7311 Stone Creek Ln.
TYPE OF PERMIT
Reroof
CITY
!.l
ElM
BUILDING DIVISION
200S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REOUESTLINE:
(714) 765 - 46?6
CENSUS CODE: 434
QUARTER SECTION: 203
,
BUILDING PERMIT NO.
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BLD2005-01051
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DATE: 4/15/2005
JOB ADDRESS: 7311 E STONE CREEK LN
LEGAL DESCRIPTION: N TR 8560 LOT 42
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CONTRACTOR INFORMATION:
BLUE SHOE ROOFING
16 CAPSTONE
IRVINE, CA '92606 0000
BUSINESS PHONE: 949 387-~428
JOB DESCRIPTION:Tear off existing material, install 25 squares of eaglelite tile ~t 5.9Ibs".
APPLICANT: ROD FORD
OWNER INFORMATION:
Richard T Wu
3717 E Mandeville PI
Orange, CA 92867
AROHITECT/ENGINEER INFORMATION:'
VALUATION:
8,250.00
'i.
PROCESSED BY: JNJ
OWNER-BUILDER DECLARATION
I hereby affirm un e-r penalty of perjury that I am exempt from the Contractor's pcense Law for the fol-Iowing reason (Sec. 7031.5 Business and
Prpfessions Code: any city or countywhi~h requires a permit to construct, alterl_improve, demolish or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that he is licenSed pursuant to the provisions of the Contractor's License Law (Chapfer
9)(commencing,with Section 7000 of Division '3 of the Business and Professions Gode) or that heis exe,mpt therefrom and the basis for the alleged
exemption. 'Any violation of Section 7031~5 by any applicant for a permit subjt;l~ts the applicant to a' civil penalty of not more than_five hundred dollars
_~ I .
o i, as owner of property, or my employees with wages as their sole comperlsation, will do the work, and the structure-is not intendedor offered for
sale (Sec. 7044 Business and Professions C-ode: The:Contractor's Ucense la~ 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 own employees, provided that such improvements a-re not intended Of _" .
offered for sale: If, however,' the building or improvement is sold with orie year:of completion, the owner-builder will have 'the burden of proving that h~
did not build or impr'ove for the purpose of sale). if'. . , .
o I, as the owner of the property, am exclusivelY contracting with licensed cO'Otl'actors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor,'s License Law does not apply to an owner of property who builds or improves thereon, and who oontracts tor such projects with
a contractor(s) licensed pursuant to the Contractor's qcense Law). ,J .
D I am exempt under Sec. , B & P.C. for this reason: 'Ii
I
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the foJJowjng declarations:
D ,I have and will maintain a certificate of, consent to self-insure for worker's6ompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the \Nark for which"
this permit is issued. ..' '
}ii Ihave and will mai~tain worker's comp'ensation insurance, as required by $ection ;3700 of
~bor Code, for the performance of the work for which this permit is issued., Myworker's
Compensation insurance carrier and policy are: '
Carrier: STATE COMPENSATION FUND Policy Number. 1713452-02
I
4/15/2005
Date:
~iS section need not be completed if the permit is for one hundred dollars ($1 00) or less.
I certify, ttJat in the performance of the work for which this permit is issued; I'shall not"
mploy any person in any manner so as to become subject t9 the worker's compensation laws
of California, and agree that if I should b e subject to the- orker's compensation
provisions of Section 3700 of the bar Code, ha forth th com ~~ose proVisions.
Date: 4/15/2005 Applicant " ~
WARNlt-IG: FAILURE TO SECURE 0 R'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALLSUBJE AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED OUSAND DOLLARS ($.100,000), IN ADDiTiON TO THE'
COST OF COMPENSATION, DJ\MAGES AS PROVI DED FOR IN SECTION'3i06 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. I
CONSTRUCTION LENDING AGENCY
I h~reby_affirm under penalty-of perjLJ_ry that there is a'constructiof.1le.ndingage_ri9yf()rll)~_
performance of the work-for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
NUMBER
810900
TYPE
TYPE
EXPIRATIONDATE
7/31/2006
C39
. HIC
Construcion Types:
-V N, ,.
Fire Sprinklered?
NO
I certify that I 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 construction, and
he by a representiv ' city to nter upon the above mentioned property for
inspe s.
Date: 4/15/2005
Fees paid for Permit:
Total:
235.66
Signature of Applicant or Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed Ii nal inspection 365 days from the date of permit issuance. A
new'permit is r~quired to com,,"ence or continue work.
INSPECTION RECORD
. INSPECTION. DATE . INSPECTOR
"'-.
T "",,,orary Power Pole
Piumblng(Drain/Waste Pipe) .
Electrical Ground Electrode/Ufer
SelbacklFormsrrrenches (Footings) .
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
.Plumbing (Wat"r Plpe.SprinklerValves)
Mechanic:al (Groundwork) .
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane.Rei m.J
Undet"plnning (Floor Joist/Girders) .
. Do not cover or conceal the work below until the
following applicable items have been signed:
1st Floor Sh"ar
Firesprinkler (Rough) .
2nd Flo .' , -
Roof ISMathinnlbiaphragmlFranel li'l-ob --...:'::1'''/ /uS. J_ .
Masonry (ReinfJBond 8l!anlPre-Grout) J
Rough Plunibing (Top Out)
Rough Mechanical . . .
Rougn t:IectrlCallUI y ..all)
Rough Electrical
Framing (Only afterPJbg., Elec.. Mech.. apd 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 (Brown Coat) . . .
T -Bar Electrical.
T ,Bar Mechanical .
T -Bar Structural
Sewer.
Water Engineering Backflow
Water Service
FINAL INSPECTION3-
Electrical Final
'.' Date l Inspector
".
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126 .
Fire Dept. Final 765-4040
Water Engfneering 765-5268
Sub List/Business License 765-519
Zoning 765-5139
Building Final fLastlnspection- Only"". .lO./'.
.After Above Complete) 71'1\ ~..
PARTIAL INSPECTIONS
BuildinalnSDections
Mechanicallnsoections
Plumbina InsDections
ElectricallnsDections
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DATE: 2/17/04
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p.o. Box 210
Walertown. SO 57201
Phone: 800-843-9888
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