7152 E. Mockingbird Way
CONTRACTOR INFORMf~+ION:
CAPT AIN CONSTRUC rl":lN C8
1225 N RAYMOND AVE' j.
FULLERTON, CA 92831 ooilo
BUSINESS PHONE:, 800 941}2116
JOB DESCRIPTION: Remove 2 existing windows and install trench doors Wi~\ sideligtlts
:jf:
VALUATION: .' 2,500.00 ,_~~./.,:......:.-_
I OWNER-BUILDER lJECLARA TION
I hereby affirm under penalty of perjury:ttlat! am exempt frpfl'l. the :c;ontracto,j<;_L!ca;1.Se law ~or the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to cOr'lstruct, a!~ir. imp!'Cv~, demolish or repair any structure, pr!or to its issuance, also
require.s the ~pplicant for sucli permit to file a signed sta!.ament that he is liC..Jfl'5€d pursuant to the provisions of th-~ Contractcr's License Law (Chapte'r
9)(cor:nmencrng with Section 7000 of Division 3 of the Buslnessa.nd Profes~~~_IS Code) or that he is~xe(npt therefror:'1and the basis for the al!eged
exemption. Any violation of.Section 7031.5 by any applicant for a permit SUL,i~ts the apDlicarH 'to a civil penalty of not more t~an five hUl"dred dol:ars
($500). r .
D I, as owner of property, or my employees with wages as: their sole con;d~nsE!ti~n, wi!! do the work, and the structure is r.oti~t~nded or oftcred fer
sale (Sec. 7044 Business and Professions Code: The Contractor's Licen.~e daw does not dl='plyto an owne'r of jJrcpe-rty who bl.1jlds or improves .
thereon, 'and\~ho does such,work himself or herself or through his or her o\,fjl.emplcyees, provided that $.uGh im;.>rovemer:ts are not intended or
offered fOT'sale'-' If" how'ever, the building ,Of' improvement is sold With one Y"i~r of r.ompleUon, the owner-builder wifi have tile bllr~p,n,of pm\ling that he ,
dld'notbuild or improve for the purpose of sale). . ~. ._ . , _ .,'
Cl. !, as the owner of the property; am exdusively contrat;;finQ'v\.jth nce:IlsGdccntractors to ..::onstn,.:ctthe project (Se>c. 7041 Busi:"!f'>.$s and Profe3S:on~
Code: The Contractor's license'Law does.not apply t9 ,an owner Of p'roper;~i'Alf10 [,uilos oiiinproves thereon, ant! who contracts for ~llch proiecb wfj;h
nontra~.or(s) Jicensed .pursuant to the C::~mtractor'~"Ucens~ ~aw). fi , '
L_. iamexempt1JnderSec. ". . .,'B & P.C. for this re::lson,: .:..._.-f
Date: Owner:' .' .. ::Ji
C. WORKER'S COMPENSATION DECLARATI.9..:'!~_r==--=-o--1
I hf!reby affirm under penalty of perjury one of the foliowi:1l;l.declarations: ~.
o ! have 'ana will. maintain a c~rtiticate of consellt to 'self-insure fo:- \,../Ork~;~i:: compe:~s3t;on,
as prnv!ded'for by' Section 3700 of the Labor Code,for the pel1orm2nc:::s-...~f~:~ \.';ort~ forwhici1
thiS Pf'rmit.isjssued. . . .).
'~, nave and will maintain worker's compensation insurance, as requiled'}'v Se,cHon 3700 of
f~e La.bar Code, for the performance, of the work for which this: pe(mit is :s:s:!eo; Mywori-.er's
" Compensation insurance carrierand'policy are: , '_ ,}\
Carrier: STATE FUND . Pplicy'-Numb.er: 17133Gt':02
. ' 'r.
This ':it."Ction need not be completed if the permit is for one hundred dollars ($1(ir!1:or leSs. .
[J I certify that in ~he performance of the work'for whi~h this permit is !SS'l!'~~: I shall: not
employ any person i~ any mannerso as, to become su!;lject to the worker'~~~_"!mp~ns~tion laws
of Cairromia, and agree thatif I should become subject to .the worker's cOiT'~nsation
proYisilms of Section 3700 of the Labor Code,! shall forthwith comply Wil.h'~,I1q5f; proyis!ons. Cons{ruCIGfI Types:
, 'v-, /) _/ ~AV7: " ,VN, .
Date: 1/28/2005 'Applicant: ~ ,1./0 'f?c-e!,.c,..,,____i " '
WARNING: FAILURE TO SECURE.WORK~'S COMPE~JSATION COVEf{AGE IS '
UNLAWFUL, AND,SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN(\LTIF-S i\ND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($10(\000), IN A[,DITiON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI(,N 3706 'OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES , , .--J,
I . ,. CONSTRUCTION LEND!NG AGENCY" -: ",I
. "_ h~~e~y:affirm urld~r penalty _()f pl'?rJury'_Jhat.th~w :ls:i::- Cf,!~~tnjdj,Ciikl1d;;].o;g?r'~yfr,r:,tt:,e.' - .1,,; _C___o..-_"
performanee-""'ofthe work for\Alhicti, this' permit is issued (Sec,309? .Civ .C): . ~
Lender's InfolTTlation:
BUILDING PERMIT NO. BLD2005-00257
TYPE OF PERMIT
Residential Remodel C I TV
DATE: 1/28/2005
JOB ADDRESS: 7152 E MOCKINGBIRD WAY
LEGAL ,DESCRIPTION: N TR 8464 LOT 32
APPLICANT: PAULAKAR
OWNER INFORMATION:
Rada Shephera
7152 E Mockingbird Way
Anaheim, CA '92807
!,'
ARCHITECT/ENGINEER INFORMATION:
BUILDING DIVISION
200 S, ANAHEIM BLvD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626 '
CENSUS CODE: 434
QUARTER SECTION: 210
PROCESSE'D BY: JNJ
I certify that I have read this appiication <=!.nd state 'that the above information is correct. I
agree to oomply with allcity ordinances and state laws relating to bunding construction, and
hereby. authorize representives Of this city to enter upon the above mentioned .property for
in ection purposes.
~' Date: 1/28/2005
Signature'of A, cant or ~gent
he permit shall expire by limitation and become null and void if the building or
_ work has not passed final i~pection 365 days from the date of permit issuance. A
ne~'permi.t is required to commence or continue work.
1
I
L1CENSEOCONT~"'!:TORS DECLAR.UloN'-:l
i h~rebj-z.tflrf!1 ,under penalt:;.- .::{ peljury th<Jt I am
licensed llih;ler provisions uf ch.::ptei' 9 (cofnmenGing
witt:! SectiQn 7000) of Divsion 3 oftM Business and
P, rofossio",s ode. M. J," ~ ~AA, .
1/28/;'005 ~t~!.:::
Date: 0/ tjJjO ..J/ ~~n('acto;-------'
NUMBER 'EXPiRATiON DATE
50850'1 4/3012005
TYPE B
185.20
Fees. paid for Permit:
Total:
INSPECTION RECORD
INSPECTION . DATE INSPECTOR
. .
Temporary Power Pole
Plumbing (DraintWaste Pipe)
. Electrical Ground Electrode/uter
. SetbacklFormslTrenches (FQOtings) . .
Do not install subflooror pour floor slab until the.
following applicable items have been signed:
Plumbing (Water Pipe,Sprinkler Valves) .
Mechanical (Groundwork) ..
Electrical (Vndergroilnd Condu it) .
Pre~lab (Compaction/Membrane,Reinf, ..
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the .
following. applicable items have been signed:
1st Floor Shear .
. .
Firesprinkler (Rough) . . .
2nd Floor .Shear
Roof (Sheathing/Diaphraam/Frame) -< .
Masonry (Reinf.JBond BeamlPre-GlOUty
Rough Plumbing (Top Out)
Rough Mechanical ~
Rough l:IectrlCaI {Dry wall) -'1.or;: '7)1- rh
RQugh Electrical . /: }
FramIng (Only after Plbg.. Elec" Mech. and Fire) !..-~~
. InsulatIon (SoundlEnergy) < J
Do not tape or plaster until the following applicable
items have beer) ~igned:. .. ...
Drywall .. .
Penetrations (Fire Rated) Electrical
PenetratIons (Fire Rated) Mechanical
Penetrations (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.. Inlj,pector
Electrical Final 1 -'2- 'f-tl' -C/, ,."
Plumbing Final
Mechanical Fil1al . .
. .
Gas Test .
.
.Engineering/Grading Final 765-5126 ..
Fire Dept. Fiilal 765-4040 . .
. .
Water Engineeri.ng 765.5268
Sub List/Business License 765.519
Zoning 765.5139. .
Building Final ~astlnspection. Oniy. ~ h~ Jfl A
fter Above Complete)
F'ARTIAL INSPECTIONS
. Buildina Inspections
Mechanical Inspections "
PlumbinQ InsDections
. Electrical Inspections