1251 Masters Ln.
TYPE OF PERMIT C. ITY
Reroof
ElM
BUILDING DIVISION
200 S..ANAHEIM BLVD.
(714)765 -'5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
. .CENSUS CODE: 434
QUARTER SECTION: 7
BUILDING PERMIT NO. BLD2004-04142
DATE: 11/15/2004
. JOB ADDRESS: 1251 S MASTERS LN
LEGAL DESCRIPTION: N TR 9960 LOT 12
CONTRACTOR INFORM.'JION.
R R ROOFING
11206'RINGWOODAVE ,
SANTA FE SPRINGS, CA9Q670 0000
, BUSINESS PHONE: 5624&\'9456
JOB OESCRIPTIONRomove existing woodshake roof, replace w/7/16 OSB ai..d Eagle Lite Tile roof (ICBO No. 4660) at 23 squares.
VALUATION: 11,000.00 PROCESSED BY: CDL ,
I OWNER-BUILDER'DECl:ARATION':f
I hereby affirm under penalty of perjury that I am exempt from the Contradot;s LI~~fl.Se Law for the following reason '(Sec. 7031.S-Business and .
Professions Code: any city or county which requires a permit to construct, 8It1.r, improve. demolish or 'repair any structure, pr;or'to its issuance, also
. requires the applicant for such permit to file a signed statement that he is liC;)h;~d pursuant to'the Proyisj9ns of the. Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Businessand ~rof~ss~ms Code) or that h~ is exempt therefrom ai1<:fthe basis forthe alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit Silt'i.;,ects the a pplicant to a civil penalty of net more than five hundred dollars
($500).. .' ,
o I, as owner of property, or my employees with wages 'astheir sole com::fr.sation, will do the work, and the structure is not intencted or offered for
sale (Sec. 7044 Business and Professions Code: The'Comractor's License :-:;)'11 COJ3;S not apply to an owner of property who buildsor improves
thereon, and who does sudl yVork himself or; herself or through his or her C\t\il ernp!o}ees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one y€',~r of Completion, the owner-builds-: wil! have the burden of proving that,h~
did not build Or improve for thffpurpose,of sa,[e). . '. :'c ' " . ,;:
o I, as the ownerofthe propertYi-am exdusively contracting with l'icense~j_pnt(acf:d:,,1 to construct the project (Sec. 7044 Busi,nes;; an~_ProfesSiO'n~:"-
Code: The Contractor's License Law 90es not apply to an owner of property ..'tho buiid:;; or improves therp-on, and who ccntracts for suCh projects-with.'
Fu:ro.ntractor(s) licensed pursuant. to the Contractor's license Law). .
U I. am exempt under Sec. '. " "B & P.C. for this reason.:
Date: . Owner:
r WORKER'S COMPENSATION DECLARATlotL_.t=~---l
I hereby affirr:n under p~nalty of p~rjury one of the following declarations; .
'0 J have and will maintain a certificate of ronsent to self-insure forworke~~~ compen'3ation,
as provided for by Section 3700 of the Labor Code, for the performance 0fti'!c werk fo( which
this perm' 'is issued. , .
7 nave and will m~.intainwofker's compe~sation -insuia~ce, as required ~y Section, 3700 of
the, Labor qode. for the performance: of the work for which this permit ~s iSSU11r..l. Mywvrker's
Compensation insurance carrier and_policy are: )
Carrier: STATE FUND Policy. Number: 158576S::-l.2
This section need not be completed if the permit is fOr one hundred doll~ ($1t'i,f, Q~ '1;Si:;,
~-th~t i~' the performance of the work-for which this ~ermitj~-jssUEii~,~~!i;jJf~not
employ any person in any manner so as to becomE:: subject to the worker's c.i)rnpensation laws
of California. and agree that if I should become subject to theworker's comf:I):nsaV6ri
provisions of Section 3700 ofthe Labc:r Code, I sha ith mpl . thjse provisions.
APPLICANT: ROBJ:RT GUILLEN
OWNER INFORMATION:
StevenA Lyle
1251 S Masters Ln
Anaheim, CA 92804
ARCHITECT/ENGINEER INFORMATION:
.
LICENSEP, CONTI>.ACTORS,:DECLARATION
j herebyaffjliTl under penalty of perjury that l am
licensed under proviSions of c~pter 9 (cornmenc:ng
Withsectlo~smess"nd
Professions Code. .
11/15/200.
Date: Contractor,
NUMBER
744581: .
'TYPE
C39
EXPIRATION DATE
1/31/2006
Date: 11/15/2004 AppliCant: ""
WARNING: FAILURE TO SECUREWO . ER'S COMPJ:NSATlON COVEFAG"JS.. ,
UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENHTIES)INDCIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN AD['iTi6!'J"TO'THE
COST OF COMPENSATION, DAMAGESAS PROVIDED FOR IN SECTI()~ 3,06:;QF T.HE
LABOR CODE, INTERESl"AND ATTORNEY'S FEES, ' ,
j CONSTRUCTION LENDING AGENCY_.~_
I hereby affirm under penalty of'perjury that there is a construction I_ending 3t~q-nc.yfor the
-pdli\;ir>laln.~-o"tile wor'K-fo-".wi-licli in;::;,pel frill is :s::>uea (Sec.'309T.l:.iv.(.;j:
Lender's Infonnatian;
C6nstrucion Typer,:
V N, ,
Fire Sprinkler~d?
NO
I certify that I have react this application and state that the above information is correct. I
agree to comply with all city-ordinances and'state.laws relating to buildrng ccnstruction, and
hereby authorize representives of this city to enter upon the above mentioned property for
ins.pectio,t!~pur s ' _'_ '
/ - . _ - - Date: 11115/2004
, . Signa . lcant ~ent
The permit shall expire 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 perinit is required to commence or continue work.
Fees paid for Permit:
Total:
255,.58
iNSPECTION RECORD
INSPECTION DATE INSPECTOR "
Temparary Pawer Pale
Plumbing (DrainIWaste Pipe)
EleCtrical Ground Electrode/Ufer ,
SetbacklFormslTrenches (Footings) , ,
Do nat install subfloor ar paur flaar slab until the
following applicable items' have been -signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork) ,
Electrical (Undergraund Canduit) ,
Pre.slab (Campactian/Membrane.Reim. , ,
Underpinning (Floor Joist/Girders) ,
Do nat cover ar conceal the wark below until the
following applicable ilems have been signed:' , '
1 st Flaar Shear'
Firesprinkler ~Rough)
'2nd Flaar Shear ' , - r'"'-.^
Roof (Sheathing/Diaphragm/Frane) II.I~ n. ~V
Masonry (ReinfJBond BeanlPre-Grout) , ...,
RaughPlumbing (Top Out)
Raugh Mechanical ' '
Rough l:IectrlCallLJrY nail) ,
Raugh Electrical ,
Framing (Only after Plbg" Elec,Mech, and Fire)
Insulation (SoundlEnergy)
Do not tape ar plaster until the follawing applicable
items have been signed: .
Drywall .
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) MeChanical
Penetrations (Fire Rated) Plumbing
Interiar Lath '
Exteriar Lath , ,
GENERAL ITEMS
ExIerior Plaster (Brown Coat)
T .Bar Electrical' , .,
T.Bar Mechanical ,
T.Bar Structural - , , ,
Sewer , ,
Water Engineering Backflow
Water Service
FINAL INSPECTIONS Date, Inspector
Electrical Final , ,
Plumbing Final
Mechanical Final
Gas Test ,
, '
Engineering/Grading Final 765-6126
Fire Dept. Final 765-4040 "
Water Engineering 765-5268 , '
Sub List/Busine,ss License 765-519 ,
,
Zaning 765-5139 , " '
Building Final ~a$t Inspection. Only f2;l,'?-ot ~c,"pr L,
fW Above Complete)
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections "
~
Plumbina Inspections,
Electrical Inspections