217 S. Monument St.
" BUILDING PERMIT NO. BLD2003-o3040
OA TE: 8/412003,
JOB ADDRESS:, 217 S MONUMENT ST
ElM
BUILDING DIVISION, ,
200 S,ANAHEIMBLVD"
(714) 765 - 5153
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INSPECTION REQUEST LINE:
(7t4) 7,65 - 4626
CENSUS CODE: 434 ' '
QUARTER SECTION: ,27
'TYPE OF PERMIT C'"I' TY,' '
Reroof
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LEGAL. DESCRIPTION: N TR 1940 LOT 47
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CONTRACTORINFOR~1ftl'TION:
COAST ROo'FING " '
,21681 IMPALAL-ANE,., i ' '
HUNTINGTo'N BEACH, eN 926460000
. . - -. ~
BUSINESS PHo'NE: :7'1496fl.8:754,
"JOB DESCRIPTION:Replace existing BUR with new BUR 1 g sq"ares, "
VAlUATION: 2,8:70,00 .. ]',' PROCESSED BY:, CAL
I 'OWNER-BUlLDERDECLARATlON ,
.! .hereby affirm un~e~ penalty,Ofperjury,that ,I am'exempt from the Gonh'acto:';$ License Lawf<?r the fo!IQwing, re~son-(Sec. 7031.5 B\.I~iness.c;nd,~ ",',
. Professions Cod e:. a ny. aty or county Which Feq uii-es a permit to construct, a.it~ r,::"i!11 prove, d er.noJist) or rep3 ir. any structure, prio r to. its ,issuance, also
req\.l~~ the:awli~nt for.-such permit to,. fill3.a.sig'ned:statementth~t he i:;; 1[~f:0.s.ed pursua"nt tq"the plO.vf~jc>ns of the COt:1tract()r'~ UGense law'(Ch~pter'
9)(cornr:nencing With.~,ection 7000 of Oivi$ion 30f the Business and'Profes,s;~o~'Code)or that heisexempt ~herefrolll and tf1e basis !or the alleged ,
ex~emption.Ai1y viol~tiOrl'ofS~ctior:J7031;5 bY"any'appJicant for a' permit' $tJJl.:'a.~ts the applicant to'a.clvil Pe,nalty.pf not more than five hundred dollars
($500), , ' ,., ' " , ,,'> ,', ',",,' "
; 0:' J. as: owner of p~opertY.. 'or my e~ployees With w~ges as their-, sole eOiTl~;nsgtion, will do, th~ work, and the structUre _is not intended or offeree! for
.sale',(Sec,-7044. Busines_sand Professions Code~. The Contractor's Lice~-s_eL:j:v{'c;Ioes,!1Qt.appIY.to an owne,r',ofproperty.who builds or improVes ", .
thereon, .and who does such work: himself or herself or throug h his 6r,her"b..i::-::&,fiployees,' provided that such. improvem.e-nts are not 'jo'te_nded 6r. '_
:~ff-ered, for sale. _l~, however, the"building or'improvement is sold wit.!i one yc-.,fpfeompletion;'the owner-builder will have tf1e: burden of proving that he:
did,riotbuiJdoriniprovidorthepurposeofsale), ..".', . -"::' . , . ' '_,".. ., ""',',
. .[], .I, ,~s-the, ov.Jner of the property, am exdusively contractillgwithliCen$ed -xfntractors toconst,ruct ~tie project (SeC.'7044 alJ~;jlJess and' p:rofe~io'ns.
c:::;octe: The Contractor'$Ucense lawdaes._"a:t.appty to.an ownerOf.properf/.,.vho'buUds or,{mprovesthereon;and who oontracts fOT such prdjectsw~h
, ~ont~actor(s),lic~n~ed '~urs!Ja'nt to the Contrac~o.r'sUGense'.la~), ", ,
.,,~ l'am'exemptunderSec. '- . " ',8 & P.C..forthfsreason:
Date:, OWner: '
I WORKER'S COMPENSATION DECL.ARATION
I h~reby affirm under p~nalty Qf,pe~ury one of the following declarations: '.' "., , ,'.
D . I have and wHlIr~intain a certificate of oonsentt() self~insure.for wori<:er'::>:cbmpensation,
: a~ provided for by 'Section 3700 qfth~ LaborCode"for the performi;uicc'o.f t;!tl Vlo~ for which
this . it is issued,. . .
I' have and will,maintainwo'rker's' compensation.insurance,as required-by Section 3700 of
Lab<?T Code_~ f<:>,rthe performance of th~,work for-which this permlii_is _issu;~. Mywprker's
mpensatkm insurance carrier and poliOj are:.
, Carrier: STATE FUND
APPLICANT: F.RANK GARCIA
OWNER INFORMATION:
. Mi<!hael,J Schreiner
217S'rvtonumentSt
Anaheim, CA 92804
ARCHITECT/ENGINEER INFORMATION:
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LICENSED CONTRACTORS DECLARATION
I hereby.'affirm under penalty 9f perjury that I am
I icerlsed--u nder provisions o~ chapter 9-'( cOTJ'lmenCin'g
with'Sectioh 70QO) 0 ivsion 3 o.fthe Business'a'nd';
~rofess!ons COde. '. ." ',~;.,
8/4/2003 rl '?<M->
Date:'
CO,ntractor
Po[j~ Num,ber. 111319Q~C2~'
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Thi~ s6C?tion need not be completed,ifthe pennit IS for one hundred dollars' ($~~Cl ot~lcss. '
o I certify tha~ i~ iheperformance:ofthewo'rk fOr which this permit is,,,i~I;~d~rsti~,lfr16t ,
employ ,any person in a 11)( manner so a~ ,to' become subject tothe:wor~e~st:"'p~pen,s'a~ion I~Ws
of Califomi_a. and agree that if "should become . d to the worker's _Gom~~nsatiorr,'.
provisions of Section 3700 of the L'€ibor Code ,sh J.l forthwit 'omply With .th,-?s's prOv'isjon~.
NUMBER
'450393
TYPE
TYPE
"XPIRATlo'N DATE
'12/3112003
C39,
HIC
Date: 81412003' Applicant: W.<., ~e
WARNING: FAILURE To'SECU' RKER'SCo'MPENSATIONCOVEP,~,GE IS
, UNLAWFUL, AND SHALL SUBJECT AN'EMPLo'YER TO CRIMINAL PEN~~TIESAND CIVIL
. FINES UP To' ONE HUND,RED TI-lOUSAND DOLLARS ($100,000}"iNADD'T10N To' THE '
Co'ST o'F COMPENSATiON, DAMAGES ASPRo'VIDED FOR IN SECTIOn,3:706 o'F THE
LABOR Co'DE, INTEREST AND ATTORNEY'S FEES, ",,'.'
I ' 'CONSTRUCTION lENDING AGENCy>:tt '
,.: I, ~~r~~~Y.!:l(fi.tQ1_l:!n~~!._pery.aJty:,Qf perjLsrYtha( thete, i$. ~'c.<?rlstr:uc.ti:On!:er0j:,"(il~.t::)r:cv.10r--the
peltorn:1l3.nce.of tt:I,ework for'which this permit is issued (Sec. 3097 .Civ.C): .C) '.
, Lenderis Information:,
Construcion Types:
VN; " '
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.'1 :certify that I have read this application and state that the above informa,ti9n is' correct. I
agreetopomplywith all city ordinances and state laws relatiog to ,building corstructio'n,and
h~reby authoriz' e resentives of-ttiis city:to enter upon the above mention~d prop~rty for,
j~pection 'Plir se.'., ,
~ Date! 8/4/2003'
, . Signature'of Applicant or Agent .
The permitshall expire by',limitation and become null and void if the buildin!! or,
work has not passed final inspeCtion 3!l5 days from the date of permit issuance. A
new perrilit is required to commence or continue work.
Fees paid for,Permit: .
Total:, "
107.91
INSPECTION RECORD'
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INSPECTION.. ..... '.
: TempQrary pc>wer PQle'.. .' . ,
... Plumbing (OiainIWaste Pipe)
Electrical Grpund Electl'OdelUfl>r .
Setbacklf:tlrmslTrenches (FQQtings) '..
. [)allot installsubfloorQr pour floor slabuntH the."
fpllowing applicable items have pet;n .signed: ." .
Plumbing (Water Pipe.Sprinkler Valves) .'. . : . .
'. Mechanlcal (GrOUnd\YQtk), .. . ". ..' ".
..' Elect.rical (UndergroundCon!luit) . '. .
'. f>re-slab (CompactioolMembrane.Reinf.
Underpinning (FlporJoist/Girders) '.'
DO not cover or conceal the work belOw until thE>
. fpllowingapplicable items have been signed:' '. .
.' 1st FloorShear . ..' '.' ... . i : . '.
Firesprinkler (Rough)' . '.' '. '., '. '.
2nd FloQr Shear.: . '.' . ,.". ". I.
Roof (Shllathing/lliaphragrnlFrame) . ~6~ U2lJ . ILl 'Ill"""
. Masonry (ReinfJBOOd Beam/Pre-Grout) L ....
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,. DATE . INSPECTOR'
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Rough Plumbing (Top OUt)
Rough Mechanical .,.. .'
l<Ought:lectr~a1 (Drywall) .,
· Rough Electrical. . .'." '. ..,..
FraminglOnly afterPlbg., EI.ec. Mech,and Fire!
Insulation(SoundlEnergy) . .'1 .'.
, PO nof tape pr pla~ter ul1til the fQllowing applicable
Items have. been' sJ~ned: ' - , , .' ",'" .
. Drywall"""':' . . . '. : '.' . . .
." Penetrations (Fire Rated) Electrical. : .
Penetrations (Fire,Rated) Mechanical. . . .'.
Penetrations (Fire Rated) Plumbing" .
InteriQ;' lath ....., '. .... . .' " .' '
ExteriQr Lath' . . . .
"GENERAl.ITEMS
. ExteriQr Plastet(Brown CQal) .
T.Bar Electrica.l. ". .
T "Bar Mechanical, '. . . . .
T~Bar Structural :' .' . . . . . .
Sewer ". .
Wate;.Engineering BackflQw
WaterSe;ylce .'.
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F'INAL INSPECTIONS
Electrical Final
PIUnibingFinal
Nlechanical Final'
Gas Test.'
EngineerirjglGrading FinaI765-512~
Date.
. Inspector
'. fire'Oept.FinaI765-4040
Wa.terEngineering 765-526.8
Sub llst/Busine.ss licensil765-51!!
Zoning 765~5139
". Building Fll1al' (Last Inspection. Only J"i 'I .-l
" . . After Above Complete), '" ;, fI-j
..; PARTiAL INSPECTIONS
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Buildina InsPElctions
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. .' MechanicallnSDec:tions .
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Plumbina insDections
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Electrical Inspections'
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