4449 Lani
CONTRACTOR INFORMATION:
WEB ROOFING
27722 BAHAMoNDE . .
MISSION VIEJO, CA 9268~: 0000
BUSINESS PHONE: 84922:'-7864
JOB DE$CRIPTIONReplace existing shake with 30 yea, comp shingle. 18 so.,(;,o.,
VALUATION: 3,500.00 1 .
I OWNER-BUILDE({DECLARATION
I hereby affirm under penalty-of perjury that I am exempt from the.Contrad:6(3 License Law for the. following reason (Sec. 7031.5 Busine,ss and
Professions Code: any dty or county which requires a permit to construct. u.:~~r; improve. demolish or repair any structure,- prior to its issuance, ,also
requires the applicant for such perm~t to file ,3 signed statementth~thefs li<f~'lsed pursuantto the provisions of the Contractor's licenSe Law (Chapter
9){cornm~ncing with Section 7000 of Division 3 of ,the Busines~ andProfes':l\":ns Code) at' that he is exempttherefromand the bllsisforthe arrege9
exemption. Any violation of Section 7031.5 by any applicant fer a permit $>l..;:))'=Cts the applicant to. a civn penattyof not more than five-hundred dollars
-~. ..... .. . . . .
D I. .as owner of property, or my employees with wages, as thei!" -soleccm~ m';;c'l~ioll, will do the work. and the stru!:ture is not intend"ed or offered far
sale (Sec. 70~ Business'and Profession,:; Code: The Contractor's Licenser:,!", does not-apply to an owner of property-who builds or improves
thereon" and who does such work himSelf or hel'Self orthroughhis o( her O'~(l employees. provided that suchimprQvements are not intended'or
offered for.sale; If, however, the building or improvement is SOld with one y"bt~r of-completion, the owner~builde~w(J1 hav~ theburde('l. of proving that he
..didnot~_ildorimp.roveforthepurposeofsale). . , , ' ., . .
o IT as-the owner of the .property, .am.exdusively contracting with IlC611Se.(i 'ontra~crs to construct the project (Sec. 7044-Susiness and Professions
Cod.e: The Contractor's .License Lawdoes not apply to an owner of property :N~.o !:>l;ilds or iMPrOves thereon. al"ld whorontracts for such. projects with
tu{ontr3~Or(s) licensed pursua~t to the Contractor's License Law). _ ' ~
U I am exempt under Sec. , . B & P.C.- for this reason:
Date: Owner:
I WORKER'S COMPENSAflON DECLARATION -
I hereby affirm under penalty of perjury /Jne of the following declarations:
o I have and wiiimaintain a certificate of ronsEmt to self-insure for worker'~-:r..olTlpen'5dtion.
as ore\'. ed for ,by Section 3700 of _the laber Code. for the pe'rformanceof th.~ wcrl< for which
this rmit is issued. '
I have and_will maintain worker's compensation insurance, as required tl~' SGctym3700 of
bor Code,-for the performan~e of the work for whichth,is Permit is ISSL:€-d My worker's
. pensatiol1 insurance carrier and policy are: .
Carrier: STATE FUND . pOii"" Number. .28b-OO !.HIT 0001681
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n'PE 0:= P~R!i.1iT
Reroof
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C1TY'i,rEIM
DA TE:10/23/2003
JOB I>.DDRESS: 4449 E LANI AVE
LEGAL DESCRIPTiON: N TR 7284 LOT 31
APPLICANT: PAT SIDNER
OWNER INFORMATION: .
: Bn.ace Ferris
6482 State Rd #E14
Pa,ma, OH 44134
,\ ..'_ .J:::..-":;:c-.:
__....-'_..,.;.~...,.,;.. ,_...~_........,.~,~v~__.......................'.-:;.
Bt:1U)ii.h3 0:."v'i~il_"J"
2(;:; B. ^NA:~~Ii'-.'1 BLVD..
(714)765- 0.1:.53
INSPECTION "-EOVES. liNe:
(714) 765 _ '526
CENSUS CODE: 434
QUARTER SECl ION: 161
ARCI:iITECT/ENGINEER INFORMA"rION:
PROCESSED BY'; CAL
:==J
Th.is section need not be completed if lhe pennl! is fur one hundred doJlar~ ($100; 01 los..
(J', ,.,' "_.', ", '0_, '_'-." .
o I certiPi that in..the performance ofthe work forwhichtnis pern_:lt is'JsstJe:!.-I~nuil ;)(it
employ. any ,person in any manner so as to orne subject to the ')forker's C~~"Tlpensation laws
of California, and.agreethat if I should b co subject to th er's .C6nl~~-'1eation.
provisions of Section 3700 of the laQor 0 s al forthwi. . co ply'." r-tiY.sc provisions.
Date: 10/2312003 Applicant:. ..
. WARNING: FAILURE TOSECl)l E ORKER'SCOMPENSATION..CQ\lEPJ.GEIS
UNLAWFUL, AND SHALL SU.B'JECT tw EMPLOYER TOCRIMINAI,>I\'~NAL TIES AND CIVIL
FINESUPTO ONE HUNDRED THOUSAND DOLLARS ($100,OOO),IN,1\DD!;lON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN 3EdTlON 3706 OF THE
LABOR CODE, INTEREST twD ATTORNEY'S FEES. . .
I CONSTRUCTION LENDING AGENCY' .
. i hereby affirm under penalty of perjury that there is a copstryc::po.n l,endJ.n.g .;;~ 'n~y foS,~_e.
. ~~!~:C:-.-:~":1: :::J"~J..-: ':J..-rt. f...:- ':'.':---.:~'" ,,:.::::.:: ;:-':::,:7~~ i: ~;::;.:.;..: t:;~~;;:;t't.~i.~):. . :'-.
Lender's Infonnation: .
I certify tl:1at.1 have read this application and state that the above information i:;.correct I
agree t plywith alJ-city ordinances' and state :Iaws relating to bu~ding construction. and
hereby, aut rize rep~ nt this dty to enter upon the above mentioned property for
i in r s.
Date: i0/2312003
. ignature of pint or Agent . .
The permit shall el<pire by Iimilationand become null and void if the !;uilding or
work has not passedfrnal inspection 365 days from the date ofpermil issuance. A
new permit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury thot I arn
licensed under provisions of chapter 9 (C
;~~;.~~~~. '. f~ lh.VS ion.. O.fthe u
10/23/2003 .. ..
Date:. . .. Contractor
NUMBER EXPIRATION DATE
746354 2/28/2004
. T~'=-., C39
~PE: HIC
TYPE B
"'....-
Construcion Types:
.v N, ,
Fees paid for Permit:
Total:
124.85
. INSPECTioN RECORD
IN~i!'ECTlON \ . DATE INSPECTOR
..
Temporary Power Pole . .. . :.. . .
'.
Plumbing (DrainlWaste Pipe)' .' .
Electrical Ground ElectlOdelUfer '.
SetbacklFormsfTrenches (Footings) . '.
Do not install subfloor or pour floor slab until the . .
following applicable items have been signed: '.
Plumbing (Water Plpe.Sprinkler Valves) .
Mecrninical (GroundWork)
Electrical (Undergrolind Conduit). .' .
Pre-slab (Compaction/Membrane.Reinf. ,
Underpinning (Roor Joist/Girders)
Do. not cover. or .concealthe wor\< oelow unt,l the
following' applicable items have been signed: . .
1 st Floor Shear... . . .' . .
FiresprinkJer(Rough) '.' . . .
2nd Floor Shear ...... /I
Rod (SheathinalDiaphragrn/Frarne) 10 "'1!,,-'>, .~ ' l..-'-
Masonry (ReinfJBond BearnlPre-Grout) .'
Rough Plumbing (Top Out) . .
Rough Mechanical., . . . . . .
Rough l:lectrlCaI (ury Wall) :
Rough Electrical
. Framing' {Only after,Plbg.. EJec..-Mech:. and Fire) ", '.
Insulation (SoundlEnergy) . .'
po nottape or plaster until the following applicable .
.tems havll been sIgned: '.,
Drywall . , . .'
Penetration$ (Fil!! Rated) Electrical . . .'
Penetrations (Fire Rated) Mechanical . .
Penetrations (Fire Rated) Plumbing ,
Interior Lath . .' .
Exterior Lath .
.'. . GENERAL ITEMS ' . ..
Exterior Plaster (Brown Cllal) .
T -Bar Electrical' '. , . .... . ,
T -Bar Mechanical. . . ..' . . .
T -Bar Structural .
Sewer . . . . ,
Water Engineering Backflow .
Water Service .
. . .
FINAL INSPECTIONS , " Pate Inspector
Electrical Final . '. .'. . '.' .
Plumbing Final .
. .
Mechanical Final >
Gas Test . '
. . "
Engineering/Grading F.inal 765-5126. >
Firll Dept. Final 765-404Q .' ..
. . . .
Water E"gineering 765-5268' . "
Sub List/Business License 765-519.< . . '.
Zoning 765-5139
Building Final \!:a~t In~pection- Only .
fter Above Completel
PARTIAl. INSPECTIONS
BuildinCllnSDecti()ns
Mechanical Inspections
Plumbina Inspections
Electrical Inspections
.PERMIT... EXPIRED.
INSPECTION
.NOT COMPLETED
DATE: .U:....iot-Oq