607 S. Pine
BUILDING PERMIT NO. BLD2005-00405
i:.~o~~F PERMIT . CITY
DATE: 2114/2005
JOB ADDRESS: 607 SPINE ST
LEGAL DESCRIPTION: NTR 1453 LOT 83
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
INSPECTION REOUESTLlNE:
(714) 765.4626
CENSUS CODE: 555
QUARTER SECTION: 73
APPLICANT: PABLO GAYTAN
. OWNER INFORMA TION:CONTRACTOR INFORMA liON: ARCHITECT/ENGINEER INFORMATION:
Pablo J Gaitan
14762 Shadow Dr
Fonlana,CA .92337
JOB DESCRIPTION: Repair roof; lear off existing and reroof 15 squares with ",phall shingles.
VALUATION: 700.00 PROCESSED BY: JNJ
I OWNER.BUILDER f!..ECLARATION
I hereby affirm under penalty' of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. -7031.5 -Business and
'ProfessiOr\S Code: anydty.orcountywhich requires a permit to construct, aite,., improve. demolish or repair any structure, prior to Hs,l~uance, also
requires the appJicantfor such permit to file a signed statement that he is licensed pUrSllarit to the provisions ofthe'Contractor's license Law (Chapter.
9)(commencing with Section 7000 of Division 3.of the Business "and Professio~s Code) or that he is exempt therefrom and tt~e basis for the alleged
exemption. (\nY violation of Section 70'31.5 b~ any applicant for a permit ~ubj.~cts tne applicant to a dvil penalty of not more than five hUl1dred dollars
($500). ..i . . ..
o ",- as owner of property"or my employees with wag"es, as their sole compf.nsation, wiildo the work, and the structure is ilofintended or offered for
~ale '(Sec. 7044 Business <;l nd Professions Code; The Contractor's License L~.'N. does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her ownemployees, provided that such improvements'are not intended or .
offered for sale. If, however, .the building or improvement is sold with one yce,~ of compietion, the owner-builder will have the burden of proving that he
_ did.ootbUUdorimprove for the purpose of sale). . :' . . . ~
~ as the owner of the property, am exdusively" coryt'racUng With licensed !";?!!'~f~ctors to construct the prefect (See. 7044 Business and Professions
(COde:' The C.on.tractor's License Law does not ~pply to 8n owner of rropeltyvrho builds or improves thereon, and who contracts fpr such projects with
FUfontractor($) I~ensed pursUant to the Contractor's LiC?~se Law).' . "
U I am exempt under Sec. , B ,.C. for Jis reason:
Date:" .,...e Owner:
L1CENSEO CONTRACTORS DECLARATION ]
. I hereby affirm under penalty of perjury that i am
ticensed under provisions of chapter 9 (commencing
with Sec~ion 7000) of Divsion 3 of the Business and
,Professions Code. .
2/14/2005
Date:
WORKER'S COM NSATION DECLA ATION I
I hereby affirm' unde'r'penalty of perjury one of the following declarations;
p ) have and will ~inta;n a certificate of cx>n~nt to serf-insure.for.worker'<>::!:ompp.nsation, .
a~.provided for by Section 3700 of the Labor Code, for the perlormanre oftt1c work for which
this permit is issued,
o I have and will maintain worker's compensation insurance, as required b~'SecTion 3700 of
the Labor Code,for the performance of the wor~ for, which this permit is issu~;!, My worker's
Compensationinsurance:carrier and policy are: ..
Carrier: PoliCy N~rroe'r:
r ThiSSec?tio~ need not be ~pleted if the pennit is ~or one hundred dol'ars,($10(i~ ct less.- .
~ I certify that in the performance of the work for which this permit is.issued,1 shall not, ".
~~ploy any person in any manner so as to become subject to the worker's ccrnpensation laws
of Califomia, and agree that if I should become subject.to the worker's compGnsatiotl "
provisions of S'ection 3700 of the labor Code, I all forthwith comply with tmse provisions.
.NUMBER
TYPE
Construcion Types:
VN. ,
Date: 2/14/2005 . Applicant:
WARNING: FAILURE TO SECURE ORKER'S COMPENSATION COVEf.~\GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN.^LTlES AND CIVIL
FINESUPTO ONE HUNDRED THOUSAND DOLLA"S ($100,000), IN ADD;nON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION '3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY
t h~reby affirm under penaltY of perjury that there is a construction lending aD~ncyfor the
performance of the work for which this'';)cIT;'rit islssued (S&.:.~097.Cj,....Cl: _~r~_._ ___
Lendai's Information: - i
) certify that I ha~ read this application ~nd state that the abov~ information is correct. I
agree to comply with al.l city ordinances and state laws relating to building construction, and
hereby'authorize rep sentives of this citY to enter upon the a bQve mentioned property for
inspection purpo;;, '
Dale: 2/14/2005
Signature of Applicant or Agen
The permit shall expire by limitation and become null and void if the building or
work lias not passed final inspection 365 days from the date.of permit issuance. A
new permit Is required to commence or continue work.
Contractor
EXPIRATION DATE
Fees paid for Permit:
Total:
160.61
INSPECTION RECORD'
INSPECTION , DATE INSPECTOR
Temporary Power Pole
'Plumbing (DralnlWaste Pipe) , , ,
Electrical Ground Electrode/uter
Selbacl<lFormsrrrenches (footings)
Do I)Ot installsubfloor orpourfloor slab until the, ,
following applicable items have been signed:
,Plumbing (Water Pipe.Sprinkler Valves) ,
Mechanical (Groundwork) , , "
Electrical (Underground Condu it)
PIll-slab (Compaction/Membrane.Reinf.
Underpinning (Floor Joist/GIrders) ,
Do not cover or conceal the work below until the
, following applicable items have been signed: ,
1 st FloorShe,ar ,
Fil9sprinkler (RoUgh) , ,
2nd Floor Shear , "
Roof (ShealhlnwDiaphragrn'FrMle) '? /IIIM IJ7A 11/ " ,
Masonry (ReinfJBond, BeamlPre-Grout) , ,
Rough Plumbing (Top Out) ,
Rough Mechanical ' "
Rougn l:Iectr,lCaI (Dry wall) ,
Rough ,Electrical ,
'Framing (Only after Plbg.. flet.. Mech.. and Fire!
Insulallon (SoundlEnergy)
Do Iiot tape or plaster until the following applicable ' ,
items have- been $igr:"ed: - -.
Drywall ,
Penetralions (Fire Rated) Electrical
Penetrations (Fire Rated). Mechanical ,
Penetralions (Filll Rated) Plumbing
Interior Lath
Exterior Lath , ,
GENERAL ITEMS
Exterior Plaster (Brown Coal)
T -Bar Electrical ' - "
T.Bar Mechanical ,
T-Bar Structural ,
Sewer ,', , "
Waler Engineering Backflow ,
Water Service ,
FINAL INSPECTIONS Date Inspector
Electrical Final ,
Plumbing Final "
Mechanical Final ,
, ,
qas Test ,
Engineering/Grading Final ,765-5126 , " ,
Fire Depl. Final 765-4040 ,
Water Engineering 765-5268
Sub List/Bus'iness License 765-519 '.. "
Zoning,765-S139 , ' .'
Building Final \tast Inspect1on. Only , i10/c;S /j IOJJ ~
fter Above Complete)
:PARTIAL INSPECTIONS ,
. 4
Bulldina Inspections
, Mechanical Inspections
PJumbina Inspections
Electrical Inspections
"