2111 E. Lincoln
1YPE OF PERMIT CITY
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BUILDING DIVISION"
200 S, ANAHEIM BLVD:
(714) 765 - 5153'
" INSPECTION REQUEST LINE: "
(714) 765 -4626
CENSUS CODE: 434
QUARTER SECTION: 113
BUILDING PERMIT NO,. BLD2005.00079
DATE: 1/12/2005
JOB ADDRESS: 2111 E LINCOLN AVE
LEGAL DESCRIPTION: . N TR 1843 LQT 7
APPLICANT: SUSAN MtLVIN
.OWNER INFORMATION:
CONTRACTOR INFORI<'.ATlON:
GRAND 'PACIFIC ROOFING CO
Pralle 8766 SAN FABIO
1249 E Imperial Hwy #A BUENA PARK, CA 906:2000:;0
Placentia, CA 92870 BUSINESS PHONE: 71442Q-0711 . .
JOB DESCRIPTION:Tear off comp,at east side of building only, Install 12 squ,.os using 2 layers of 151bs, and 30 year dimensional shingles, (Ori~i".I~'
VALUATION: i"H~,88J1dd1 E IdA...I") , ." . PROCESSED BY: MJP.
I ..' . OWNER.BUILDER Q.ECLARATION . .
,I hereby affirm under penalty of pelJury that I am exempt fromthe ContractDr's_Lic~n$e Law tor the allowing rea~ ( ec. 7031.5 Business and rofessrons
Code: any dty or county which requires a permit to ronsJruct, alter, improve, dem:~iish or repair" any structure, prior to its issuance, also requJresthe applicant
for such permit to ,file a signed statemenfthat he is licensed pursuant to the prov~;:jons of the Coo tractor's License law (Chapter. 9)(commencing with Section
7000 of Division 3 of the Business and. Professions Code) or that he. is. exempt, !h(.refrom,ar.d the baSiS: for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the.applicant to a civtl penalty of noimor.e than five hundred dollars ($500).
, .
ARCHITECT/ENGINEER INFORMATION:
o .I, as oWne'r of property, or m'yemplo-yees with wage~ as their sole cDmpen$~i!tin, wiil do the work',_and the structure is not intended or offered for sate
(Sec. 7044 Business and ProfessionS Code: The Contractor's ,License Law doeStiOt apply to an owner of property who builds or improves thereon, and who
does such work himselfor herself or through his or her -Own employees, provided ~':'at such improvements are not intended or offered for sale. If, hoWever, 1he
building or improvement is sold with one year of completion, the owner.buildar wilrh~ve thd burden of proving that he did not build or improve 'for the purpose
"efsaie), .
l~ I, 'as the owner of the property, am exclusively contracting with licensed confadors: lo cons1r~d the project ,(Sec. 7044 Business and p~fessiolls Code:
The Contractor's'LicenseLc.w does.not apply to an owner of property who hliilds ~'!"lm?fo'ies thaeon, Clhd 'Who contracts for sum projects with a contractor(s)
e:rnsed pursuant to the Contr-3ctor's. Ucense.law). ., '" . ,
. I am exempt under Sec.. . _ ' ,', B & P ,C. for this reSls.on: ___-->_
Date: Owner:
I WORKER'S COMPENSATION DECLARATION f:==: J
I hereby affinn under penalty of perjury of!e of the following declarntions: l
o ." have and will maintain~ certificate of ronsent to self-insure for worker's co;\ipensaticn, as
provided for by Section 3700 of the labor Code, for the performance of thE'!! \r\'Ork f..;r vwnich this.
permit is issued. ,
~' have.and will maintain worker's oom.pehSatiOn insurance, as required by Section '3700 of ~hs
Code, for the performance of the work for which this pennit is.issued. My w_'!i<er's
ompensation in.surance carrier and policy are:, .'
. arrier: STATE FUND ., .Policy Number: 285-01 Uf\n 0001686
This section need nol be completed if"lI)e permlis for one hundred dollars ($10Gl c;les$.
o I certifY tha't in the peitormance of the work for-lNhich this permit is issued,! .."al! not empioy
any person in anymanner so asto become subject to the worker's compensation"a~ of California,
and agree that if I should become subject to the er'scompensation provisionfcf Sedion 3700
of the Labor COde, I shall forthwith comply with ttl. e provisions,
NUMBER
741260
TYPE
TYPE
EXPIRATION DATE
6/30/2005
HIC
C39
Date: 1/13/2005 Applicant:
WARNING: FAILURE TOSECLlRE W
AND SHALL SUBJECT AN EMPLOYE TO CRIMINAL PENALTIES AND CIVil. fiNES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE ~ABOR CODE,
INTEREST AND ATTORNEY'S FEES, . .
I CONSTRUCTION LENDING AGENCY __
i he!eby affirm under p~nalty of perj~ry tt~_t~~~~i_s a_,~onstnJcti.on I~ndina ag~:;y }i!.~h.~_
-'t't~":~'-!'t~~"cf-~.:.-;:nki;:ii~'mit;1f1ills jJennll IS iSSUed. (~ec.J09! .Crv.C):'
Lende(slnforrnatlon: .
Construcion Types:
VN, ,
Fire Sprinklered?
NO
I certify that I have read this applicatfon and state /hat the above infonnation .is corrl~ct. I agree.to
comply with all cit ordinances and state lavvs relating_to building construction, and hereby authorize
represenlives of is ity to enter upon the 'above mentioned property fO! inspection purposes.
Date: '1/1312005
Fees paid for Permit:
Total:
160,61
ignature of Applicant or Age
The perm' -shall expire by limitation and become null and void if the building orworl< has
not passed final inspection 365 days from the date of pennit issualce. A new permit is
required to commence or continue work.
INSPECTION RECORD .
. . INSPECTION DATE INSPECTOR'
Temporary Power Pole .
Plumbing (DrainJWaste Pipe) .
Electrical Ground Electrode/uter
SetbacklFormslTrenches iFootings) .
Do not install subfloor or pour floor slab until the .
following 'applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (GroundwOrk)
E1ectricallUnderground Conduit) .
I're-slab (CompactionlMembrane.Keinf. . .
Underpinning (Roor Joist/Girders)
Do not Cl)ver or conceal the work below until the .
following applicable items have been signed:
.1 st Floor Shear .
Flresprinlder (ROugh) .
2nd Floo.r Shear
Roof ISheathlng/Diaphra!lm'Frame) I-/j.t1$ <Zf1 /~. ". L
Masonry (ReinfJBond BeamlPr.arout) 1(1/ J
Rough plumbing (Top Out)
Rough Mechanical
KOugn t:lectrlCaI . .
Rouah Electrical .
Framing (Only after-Plbg., Elec.. Meco.. and Fire)
insulation (SoundlEnerllS'l
00 not tape or plaster until the follOWing applicable . .
items have been signed: .
Drywall .. .
Penetrations (Fire Rated) Electrical
Penetrations (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
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765.S126
Fire Depl.Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-519
. Date
Inspector .
,
Zoning 765.,5139
Building Final . ILast Inspection. Only
'. After Above Complete)
1'/9.'t!!i>
PARTIAL INSPEC IONS
Buildina Insoections
Mechanicallnsoections
Plumbina Inspections
Electrical.lnsoections