522 E. Vermont Ave.
CONTRACTOR INFORWTiON:
. R A V CONSTRUCTION '.:
7061 SYRACUSE ST
.' .STANTON, CA .906800000 .
JOB DESCRIPTION~G'merator installation on 'new pad"
VALUATION: . 15,000.00 . .' . PROCESSED BY: HRO'
I .' .'. .' .... . . .' . OWNER-BUILDER;)ECLARATION . . . .'
I hereby affirm under pe'narty qf perj,:/r.y tha.tl am exempt from the. Contractor.$"~icense Law for th.~ following reason (Sec. 7031. 8usinessand ,
Prq,fessions Coda: a ny- c;:ity or county which requires a permit to construct, an.~r, 'improve, demolish or iepa"irany structure, prior to its .ssuance, also.
requ'ires the' apgli_c:aJ.1tfor such permit to frle:"a,signed statementthaf h"e- islicEhsed-pursUqnt,to the p,rovision"s of the Contractor's Lice'n.se_Law (Chapter
9}(commencing wrth Section 7000 ofDivi,si.on 3 of the Business and profes~;{}n$ Code) or that he is exempt therefrC?m "and the basis for: the alleged .
exempti,Oil. p:n'y violation -of Section 703:~.5 bY,any applicant for a p,ermi,t SUb{;:;ct~ the' applicant to a .civil penalty of no..~ m.ore than fiv~ .hundred dbl\a~s
($60Q). .'. " .' '. !,>" .' .' . ' .
.0 I, as'owner of property, 'or mY empl.oyeeswith wages as their.sole,comp!insation,'wi.1l do the, work, and the structure, is nat intended-or offered for
sale (SeG.~044 8u~iness <;l,nd ,Prafessions Code: The Contractor'sUcens~I.D'w does pot apply to an .owner .of pr:aperty whC?,buiJds .or improves
th;~reon:.. ~riq,wh~~i::lO~S s.uch work himself" or herself .or thr9ugh his .or hero......rt~mp~oyees, p~o~ided that s~ch jmprov~rrtents are not intended .or
offeredfors~le", tf,.however.th~.~ilding o"r improvement.is saId w(th .one Ye;:~I:of'completidlJ, tl:le ,owner-build~r will'have the bllrden .of praYing thaylie
did not bu'ild or improve forthepurpO$eof sale). . . ,.^~t , '", ,_,' _/' .
. O~ ,1;_a5 the .owner .oJ the' property, am exclusively cantracting with licensed"~n"trad.ors 'to construct the project (S~c. 7044 Business and Profe~i_ons ."
Code:-,.~rhe Go;;tractor's' Ucense.L,aw does not apply to an.awner .of prapert/whO builds or improves thereon, and who oontracts for such projec~bwittl
acontr:actor(s):,ll~ensed plirsuantto the Contractor's' License'-Law}:.' '~..' '
O. ,'I~-am exen'fpt underSec. ".' . ._ ,B & P.C, r~r thisr~ason:' ,
Dale:'.' ',. ~< " Own~r: ,~}{' .
I WORKER'S COMPENSATION DECLARATION_.;~,
'-_hereby..:ifflhi1 under p'en~.lty afperju'ry,one of the following-declaratjons: '..'
. 0 I, have and will maintain a certificate of consent ta .self-insure for worker'\ compensation.~':
as prqvided for by Section 3700 ontie labor Code, for the petformance' ofth~ work for. which '
this permit :si$s;ued: _.. _ . _ ' (" '
rM _, have _andwillmafntain worker's compensatian ins~rance, as required e:rSect.ioo 37006f
~or ,Cade, far the performance of the work for which this permit is is::;u~ld. Myworker'::;:
Compensation insuranCe carrier and poliO} are: '. '. !! " _'
,Carrier: . . . . '. '. . Policy Number.~. . .
This 'section ri,eed not be completed if the p~nnit is for one hundred doilars ($1 Q!:! ~mj~s. ,
,0 . " ce~ifytha~ in th7 performance bf the 'worK (or which this permit' is. i_~~e~~':~r~ha II not. .
employ any person in any mann~r s9 as to be,come subject . the workefs c::-!!ilmms~tion laws
Of Galifamia, :and agree that if I s"trDuld become bject to t ~ warker's cOrPp.;.!"~:ation
. provisions ofSE!ctibn 3700 of the Labor Ce, I hall'/1 comply .wi'ti.1~:t3 provisions. .
-.,.:
BUILDING PERMIT NO, BLD2004-02646
?5;;:('~N,~J~(~ '.' '.
'ki\\IEIM
" ",:!~t.~"..
~\ \~ :*-t~~:t ,;;,. '
~...." '~.'~: l-P:^/1 /;.
~?: ,;.~~;"':bY' .
~",-~., _'30
,-;.
TYPE OF PERMIT
Accessory Building (Shed, Garage,..) . CITY,
DATE:6J23J20Q4
. JOB ADDRESS: 522 E VERMONT AVE
LEGAL DESCRIPTION: ANAHEIM EXTLOT 23 POR OF LOT
APPLICANT: RICK VANDERHOVEN
OWNER INFORMATION:
~
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(114),765 - 5153
INSPECTION REQUEST LINE:
(714)765"4626
CENSUS'CODE: 434
QUARTER SECTION: 95
ARCHITECTJENGINI:ER INFORMATION:
.',"
Dale: 6/23/2004' Applicant: . .,. "~
WARN ING: FAILURE TO. SECURE W RKER'S COMPENSATION COVEF.;t;E,IS
. UNLAWFUL, AND SHALL SUBJECT.AN EMPLOYER TO CRIMINAL PE~A,.nE!S AND CIVIL
'. FINESUPTO ONE HUNDRED THo.USAND DOLLARS ($100,000), INADL"mq!'J TO THE
. Co.ST OF COMPENSATlo.N,DAMAGES AS PROVIDED FOR.IN SECTIDl' 370i;OF THE'
LABo.R CODE, INTEREST AND ATTORNEY'S FEES.: .
.1 CONSTRUCTION LENDING AGENCY
I hereby affirm .u.nder'pen~l.ty ~f. ~erj~~ that ~h~(~.is a corrstructi~n !~ndi~,lg.c::.~I.lCY ioHh~
;::.::-:,-,,;:.~~;;:..:. ~;~:';.:;, .....~j}: ';::: ..:;..:..::; tl;;:: ;>-.::;.."t ;..,..:...~~ (:::'or..~::::::Z, ,~-.....:::;;:-' . --'~-
. Lender's Inf.ormatian:
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
..h.er. e~Y. ~Lithoriz1reP. re ntives .Of thi. s ci.ty.. toe. nle r.upon the a b.ave mentioned property for
. in5P77J;:; S., .' . .' .
K. . .' '. . : . ".' Dai.: 6/23/2004
. .. ,. Signatore of Applicartt 9r Agent. - . - .'
The permitshall expire by.limitationandbecome null and void if too building or
wor.k has not passed finaUnspectlon :j65 days from the date .of permit-issuance. A
new permit is. required to comlllenceor continu,e work.
LICENSED CONTRACTORS DECLARATION
. I ereby a inn under: penalty of perj!,lrytlJat I ?fYl
licensed under provisions .of cha ter 9 (commencing
. with s'ect.ion 7. O. 00) of Dir,n 3 the Businesfand.
:/;:~;:~:~ VI
Date:
Contract9r
Ni.lMBER
637429
TYPE
. EXPIRATION DATE
2/28/2006
B;
Construcion Types:
VN, "
Fife Sprioklered?
NO
'-
Feesp~id.for Permit: .
Tola!:
210,70
INSPECTION RECORD
, .
.' . . INSPECTION. . DATE . INSPECTOR
. . .
Tl!mporarypower.Pole. . . '.
Plumbing (DrainiWaste Pipe) .' . . . .
EleciricalGraund El&clnldelUfer : I . (J .. .
~FormsfTrenChes (Footil'lgs).' 11't1Ii)l .'
DO not install Subfloo( or pour flllor slab unt.il the .,
following applicable .items have been signed.' .
Plumbing (WatilrPipe.Sprinkler Valves) . . .
I','/echanical (GiOu~k). '. .... '. . .
'. !:leclrical. (Undergr.ound CondU it) . . .
PnI.-slab (Comp8Ctionl ane,ftemf. .
.' Llnderpinning (Floor JoistlGhders) ., .
. Donot cover or conceal the wone. below until the . '.
'followhigapplicable items have been signed: '. .
1SlFloor Shear .. .' .. ,
.
F1'resprinkler (Rough) , . .
2nd Floor Shear . . . .... . '.
ROof ISheatllinalDiaohragmlFramll) . . .
Ma()nry (Rlliinf./Bond BeamlPre-GlOIItl '. '.
Rough Plumbing (ToP Out) . . '. '
Rough.Mecllanical . '
t<<lU9n l:Iectrccal. IIJl.'Y wall' . . , ,.'
Rough Electrical, , '. " . .
Framing (Only after Pltlg~. Elec.. r~lecll. and Fire} . .
In,sulati()n (SoundJEnergy) '.'
DO not tape or .plaster until the following applicable .' '.
items have been s'igned: .' '. . '. .
Drywall' . . . '. . .'
/>l!rletratiOll$ (Fire Rated) Electrical . .'
Penetrations (Fire Rated).Mechanieal . '
PenetratlOns(FireRated) Plumbing '. ,
'nterior.lath . .' . . .
Exterior Lath . ' , ". .
'. .' . . .. '. GENERAL ITEMS
Exterior Plaster (BlOWn Coat). :
T-Bar Electrical . . . , .
T -Bar M!lchanical . .
T -Bar Structural . ., ....
Sewer . .
Water Engineering aackflow .'. ....
Water Service
FINAL INSPECTIONS
.Electrical Final
Plumbirig .Final
Mechanical Final
Gas Test
Engineering/Gracling FJnaI765,6126 .
. Fire Depl, Final 7.65-4040 .
Waler Engineering 765_5268'.
Inspector
. .
Sub'ListlBl!SIn8$S LicenseJ65;5.19
Zoning 765~5t39
Building Final'lUstlnspec!. ion- Only ,'~...
. . . 'After Abov,e Complete}. ,....,
. ,PAR!IALIIIISPECTION,S
BuildinalnsoectioilS
. Mechanical Inspections
'. PlumbinQ Inspections
Ele~ections
~." ,~
'l '
~,<<....;1 ~,[o'