3634 W. Savanna St.
~~O~?FPERMIT 'CITY
DATE: 4/15/2005
JOB ADDRESS: 3634 W SAVANNA ST
LEGAL DESCRIPTION: TRACT NO.743 LOT 24 AND TRACT NO
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
, (714)765; 4626
CENSUS CODE: 555
QUARTER SECTION: 2
BUILDiNG PERMIT NO. 'BLD2005-01058
CONTRACTOR INFORMATtON:
GOLDEN CONSTRUCTION
3812 FRANCES AVE
CHINO, CA 917100000
BUSINESS PHONE: 909468-2294
JOB DESCRIPTION: Rerqof 60 squares with BUR over existing one iayei
VALUATION: 9,000.00
I OWNER-BUILDER DECLARATION'
, hereby affirm under penalty of perjury that I am exemptfrorn the Contractor's License Law for the following reason (Sec. 7031.5. Business and
Professions Code: any city or county which requHes a permit to construct, alter,' improve, demolish, or repair any structure, 'prjbr to its issuance, also
.req~ires the" applicant for ~ch permit to file a sign6d statement that he is lic~nsed pursuant to the proVisions of theyontractor's LiCense Law (Chaptar
9)(commencing with Section 7000 of Division 3 of the Business and Pr:ofessions Code) or that" he is_exempt therefrom and the basis for the al.leged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civ~ penalty of not more than five hundred dollars
(8500). , ' "
o I, as owner of property, or my employees with. wages as their sole compenSation, will' do the work,.'and the structure is not intended or offered for
. sale (Sec. 7044 8us~ness and p'rofessionsCode: The,Contractor's Licen~e Lalv does not apply to an owner of property.who builds or improves.
th~reon; and who does such work himself or herself or through his or her own employees, provided that such improvements are not-intended or
oltered for sale. If,l:Iowever, the building or improv~ment is sold with one year~of completion, the owner-builderwiH have the burden of proving that he
.did not build or improve for the purpose of sale).-
.01, as the owner of the property, am exclusively contracting with licensed ccntractors to construct the project (Sec. 7044 Business and Professions
Code:, The Contractor's LiCense Law does not apply to an owner of propertywno builds or improves thereon; and who contracts_for such projects with
a contractor(s) licensed pursuant to the Contractor's' License Law).
D I am exempt under Sec. ',8 & P.C. for this reason:
Date:' Owner: - - '
I
APPLlCANT:,HUN KIM'
OWNER INFORMATION:
Prince Casa Pac[fica Properties Lie
3634 W Savanna SI '
Anaheim, CA 92804
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY:JNJ
I
WORKER'S COMPENSATION DECLARATION :r
I he.reby affirm under'penalty of perjury one of the following declarations: , - ,
~ have'and wiU maintain a certificate of consentto selt-insure for worker,~'~ompensation,
as pr9Vided for by Section 3700 of the Lapor Code, for the pertormance of the work for which
this permit is issued.
o I have an.d will maintain worker's-compensation insurance. as required by Section3700 of
the Labor Code, for the performance cd the work for which thiS permit is issued. My worker's
Cqmpensation insurance carrier and policy are: .
Carrier: STATE COMPENSATION FUND, Policy Number. 564-0000065
I
LICENSED CONTRACTORS DECLARATION
'I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Di\lSion' 3.of the Business and
Prqfess!ons ode..
4/15/2005
Date.
This section need not be oompleled il the pennil is 101 one hundred dollars ($100) or less.
o I certify that in the perfonnanceofthe.work for which this permit is-issued, I shall not
employ any person in any manner_so as to become subject to the worker's compensation laws
of Califomia, and agree that it I should become..subject to.the worker's compensation
provisions of Section 37QO oUhe labor Code, , shall forthwith comply with,t.hose provisions. .
NUMBER
702267
TYPE
TYPE
TYPE
EXPI RATION DATE
2/28/2007
B
C39
HIC
Date: 4/15/2005 Applicant:
WARNiNG: FAILURE TO SECU WORKER' OMP
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER T CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADD!1l0N TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN'SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES, e
, CONSTRUCTION LENDING AGENCY')
I hereby af:flrmunde.r penalty ofp'erjury that there is a eonstruction-lendillQ &.~cy for the
performance of the work for which this-permit is issued (Sec.3097.Civ.C):
Lender's Information: .
,.~
Construcion Tvpes:
V N, ,
, ,
, ' . '
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 authorize representives of this city to enter upon'the above mentione~ property for
in action purposes.
Date: 4/15/2005
Fees paid for Permit:
Total:
374.49
i natur of Applicant or Agent
The permit shall xpir by limitation and become null and void if the building or
w, ork has not passed fi !lal inspection 365 days from the date of permit issuanCe. A
new permit is required to Cllmmence or continue work. '
INSPECTION RECORD
. . INSPECTOR
. INSPECTION . DATE
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Eledrical Ground Electrode/uter .
Setbacl<lFormsfTi"enches (Footings) . .
Do not install subfloor or pour floor slab until the
following appiicable ilems have been'signed: . ..-
Plumbing (Water Plpe.Sprinkler Valves) .. .
Mechanical (GroundWork) .. ' .
.. EledricaJ (Underground Conduit)
. Pre-slab (Compactlon/Membrane.Reint.
Ui1derpinl'ling (Floor JoIsUGirders)
Do not cover or conceal the work below until the
. . following appiicable items have been signed: .
1 st Floor Shear ,.
Aresprinkler (Rough) . . .
. 2nd Floor Shear. I .--..
Roof ISheathiI1ll1Diaphraam'Frame) H- hu, " . 1.11>--,
Masonry (ReinfJBond BeimlPrM;rout) . . .
, Rough Plumbing (Top Out) ,
Rough Mechanical - ,
KOugh l:IectricllllLJI'Y Wall)
Rough Electrical ,,'
Framing (Only after Plbg., EJec.. Mech.. 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) Mechanlcal '
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat) , .
T -Bar Electrical , .
T -Bar Mechanical ' , . ' .
T -Bar Strudural
Sewer .
Water Engineering Backflow .,
Water Senilce ' ,
FINAL INSPECTIONS Date Inspector' .
ElectricalFinal , " , .'
Plumbing Final ' ,
Mechanical Final ,
Gas Test
Engineering/Grading Final 765-5126 ,
Fire Dept. Final 765-4040
Water Engineering 765.5268 ,
.
Sub List/Business License 765.519
Zoning 765-5139 . r
Building' Final \l:ast Inspection. Only ~III\~ ~y\~mn.
fter Above Complete)
, PARTiAl INSPECTIONS
, Buildina IAs~ct~'
WM--~71 '
\"
MechanicallnSDections
Plumbina InsDections
ElectricallnsDections