2415 W. Lincoln Ave.
TYPEOFPERMIT 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: 26
BUILDING PERMIT NO. BLD2005-00519
DATE: 2/28/2005
JOB ADDRESS:~2415 W LINCOLN AVE
LEGAL DESCRIPTION: P BK 202 PG 14 PAR 2.
CONTRACTOR INFORMATION:
ROYAL ROOFING CO
B111 W COMMONWEALTH AVE
BUENA PARK, CA 90621 00:)0
BUSINESS PHONE: 714 521-d100
JOB DESCRIPTION:Tear off exlsling material, instai/84 squares of built up roof.
VALUATION: 16,000.00
f OWNER-BUILDER r;ECLARATrON
I hereby affirm under penalty of perjury that I am exempt from the Contractcr'~Ljcense Law for the following reason (Sec~ 7031.5 Business and
. pffi.fessi"on:l Code: any city or (;oumywhich requires a permit to cQnstruct, alte:", ,improve, demolish or reooir any str1jcture, prior to its ,issuance, also
reqUires the applicant for such PElrmjt to file a signed statement that he islicei;~d pursuant to the provisions of the Contractor's License law (Chapter.
.9)(commencing with Section 7000 of Division' 3 of the Business and Professio'~,9 Code) or that he is ~xe!npt'therefrom and th.e basis'forthe_alleged
exemption. Any violation of Section 70.315 by any applicant for a permit-subj~'~6t::: the .applicant to a'dvil penaltyot not more than five hunorees dollars
($500). . .. _'.. .
o I, as owner of property, or my employees with wages as their sole cornp:;:::nsalion, will do the work, and ths structure is net intended or offered for
'sale (Sec. 7044 Business and Professions Code: The Contractor'!? License U~t: does nut apply to an owner of property who builds or_i!Tlproves
thereon, and who does such work hims~lf or herself or through his or her own,~mployeeS, provided that such improvements are not intended or
offered for sale. If, however, the building or improvemer:rt is sold with one yea,'of completiqn, tl"!e oWner~buHder will have the burden of provlng that ~
did not build or improve for the puroose of sale).
o I, as the owner of the property, am exclusively contracting with licensed ,';?ntractors to constnJct the project (S0<'.. 7044 BUl:!iness ~rld Prcfe~ibn$
Code: The Contractor's license law does not apply to an owner of propRrtyv,-ho builds or.impro\les thereon, and who contracts forsuCl'1 projects with
a ~Gntractor(s) licensed pursucmt to the Contr<:lctor's Licens& Law).
Lrl .
j I ~m ~xempt under See, ._. , S.&' P .C. for this reason:
Date: Owner:
APPLICANT:.PAUL POWDERLY
OWNER INFOR~1ATION:
Young Lew
1015 Calle Sonrisa
Giendale, CA 91208
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: ENO
1
, ..
L-
i hereby affinn under penalty of pcrJljry one of the toll owing declarations:
o I have and wil.l maintain a certificate of 'consent to self-insure for worker'",'.-;cmpensaticn,
aSprcvitjed for by Section 3700 of the i. abor Code, for the perfol"mance of tn"1 '.-.:ork for whim
!2s permit is issued. ' , ,
. ~ have andwill maintainwori<er's compensation insurance, as requJred_b/S~c~ion 3700 of
the labor Code, for tt'1e performance oj tne work for which this permit is jssu,~O. Myworker's
Compensation insurance earl:ier and polley are:
Carrier: ACORD
WORKER'S COMPENSATION DECLARATION
Policy Number. WCQ5Q,;)'!-(l,W0002
NUMBER
678705
TYPE
TYPE
'TYPE
-XPlRATiON DATE
1/31/2007
8
C39
C33 PAIN
Date: 2/26/2005 App:jcanl'
WARNING: FAILURE TO SECURE RKE 0
UNI.AWFUL, AND SHALL SUBJECT ~ EMPLOYER CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED TH USAND DOLLARS ($100,000i,-.IN ADD! nON ,0 THE
COST OF COMPENSATION, D AGES AS PROVIDED FOR IN SECTIONl'/06 OF THE I
LABOR CODE, INTEREST AND TTORNEY'S FEES. . .. .
I per~bv nffJrm up.-~er peM~O . p~:~~Ct~~~~e:~:~~~:~~:~~~3;n~ ~~~f'~~'fur th~. ,.
peiformance of~hework fOr-~jd1 this permit is issued (Sec.3097.Civ.C):
lender's Information:. /--- ._
Construcion Types: ,
VN, ,
Fire'Sprinklere>d?
NO
this dty to enter upon the above mentioned property for
Fees paid for Permit:
Tota!:
537,06
ate: 2/28/2005
.gnature
mit shall expire . itation and become null and void if the building or
s not passed finalinspection 365 days from tile date of permit issuance. A
t is required to commence or continue work.
INSPECTION RECORD
: : INSPECTION DATE .INSPECTOR
Temporary Power Pole .
. Plumbing (OraintWaste Pipe)
Electrical Ground Electrode/Ufer -,--
SetbacklFormsITrenches (Footings)
00 not install subfloor or pour floor slab until the .
following applicable items have been signed:
Plumbing (Water Plpe.Sprinkler Valves)
Mechanical (Groundwork) .
. I Electrical (Underground Conduit) .
: Pre-slab (CompactionlMernbrane.Reinf. .
. Underpinning (Floor Joist/Girders) .' .
. fJo. not cover or conceal the work below until'the
following applicable items have been signed:
1st Floor Shear .'
Rresprinkler (Rough) . c
2nd Floor Shear .' .---/7
Roof (Sheathing/Diaphragm'Frane) i't.["r:J5 '-'-
Mallonrv (ReinfJBond BeanlPre-Grout)
Rough Plumbing (Top Out) . -,--.
Rough Mechanical
Rough electrIC all)
Rough Electrical
Framing (Ooly after Plbg., Elec.. Mem.. and Fire)
Insulation (SoundlEnergy)
Do not tape or plaster until the following'applicable .
items haVe been signed: .
Drywall .
Penet!'aliollS (Fire Rated) Electrica.1 .
Penetrations (Fire Rated) Mec:hanical '.
Peneti'alionli (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' Date Inspector
.Electrical Final
Plumbing Final
Mechanical Fin/II
Gas Test
Engi.-ringlGrading Final 765-5126 .' .
Fire Dept. Final 765-4040 .
.
Water Engineering 765-5268
sub List/Business License.765-519'
Zoning 765-5139 r '-
Building Final ~ast Inspection- Only '"?/ I J. 0---
Iter Above Complete) (l>/l
. PARTIAL INSPECTIONS
BuildinQ Insr:>ections _
6~-e
'~"1l~
. MechanicallnSDections
Plombina InsDections
ElectricallnsDections