1747 Landfair
BUILDING PERMIT NO. . BLD2004-04165
TYPE OF PERMIT CITY, .
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
INSPECTION REQUEST L1N8
(714) 765 - 4626 .
CENSUS CODE; 555
QUARTERSECTION: 138
DATE: 11/16/2004
JOB ADDRESS: 1147 N LANDFAIR ST
LEGAL DESCRIPTION: N TR 5623 LOT 67
CONTRACTOR INFORM.\TION:
LEWIS & SONS CONSTRUCTION INC
310 S MAPLE ST #E
CORONA,CA 928820000
BUSINESS PHONE; 909273-0901
JOB ,DESCRIPT.lON:Tear off existing roof and replace with 24 squares of 30j~. compo~ition-shingles'.
VALUATION: 4,200.00 ", i .
I OWNER-BUIi..DE~ DECLARATION
I hereby"affirm under penalty of perjury that I am exempt from the:C()n~i"3~o;'~:VcenseLaw tor the following reason (Sec. 7031.5 Business. and
Professions Code: any city or ,?ountywhich requires a permit to constfJctit{.er. improve, demolish or repair any&tructure, prior to its issl!ance, also
requires,~he applicant for such permit to file a signed statementthathe isJ!i::i-:n,sed pursua.nt to the provisions of the Contractor's. license' law (Chapter
. 9)(commencing with 8.ection 7000 of Division 3 of the Business and Profes.s;ons Code) 'Or that_he is exempt t.herefromand the basis for the alleged
exemption. Any violation. of Section 7031.5 by any applicant for a permit ~u!jects the:applicant to a evil penalty of not more'than five,hundred dollars
~~ .!' . .'
O. I, asowne~ of prope,rty,'or my' employees with wages as their sole'c:om~j;lTisat:on~ will do the work, and 1he structure is f10t iritend8d'or offered fo~
sale (Sec. 7044 BuSiness and Professions Code: The Contractor's Licens,e L.aw does not apply to 81) owner of property who buHdsorimproves
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 y~~r of oompletion, tOe_owner-bu\!der will have the burden of proving that he .
did not bu ild or improve for the pu'rpose of sale). . ~. . . . ,~ .
o I, as the, owner of the property, am eXdusively contracting with licensed:'::cmtractors to-construct the project (See. 7044 Business and ProfessiOns
Code: The Contractor's License l.:aw does notapply to ~n owner ot property,who builds or improves thereon, and who contracts for such projects-with'
. ~!)ntraci:.or{s}licensed pursuant to the Contractor's License Lawf' .
U '1 am exempt under Sec... ., B & 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.haye 'andwill maintain a certificate of consent to self-insure for wor~~/<;'compensation, .
as providectJor by'Section.3700 of the Labor Cod~, for the performanCe of the work. fo(whid)
~hi. permit is issued. ' .,.. :' ,
i'l have an~ w. iil m.alllta. iri worker's compen'sation l.nsurance, as re9uired ~~y Section 3700 of
e labor Code, fer the performanoe of the work for which this permit is isstJ,i:id. -My worker's
Compensation insurance cahier and policy are: _ .
Carrier: EXEMPT. ' Poll Nu mber. EXEMP"\- .
APPLICANT: KYLE LEWIS
OWNER INFORMATION:
Hoo K 800
1715 N Partridge St
Anaheim, CA 92806
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: MSM
~
.LICENSEDCONT C ORS DECLARATION
I hereby affirm u er enaltyof perjury that-: am-:'
on of chapter 9 (commencing~~'
Oi t. n 3 of the BUsiness and
Contractor.
This section need not be completed if the pennitis for 0 hundred dollars ($1(';(!) or. less.
~ I certify that!n the performance of the work t w ich this permit is issl;~d.l. shalf not
'. ploy any ~rson in any manner so as to beeo e _ bjeet to the wmkers ,>'nlpensaiion laws
9f Califomia, and agree that if I should become bj ct tothewo~er's com~f'!satjon' .
provisions of Section.3700 of the Labor Cod h fprthwith ciomply withtj:Qs/9 provisions.
NUMBER
416525
TYPE
TYPE
EXPIRATION DATE
4/3012006
B
C39
Date: 11/16/2004 Applicant:
WARNING: FAiLURE TO SECURE 0 OMPENSATION COVEf.:AGE IS
'UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN!\~TIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDiTION TO THE
COST OF COMPENSATIOr-j, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY
I h~reby'affirm under pe Jty of perjury.that there is a construction lending ecencyfor the
';J~~C:'i11!.:~o-3'C!thc ',;'fer: ~or \;.J~:ch.th::;; p~:"m;t-i$ is::;ucd {Scc.:k.'"'C7 .Civ.C~:'
Lender's Infof!Tlation:
Construcion Types;
VN, ,
Fire Sprinklered?
NO
....
~...
,
this appHcation and state that the above information is correct. I
JIGity ordinances.and state laws relating to building ce,1struction,and
sentives of this city. to enter upon the,abovementioned property for
D"le:.1.1/16/2004
Fees ~aid for Permit:
Total:
235,33
i nature of Applicant or Agent
The permishallexpire 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.
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormsrrrenches (Footings) . .1' .
Do. not installsubfloor or pour floor slab until the
following applicable items have been signed: ".
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork) .' -- . .
Electrical (Underground Conduit) . . .
Pre-slab (Compaction/Membrane.Rei nt. .
Underpinning (Floor JOist/Girders)
Do not COver or conceal the work below until the
fOllowing applicable' items have been signed:
1 st Floor Shear . . .
Firesprinkler (Roligh) .
2nd Flo'" ~hA"r . .
RoQffSheath' aphragrn'Frame) I ~.
Mas InfJBond BeamlPte-Grout)
Rough Plumbing (Top Out) '.
Rough Mechanical .
Rough ~ectrical all) .
Rough 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 . .
Pen~ratiol1S(Fire Rated) Electrical
Pelletiations (Fire Rated) Mechanical .
Penetrations (Fire Rated) Plumbing' '. .
Interior. Lath . . .' .' . "
Exterior Lath .
. GENERAL ITEMS .
Exterior Plaster (Brown Coal)
T -Bar Electrical '.
T.Bar Mechanical
T~Bar Structural
Sewer
Water. Engineering Backflow
Water Service
.
FINAL INSPECTIONS 1. Date Inspector .
Electrical Final . . . .
Plumbing Final .
Mechanical Final . .' '.' . .
Gas Test.
EngineeriilglGrading 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 /. J". .z;b(,
fter Above Complete) '~A
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections
Plurnbina Inspections
Electrical Inspections
.
. .