245 N. Mohler Dr.
TYPECOF PERMIT
Reroof
CITY
BUILDING DIVISION
200 S. i)<NAHE!M BLVD.
(714)165-S153...
INSPECTION REQUEST LINE:
(714) 765 -4626
CENSUS CODE: 555
QUARTER SECTION: 196
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BUILDING PERMIT NO;
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BLD2004-04380
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DATE: 12/9/2004
JOB ADDRESS: 245 N MOHLER DR
LEGAL DESCRIPTION: .. NTR 7130 LOT 16
APpLIcANT: RICARDO MORALES
OWNER INFORMATION: CONTRACTOR INFORMATION:
Roberta S Tatro UNIVERSAL ROOFING j
. i
245 N Mohler Dr 6675 PALMA CIR i
. Anaheim, CA 92808 YORBA liNDA, CA. 92886 9000
.' BUSINESS PHONE: 7146930724
JOB DESCRIPTION:Tear off existing r0?f and replace with 23 squares of 30 y.ir?-r composition shingles.
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VAI,UATION: 3,000,00 , . PROCESSED BY: MSM
I OWNER-BUILDER DECLARATION
I hereby C!lffirm .under,penaltyof perjury tha.t., am exempt from.the, Contractoi"~ license Law for the following reason {Sec, 7031.5 Business and
Prqfessions Code: anicity or county which requires a" permtt to ccn$.truct"a,~!~r._jmpro.ve, demolish or repair any structure, prior-to Us issuan.ce, also.
requires the applicant for such permitto file a signed statement that he is Iicepsed 'pUffiuant..tQ theprOvisionsnofthe_ Contractor's License Law (Chapter
9)(commencing with Section 70aOof Division 3 of the Business and Profesei)Ji"iS Code) or that :~le is exempt therefrom and the basis for the alleged
exemption. . Any violation of Section 7031.5 by any applicant for a permit sor~jects the applicant to acivU penaltyof.nbt more than five-hundred dollars'
_~ . . . . .l .. .....
0' 1, as'ownerofp~operty, or my em~loy~es with wages as their so~c,comJrn:sa~ion, wilrdo th~ wqrk,and th~ strucwre is noti.ntei1d~_oroffered for
sale (Sec. 7044 Busmess and ProfesSions Code:. The Contractor's llcenscta-w does not apply to.an owner of property who bwldsor rnproves
then~on, and whodoes such work hil11Self or herself or throughhis or her ow;~ employees, provided that,such improvements g1:re not inten~_ed or
offered for sale, If, hoWever, thl? building or improvement is sold with one yctir of completion, the owner-builder will have the bvrden of proving that he
didnotbuildorimproveforth~purposeofsale)" . ,~'.. ' ..,. ... .
o I, as the owner of.the property, am exdusively, contracting with licensed~ccntract.ors to construct the project (Se~ .7044 Business and Professions
Code:, The Contractor's License Law does not apply to an owner of pfoperty[...vr,o builds or improves thereon, and whooontracts for such projects with
~ntractor(s) li~e~~ pursuant to the Contractor's LIcense taw).- :,~ .
U ! am exemp~ under Sec. . ,B &.P.C. f9r this reason: _:..~
Date: ., Owner: .-:.,Jt.
I WORKER'S COMPENSATION DECLARATION i .
. t hereby affirm under penalty of perjury one of the following Jec1arations: 1. .
o 1 have and.will maintain a c~rtificate of wosent to self-insure f~r worker'~c:ori1pen$at.ion,
.a.s pr9vided for by Section ,3700 of .the Labor-Code. for the.parformance of tll~ woli< for"whictl
g:"':a~: :n~~i~d';'aintain worker's compensation insUrance, as required \+se<:tion 3700 of
-the Labor Code, for the performance of the work fur which"thls permit is issW-,:d. :Myworker's
Compensation in.surance carrier and policy are: . ..'
Carrier:- STATE FUND .Poli"" Number. 16438""::02
:);:
ARCHITECT/ENGINEE.R INFORMATION:
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T,hi's sectiOI') need not beool1lpleted if the pennit is for one hundred dollars ($1 09) or less.
o I certify ,that in the perfpnn~nceofthe ,,-",ork for which this permit is iSSll~d;..1 shail not
employ: any person ,nany manner so as to become subject to the workels~:~~rJ:lpensation laws
of Califomia. and ,agree that if I should become subje~ to the w,?rker's .con:petisation
provisions,of Section 3~OO oftt:!e lab~r.code,1 shall forthwith comply wiUlt~'!Ose provisions.
LICENSED CONTRACTORS DECLARATION
I hereby C'!ffirm under penalty of perjury that I ar;n .,.
licensed under provisk>ns of chapter 9 (commencing
with Section-70QO) of Divsion 3" of the Businessa,nd ,
. ~;;;;~~\ 7'f,'~ .
Dale:' r ... Contiactor.
NUMBER . EXPIRATION DATE
765451 7/31/2005
TYPE HIC
TYPE C39
Date: 12/9/2004 Applicant
WARNING: FAILURE TO SECU WORKER'S COMPENSATION COVt:?AGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES Uf>TOONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADl1I110N TOTHE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTJON..3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES..
CONSTRUCTION LENDING AGENCY. .~.
I hereby affirm under penalty of perj~ry that there is a: constructior, I~Cld_lilg.ac;.ancyfor the
.p:erformz:nce_ oH:'ewo~'k f"Grwhid) thiSr.'If'r;:nit i~j'3'f.;lJ~.c (St>,;.::l.a9.L.C1\t_C\:_:1;_~_.::'-,..~__~=,,-_=,,--_-
Uinqer's information: . - . , '
Construclon Tvpes:
VN, ,
Fire Sprinklen:!d?
NO
-~---'-------------'.---, --~~-. '-,-<",,~-~~--~----:'.....--.'"~
> ':'-):-. i.,-",,~,~'V' i
I certify that I have read this application and state that the abo~ '-information is correct. I
:agree to -oomplywith all city ordinances and state laws relating to building-construction, and
h 'r y authorize representives of this city to enter upon the above mentioned'property for
ins ction purposes. ' . .
Date: 12/9/2004
Fees paid for Permit:
Total:
235.33
. .', Signature af Applicant or Agent . .
The. permit shall expire by limitation and become .null and void ifth& building or
work has not passed final inspection 365 days from the date of permit issuance, A
new p"",mit is required to commence or continue work. .
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INSPECTION RECORD
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INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWastePipe)
Eledrical Ground Electrode/Ufer
SetbaeklForrnsfTrenches (Footings) . .
Do not install subfloor or polir floor slab until the . .
following applicable items have been .signed: .
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork)
Eledrical (Underground Conduit) .
Pre-slab (Compaction/Membrane.Reinf.
Underpinning (Floor Jojst/Girder~)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear .
Firesprinkfer. (Rough)
2nd FI ~,
Roof (Sheathin!ll[JjaphragmlFrame) h-ItNiI' -yr/[.,,- .
Masonry (KemfJBondBeamlPrlH>rout) ,/
Rough Plumbing (Top Out)
Rough Mechanical .
Rough Electrical (Dry Wall) . .
Rough Electrical
Framing (Only after Plbg" Elec,. r..1ech.. and Fire)
Insulation (SoundlEnergy)
Do 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 (Bl9Wn Coat) .
T -Bar Electrical
T -Bar Mechanical
T -Bar Structural
Sewer
Water Englneerl.ng Backflow
Water Service . . .
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FINAL INSPECTIONS - pate Inspector
<
Electrical Final ' ,.1
.
Plumbing Final
Mechanical Final
Gas Test ..
.
Engineering/Grading Final 765-5126
Fire Dept. Final 165-4040 . .
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Water Engineering 765-5268 . .
sub List/Business License 765-519 .
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Zoning 765-5139 . . . "..
Building Final ~astlnspection. Only 17..-ul. c '1dd~
fter Above Complete) .
P RTf IN 7
A AL SPECTIONS
. Buildina Inspections
Mechanical Inspections
Plumbina Inspections
Electrical Inspections