105 E. Wakefield Ave.
BUILDING PERMIT.NO. BLD2004-G2346
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BUILDING DIVISiON
200 S. ANAHEIM BLVD.
(714) 765: 5153
INSPECnON REQUEST LINE,
(714) 765' 4626
CENSUS CODE, 434
QUARTER SECTION: 98
TYPE OF PERMIT
Repair
.'
DATE .9/20/2004
JOB ADDRESS, 1,05 E WAKEFIELD f'VE
LEGAL DESCRIPTION: N TR 3419 LOT 1
CONTRAcTOR INFORMhION'
K B BROWN CONSTRUCTION CO
126 POMONA AVE ,
MONROVIA, CA 9101S0'XJO
BUSINESS PHONE, 626911249
JOB DESCR1PTIONRe5. idenlial Repair. Fire damage repair at Unit #7 and lht ga'"96.. s. .
VALUATION:. 75,000.00 '.
I '. . . . . OWNER-BUILDH DECLARATiON
I h'ereby affirm-under penalty-of perjury-that I am exempt frpm the Contract(:. 'sUcense Law for the following mason. (89C. 70.31.5 Business and
Professions Code: 8_ny dty or county which requires a-permit to constllJct, ~" ?_~" impiov.e, demolish or repair any structure, priqr to'jts Issuance,. also
req~ires the,8ppliC3nt for s~ch permit to fife a signed statement that h~isHc: ';-jsE:d P~;'~llar'lt 'totheprovts!9ns of the Contractor's License law (Chapter
'9)(commencing with 8ectlon70'00 bfDivision 3 of the Bus.Jnessand Frofes~~.,_jns COde} or that he!s exempl. therefrom and the basis for the alleged
"exemption.Any violation of Secti,or. 7031.5 by any applicant for a perrr.(t-su:jects"the .:,;pplicant to a' dv~ penalty of (1otmore than five hundred'(f.ollars
($50'0). ..,' . . '." . . . . ."... .'. .
o ,1; as ownerof property, or my employees with wages'as.,their s(.l!e ~.cm' ~nsa~fnn, WIll de the work, and thestn;cturc(!s nofintendeci0r offered for
saje_(~~c. 7044 -Sus"iness and Professions Code: The'9ontrd_('.tor's Ucen:;-c~, a;~)joc_~_!)~jl aj:'~::Y t::.: ail i)Wner of property who buildsor improves
the'r.eon" and who does suctrwork ~imself or he !Self or through,his or her o\l':empluY9":S, provldeotl1at such jrnpl"Ovem~nts are not intended or
offE;!:red fOL~le, 'If. however, the bu!icfing or improvement is sold~~:.Hh one 'J , "j of.cpinpletioll" the owner-bunder will have the burden of !Xo"ing that he
:didtiotl:>uildorirripro'v~forthi?:puiPos'eofsale). ,. i, >_ ;' ._",. '~---. .. _ _ ._
0:,( aS,the owner ofti1e propet1Y., ~m,exclusi\lely cQl'etracting with license.. ,~i1t,;ador3 ~o cQr:~1rud the project (See, '7044 Busir1cssand Pr9fe~iOns
Code; The Contractor'~ License Law doe~i'not_apply to ~n o.w-ner of properi.~ ';v~)O bl,lilds orim:..,roves thereon, and who O?ntracts for st:ch projects with
FL'fl?ntracto~(s) Iice~ed pursuant to the Ccntractor's License Law}. .
.U lame)(empt-underS~c. "'. ,B & P.C. for this reasoJ'l:
Date': ,':'Own'er:
I . . '. . WORKER'S COMPENSAtiON DECLARATION l' L LICENSED CONTRACTORSDECLARATI€]
I hE!r~Qyafflrrn under penalty otperjury oneoOhe following declaratians:,y\. _ . :' I. ',I he,~ebyaffjrm"lJnder pe , of perjllf)' ~hat I C'm._ .
Qt,have and\\lil\'~intain a ~ertjfic-ate'of consent to self-in$ure for_weiKel:' ..~~(;!~'p,em~ati?i1:-" l:ce~s~du'ricfer pro'/i,sionsof ::\p r 9 {co.mrr.ancing ,
a. s.pr<:>v.,i~e. d for bY. Sect.ion3700-of the La~r COde. . for the peFforman~ d;':'l'B.~:;O~!:.. forw.mC1lj
~hi permit isisst./ed. . . ' , .
. ,I have and wH! '.naintain worker's compensation insurance, as reqUlredtl:Section 370,9 of I 9/20/2004
. ,the LaborCode, for the perforr:nance of the work for whlc.h this permit is i$$":'~I:L MY"'\fOrKer's .,. Date:
Compensation insurance carrier and policy are: ,.' ' . .' .
Carrier: FREMONT ' . Policy Nu.mber: .16136162.093 I
This section 'need not be co'!lpleted if the pennit IS for on~ hundred doilars _i$f~J ~.r less. ' t
o -, certify that in the perfo011a,Ace ofthe work for W.'hich this' permit is"isSU~~lGhal! not
em~loy any person in any manner so as to become subject to the worker's;'c~:j\pensatiGn laws
of, California, and agree. that.if I_should become su .~ct to the wo~er's COnipi..H~saiion
provisions of Section 3700 of the Labor Code, . t' hwith comply with,t:p::>.eprovlsions.
t:
Date:- 9/20/2004 Applicant, ::,.
WARNING: FAILURE TO SECUR WO KER'S COMPENSATION COVER!\j:;;EIS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE~JAiltJES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000),' iNAOO'.lION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIO~i,3709 OF TfiE
LABOR CODE, INTEREST AND ATTORNEY'S FEES: y. .' . i .' ".
I . . . CONSTRUCTIONLENDINGAGENCY-,.': i~
I hereby affirm 'u~er penalty~f. perj~ry ~hat ~h~r~ is a ~:~~trt~C}~o-".~en~,~~g~i:"',n~~ ~~-~the~
-;;c-ifOti;";S,.,~ '.of ~n,<> .....otkfor wi'nd.-t\',r$ P-;:;-fi'-,it-,$ i:.~~e(,f\ ':>~~';}vl;71 ,\.,.IY.(,( . - _ .
Lender's Information:
. APPLICANT: HANS C HANSEN
OWNER INFORMATION,
Janet A Lloyd
105.E Wakefi.eld Ave
Anaheim,. CA:' 92802
ARCHITECT/ENGINEER INFORMATION:
HANS C HANSEN
173711RYINE BL #200
TUSTiN, CA 92780
. PROCESSED BY: JJJ
Contractc:-
NUMBER
385923
TYPE'
TYPE
fl'
Hie
EXPIRATION DATE
12/31/io05
Co'nst(uCion Types;
VN, .
Occupancy Groups:
R3" "
Fire Sorinklered?
N~? '.j
Fees paid for Permit: .
Total:
1,527.59
Dale. 912012004
Signature of Applicant or Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
. new permit is required to commence or contiilUe work.
INSPECTION RECORD
,i
ii'
" ' , INSPECTION " , DATE, INSPECTOR
, ' ,
Tl!mporary Powl!r poll! , ,
, Plumbing (Drain/Wastl! Pipl!)
, ,
Eklctrical Ground Ell!ctl'O,h"Ufl!r
SE!lbacklFormslTrl!nches (Footings) ,
Do not install subflQQr orpourfloor slab unlil Ihe '
following, applicable items have been signed:,
Plumbing (Water P1pe.Sprinkklr Valves)
, Mechanical (Groundw9rk) " ,
Eklctrical (Underground Conduit) " ' ,
PI&-slab (Compaction/Membrane.Rei nt.
,Underpinning (Floor Joist/Girders) , ,
Do nolcover or conceal Ihe work below until Ihe,
following ,app'lic<lple items have Peen signed: ' ,
1 sl Floor Shear ' ,
, FireSprinkler, (Rough)
2nd Fioor Shear' " - ,
RQof (Sheathing/Diaphragm/Frane) t?-$-"'- r I' ./r""'L.
Masonry (ReinfJBond BeamlPre-GlO\It) 1./
Rough Plumbing (Top Outl
ROllgh Mechanical, ,
Rough 1:lec1<1cal (Dry WaUl
Rough Elecirical " ' .
", Framing fOnly after Plbg.. Elec.. Mech 'and Fire)
Insulatipn (SoundlEnergy)
PO not tllpe or,pla~ler, until the following applicable ,
It~ms have been sl,gned: . . - , ' ,
Drywall " , , '
Penetrations (Fire Rated) Electllcal
Penetrations (Fire Ratedl Mechanical
Pen,etrations (Fire Rated) Plumbil1!l ,
Interior lath '
Exterior Lllth ' ,
, , GENERAL ITEMS " "
" Exterior Plaster (Brown Coat)
T -Bar Electriclll J , /
T -Bar Mechllniclll ,
T-Bar'Structural , ,
, Sewer .,
,', Water Engineering Backflow , .
Water Service ' ' ,
" ,
FINAL INSPECTIONS.
Electi"ical Final
-
'~
"
Plumbing Final
Mechanical Final
Gas Tl!st
Engif1l!'lring/Grading Final 765-5126,
Firl! Dl!pt. Final 765-4040
Wall!r E,nginel!ring 765.5268
Sub UsllBusiMSS li,cem;;e 71;5.519 ~'"'i"-o
Zoning 765-5139
Building F,nal ILast Inspection- Only ,,., ,)tJ-
,', After Above Completel ~ '
PART'AlINSPECTIONS
BuildinQ Inspections ' . , , '
,~ 'S'~~f$nu'!$.~&4MK>.
',Mechanical Inspections'
,Plumbing Inspections
ElectricallnSDections