1746 William Miller Dr.
BUILDING PERMIT NO. BLD2004-01575
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BUILDING DIVISION
200 8. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 43
TYPE OF PERMIT- .
Residential. Remodel C I TV
DATE: 5/13/2004
. JOB ADDRESS: 1746 S WILLIAM MILLER DR
LEGA.L DESCRIPTION: N TR 1808 LOT 7
APPLICANT: KELVIN LUONG
ciWNERINFORMATION: . CONTRACTOR INFORM/-TION:. ARCHITECT/ENGINEER INFORMATION:
. .KELVIN LUONG
1746 S Wi"lIiam' Milier Dr
Anahei m, cA 92804 .
. JOB DESCRIPTION:lssued permit-for relocated interior wall, work done_witholir permits or.inspections.
VALUATION: . . 500.00
I OWNER-BUILDE!{DECLARA TION
I hereby affirm under penalty of perjury that I am exempffrom -the Contractc-:<:: Ucens~ Law for the following reason (Sec. 7031,5 Business and
Professions Code: a ny:dty orcoulltywliich req uires a permit to construct; a :ter._ ir:nprove,demoli~h or repa ir any structure, priOrto its_issuance, also
requires,the ,applicant forsuch perrt')it to ,file a signed stat-ement that he 1:5 lid~n:sed pursuant to the provisions.ofthe Contractor's Li<;:ense Law' (Chapter
'9)(comn;encing with Section ,7000 of Division ,3 of the_Business and Prcfes~~ri~~Code) or that he is exempt therefrom and the basis for the'alleged
exempti' fl.. Ally'violationcf Section-7031.5 by any applicant fer a perm:t sll.5.j....cns 'the applicant to a dvil penalty of not more than five hundred dollars
(S5 '.' .... ...... !. ..' . . . . ....
I I,' as owner of property, or my employees with wages...as.lheirsol~ corr..~~.i.sation, will do the work.-, and the structure is'nat intended or offered for'
(See: 7044' Busin~ss.andProfessions Code: The.C.onti'.3ctor's Licl:1nse(~.w dces not app1'y to an owner of property who builds or improves
thorean,.and whoqoes sudl worf<.himself orherse!f orthroLlgh bis or her OWil'}.rnployeesr,provlded that such improvements are'not intended of' .
of(eredJar sale'. If, however, the building or improvement is scld with one V;.'-'3i: of tOmpleti'on, the owner-buirder wil) have the barden of proving that he
did notbulldor i.mprove'forthe'purpose.of sale), . __~. '~j ,', . '. . '."."
[J.. I, as the .owner .o(uie property, .am exdusively contraC:-i,ng '.~"ith I!cens'edi';;mractors to construct-the project(Se~_7044 BIJsinessand ProfesSions "
Code:,Th,e GontraGtor's License'Law doe's not apply to. an owner'of prooerty,'-vhot.uil(:ls'.cr improves thereon. and who OO!ltracts fo~ such projectS WITh
[Jo~tractbr(SJ-I!C~nSed,~rsuant ,to the Co~tr~ctor's Li~~se Law,I,;, .
., 1 am' exem;:>t" underSec", . .C, for th~s r f"Of'l:,
Date: Owner:
I . WORKER'S COM ,ENSATION DEClAR nON -_,__~
I hereby, ?lffirm under pefJa1ty of perjury cine of the following deClarations:, i
'0 :J;:~~ve an(~i.1I ~intain a' 9~rtificafe of co~sent t'J self-insure fel wCrk€(j3 ~'Jt1.1pen~ation,
,:'5 pro'{j.cledJcfr bySectJon 3700 of-the Labor C:ode, for the performance-of ti:\_~.WOrK for which
-.thi::; pefri-fit.rS:issued. . . ,'.' '." ,:
[J I,h,aye .and will mair;'ltafn worf5er's compensation insurancc',as require~ t;, Section 3700 of
th3 Lebor Code, for the petf?rmance'of the work for which ff.ils,perrnit is issl).j:d. Myworker's
Compensation insur~nce carrier and poilc:yare:' 'I". ~
Carrier; , 'Polic,! Nu-mber.
PROCESSED BY:CAL
I
LICENSED CONTRACTORS DECLARATION
I here y affirm under penalty of perjury that I am
licensed under provisions ofchaptet._9'(cominEmcing
,with Sedion 7000) of DivsiO'l1 ~ of the_Business and'
Professions Code. .
5/13/2004
Date:
C9ntr~ctor
NUMBER
EXPIRATION D"TE
, / . ,-'-
.' 'This seC~,i_OI.1, need not -be completed if the pennit 'j's for one hundred doilar5!$"i. ~H,':'nr :ess~ "
~rtify that in the perfom,ance of the work for whic~ this'permit jsiss'J~1::1 shall not
~pr~y -ahy. person in any'manrie.r so as to be'come subject' to the worker.~:,c(.j'npensatIon laws
of C?,lifomia,and agree that if I sho'uld become 'subject to the worker's C01'Tl;)~~qsation
provisions of Section 3700 of the Labor C . shall forthwith co. ply wi~h ~r:')~e provi:sions:
TYPE
Date: -5/13/2004 Applicant: .
WARNING: FAILURE TO SECURE RKER'S COMPENSAT;QN.COVEKAGE IS
UNLAWFUL, AND SHALL SUBJECTAN EMPLOYER TO CRiMINAL PENhT!ES AND CIVIL
. FINESUPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADrATION TO THE
COST'QF COMPENSATION, DAMAGES AS PROVIDED FOR INSECT!O~' 3706 OF THE
LABOR CODE, INTEREST ANO ATTORNEY'S FEES.. -,. .
I. -. CONSTRUCTION LENDING AGENCY';.!
I hereby aftirm under penalty of perjury that there is a con3truction ler'iding a.'l.ency for the
De~or~!",:~. of 't~e ~ork ~or wh,ich .t~is p~rrnit is iSSlldd (Sec..3037 .Ciy-,_~~_~,:.-L .
;':~Iiuc:a d: .illvlil;a.iJ0f1:
Construcion Types:
VN, ,
Fire&prinklered? NO
I certify that I have read this a pplicationand ,state thatthe above information is correct. I
agree-to romplywith all city ordinances and state laws retating tb buDding cO:lstruction, and
hereby authoriz~ re nt!ves of this city to enter upon the abovementioned property for
inspection purpq s
Fees paid for Permit:
Total: 0.50
. '. ignature of Appli~nt or Age
The permit hall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date ofperlT.it issuance. A
. new permit is required'to commence or continue work.
Date: 5/13/2004
INSPECTION RECORD
. ,.
! INSPECTION .... DATE .., INSPECTOR
Temporary Power Pole . . . . ,
Plumbing (DrainlWaste Pipe) . : .
, Electrical GroundElectrodelUfer .
. SetbacklForms/Treriches (Footings) . .. .
. Do hot install subfloor or pour floor slab until the
following applicable items have been signed: .
Plumbing (Water Pipe,Sprinkler Valves) .
Mechanical (GroundwOrk) . .' .
. Electrical (underground Conduit) .
Pre-slab (CompactionlM8Il)brane.Rei nt. .
Underpinning (Floor Joist/Girders). .' .
Do not cover or conceal the work below until the
following applicable items have been signed: . '. .
1 st Floor Shear '. . , , .'
Firesprinkler (Rough) . . . '....
2nd Floor .Shear : . . '.
Roof (Sheathing/Diaphr,lgmlFrame) ,
. Masonry (ReinfJBond BeamlPre.Grout) .
Rough Plumbing (Top 'Out) . ".
Rough Mechanical " '" , '. . .
Rough ~ect..cal (Dry wall) :.
Rough Ele~ric:al . .' .
'. Framing ',(Ordy after Plbg., Elec..Mech.. and"Fire)' .
Insulation (SoundlEnergy). .
po not tape Qr pla~ter until the following applicable .
Items, have been signed:, ....'.. - . " .
Drywall . .' . : .
.Penetrations (Fire Rated) EI.ectrical', . . .
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 -Ba'-Structural " . . .
Sewer. . . '. . . .'
Water Engineering .Backflow ., .
.
Water Service
FINAL INSPECTIONS.
Electrical Final
Plumbing Final.
Mechanical Final,
.GasTest
Engineering/Grading Final 765-5126
Fire Dept, Final 765-4040
Water Engineering 765-5268
Sub List/Busine.ss License 765-519
Zoning 765-5139
Building Final, flast Inspection- Only
. After Above Complete)
.PARTIAL INSPECTIONS
Buildina Inspections
, .
. Mechanical Inspections ..
Plurnbino'.lnspectibnll
. .
ElectricallnsDections . .
BUILDING PERMIT NO. BlD2004-015i4
TYPE OF PERMIT C.ITY
Patio Cover
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BUILDING DIVISION
200 S: ANAHEIM BLVD,
(714)765.5153
INSPECTION REQUESTLINE:
(714) 765: 4626
, CENSUS CODE: 434
QUARTER SECTION: 43,
DATE: 5f7/2004
JOB ADQRESS: 1746 S WILLIAM MILLER DR
LEGAL DESCRIPTION: N TR Hi08 LOT 7
APPLICANT: KELVIN LUONG
OWNER INFORMATION:,
, KELVIN LUONG
1746 SWIINam Miller Dr
Anaheim, CA 92804
JOB DESCRIPTION Solid roof patio cover4'~8" x 33'.6", (HIH)
, VALUATION: 2;342,00
'I OWNER-BUILDER ~'ECLARATION
I hereby affIrm Linde rpena Ity of perjur.y that I am exemptfrom tHe Gontractor'~ Uc~nse,law for the following reason' (8'ec. 7031.5Bus_iness BRd
Professions Code:anydty or county which requires a permit to cpnstruct, alte:'i", improve, aemolish or repair any structure, priortoits issuance, also
. requires lhe 8pplJcan't tor,such" permit to ,file a si9r:ed s~atement that,he is liC~:~:St::d,pursuant to the provisions of the COf".ltractor's .License La.w (Chapter.
9}(comh'lencing with Section 7000,of Division ;3 of the Busi.ness and Professiql~ Code),or th<:it he is exempt therefrom and the basis for the alleged
.exemption.' ,Any violatIon of Section 7031.5 by 'any applicant for a permit su.bj~~t~ the applici:mt to a;civil peria~yof not more than five h4ndred'dollars
. ~O?)~s owner of property, or my employees with wages as their so]ecomPEh"atio~, will do th~ work, and thestruclure is not intendedor offe;ect for
~,e (~e'c. 7044 Business and Professions Code: The C,ontractor's License l:;:!\o.~ does not apply toan owner of property who huildsor improves,
thereon~ and who does SUdl work himself'ot herself or through hi,-:: ur her owr,:amployees"provided that suchim'provements _arenot inten<;led or .
offered for sale. .If, however, t!1e ~uilding or improvement is sold with one yea,~ ofoompletion, the.owner-builder'willhave'the-burden of proving that he
did not buildor improve for the purpose of'saLe). ", ,.__1: ',.
o. I,as_the own.er of the property, am exdl!~iV'ely contracting with licensed. (t<,jltractor:=: tocrnstruct the projecr(Sec. 7044 Business_ and Professions
Code: The C'ontractor's License.,Law does not apply to an own.erof propertY~_;;'iO builds or improves thereon, and who oontracts for such projects with
Uon.trAct.or(S},IiCenS~d pursuant to~heContractor's License La\:,j, t '
-.J. I am ex mpt under se~~. . & P.,;.C. for.this an:' r
i( Date: ?" 0;::), 'Owner: f\....
WORKER'S PENSATION DE CLARA ION .,
I her~by affirm under penalty of perjury one of the following declarations' '. ~ .
D I' have and will maintain ac:ertifi~ate of ~nsent to self-insu.refor worker's;ompensation,
as prqvided forby Section '3700 of' the 'l..abor:Coqe, for the pe rforman ceo of th e\.vo rk fa r whidl
this. Permit ,is'issued,.,,':'::- _" . _'. _ ' _;';
o I have 'and will maintain wOrker's '90mp.ensation insurance, as required bi';.'Section 3700 bf 'f>17/2004
, the Labor Code"for the performance of the work for which-thls permit is issLie.(f~ Myworker's Date:
Compensation insurance carrier and -policy are: ~.r:
. Carrier: Policy Number. 'f
This sec~on-iteed not be comple~d ifthe_pennit is for pne hundredqollars ($100)-~'f less,
o ,I certify that in the'performance of the work ,for which this permit is issued: I shall not .
employ any person,in any manner so as to become subject to the worker's cor~lpensation ,laws
of California, and agree that if I should become subject to the worker's comper$ation.
provisions of Section 3700 of the L ar Cod hall forthwfth comp( witht!:lo.{4'provisions.
, .-;.j..t- .
,Date:' 5/7/20.04 Applican. ~' -'
WARN]NG: FAILURE TO SECUREW RKER'S COMPENSATION OVERP,GE]S
UNLAWFUL. AND. SHALL SUBJECT AN EMPLOYER TO CRIMIN PENAL 'qjEs AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDti10N TOTtlE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OFTHE.
,LABOR CODE, INTEREST AND ATTORNEY'S FEES,'" . ' "
I CONSTRUCTION LENDING AGENCY ,
, I hereby affirm under penalty of perjury that there is a construction lending age lCY for the
performance of the work ~or which.this.peri"nit is issued {Sec.3097 .Civ.C): .
Lenger's tnformation:
,
CONTRACTOR INFORMAiION:
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: PMK
LICENSED CONTRACTORS DECLARATION
I hereby affirm urider penalty of perjury that lam
licensed under p.rovisions of chapter 9 (commencing
with Section 7000) of Divsion 3.of the Business and
Professions_Code-. .
Contractor
NUMBER
EXP]RAT]ON DATE
TYPE
Construcion Types:
VN, ,
Fire Sprinklered?
NO'
L
I certify that I have read this application and state thaUhe above information is cOirect. I
agreeta.. ootnply with all cIty ordinances and state laws relating to building construction, and
heteby authorize representives of this city to"enter upon.the aboye mentioned prope_rty for- -
'os e' rposes.
II\. Date: 5/7/2004
, ,Signature ofApplica t or Agent
The permit shall expire by limO io.n and become null and void if the building or
work has not passed final insp tion 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
0.50
INSPECTION RECORD
. .... INSPECTION . DATE INSPECTOR
Temporary Power Pole .
Plumblng(Drain/Waste Pipe) . . . .
. Electrica! Ground ElectrpdelUfer' ". ~..
SetbacklFormsfTrenches (Footings) ~
Do not installsubfloor or pour floor slab lmti I the /.
'. following applicable items have been signed: .
Plumbing (Water Pipe.Sprinkler Valves) .
Mechanical (Groundwork) . . '.
Electr.ical (Unr.lerground COnduit) . ..
Pre.,slab (CompactionlMeml?rane.Reinf.) .':. .'
Underpinning (Aoor Joist/Girders)'
Do .not cover or conceal the worK below until the
following applicable items have been signed: . .
1 sl Floor Shear . . . .'
Firesprinkler(Rough) . .
2nd FlOor Shear '. . ./
Roof (SheathinglDiaphragrn'Frame) .
. Masonry (R/!infJBond BeamlPre-Grout) . . . I
Rough Plumbing (Top Out) .
R<!ugh Mechanical
'Rough t:Iec~lC.. ,....y ..'all) . .
Rough Electrical '. .
Framing. (OnlyafterPlbg.,Elec" Mech..and'Fire) . .
Insulation (SoundlEnergy) .
Do not tape or plaster until the following applicable . .
items have been signed: ' '. .
Drywall . . ..' . . . . . ... I '. . 1
Penetrations (Fire Rated) EleCtrical' .1
P<metratlons (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing .'. .
Interior Lath . .... .
Exterior Lath . .
.' . GENERAL ITEMS . .
Exterior Plaster (BlOWn Coal) .
T .Bar Electrical . . .' .
T.Bar Mechanical .
T-Bar Structural '. . . .
Sewer. '.
Water Engineering Backflow .
Water Service .
FINAL INSPECTIONS' . I:' D.ate . Inspector. .
Electrical Final. . , . .:. . .
Plumbing Final I.
Mechanical Final' .
Gas Test . . .
.
Engineering/Grading F.inal 765-5126 I.... . .'
Fire Dept. Fi~al '165-4040 '. '. .' . . . . '.
Water Engineering 765;5268 .' .
Sub List/Business License 76,5-519 , I. ....
Zoning 765~5139 . " 1 '::'
. .
Building Final ~astlnspection. Only 3/1{/o; 1<: .Q. .A'
. - .... . fler Above Complete) ':
PARTIAL.INSPECTIONS
BuildinCllnspections
'-..u>'''l e.
. t....~ I "'"1
Mechanical Inspections
. .
Plumbina Inspections
. Electrical Inspections
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BY
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ISTRICT REVIEW;
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SEE BUilDING PERMIT FOR
ANY CONDITIONS
~~, of ?C~~
dr . 1746 South William Miller Drive
Property ad ess. h' CA 92840
Ana elm,
House
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*lliE Vtl$r~ ~~~ES OF THE CITY,
THE HOL.OER OF HIS PERMIT
PRO EECS AT HI OWN RISK,
MAY 0 7 2004
BUILDING DIVISION OFANAHEfM
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Patio depth -"1- ~
Patio width - 33. f.::
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Solid roof covering
Lattice cover
12' '1--11
Pilch 1_
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1- Overhang
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SIDE VIEW SECTION
(< ",,:,:. .'.": .:::: :.,',':' . .....,:~.;"" -.:. :.: .>/= ~. '." ':.' .: :.;:: .:".~ . ;
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. .. FRONT VIEW ELEVATION
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Footings: ~ inches square x 12 inches deep
Posts: -4- " x .!:L- "
Headers: '1 "x 10 " (or) two~"x-.1!2...."
Rafters: ~"x -!1--" spaced ~ 2--" on center OR
Two " x " spaced " on center
Solid Roof: .1..11:::..." Rated plywood sheathing with exl. glue
_" x _ solid wood sheathing
With ?PM ~hi/lafe.. roof covering
L..tt> _ COllet:: "x " spaced " on center
Building Division Approval
Zoning Division Approval
RAFTER SPAN: #2 Douglas Fir
Lattice or solid roof.
Rafter Rafter Spacing
Size 12" O.t. 16"o.c. 24"o.c. 32"o.c.
2~ ; 13' ~ 0" 11'.6" 9' .6" 8' ~ 0"
2x6 19'... O'l 11'-0" 13' - ...9" 12' ~ 0"
2x8 20'...0" 20' -0" 17'-6" 15' -3"
2 x 10 20' ...0" 20' -0" 20' - 0" 18' - 6"
2x 12 20'... 0" 20'-0" 20'.0" 20' -0"
Max. span of
rafter with a
Ujrto 8 ft.
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Up 10 14 ft.
2.18" square - 12 inches deep. 3.21 inches square- 12 inches deep.
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,
... Ifthe value of the patio cover exceeds $1,000, Smoke Detectors ,.....
are required to be installed in each sleeping room, the areas giving ,....
access to the sleeping rooms, and on both floors if two story.
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PROPERTY OWNER: '( e-\",,, L'^-.p~ ,
Lei: \\,"''''' /wl\.er D^ I
ADDRESS: \7"-tb 5:..
,k~';'" CA C1'2-j 0 'T
Phone: 71<.; i'll. (Z.'-<J... Date: '/7/0'+
.1..)'10. ~, SQUARE FOOT PATIO COVER
TYPE0FPERMIT CITY
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BUILDING DIVISION
200 S. AijAHEIM 8LVD.
(714) 765. 5153
- INSPECTION REQUEST LINE:
(714) 765,4626
CENSUS CODE: 434
QUARTER SECTION: 43 \".
BUILDING PERMIT NO. .BLD2004-01709
DATE: 5/13/2004
JOB ADDRESS: 1746 S WilLIAM MillER DR
. lEGAL DESCRIPTION: N TR .1808 LOT 7
';.
,
-
APPLICANT: KELViN LUONG
OWNER INFORMATION:
, Thinh'T Nguyen"
1746 S WiUiam Miller Dr "
. Anaheim, CA 92804 . . '.' .: { . .
J013 DESCRIPTIONRe-rool and, install 8sq of "roll roofing" over 1 layer on P"li'f roof (HI.H)
VALUATION: 900.00" . 'I . PROCESSED BY: HRO
,. . OWNER-BUILDER\PECLARATlbN' "~
I hereby aff.irm under p~naJ~y ,of perjury that I am exempt from the Co~troctQrfUCensErLaw ,for the fOllowing reacon'(Sec;. 79?1:5,Business and "
p~ressjons COde: any dty.or county which requ;res a permit to constrllct;-_?!t~,-; ijl,pi.ove, demolish'or re'pairany struc:tur~lpr:6(.tQj~ issuanc~, also .
requires '~he applica;-:tforsuch permit to file a s!gned statement th_athe i$Jlc~~~ed pur::PJ;:lnt to the'provisions onh~C_ontraq';{)':'$Lib:l:Os'eLaw (Chapter
9){co~mencing with Section 7000 bfpivision' 3 of the Bus.i(less and PfOfeS$i,~t\f:. 9od~) or th::tt,he is exe'!'pt ,therefror.T<:!n?:i~~_ba$is for-the_alleged
exemption, Any violation of Se<:;tion-7031.5 by any applicant for a permit S'.lt.];3cts the applica.nt to a- dv~ penaity of "ot more than five' h.undred doltars
, ,~O'~\s' 0\. .nerof pro.p~rtY:' 0; my. employees,With wages a~ their sOI..co",!p,.">_._i~.,s"t;c", will'QO the WO.~k, andt~e StrLete',;, .'soot!".te. oded o'r.'p~e.r.ed f~~ .
~Sec.. 7044 Business and Professions Cede: ,The Contractor's Ucer.tse 1.11\N ,joe~ not apply to an owner of prope~ty \l'J-ho builds o~'improves
, tner.eo'n,and whod:oes,such-.work hlmeelf or,herselfofthrough hi,S 0: her ov:'{~mproyee:::, provfded that such improyements are not intended or . .' .
o:ffere-dfcr.sale. If,h~,~ver,':th~_ buildlng 01 lmprovem~nt is sold with one y~<ll;~ ~f '.compl€'ti9n. the owner-b~.iider will have,tr.e -i:.vJlde.n of provir.g t.ha1 Re..~
.did not build or improve.forthe purpose of sale), . . ' d -', . ',:, .' " . .' "
n I, as, the owner ottheproperty, 'am exdl;SiVe,lY contracting with licensed &;ntra,ct~lrsto,constn.ict the projed (SeG;-".704..~' Business'and 'Professions '
. Cod~: The Gontrac~or's License ~aw does not apply to an owner ofp~0pe:-ty :J,'~o b:Jilds cr improves,thereon::3ruf who' oontl.?cts f~r such projects-with .
E::Jontractor(s)ticensed.pur~uantto ~he Contra~tor'sLicenseLaw). l , ., -- :, ,. "
,..I~.mex mpt. n~erSe~<.. " P..C. for.this:r~~on: '__~~---;-.
....vale: '> 0 . Owner:^ ~_ !
-- WORKER'SCO ENSATION r;ECLARATI -"'"C=-__:::J
i hereby affirm' ~nder'pcnalty of p~rjury one.of.the foJ/owing dedarations: i .
o I hq\i~ and wHl maintain-a certi.ficate_ of cOnsent to serrjnsure'for work~r"~'::<)r,1pe.l"\Sation,
as' provided for by Sectiori~700 Of the Labor Code, for the performance of t;'I.l.wo!"k.for "Yhich
this permit is issued. ", , '~
o 1- have and will'maintajn w~rker's compensatiOlTirrsurance; as required b~Secticn3700 of
the labor Code, for the. perfortnance of the .vork for which this permit i6 iss~;:;'!~.' Myw;lrt.:er's
C-ompeliSation i,nsurance carrier anti poHcyare:' .
Carrier:
i
{
CONTRACTORINFORMAr;ON:
. ARCHITECT/ENGINEER INFORMATION:
[ LICENSED CONTRACTORS DECLARAiJ~N .t
1_. .. . I he~E:bv 3ffirm _ur::~~r pE'nalty ofperj~ry that I ~ril
iic~nsed under provIsions-of ch~pt'er9 (commencing
with Se_cUor,700C) of O:\lSiOn 3 of the Business and' .
professions Code. .
511312004
Date: .
COr]triictor
Pol}cy Number. 'd
. . 1
This section need, not be' ~mplet~d if the pennit is for ona hundred doll,ars t$1~_t);:'.;.( 'Iess. " .
O. l~er:tjfy that in th~'perf6rri1anC'e ofttWworkfor-which'thiS permit is'issu.o;.c:: 1-~l1an not' . ..
employ anY,person in any m<3nner~o as.to becomesu,bjecticr-the worker's cv;npeos'atlon la\vs
of Califoniia,- -and agree that tf f should become s 'ect,tothe WOlker's. comp-=-;,:saticn
provisions C?f Section 3700 ~ftheLa'bor Co_ II forthwith c7m Y WI thc-:e prcvlsio.1S.
. , ,.
Date: 5/1312004 Applicani: . '-
. WARNING: FAILURE TO SECURE KER'S COMPENSATION CO .RJ-,GE'S
UNLAWFUL, AND SHALL SlJSJEGTAN EMPLOYER TO.CRIMINAL PENAC:' :ES AND CIVIL
FINES UPTO ONE HUNDRED THOLiSANDDOLLARS ($100,000), IN ADD! nON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 'j>C6 OF THE,
LABOR CODE, INTEREST AND ATTORNEY'S FEES. . .
I '. CONSTRUCTION LENDING AGENCY__
lh~rebY affirm under p~nalty of,. pe.rj.~ry~t ~h~r:-is a ??n~tr:cti~_ ~:ndi:'l~~ ag-,'ncy for thf~
-:~$~C''':ic-:~~Z-.cJ-t!:~ 'N(;''':,~-b:" ';';:~i.;.':; -~;";-;;:: ;:;.;.>;-;,,;.t:d<:';~;.<<, \s.::,~v:~.';'....,';:;:;-';: __I..- -
Lend~r's Information:
NUMBER
E.XPIRATION DATE
rYPE
Construcion T\;"pes:
VN" .
I Fire.sprinkle-red?,
NO
I certify that I have' read 'this application _and state that the above in'formation h; correct. I
agreet6 comply with all city ordinances and, state laws rel.ating to building cor,struction. and
hereby'aut rize-representives 'of this dty to enter upon the above mentioned prdperty for
1M,. "p iOn u sa. s~ . _' /. .
, , 06. . 'Date: 511312004
Signature of Applicant or
.Th permit shall expire by limitation nd become null and void if the building or
work has not passed finallnspection.365 days from the date of permit i.ssuance. A
new permit is required to commericeor continue W()I'k.
Fees pa!d for Permit:
Total:
0.50
INSPECTION RECORD
. .. ,. ..
.. ,NSPECTION .. . DATE INSPECTOR
TempC!raryPower Pole.
PIl,.mbing (Drain/Waste Pipe) .
EIeClr.icat Ground Electrode/Utei' . .
.
SetbacklForinsfTrenclJes "(Footings) . . .
Do nC!tinstall sub floor or pOllr floor. slab until the . .
following.applicable items h",ve been. signed: . .'
Plumbing (Water Plpe.SprinklerValvesj
Mechanical (GrC!undwork) .
Electrical (Underground COOduit) . .
Il:'re-slab (CC!mpactionlMembrane.Reim., . .
. Underpinnillg (Floor. Joist/Girders)
, IJ<> nC!t rover C!rconceal the work below unttlthe
following applicable Items have been signed:
1 st Floor Shear; . . .
Firesprinkler IRpughj . . .
. 2nd FIOC!rShear . . .; .
Roof (SheathinglDiapbragm'Frame) I
Masonry (ReinfJBondBllamlPre-.Grout)
Rough Plumbing. (Top Out) . . .
Rough Mechanical . .. ; .
KOugn t:Iectncal (Dry Wall) . .
Rough Electrical . .
Framing. (Only a,fterPlbg.: EIec.: f..lech.. and Fire)
. Insulation (SoundlEnergy) '. .
po not tape or pla~te.r Ontil the following applicable.
Items have been signed: '. . .'
Drywall . ..
penetrations (File Rated) Electrical "
penetrations (File Rated) Mechanical. . . . . ..
PenetratiOl)S (File Rated) Plumbing ,
Interior Lath. ..
~terior Lath . . . . .
. GENERAL ITEMS
Exterior Plaster (Brown Coat) ..
T-Bar Electrical . ..
T -Bar Mechanical' . . . ....;.
T -Bar Structural .' . .
Sewer .
Water Engineering BackfJow .. .
Water Service . ..
,
FIN'AL INSPECTIONS Date..' .Inspector
Electrical Final . . ., . .
Plumbing Final . . . '.. .. .'
.
Mechanical Final . . .. .
Gas Test . . . .' .
Engineering/Grading Final 765-5126 .
Fire. Dept.Fjnal.785-4040 .
. .
Water Engineering 765.5268 . . .
.
Sub List/Business License 765.519 .
.; . .
Zoning 765.5139' . . . '. .'
Building 'Finalltast Inspection-Only' .. , .
. ; fter Above Complete) . . .' ,
PARTIAL INSPECTIONS
Buildina InsDections
. Meehanical.lnsDectiol"ls
PlumbinalnSDectiol"ls
. ElectticallnsDections
PERMIT. EXPIRED
INSPECTION.... .
NOT COMPLETED/
'DATE:(,/~qbr .......