924 S. Lake Summit Dr.
TYPE OF PERMIT CIT. Y
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765- 4626
CENSUS CODE: 555
QUARTER SECTION: 217
BUILDING PERMIT NO. BLD2005-00984
DATE: 4/11/2005
JOB. ADDRESS: 924 S LAKE SUMMIT DR
LEGAL DESCRIPTION: N TR 8515 LOT 2
CONTRACTOR INFORMATION:
RRST QUALITY ROOFING
906.S FIGUEROA ST
SANTA ANA, CA 927040000
BUSINESS PHONE: 714775-3375
JOB DESCRIPTION: Tear off existing and re-roof 23 squares. of "Eaglelite Malibu tile"; ICBO#4660; 5.Slbs.
VALUATION: 9,300.00 PROCESSED BY: SAM
OWNER-BUILDER DECLARATION
J hereby a.ffirm un sr penalty of perjury ttlat I am exempt from the Contractor's License Law for the following reason (Sec. 703.1.5 usiness and
Professions Code: ,any city or county which requires a permit to construct, alter, improve, demolish or repair any structure; prior to its issuance, also
requires' the applicant for such permit to file a signed statement that he jsJicensed.pursuan~ to the provisions of the Contractor's License: Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt the refrom ,'and the basis for the alleged
exemption. . Any, violation of Section 7031.5 by any applicant for apermit SUbjects the applicant to a civil penalty of not more than five hundred dollars
($SOO). .
o I, as owner of property, or my employees with ,wages as their sole compensation; will ~o the work, and the structure IS not intended or offered for
sale (Sec. 7044 Business and ProfessiohsCode: The Contractor's License Law does not apply to an owner of property who builds o(improves
thereon, and who does such work himSelf or herself or through his or her'own employees, provided that such, improvements are not intended or
'offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-bu flder will have, the burden of proving that he,
did'not buil<;t or improve for the pu'rpose of Sale).
o I, as the owner of the property"am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professio'ns
Oode: The Contractor's License Law does not apply to an owner of propertywhobuilds.or improves thereon, and who contracts for such projects with
$iQontractor(s) licensed pursuant to the Contractor's License Law).
U I am exempt under Sec. " a & P.C. for this reason:
Date: Owner:
I. WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o . I have and will maintain a certificate of consent to self~insure .lor worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
t is e/mil is issued.
I ave ana will maintain worker's compensation insurance, as .required by Section 3700 of
he La or Code, for the performance of the work for which this permit is issued. My worker's
Compensation insurance canier and policy are: .
_Carrlec. STATE FUND Policy Number. 0026S99-2004
This section need not be completed If lhe pennit is for onehuntlred dollars ($100) or less.
o I certify that in the perfonnance ofthe work for which this permit is issued, I shall not.
employ any person in any manner SOaS to become subject to the. worker's compensation laws.
of California, and agree that jf I should become sub. ct to the worker's co '. nsation
proVisions of Section 3700 of the: Labor Code,.1 al forthwit 0 ply with e provisions.
r
APPLICANT: FRED V ASQU E4
OWNER INFORMATION:
tr; Q Pharr .
924 SLake SummJt Dr
Anaheim, CA 92807
ARCHITECT/ENGINEER INFORMATION;
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under p~ovis(onsof chapter 9 (commencing
~~~~:~~~ ~ ~ionJ3Athtus;ne^r
4/11/200S. ~ ~/. '>Avy/
Date: ( ,'_ ' Contractor. : <S 0
NUMBER EXPIRATION DATE
n6969 4/3012006
TYPE C39
TYPE C27
TYPE HIC
Date: 4/11/200S Applicant:
WARNING: FAILURE TO SECUR.EW E' OMPENSATION COVE AG S
UNLAWFUL, AND SHALL SUBJE N EMP ER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED "THOUSAND D LLARS ($100,000), IN ADDI1lON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECT10IiI.3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .. .
CONSTRUCTION LENDING AGENCY
I h~reby affirm under penalty of perjury that there is a construction lending ager.~yforthe
performance of the work for which this permit is Issued (Sec.3097.Civ.C):
Lender's Information:
Construcion Types:
VN, ,
Date: 4/11/200S
Fees paid for Permit:
Total:
235.76
Signature of Applicant or Agent
The permit I expire by limitation and become n d void if the building or
work has not passed fi rial inspection 365 days from the date of permi.t issuance. A
new permit is required to commence or continue work.
INSPECTION RECORD
INSPECTION . DATe INSPECTOR
Temporary Power Pole.
Plumbing (DrainlWaste Pipe) .
Electrical Ground Electrode/uter
SelbacklFornis/Trenches (Footings) I ..
Do not install subfloor or pour flopr slab untillhe
following applicable items have been 'signed:
Plumbing (Water Plpe.Sprinkler Valves)
Mechanical (GrOundwork) . .
Electricm(U~~roundc~um .
I pre-slab {CompactioIllMembrane.Reim.
Underpinning (Roor Joist/Giiders)
, Do not cover or conceal the work below until the,
following applicable items have been signed: ..
1 st F.loor Shear
Firesprinkler (Rough) ,
2nd Floor Shear .. /
Roof (Sheathing/Diaphraam/Frame) Lt '74I~ Z(l. ./J,~
Masonry (ReinfJBondBeamlPre-Groul) . .
Rough Plumbing (Top Out) , . .
..Rough Mechanical . .
Rougn l:Iectr III} . , .
Rouah Electrical .
Framing (Only after Plbg:, -Elec.. Mech.. and Fire)
Insulation (SoundlEnergy)
00 not tape or plaster until the following applicable
it~ms have been signed:'.. '.'
Drywall . ,
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing .
Interior Lath " . . ,.
Exterior Lath .
GENERAL ITEMS.
Exterior Plaster (Bra;vn Coat)
T -Bar Electrical
T -Bar Mechanical . .
T -Bar Structural
Sewer .
Water Engineering Backflow ' "
Water S"rvi~e. ...
FINAL INSPECTIONS 'Date Inspector
Electrical Final
Plumbing Final ' , " ..
Mechanical Final . ,
I
Gas Test .
Engineering/Grading Fina1765-5126 , .
Fire Dep\. Final 765-4040 .
. , ,
Water Engineering 765~5268 ..
Sub List/Business License 765.519
Zoning 765.5139 , ,
Building Final !}ast Inspection. Only 11'1"c::,~, I//.' \. ~
fter Above Complete)
PARTIAL INSPECTIONS
. Buildina Inspections
Mechanical Inspections
Plumbina Inspections
Electrical Inspections