886 0000
. . BUSINESS PHONE: 71452ii1758
JOB DESCRIPTION:Remove exlStin~ material, install 16'SQuares of 30 yearco!npositionshingles.
VALUATION: . 7,800.00 . PROCESSED BY: .JNJ
OWNER-BUILDER DECLARATION
I ere y affirm under penalty of perjury that I am ,exempt from the Contractor's Ucense Law. or the following reason (Sec. 7031.5 Busine~s and
Professions Code: any city: or county_wh_ich'requires a permit to construct, alter, imprOve. demolish or repair any structure, prior to its iss,uance, also
requires'the applicanffor such permit to file ~ signed statement that he is licensed pursuant to the provisions of. the Contractor's License Law (Chapter
91.(commencing with SeGtion-7000 of Division 30t the ~usiness and'Profes:;>ions Code) or that he is_exempt-therefrom and the basis for, the 'alleged '
exemption._ Any Violation of Section 7031.5 by any applicant for a permit subj~ts the applicant_to a civil penalty of not more than five hundred dollars
($800). .' . . ..1 . ....'. . .'
o I, as owner of property, or my employees with wages as their S9le compensation, 'will do the work, and the strt1()tureis not intended or offered for.
sale (Sec.' 7044 Business and Professions COde: The Contractor's License law does not apply to an owner of property who builds or improves
thereOn, and who does such. work himsetf 'or herSelf or through his 9r her own~mployees, prOVided that such improvements are not i~tended.or , .
offeredfor,sal~.- If, however, the building orimprovem~nt is sold with one year of completion, the owoor~builder will have the burden of provlil~(that he
did not-build or improve fo~ the pwpose of sale). . '. . !: ' , . . ' .,..
o .1, as the :owner ot the property, am exclusively contracting with licensed contractors to construct the'project (Sec. 7044 Business 'and Profe.ssions
Code: The yontractor's License Law does not apply to an owner of property Who bu~ds or improves thereon, and who cory tracts for such projects with
~ontractor{s) Hcense9 purs~ant to the c.ontractor's License Law). '
U, I am exempt under Sec._ , B & P.C. for this reason:
Date: OWner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm -under penalty of pe~ury one at the following declarations: .
o I have and 'will ma-intain a certificate of consent to self-_insure for worker's compensation,
as provlded/or.by Sectiorr 3700 of the Labor Code, for the performance of thawolk for which
this permit is issued.' ,
IT I have and wll! maintain worker's compens,ation insurance, as required by Section 3700 of
the labor Code, for the performance. of the work ,for which this permit is issued. My worker's
Compensat'ion.insurance carrier and policy are:"
Carrier: STATE FUNQ . Policy Number. 1066S~-2004
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
o I certify that in the perlorrnanceof,the work forwbichthis permit isiSsued"j shall not
employ any person in any manner so ~s to become subject to the worke(s compensation laws
of California, and agreEHhat if I,should, become SLi . ct to th rker's compensation
provisions of Section 3700 of the Labor Cod all 'fort Ith omply with 058 provisions.
LICENSED CONTRACTORS DECLARATION
I herebyaffirmu erpenalty of perjury .that I am
licensed under provisions of chaptsr o.mmencing
with Section 7000),of Di' of siness and
Professions Code.
612012005
Date:
NUMBER
323842
TYPE
TYPE
HIC
. C39
EXPIRATION DATE
1013112006
Date: 6120/2005 Applicant"'--'-:
WARN ING: FAILURE to SECUR E WORKER'S COMPEN A TION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMiNAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100;000), IN ADDfllON TO THE
cost OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES, .
. CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a'construction lending agency for the
performance of the work for which ,this permit is'issued (Sec.3097.Civ.C):' --
Lender's Information: '
Construcion Tvpes:
YoN, ,
Fire Sprlnklered?
NO
Date: 6/2012005
Fees paid for Permit:
Total:
160.89
Ignat A plicant or Agent
The permit shall expire by limitation and become null and void if the building or
work hits not passed final inspection 365 days from the date of permit issull1Ce. A
new permit is req4ired to commence or c:ontinue work.
INSPECTION RECORD
..
INSPECTION
DATE.
Temporary Power Pole
Plumbing (DrainM'astePipe),
EleCtrical Ground ElllctrodefUfer '
SetbacklForlllSrrrenches. (Footings)
00 not iJ)Stall subfloor'<;lr pour floor slab until the
following applicable items have been signed:
, Plumbing (Water Pif)e;Sprinkler valves)
Mechanical (Groundwork)
. Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane.Rainf.
. Underpinning (Floor Joist/Girders) ....
00 not cover or conceal the work below ,until tile
'following applicable items havebeen signed: .
1 st Floor Stlliar
Firesprinkler' (Rougtl)
2nd Flo9J:.Sbe~ .
Roof JShelllfll tlraam/Frame)
MasolK:Y' /ReiDf:1Bond BeamJPre.Grout)
Rough Plumbing , (Top Out)
Rough Mechanical '.,
, , mugn t:Iectricallury .,all/
Rough Electrical
. Framing, (On~ afier PIbg.. EIec.. Mem.. and F;re.l
Insulation (SoundlEnerllY)
po I10t tape or pla~ter until tl1e following applicaQle
Items have'been sIgned:, ' ' . " ,
Drywall. .
Penetrlillons (File Rated) Electrical
Penetrlillons (Fire Rated) Mechanical
Penetrations (Fire Rliled) Plumbing
Interior Lath " ,
Exterior Lath
" " . ' GENERAL ITEMS
Exterior Plaster /Brown Colil)
T -Bar Electrical '
T -Bar Mechanic;!1
T -Bar Structural
Sewer
Water Engineering Backflow, '
Water Service
.
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,.
, ,
iNSPECTOR
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.
"~.
I
FINAL INSPECTIONS, Date, Inspector
Electrical Final' , ..
Plumbing Final ' .
" , . ,
Mechanical Final '., : . ' ' ,
:. Gas Test .
: , ..
EngineeringlGrading Final 765-5126 ,
,,' '.
: Fire Dept: Final 765-4040 ,
,
Water Engineering 765-5268
Sub LlstiBusiness License 765.519 "
, Zoning 765-5139 , , . 'j,
.
Building Final ~ast Inspection- Only '7-/1.0-)' ~.h ~//
, ' , ,fter AbOve Complete) ~
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PARTIAL INSPECTIONS
~ Buildina Inspections ,
',. ' Mechanicallnspections
, PlumbinCi Inspections'
,
Electricallrispections