3130 W. Vallejo Dr.
TYPEOFPERMIT CITY
Residential Addition. .
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BUILDING DIVISION
'. 200 S. ANAHEIM BLVD,
(114) 765.. 5153
INSPECTION REC0ESTUNE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 9
BUILDING PERMIT NO. BLD2003-04023
DATE: 11/21/2003
. JOB ADDRESS: 3130 iN VALLEJO DR
LEGAL DESCRIPTI()N: N TR 2611 LOT 53
APPLICANT: RUDY GABORNO F .
OWNER INFORMATION:' CONTRACTOR iNFORiv.p.'-ION:
Zenonna Sema R P GABORNO'S CONS~';\JCT!ON CO
3130 W Vallejo Dr 7831 SANTA!<JTA '. '3
Anaheim, CA 92804 STANTON, CA 906BO.{)O,y
_ '. BUSINESS,PHONE: 714 ~~.~_:2:?65' '_ . _ _ _ _' _ .
JOB DESCRIP:TIONR~ol!'..4,dditiO~. New kitchen and laundry. Extension of 'J. 'i~de.t;ng-bathrooms and bedroom._Total new livIng area, 365sf.,RemQdel
VALUATION: eXls~~~ff8,'IM'orch, .... X.: . PROCESSED BY: JJJ . .
I'. .' . 'OWNER-BUILOEr,ti-;eCLARATION'" ..' ". .. . . .
I herebyaffirrn underpenalty of perjury thall arl1 exer:npt from the ContraCl,DY~J;ceiise,lawtor the followif19 r,r8son (Sec. 7031.5 BusinessRnd _ .
Proi~s$!~m; 'C.1d?: an): city orcol:nt~:~\'hjc.h ref.f~!ireS z perm,it to constru~t; ~,t~i,; il11prpve, de~lish or r~f?CIir any strubtur~, prior, to. its issu,ance, also,
requl,r~t1he a P.P!i.'" ~ n. t TOr such p..p.rml.t tc fil.e c .s,tgn~d stat~~: :1t !~::'~he :3, ll:"..'r;"....:sed..... purs ua. n.tto ~J~p. ro.V1Sl 0 ns. Of. t.h..e c.o...ntrad..O. '.~S Lloe nS6 law ICh.a.Pt or
9)(CC'!rtnl0HCirig lNi,:h S-=ction 7000 of Division 30f the Business Cl~1Q Prafes$ "~':;_Code)"cr that he is exempt therefrom and the ba~is for the alleged .
-exem,ptior.." An/violation of Sec~on 7031.5 by any' applicant forapermit:s:.!: ~c;ts the-&ppIiCan( to'a civa penalty of not nior3 thzn five hundred dollars .
. ($500).' . '. . . '.', . '.' .
o : i'~, a~ owner'of fJTOperty;o,r my"employees witl"t wa~es c;~s ~heir ~-:Jle- .con:::,;tr:,,>ati0n, win do the work, and..tf:\e $truct\!~~ ico ~lct intend~-I)r offerE)d for
sal~ /Sec. _7044 BUtllness and P,rofessions Code: The ContractQr's llcE'r";:~1r~-: C9d~,;"Jot Clppiy to ::m O"mer of prop~rtr whobuildsor.improv~s:'
'th~J€:Ol"" ano wlio'does_such work- himself or,he_meJ(orttlfCugh his or h€:r O~~~\~~1:P:ovees~ provideq that sue" ~mprovQments'ar~ not,intended'oi','
off:e(~d fc;rsal~, if,however, 'the building or improvement is sc!d_wi:h or~)y~~t' ~r9f oompletion, tho,oWner,-builder Wl,:: hava:the Qurden of- proving.that he
did-r.otbu~dorinlprovcfCirth'epurposeof'sale}. _" , ," ", \,"..- '~;. :~":",,:: ' . "<.' " ,::
. '0, ,I, ,'as the:owner of the property,- am exdusively contracting with liGen~',:6 '_:~":i1~racto~3 toccnstrllct the project (Sec.'7044 Bug;ness and PrdesSK,ns
Cods: The Contractor's License_,law,qoe:'toof. apply to ',:m o~n~,r O{CiO!'),C:lt~*.: he) buijG~ cr_improves thereon,' and,who <?o:9tracts ~orsllch p~oJe.cu.. ~ith.
"'.Mon!r:aqw(s)Iicepsed purs,uant to the Contr,act~r's-Licenre~w). '-.t,~_ . , , ..... . ..- . :_ - _" . . ':, .
~ lame~emptunderSec. ' .S&P.C.forthisreason: ~.t.>- .:.." " , ' . -': c, .'-'.-'''' "
fata: WOR:":'~ COMPENSA1'IONDECLARATlm: -t-_.~ ".:::J liCENSED CONTRACTO~S DECLARATION J
I hereby afflrm.upder pena1w of ~~~ury one of the fl'lIowihgdecla~pon$: '1 hereby..atfirrn ,unoei .'~enaltyof perjury that.ta.m
o I have,and'VIIill maintain a certificate of oonsent to,self-ins,vre ~l)r'!Vcrr;t=,i;b~ccmP'3r.sation. ncensed under provis"bns d chaptEr 9 {ccmmel1Cir:g
aoprovid~fcr. b.~' Section, .3700 of the Labor .Gode, for the perl"Qrmanc':l of ~)!.:.... we*, ~~r which with Section7UOO)of Divsioll :3 of the Bu-sillessand
_~.is I';;:: n~~.~ld~~intai.nWOri<e.r's corr.pe'~~tion 'Insura. 'nce;as requ il~dtf~~. Sectk>n3700 01 '~1~;~;;ci~;S~. .~."", ".. ~.' '..
~abOrGOde,fOrtheperforma,nce.oftheWOrkfCrWhichthispetmnisjSG: i~. Myworker's Date: r-. <,.. . Contractor.
'Compensation insurance carrier and policy are: '.'..,
Carrier: STATE FUND . .' Policy Number. 162752:h ;. . NUMBER EXPIRATION DATE
. 485670 j/J1/2004
TYPE
TYPE
ARCHITECT/ENGINEER iNFORMATION:
'rhis section need not be cOmpleted if the pennit is for one hundred doll&'$ {$'1 ~h~ Jess.
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[J' I certify that in the pelforma,:,ce of the work for which,this perrPit ~'f5:?:~:j~o., I, shan not" I
(:mploy any person ,in a ny manner so as .to becom~ subject to the wor~).~ ,..i{;::t~pe.,sation laws.
of California, and agree thai.,if I should.-become subject,to th~worker'sr'6om"::\;,sa!ion
provisions of Sdction3700 ot the Labor God I shall forth\.t om ly with (;r~ie provisions."
B
HIC
Date: 11/2112003 Applicant: ~, ,
WARNING: FAILURE TO seCUR ORKER'S C PE;NSATION G6VE;"~'GI: IS .
UNLAWFUL, AND SHALL SUBJE T AN EMPLOYER TOCRIMINI\l;'PE'.NA;:,!ES AND CIVil
. FINES UPTO ONE HUNDRED TI-tOUSAND DOLLARS ($100,000), IN AC.';"'IO:'-I to THE
COST OF COMPENSATION. DAMAGES ASPROVIDED FOR IN SE'.CTI~";';7C5 OF THE
. LABOR CODE, INTEREST AND ATTORNEY'S FEES. . , :
I CONSTRUCTION LENDING AGENCY~_. .,!..~' ..
! here,?,} affirm _u~e!p~,-",~I!Y_9f~rild..ryJhat t/:1_ere!S_3__~onstrllct;')_!1 i~_",'iir::r'":~',:;r.::.).~J(:!'.t~g
pi"-i0rmaric;e-o-rth-e vlork forwnidl this permit is issued (8ec.3097 .Civ.C): .,
. Lende(s Information:
Construcion Tvpt:Js:
VN, .
Fire Sprinklered?"
LivinQ Area:'
Patio Area:
NO
365
35
",
, I certify that Lhave read this application and state that the above information is correct. I
agree_to. comply with all city ordinances and state I(:i:ws relating to buildingccnstructio(t, and
hereby ~uthorize representives of this city to enter upon the above mentione':J property for
InSRectioqS%- -e . .' .
..-J?- . . . ct-1A-Q
'. I ature of Applicant or Agent.
The permit shall expire bylimitatio!l and become null and void if th" building'or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or'continue work. .
,Fees paid for Permit:
Total:
929,70 >.
Date 11/21/2003
INSPECTION RECORD'
INSPECTION, ,
INSPECTOR I
I
I
L
DATE
w
Temporary Power Pole
Plumbing (DrainM'aste Pipe)
Electrical Groond Electrode/Ufer
Setback/For.msfTrenches (Footings)
,Do not install. sllbfloor or pour floor slab until the
following applicable items have been signed: .
Plumbing (Water Pipe,Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit) .
re-slab ompOOtlO .' Membrane.Reinf.
Underpinning (Floor JoistlGirtlers) '"
natcover or con<;eal the work elow unt,l the
following applicable items have been signed:
1st Floor Shear'
Firesprinkler (Rough)
2nd Floor Shear '.
Roof (Sheathing/Diaphragm/Frame)
Masonry. (ReinfJBond BeamlPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough ectrical (
Rou h Electrical
Framing (Only afterPlbg.; Elec.. t-":ectl... and Fin;;)
Insulation (SouncllEnergy)
po not tape or pla~ter until the following applicable
,tems have been Signed: . . . .
a all
Penetrations (Fire Rated) Electricai
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing .
litteri9rLath
Exterior lath
!
FINAL.lNSPECTIONS
Electrical Final
Plumbing Final
Mechanical F.inal
Gas Test
Engineering/Grading Final '765.5126
Fire aept: Final 765..4040
Water Engineeriog 765-5268
Sub listll3usinells License 765.519
. .Zoning 765.5139
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GENERAL ITEMS
Exterior Plaster (Brown Coat) . 0& 'rI
T .Bar Electrical
T.Bar Mechanical.
T -Bar Structural
Sewer
Water Engineering Backflow
Water Sa ice
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