2375-2377 W. Lincoln
APPLICANT: FRANCISCO LAGUNAS
OWNER INFORMATION: CONTRACTOR INFORMi'TION:
Union L Best 'CAL STATE ROOFING '
1300 Kalella Ave 1142 W BOMO KORAL CIR ,
Orange, CA SANTA ANA, CA 9270300;o
, BUSINESS PHONE: 714813-7736
JOB DESCRIPTION:Tear off existing malerial install 100 squares of '2 ply huLnop,
VALUATION:, 10,000,00
I OWNER-BUILDERDECU;'RATION
I 'hereby affirm under penalty of perjury that I am exempt from the Con-tractor s license law fer the following reason {Sec. 703-1.5 Business and
Professions Code:' arry city or county which requires a permit to construct, a:i~r. improve, demolish or repair any structure, prior to its issuance, also
requkes the applicant for such permit to. file a signed statement that he is lic';r;sed' purs1Jant to the provisions ofthe"Contrador's license Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and ProfsssV,;r,!; 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 sub!e>cts the 3: pplicant to a dvil penalty of not more than five' hundreddoltars
($500), ' " "
o ..I,'as owner of property, or my employees with wages as their sole comp:3~S<!ltlcn. wi/! do the work, and ~he structure- is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's license l;.nw does not applyfo an owner of property Wll0 builds or improves
thereon, and who does such work himself or herSelf or through his pr her o'.\h em pl0yees , provided that such improvements are not intendecfor
offered for sale. If, however, the building or improvement is' sold with onB ve'c.r of cornpletiop., the Qwner-builder will have the burden of proving that he
did not build or improve for theputpose of sale). ' ~~, , . ,
o I, as the owner of the property, arri exdusively contracting with license-rl:oootractors to cons~rllct the projet;t (Se!;. 7044 &JSineS5 and' Professions
Code: The Contractor's License Law does not apply to an owner of property:\rho bu;ids Of improves thereon, and who ,oontracts for'such projects with
~ontractor(s) licensed pursuant'to the Contractor's License .law).
U I am exemptunder Sec._ ,B &P.C, for this reason:
Date: Owher:
I WORKER'S COMPENSATION DECLARATION
(hereby affirm under penalty .of perjulY one of the following dec!arations:
o J have and will maintain a certificate of consent to self-insure for worke.-'s compensation,
as provided for by Section 3700 of the Labor Code, for the ~rformance of tt.-i} work for Which
this permit is issued. . ~
.E] Iljave and will maintain worker's compensation insurance, as require.d'h! Section 3700 of
the Labor Code, for the performance ofthe work for which this permit is issu'~. My worker's
Compensation insurance carrier and policy are:
Carrier: 16779165-03 I Polic.y Number: STATE FUND
BUILDING PERMIT NO. BLD2004-G4444
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;;;'~O~?F PERMIT CITY
DATE: 12/16/2004
JOB ADDRESS: 2375 W LINCOLN AVE
LEGAL DESCRIPTION: SEC 7 T 4 R 10 1.81 AC MIL'IN W1/2
BUI~DING DIVISION
200 S, ANAHEIM BLVD,
(714) 765" 5153
, INSPECTION REQUEST LINE:
(714) 765- 4626,
CENSUS CODE: 434
QUARTER SECTION: 32
'ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: ENO
-,
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,
, '
This section need npt be compl"~d if lh"pelll1il is for on" hundred dollars ($19C'<1f less, ,
~~ertify that in the perfoTTmipce of the work for which this' permit is iSStl&.J, ! sh9:" not
~y any person in any manne( so as to become subject to.thewo'rl<er's cli"":1pensatjonlaws
ofCaUfomia, and agree that if I SH0Uld becomE! subject to.the worke~'s comJ:.eilsatiO!1
provisions. of Section 370,0 ofthet.?Xo~c e, I shaU,forthwith/ 0' 'ly witnth.)se provisions.
, - , Y
Date: 12/16/2004 ' Applicant,/,: _
WARNING: FAILURE TO SEC\JRE WOR ER'S COMPENSATION COVEP.",GE ,IS ,
UNLAWFUL, AND SHALL S UBJECT AN EMRLOYER TO CRIMINAL PENA:,TIES AND CIVIL
'FINES UP TO ONE HUNDRED THOUSAND UObbARS ($100,000), IN ADDiTION,TO THE
COST OF COMPENSATION, DAMAGES AS PROViDED FOR IN SECTION 3706 OF'Tl'lE
LABORCODE, INTEREST AND ATTORNEY'S FEES,
CONSTRUCTION LENDING AGENCY
I t>~"'eby <=l:ffirm t!l"I'i":r.~n::"lty '!)f f-'E'rjurj that then:' i<; e ~':"netrtict!o!'l.i~min0 -8~:f:"'cy f!)f. tl1<:>
perf.ormance of the work for which this permit is issued (Sec. 3097 .eiv.C);
lender's Information: .
I certify that I have read this application and state that the above informa'tion is correct. I
agree to oompfy with aU city ordinances and state laws relating to budding construction. and
ere by aut . e repre~ves of this Gity to ent r upon the above mentioned property for,
in ecti purpo s. . , . ( J' ~_-~ .- .
,,' , '~Date: 12/16/2004
Signatur of Applicant or Agent
The permit s expire by limitation and become null and void if the building or
wo has not passed final inspection 365 days from tile date of pern.!t issuance. A
new permit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I hereby affirm Lind~r per:\alty of .perjury that I am
licensed unde rovisions of chapter 9 (commencing
with,Section.O ) of DivslOO 3 of the BUsiness and'
ProfessJons C: \ /\.... I
12/16/200~/' ----...
Date:
NUMBER
801616
TYPE
TYPE
Construcion Types:
VN,' "
Fire Sprinklered?
i
C39
HIC
NO
Fees paid for Permit:
Tolal:
589.17
INSPECTlC)N RECORD
.
INSPECTION , DATE INSPECTOR
Temporary Power Pole
Plum~ing (Orain,waste Pipe)
Electrical Ground ElectmdelUfer
. SetbacklFormsrrrenches (Footi!lgs)
00 not install subf/oor or pour floor slab until the'
following applicable items have been signed:
. Plumbing (Water Pipe.Sprinkler Valves)
Mechanical.(Groundwork) .
Electrical (Unde'llround Conduit) .
Pre-slab (Compaction/Membrane.Reint.
Underpinning (Floor Joist/Girders)
!J? not cover or conceal the work below until the
following applicable items have been signed: .
1 st Floor Shear .
Hresprinkl&l' (Rough) .'
2nd Floor Shear . .
Roof (Sheathing/lliaphragmlFrame) I \1.(ViJ(O -.---
Masonry (ReinfJBol1d BeamlPre-Grout)
Rough Plumbing (Top Out) .' .'
Rough Mechanical
Rough E1eclflCal. lOry wall) . .
Rough electrical . .'
framing . IOn~ after Plbg:. Elee. Meeh:. and Fire!
insulat.ion (SoiJndlEnergy)
Do not tape or plaster until the following applicable .'
items have. been signed: . . .
Drywall . .
Penetrations (Fire Rated) Electrical .
Penetrallo.ns (Fire Rated) Mechanical .
Penetrations (Fire Rated) Plumbing .
'nterior Lath
Exterior Lath .
. GENERAL ITEMS
Exterior Plaster (Brown Coat) .
T.Bar Eleclrical
T -Bar Mechanical . .
T -Bar Structural . :
Sewer' ..
Water Engineering Backflow
Water Service /
FINAL INSPECTIONS Dale In'spector
Electrical Final :
Plumbing Final . ' "
Mechanical Final ,
Gas Test . . '.
.
Engineering/Grading Fi.naI76$-5126
Fire Dept.Final 765-4040 .
W'1ter. Engineering 765-5268
Sub List/Bulliness License 765-519 .
Zoning 765-5139
Building Final \\-"st Inspection- Only" . (7/-0) ~&. ';t
fter Above Complete)
PARTIAL INSPECTIONS
.BuildinQ Inspectiolls
Mechanical Inspections
Plumbina Inspections
Electrical Inspections .