1795 Sandalwood
BUILDING PERMIT NO.
BLD2004.Q3695
.,:.'-,;':". ,..-- ,
i~:~'j:' . ..'3~~\
CITY~ffii~im~HEIM
.\'?5~i~tt/
BUILDING DIVISiON
200 S. ANAHEIM BLVD.
(714) 765 - 5153
. INSPECTION REQUEST LINE:
(714) 765 -4626
CENSUS CODE' 434
QUARTER SECTION: 101
TYPE OF PERMIT
Reroof
DATE: 10/4/2004
. JOB ADDRESS: 1795 E SANDALWOOD AVE
LEGAL DESCRIPTION: N TR 8866 LOT 40
CONTRACTOR INFORMPT!ON:
UNIVERSAL ROOFING'
6675 PALMA CIR
YORBA liNDA, CA 928860000
BUSINESS PHONE: 71469:f0724
JOB DESCRIPTION'!"ea' off eXisting and replace witli 26 squares of Eagle lite 5.BSlbs ,oaf, ICBO # 4660. .
VALUATION: 4,000.00 . PROCESSED BY: EMA
I OWNER.BUILDERDECLARATION
. J hereby aff-jrm under penalty of perjury that I_am exempt from the Contractor",&Uc:ense Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a'permit to constrl1ct,al:t.~_r. 'improve, d.ernoli.sh or repair any structure, prior to'its isSuance. also
requires the ,3pplicant for such permi~ to file a signed statement that he is lice,}:;ecl pursuar)t to-thEl provisions ~fthe Cor;tractor's License Law (Chapter'
9)(commencing with Section 7000 qf Division 3 of the Business'and Profess\();,s Code) or that he 'is exempt therefrom and the basis forthe alleged
exemption. Any vIolatior. of Section 7031.5_ by any 'applicant for a permit sul)~'ectsC the a pplicaflt to a dvil penalty of not more tha n ,five 'hundred dollars
($500).
o I, ~s owner of property, or my employees with wag_esas their sota comp~!l:SC\tion, ......i.n do the work, and the structure is noJ intended or offered for
sale (Sec. 7044 Business and Professions Gode: The Contractor's Licemse l:aw dpes not apply to an owner of property wno,builds or improves
thereon, and who does such work himself or nClSelf or through his or her ow:,! em~!oyees, provided.tnat such improvcment~ arp, not intended or
offered for sale. If, however, the bullding or improvement is sold with one y~,;!" of completion" the owner-bu"der will have the burden of proving that he
did not build or improve for the purpose of sale).
o 1,- as the owner ot'thc property, am ,exdusively COfltracting with licensed e-oniraaors to coostructthe profect (See. 7044 Business and Profe;ssior.$
Cod~:' The Contractor's License Law does not apply to an uwne(of p,rc.perry l:ho builds or improves thereon,' aoo who contra-cts for"sucn p:-cjects with
~ontrador(s) licensed ptlr~uant to the Contractor's License La...!)~ _
LJ I am exempt under Sec. ' ' , [3 & P,C. tor this reason:
Date: Owner:
~ WORKER'S COMPENSATION DECLA~TION
I hereby affirm under penalty of perjury' one of the fottowing declarations:
o J have and wiU maintain a certifICate of mnSent to self-ineure for worker'~ cCJl1pen~ation,
as provided for by Section' 3.700 of the Labor Code, for: the performance o~ ih;~wolx fer whic.'1 I
, this .F"mit is fssued. ", ", I
~'I have and will maintain worker's compensation insural'ic.e, ~s requj~d b) Se;::tion'3700 ef
'the ,Labor Code. for the pP,rformance of the work for which this pF.:rlTlit is iSSi,lFj:t My"\'.orker~s I
C6mpensationinsurance carrier ant! poticy <;Ire: . \"
Carri~r; ,STATE FUND Policy Number. 1643866-02
Thissectioo need not be ,completed if the pennit is fOr one hundred dollars ($10C; Of less. ,
o I ,certlfy that il1 the perlorrnance of the, work ,for which -this permit is issuec.t, '. shall not' I
employ;:my person in any mannerSQ as: to become subject to .the worker'S., yo{npe.n,sation raws '
of. Califomia,and agree that if I should become subject.to the workel"s ccrnpeilsation, '
prOVisions of Section 3700 of the Labor Code, I shaU,forthwith comply with thqse provisions. Construcion Types:
Y" . .r::?,.-/ i., V N, ,
Oat,,: 10/4/2004 Appncanl:/-=""""'-::!::' ~ . ,
WARNING; FAILURE TO SECURE WORKER'S COMPENSATION COVERijCE IS
UNLAWF.UL, AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL F?,,~JAL[IESAND CIVIL
FINES UP TOONE HUNDRED THOUSAND DOLLARS ($100,000), iN0I1PPI'iION TO THE
COST OF COMPENSATION, DAMAGES AS PRDVIDED FOR IN sEci'lON ,\706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.. ... . "'i<; ;
....:,
CONSTRUCTION LENDING AGENCY , I.
I hereby affirm-under penalty 'of perjury tryat there is a constructiont~ndi'1g :agenc~"for the
perfopnar.ce,afihe work fer which this permit is issl,led (Sec.,0q9?~.,gjv,CL '~ ~
Lcnqtf"~' j,il(j'rn:(i:uiod:' .
APPLICANT: RICARDO MORALES
OWNER INFORMATION:
, Cuo ng ,Nguyen
1795 E Sandalwood Ave
Analieim, CA 92805
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION J
J hereby affirm'lJnder penalty of perjury th~t I am
licensed under proYis.ions of chapter 9 (commencing
with,Section 7000) of Divsion 30fthe Business and'
p~fessio~~
101412004 ~
Date: COlitractor
NUMBER
765451
TYPE
TYPE
EXPIRATION DATE
7/31/2005
C39
Hie
_';0..
I certify that! have read this application ,and state that the above information is correct. I
agree to comply with all city ordinances and-state laws. relating to bUilding con:;truction, and
hereby authorize representives of thi's city to enter upon the above mentioned property for
::;:e~.. . .'. . Date: 10/4/2004
/' " Signature of Applicant or Agent
The permit shalll1xpire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the datil of permit issuance. A
new permit is required to commence or continue work.
Fees pa~d for Permit:
Total;
235.33
INSPECTION RECORD
, , INSPECTioN , DATE' , INSPECTOR
Temporary Power Pole -,-, ,
Plumbing (Or<linlWaste Pipe)
Electrical Ground Electrode/lifer
SetbacklFormsrrrenches (Footings), '"
Po 1101 install subfloor or pour floor slab until the, ' ,
following applicable items have' been signed:
Plumbing (Water Pipe.Sprinkler Valves) ,
Mechanical (Ground\M)rk) ^,'
Electrical (Underground Conduit)
Pre-slab (CompactioolMembrane .~ei nt.
Underpinning (Floor Joist/Girders) , "
Po nOlcover or conceallhe worK below untillhe
following applic<lble Ilems have' been signed: " " ,
1S1 Floor Shear ' " ,
, "
Fill!spnnkler (Rough) , " , "
2nd Floor Shear /7
RQof (Sheathing/Diaphragm'Frane) -z;:::'
Masonry (ReinfJBOnd BeamJPre-Gfll\It) , ,
Rough Plumbing, (Top Out) ,
Rough Mecha"ical ' -,-
I Rougll8ectriCaI (Dry Wall)
Rough Electrical" ,
Framing' (Only after P1Dg.. EJec., ',:lech , and Fire) ,
Insulation (SoundlEnergy)
Do not tape or plaster' until the following applicable
items have been signed:, ,- ' -, .
Drywall ,
Penetrations (Fire Rated) Electric:al "
Penetrations (Fire Rated) Mechanical, I '
Penetrations (Fire Rated) Plumbil19 ' ' ,
Interior Lath
Exterior Lath ,-c-
" ' ,-:-, GENERAL ITEMS " '
Exterior Plaster (BlOWn Coat) -,-
T -Bar, Electrical " -,- " ,
T -Bar MeChanical
T -Bar ,Structural , I,
Sewer ' , ' , 'C -,-
Water. Engineering Backflow
Watei'Oervice "-'- ,
FINAL INSPECTIONS. ' ' Date Inspeclor
Electrical Final 'C, - , ,
,I,
Plumbing Final , , ,,'
, '
, , Mechanical Final
0' I, ' ,
Gas Test , ,
E!lgi.neering/Grading Final 765-5126
Fire Dept. Final 765-4040 ,0 ' "
Water E,ngineering 765-5268 "
Sub L;st/BusinessLicense 765-519 , , ,
Zoning 165,51,39 , " J'
Building F,inal ~ast Inspection- Only , '1!J$105 1,\t\I.)l>C.(~1
fler Above Complete)
PARTIAL INSPEC"'ID'NS
Buildinqlnspectioils '
Mechanical Inspections
",PlumbinQ Inspections
, Electrical inspections