2501 W. Lorena Dr.
B,UILDING PERMIT NO.
BLD2003-04324
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BUILDING DIVISION
200 S, ANAHEIM BLVD,
(714)765-5153
INSPECTION REOUI;ST liNE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTioN: 28
TYPE OF PERMIT
Blockwall/ C()iL'm~~
DATE: 11/31200"',
JOB ADOI? So' 2501 W LOR~NA DR
, ...
LEGAL DESCRIPTION: 'N TR2062 LOT 16
APPLICANT: EVONNE MORTON
OWNER INFORMATION: CONTRACTOR INFORMflTION:
Ronald R Gervais C J R CONSTRUCTION; tiC ,,'
2501 W Lorena Dr 1885 W COMMONWEALTH ,!.,VE #A
Anaheim, CA 92804 FULLERTON. CA 9288300JO
" BUSINESS PHONE: 714 6";,,"6,,5
JOB DESCRIPTION:315 sq It alum. patio enclosure leBO # 1968p,
VALUATION: '5,700,00
I OWNER~BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt"from the Contractor~ License' Law for the folfbwing reason (Sec. _7031.5 Business a~
Pro'fessior~s Code: any city or county which req.uires a permit to construct, aak. improve"demolish or repair any structure, prior to its , issuance; also
requires the :Jpp!icant for such pem1it to fite ::: s'9nedc;tate,-nent that he is,lic-:l:sed 'plJrs'uant to the provision~O'fthe Contractor~s License Law (Chapter
9)(commenG:ng with Section 7000!?f D!vlsicn :JoT the ~lIe:I1€SS find profcssi.{ns cod~h:>r-that he is exempt therefrom and the'basis for the all~g~d
exemption. Any v!qlatPofl of Section7C3'1.5 by any appl_icar:t for a cermit"sut:rn,r..;ct$,the applicant to a ~vil penalty of not more than five hundred dollars
~o?)~s ~wner of property, or my ~'mployees with wa~es as their sole comi),L1S~tiOn, will do the work,' and tlie st~uc'ture is ~ot int~n~ed or offer:edfor
. sale (Sec. 7044 Business and Professions Code: The Contractor's Licernsc r~w does not apply to an owner of properly who buildsor improves '
<thereon, and who does such work himself or herself or through his or hE'r OW~I'- employees, provided that such improvements are not :int~ndect or '
offered fOJ sale~ If, however, the ~uilding or improvement is sold with one .,'~- r of oompletion, the ,0wner-builderVtlill hav~ the. burden of, proving that he
did not build or improve for the purpose of sale). ' .' '
o I, as the owner of the property,_am exdusively contracting with licensedbntractors.toconstruct the project (See. 7044 Busfness and PlofessKms
Code: The Contractor's Licen'se .Law does not.applY to an owner of propertYlNno builds,or improves thereon, and' who oontracts for such projeots with
[jontractor(s) licensed, pursuant to Jhe Contractor's License Law), ' i' ,
I, am exempt under8ec., ,__ ,B & P.C. for this reason:---:-_ .~.
. Date: Owner: _ ..1--,
I WORKER'S COMPENSATION DECLARATION '\ --.-J
I hereby affirm u.nder penalty of pe~ury one. of the foll,owing declarations', i
D I have and will mainUlin acertificate.-of oonS€l!it to self-insure forworke!'{ ,,;ompensatlon,
a~ provjd~ f~r by ~dion 3700- of the Labor Code; for the perforr:nance of l~;~ 'Nork forwhicP
thiS permit.1S ISSUed. _ _ -, . __n_._ .;,
o. I have andwil/ maintain worker's c6~pensation insurance, as required ~.y Section 3700 of
the Labor Code, for the performance of the work for which this permit is :ss;}~:-1.Myworker's
Compensation insurance carrier and policy are: 'A'
Carrier: . Policy Number. EXEM~"_~;
This section need not be completed if the pennit is for one hundred doll:irs ($1~tl~or 'less.
o I certifythatin,the perfom1an~e of the work for which this p~rmit is,issl!;.:':tl sha,!1 not
employ any pe~son in any manner so as to become subject to the worker's >";;,:Inpensation,!aws
of Califomia, ~nd agree that if I should become su bject to the worker's COj)1~''-:!',~ation
provisions of Section 3700 of the' La bor Co~e. I shall fortl1with comply ,..:!th tt":j~~'prOvisions.
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: CAL
LICENSED CONTRACTORS DECLARATION
Ihp.reby a.ffirm under penalty of perjury that I am
licensed under provisions of chabt~r.9, (commencing
with Section 7000), of Divsion;3 of the Business and .
Professicns Code.' .
11/3/2003
Date:
Contractor
NUMBER
634099
TYPE
TYPE
EXPIRATION DATE
12/31/2003
B
HIC
Date: 11/312003 Applicant: " ,
WARNING:, FAILURE TO SECURE WORKER'S COMPENSATION COVEl'AG.E IS
UNLAWFUL, AND SHALL SUB,JECT AN EMPLOYE" TO CRIM INAL PEN",~ TIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN Al)[:'T10N TO THE
COST OF COMPENSATION. DAMAGES AS PROVIDED F.oR IN SECTiON 3706 OF:1JiE
LABOR CODE, INTEREST AND ATTORNEY'S FEES, ';'j:
I CONSTRUCTION LENDING AGENCY J.
: he:-eby affirm under penalty bf perjuiY that thel.e is a constructio_t1 lendirig!l~~-:ncyforthe.
> ;:1...:.-,-;:',;...::-~~ tl-;;:;......-. ;,-;'.:i. -.-'.i .iu-!.<j ,-;;:>~;ii'.-y'~';-l::iwl;;;c.;-13$~(j,-..)0~7-..:;'iv'.i..;j:. '-~- -
Lender'$ Infprmation: . .' .
Construcion Types: .
VN. .
'-'to '.',-\-.'
I certify that I have read this application and state that the above information is correct. I
agree to rom ply with all.city ordinances and state.laws relating to bu.ilding corlstruction, and
hereby authorizerepresentives of this city-to enter upon the above mentioned property for
inspection pur~ '~ "
, ' , , t, " Date: 11/312003
. 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 pemlt issuance. A
new permit is requjredto commence or continue work.
. Fees paid for Permit:"'
Total:
255.36
INSPECTION RECORD
INSP~CTION . . . DATE INSPECTOR
.
Temporary Power Pole' - - . '.
plumbing (DrainlWaste Pipe)'. .
Electrical Ground Electrode/lifer
SetbacklFormsfTrenches (Footings) .
00 not .install Subfloor .or pour floor slab until the
following applicable items have been signed:'
Plumbing (Water Plpe.Sprinkler Valves)
Mechanical (Groundwork)
.Electrical (Underground Conduit) . .
Pre-slab (Compaction/Membrane.Reim.) '.
underpinning (Floor Joist/Girders)
'.. 00 not cover or conceal the work belO\v until the
following -applicable items 'have been signed: . .
. .
1 st Floor. Shear
Firesprinkler (RoUgh) .'
2nd Floor Shear .
Root (ShBalhing/Diaphragm'Frame) .
.. Masonry (ReinfJBond BeamlPre-Grout)
Rough Plumbing (Top Out) .' .
Rough Mechanical
I ROugh E1\!(:trical (Dry Wall)
Rough Electrical :.... .
Framing' (Only atterPlbg., E!ec.. Mech."and Fire) . .
Insulation (SoundlEnergy) . I .
00 not tape or plaster until the following ap'plicable .
items-have been signed: .
Drywall . . ,.
Pllitetrations (Fire Rated) Electrical . "
, Pllitetrations (Fire Rated) Me!=hanical .
Penetrations (Fire Rated) Plumbing .
Interior Lath' . . ,
. Exterior Lath I I
. GENERAL ITEMS
. Exterior Plaster (Brown Coal) ,
T -Bar Electrical ' . . ' , ,
T'Bar Mechanical
T -Bar Structural. .. .
Sewer. , .
Water Engineering Backflow:
Water Service
-
FINAL INSPECTIONS Date Inspector
Electrical Final ,
Plumbing, Final -";, ,
Mechanical Final .
Gas Test ..
Engineering/Grading Final 765-5126 . .,'
Fire Dept. Final 765-4040 ....
Water Engineering. 765-5268 , ' . " .
Sub List/Business License765-519 , .'. .
Zoning 765-5139. . , . ,
Building Final '!kast Inspection. Only
fter Above.complete) . "
PARTIAL INSPECTIONS
Buildinqlnspections "
Mechanical Inspections
. Plumbina Inspections
Electricallnspectioris
. .
,
,
)
PERM\l EXP\t=\EJ
. . \NSPECT\ON "
NOT COMPLETED.
O:~1E~1l10 317--Do'-\ -
PERMIT APPLICATION
JOB ADDRESS
PART 2
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NUMBER . ,_ . I
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TYPE OF
PERMIT
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To obtain this permit. the undersigned hereby files this applicat ion and agrees, certifies and declares:
That notice has been given me that this r~rmit may be used only in compliance with the Anaheim
Municipal Code, and all other applicable ordinances and laws.
That this permit does not allow..occupancy, and that no occupancy is permitted. of the construction
for which this permit is Issueo until it has been approve<:! m wr(tmg by \his Oftic9 101 occupancy
alterlinalinSp$ction,
That this permit does not allow, and separate permits are required lor, any plumbing,electrical,heat-
ing and air conditioning work.
That a double fee will be paid for any permit issued after any work thereby allowed has been com-
menced. .
I agree that the City may enter upon the job premises at any reasonable time to inspect any, work
installed under this permit, and to otherwise act as and when reqUlredbytheA nahein1 Municipal
Code.
,-."')"
L1CENSEO CQNlRAClOR$ DECLAAAllON
I hereby affirm that I am licensed under prOvisions of Chapter 9 (commencing with Section 7000) of
DiviSIon 3 of the BUSiness and Professions Code, and my license IS Intull force and effect.
license Class ,~ lic. Number (,3 i..~,(!(; Exp, Date t7 -. -=< ,! :._~
Contractor I c:::.~:r ~~~~~-B~I~~~~~RAll~ /. ." ~--1 j' ( "IJIC
I hereby affirm that I am exempt from t/1e Contractor's Ucense Law for the following reason (See.7031.5
Business and Professions Code: any 0''''J <)r cou-n"'J which lequires a permit to construct, alter. improve,
demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a
signed statement that he is licensed pursuanl to the provisions of the Contractor's license Law {Chapter
9} (commencing with Section 7000 of Division 3 of the BuSiness and Professions Code} or that he is
exempt therefrom ano' the baSIS for the alleged exemption. Any viola\lOn of Section 7031.5 by any appli~:
cant for a permit subjects the applicant to a civil penalty 01 not more than five hundred dollars ($500),'
o I, as owner of the property, or my employees with wages as their sole compensation, will do the work,
and the structure is not intended or offered for sale (Sec. 70448usinessand Professions Code: The
Contractor's License Law does not apply to an owner of property who builds or improves thereon, and
who does such work himself or through his own employees, prOVided that such Improvements are not
intended or offered jor sale. \j, tlcwe'>ier, 'the wilding or improvement is sold within one year of completion,
the owner-builder will have the burden of proving that he did notbu ild or improve for the purpose of sale).
o I, as the owner of the property, am exclusively contracting with licensed contractors to construct the
project (Sec. 7044 Business and Professions Code: The Contrator's License Law does not apply to an
owner of property whO builds or improves thereon, and who contracts for such projects with a contrac-
tor{s) licensed pursuant to the Contractor's license Law).
o lamexemptunderSec.
B&PCforthisreason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate Of consent to self-insure, or a certificate of Workers' Compensation
Insurance. or acerti!ied copy thereof (Sec. 3800 Lab. C} Policy No. Company_
Certified copy furnished. Exp. Date Applicant
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is 10f on~ hUndred OOI\aI5 ($'00) or less). 1 certify
that in the performance of the work for which this permit is issued, J shall not employ any person in
any manner so a_s to become subject to the Worker.s' Compen~ation l,.a\\!sOf California, ,1
Date t ",- ? \ ..(",";', Applicant (j.....;.....-<.I \ ~ J -" ~
NOTICE 0 APPLICANT: If, after ~aking this Certificate of Exempfton. you shouid be~~me~Ubject t?
the Workers' Compensation prOVISions of the Labor Code, you musJ forthWith comply With such proVI'
sions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work for which,
this permit is lssued (Sec,3()97. Civ. C):
Lender's Name
Lender's Address
J 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 constr uction,andherebyauthorilerepresen-
tatives of this city to enter upon the above menfioned property for ins pectionpurposes.
THE PERMIT SHALL EXPIRE BY LIMITATION AND BECOME NULL AND VOID IF THIS WORK
IS NOT COMMENCED OR COMMENCED AND SUSPENDED AFTER A PERIOD OF 180 DAYS.
NEW PERMIT IS REQUIRED TO COMMENCE WORK.
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