147 N. Mohler Dr.
CONTRACTOR INFORM,6nON:
UNIVERSAL ROOANG .
6675 PALMA CIR ,
YORBA LINDA, CA 92886 9000
BUSINESS PHONE: 71469;10724
JOB DESCR!PTION: Tear off existing and reroof 23 squares-with compositior1.:if\!ngles
. - . ,
VALUATiON: 3,450.00 ~
I ' ,~, OWNER-BUILDEnIOECLARATION
I hereby affirm under penalty of perjury that I 8(Tl exemptfrom the Contractor)::; Lioense Law.for the-following reason (Sec. 7031.5 Business and
Professions Code: any city or county which req'uires a permit to construct, ai\D,r, improyo, demolish or repair any,structure, prior .to its, iSsuam~e, a/sa
requires .the applicant for such permit to file a signed statement that t:'J"e is l;cl'!~sed pursuant to the proVisifms of the Contractor's License Law (Chapter
9)(cof!1mencing with Section 7000 of Division 3 of the Business and Profess:;-~~~ ~odei elr ihat he is "exempt, the-refrom and thebasls for the allege9' '
_ exemption. Any violation of Section 7031.5 by any applicant for a permit subk:JCts theapolicant ta a civil penalty of not more than five hundred dollars
rJSO~)as owner of property, or my emp;o;ees with wages as their soie coml~..t~auon, wi,;! d~ the work, and the-structure is not lntend~ or offered for
sale (SsG. 7044 Business and Professions Code: The Contractor's 'UcenS-3 Lkw does notapply ta-anowner of pro perty who builds,or improves
thereon, and who does such work himself or herself or through his or her a~:,r) ?mp!oyee~~~'pr6vjded that such improvements are not intended or
. offered for sale. If, however, the building ar improvement iG sold with one ydr of'compfetron, th~ owner-builder will have the burdell o,fpraving tl1:;'1t he
did not blilld O( improve for the purpose of sale}. ;. r ," "~':>- :, . . '
OJ, as the. o\\;ner of the property, am exdusively contracting with IicensedFon:ri3ctor~"tocol1struct the project (Sec". 7044 Business and Professions
Code: The Cqrotractor's License Law does not apply to an owner of.W9peri,/i.vho bu!lds or improves thereon, and who contracts for surn projects with
Montractor(~)licensed pursu,ant to t~e Coritr'actor's J,..icense Law). " " ,"<
i.....-lj am exempt under Sec, __ ,8 & P .C. for thi:o:; reasQn: _______'-_., """S" .
Date: Owner: ._--'J.
I WORKER'S COMPENSATION DECLARATION _3__ ~
I hereby affirm iJnder pe~alty of perjulY one of the following deciarations: .. \
. 0 I have and. will maintain' a certificate of consent to self-insure 'for workor;J'compensation,
a~ provid~ f~r by Se, dion 3700 of the Laber Code, ,for the performanca of L'1,",t".I!o!OrK ~or which I
thIS permit IS ISSUed. ',' I'
~, have and wHlma-intain worker's compensationihsu~ance: as requir~d b~ S~tion 3700 of
(fh~ labor Code, for the perfon::nance of the work for which-this permit is i~tr;:~d. Myworker's
Compensation Insurance carrier and poliOf are: "
Carrier: STATE RJND Po~Cf Number. 164386c:FZ
,I
This, section need n~ be_ completed!f the pennit is for one hundred dol,lars <.$iC'CJ(cr ~ess,
0, I certify that in-the perfor!"nance of the work far which this permit is 1s.'3U~4;I_Shalf not '.
empioy any person in a ny manner so as' to become subject to the worker's cCfilj:;ensation laws
of Califomia;' ,and agree that if I should become sUbject to the workers compensation
_provisions of Section 3700 of the Labor Code; I shan forthwith comply with tr.cse ;:'lrt,lvisions.
Date: 11/10/2004 APPlicant:\-"'~?" , ",
WARNING: FAILURE TO SECUR~~~OMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAiiTiES AND CIVIL
FINES UP TO ONE HUNDRED mOUSAND DOLLARS ($100,000), IN ADDinOI, TOTHE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION,370S OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .
I ' CONSTRUCTION LENDING AGENCY._~.
l'herebyaffirmunder penaltyof'perjury"tnatthere is a-construbtioh lending ;2D:3r.;::.yfo, t-,I-V3 .'
-;-,::;fr";;;-O=;~~~7;n.~J.~~.~,;.,i-.,;l-:,;;~,t-!,-;;~~i-i;;;~tr-(-S':""':;:%-T-.;:),:;-,C';: ~.,-,-'~-~:' -" ~'- ~ -----
LBnder's lrif9rmation:
BUILDING PERMIT NO. ,BLD2004-04105
. 'I,;' ,;.
t1:fl.f:;';;:::tt;;;;\ '
Jf;o.XI;4J .:,:> ri., '"~}~_.
CITY ~1~!L, /JnEIM
\\ ,~,;,""~"..;;"/~ :41: if
~'-:,;o."~t.<'>;!;Y!""f.;#.9.; IJ
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TYPE OF PERMIT
Reroof
DATE: 11/10/2004
JOB ADDRESS: 147 N MOHLER DR
LEGAL DESCRIPTION: N TR7730 LOT 8'
APPLICANT: RICARDO MORALES
OWNER INFORMATION:
Gardon V Boden
441 S Cedarhaven Way
Anaheim, CA 92807
BUILDING DIVISION
200 S,iANi,HEIM BLVD.
(714)765"5153
INSPECTION REQUESTLINE:
(714) 765,4626
CENSUS CODE: 555
QUARTER SECTION: 196
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
...-,
LICENSED CONTRACTORS DECLARATION I
I hereby affirm under penalty of perjlJry that I am
licensed J-lnder provisions of ctlaptel 9 (commencing
with Section 7000) of Divsion 3 oftheBu::.iness and
Professions Code. ~ .
11/10/2004 )c< ~~-, ~,
Date; . . Cont,ractor,
NUMBER
765451
TYPE
TYPE
Construcion Types:
VN,
I certify that I have read this application and state that the above lnformatbn is correct I
agree to comply with all city ordinances and state laws relating to buUding copstruction, and
hereby authort;e representlves of this city.to enter upon the aoove mentioned property .for
inspection purposes.
V ~~ Date: 11110/2004
I \. " , Signature of APPli~nt or ~g~nt
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 permit is required to commence or continue work.
EXPIRATION DATe
7/31/2005
HIC
C39
Fees paid for Permit:
Total:
235.33
INS!,ECTIO.N . '. DATE INSPECTOR Electrical final . '. . o'
Temporary Power Pole . Plumbing final '. . '. . .
.
Plumbing (OrainiWaste Pipe) Mechanical final . I.
Electrical Ground Electrode/Uter . .
Selbacklformsrrrenches (Footings I . . Gas Test
Do. hot .installsubfloor or pour floor slab until the Epgi.-rlngfGrading Final 765-5126
following applicable items have been signed: .
Plumbing (Water Pipe.Sprinkler Val\les) . Fire Oept. Final 765-4040 .
.
Mechanical (Groundwork) Water Engineering 765-5268 '. .
.
Electrical (Underground Conduit) Sub Llst/Busihess License 765.519
Pre-slab (l;ompactionfMembrane.Reinf.
Underpinning (Floor Joist/Girders) . Zoning 765.5139. . ..'
Do not cover or conceallhe worl< below until the Building Final \l-ast Inspection. .Only . '1Z1tJ'~ //. />. .'.
following applicable items have been signed:. . . . Iter Above Complete)
1 st Floor Shear . . PARTIAL INSPECTIONS
FIlllsprirlkler (Rough) . . . .
2nd 1'.10 . . /)/ . Buildina Insoections
Root1Sheathln!ifOlaphragm'Frane) 'IN~ '- , .
x
Masonry t.....'nfJBonlI BeamlPre-Grout) I .' . .
Rough'Plumbing (Top Ollt) ,
. .'
Rough Mechanical .
I ROUgh l:Iectrlcal\ury ..all) . '.
Rough Electrical
. Framing (Only. after Plbg., Ele,c.. MeeA. and Fire) ..
Insulation.(SoundlEnergy) .'
Do not tape or plaster Until the following applicable. Mechanical Inspections
items h~ve been signed: . . -' , , . " .
Orywall .
Perietratlons (FIIll Rated) Electrical 0 . ..... .
Penetratiol1s (Filll Rated) Mechanical . .' . '. .
Penetrations (FIIll Rated) Plumbing'
Interior Lath . . .
Exterior Lath' , . Plumbina Inspections'.
GENERAL ITEM$ . . . . .'
Exterior Plaster (Bn!wn Coal) . . .. .
T -Bar Electrical' . . . . . .
T.Bar Mechanical . .
. . . '. .
T -Bar Structural . . . "
Sewer '. . . . .
,
Water Engineering Backflow . . Electrical Inspections - .
Water Service . , .
.
.. mSPECT'ON RECORD
FINAL INSPECTIONS
(.Data
Inspector