234 S. Monument St.
..'0.-.:...., ,
Bun:.DING PERMIT NO. BLD2004.01457
TYPE OF PERMIT C
Residential Remodel .' . ITV
DATE: 4/29/2004
JOB ADDRESS: 234S MONUMENT ST
LEGAL DESCRIPTION: N 'I~ 1940 LOT 55
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BUILDING DiVisION
200 s. ANAHEIM BLVD.
(714) 765,5153 .
INSPECTION REQUEST LINE:
(714) 765- 4626
CENSUS CODE: 434
QUARTER SECTION: 27
.c
APPLlCANT:.MARY BOYD
OWNER INFORMATION:
Mary A.Boyd
. 234 S Monument St
Anaheim, CA 92804
JOB DESCRIPTIONlnterior kitchen and master bath remodel. .
CONTRACTOR INFORMATION:
,
ARCHITECT/ENGINEER INFORMATION:
;
,
,
VALUATION: 30,000.00
I OWNER-BUILDE~JjECLARATION
Ihereby affi~m under penalty-of perjurytnat I am exempt frof11 the Contractqr'i; License Law for the following reason (Sec. 7031.5 Bu~'iness and
Professions Code:_any city or county which requires a permitto construct; a'!:i~ri',i[i1prove, demolish .or repair any structure, prior to its-issuance, also
requires the applica:nt for ~uch permit to file. a signed statement that he is :~c::!~sed ~lJrslJ<mt to 'theprovi<3ions of the Contrado.r's Licens~ Law (Ch<::ipter
9)(COmmencin:g with Section 7000 of Divisjon 3 of the Business and_P'ro,fes3,IRns Code) or that he is'exempt therefrom'_and,the_l;>asis fortheaHeged .
exemption.. Any violation pf Section'7031,5 by any applicant for a permit ~ut;j~cts the C:lpplica'nt to a civil penalty of not m.ore than five hundred dollars
. $500 . . . ',i . . . '.. ..' .- .'
I, ,asownerof property,ormy, employees with wages as their sale compt)!isqtion,_w;!l'do the work, and the structurt~_ is not intended oroffer~d for
sa ,(See: 7044 Business and Professions Code:, The Contractor's Licenst-~ l}w does'not apply to an owner of property' who builds or improves
, ,thereon. and.who does such work ,himself or herself or through his-or,her O'J'.;:lempl<)yees, providerJ,tf:1at such improvements are not intended or .
'offered for sale. .It,.however, the' .building _or. improvement is. sold with one y.~)r of completion,; the owner-buil<ier will,have the 'qurden of proving that he
..didnotbu~dodmprovefOlthepurPos~of_sale). .: ,:' _' .,~!, . - _ . .. ....
o I,. a& the ow"ner of-the property, am exdusively contra ding with licensed';f:x:.:ntraytors to construct the project (Sec. 7044 Busines~ and Professions
. Code: The ContractOl-'s License Law does' not ,apply to an owner of~ropf:tty:\"ho builds'or improves thereon, and who ront(acts for such projects wrth ,
F-Qon~r~cto~(s) licensed pLirsuait -r:~h~cntractor's license Law). ;';, .
,-.J.l am exempt under Sec. ~ I B & P.C. for this reason:, j.~
Date: ' , Owner:.... . ' _~
c:: WORKER'S COMPENSATION DECLARATION
lhereby'affirm under, penalty: of perjury one of the following dtScla'rations~
o I have and"'~ilI maintain a-certificate_~f consent to seif-insure jor wt)rkef;> (;omo~nsation,
as proYidea for by Section 3700 of the labor Code, for the performanCe of th\~ \,':urk fer whidl
this Permit is issued: ~:
D. I :have and will maintain wo-rker's compensation in1Siurance, as require,~i t__~,.. 3ectbn 3700 of 4/29/2004
the Lab_or Cod'e, for the performance ot the work for which this permit is !~St!~'.i. My worker's ,'Date:
Compensaticin .insurance- carrier and policy are:. . .. ,
Carrier:. Poli~'Number:
This'section need not be -COmpleted' if the pennit is forona hundred dollar~ ($1 C.f~~ pr less..
~fy that.in 'the perforrilance of the work for which this permit is issl..~');:'! sha.II not
~oY,any person in any rnannersoas to'become subject to the worker's &c.~~pan":i>;3:tlon laws
o-f""Cal ifonlia, anctagree _ that if Ishou Id become su bject to .th e wo rker's. CO'ii:k~'lsatidlj"
. p~.o Vision. s o~ $ection alOO of the Labo C de, I shall o. rthwith c~)I'h ~ wi~ tl'. .'e.p(O.,F~t'.isiQns.
Date: 4/29/2004 Applicant: "_ .'
WARNING: FAILURE TO SECUREWO ER'S' MPENSAtlON COV fi.\ -E IS
UNLI\WFUL, AND SHALLSUBJE'CT AN EMPL ER TO CRIMINAL PE;~1J;'n"s AND CIVIL
FINES UPT0. ONE HUNDRED THOUSAND DOLLARS ($100,000), IN AD(r;nON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIOiJ.m06 OF T:;E
LABOR CODE, INTEREST AND ATT0.RNEY'S FEES. '. '
..
.1 . CONSTRUCTION LENDING AGENCY.'" _ . ~""
. I...h.ereby.affirm. .u~.e.rpenaltyo~ p. e.riu. ry th.at there is a,constructio.n lendin. 9 r~t...-.CY. for'tK.~:.
. performan~ of~l1ew?rk for whk:': -this pormit is i5~~d. (Sec.3097 ,Ciy:StL1 ~ ___ ._-=-~_
...<;:--nti:::J';:' iii;''';(lI.ld~lq(;. -, -' -.-- - -
PROCESSED BY: CDL
I
~
L1CENSEDCONTAACTORS DECLARATION'
I hereby affirm undfi'lr'pena!ty of perjury t'1at l,am
licensed under provisivr.z 0f chapter 9 (commencing
with Sectio'n 700.0) of Divsion a of the Business and
Professions Code . - .
Contractor
NUMBER
EXPIRATION DATE
TYPE
Gonstrucion Types:
VN, ,
Fire Sptinklered?
OwellinQ Units:
NO
1
-,i.
I certify that I have read this application,and~state th'at the- above informatipn is c9rrect. "
agree: to comply with all city ordinances and telaws relating to building c.o"'struction, and
~ hereby authorize representives of this City-to' ter upon the above mentioned property for
insp cti n purpo' '.
Dale: 4/29/2004
.Fees paid for Peimit:
Total:
3.00
'Signature of ARPlicant orA ent
The permit 5 all expire by limitation become null and void if the building or
work has not assedfinal inspection 5 days from tt.e date of permit issuance. A
. new p-ermitis required to cOmmence or continue work.
INSPECTION RECORD' .
. '. INSPECTl6N ..: . DATE '.INSPECTQR.
Tempo!'llryPower Pole ..' . . .
Plumbing (DrainlWaste.Pipe) . . . .' .
. Electrical Ground Electrode/Uter . I
SetbacWFormslTrenches(Footings} .
Do not install subfloor or pour floor slab until the
following applicable itertis have been signed: '.'
Plumbing (Water Plpe.SprinklerValves) .
Mechanical (GroundWork) . .-
. Electrical (UndergrQUnd Conduit) . . -
Pre-slab (coll1pac~iOll/Membrane.Reinf. ....... .
Underpinning (Floor Joist/Girders) '. . . ..
Do not cover or conceal. the work below until the
following applicable ilems' have been signed:
1 stFloor Shear . .
Firesprinkler. (Rough) . - .
2nd Floor Shear-' '.
Roof IShealhiIlll1Diaphragm'Frame) .
Masonry (ReinfJBond BeamlPre-Grout) '.
. RoughPlumbing (Top Out) . .
Rough Mechalllcal' ....
KOugll t:IectrtCal~lI) . . .
Rough Electrical . . , . .- 3m
. Framing. '.{Only after Plbg.. Elec.. f,,1ech' andF.ire) ~
Insulali.on (SQUndlEllergy) . -
Do 1I0t tape.or plaster until the following apPlicable .
items' have" been signed: ' '.' -,
Drywall'. . . ., '.
Penetrations (Fire Raled) Electrical , .
.'
Penetralions (Fire Rated) Mechanical
Penetralions(FireRated) Plumbing'.' . . .
InteriOr Lath '. .' ..
Exterior Latl) . . ."
. . GENERAL ITEMS
Exterior Plaster (alOWn Coal) .
T -Sar Electrical . "-
T.Bar Mechanical - . .
T.Bar Structural . '.
Sewer ,"
Water. Engirleerillg 'Backflow
Water Service' ...
FINAL INSPECTIONS Date inspector
E.lectrical Final . - .1:tJ.;'Y b-u.< t.~
Plumbing Final . . I.... '.
Mechanical Final ~ .- . . no,p-f $}",,--AJd
Gas Test . '{-of. of sl..",-t.krh
.-
EngineeringfGracling FinaI765.s1~6 . .
,~
Fire Dep!. Final 765.,40.40... '. .
Water Engineering 765-5268 . .
Sub List/BUsiness License 765-519 ,- .'
Zoning 765-5139 .'
. . .' -,
Building Final ~ast Inspeclion- Only .. .
, fterAbove Complete) , .'
PARTIAL INSPECTIONS
Buildina Insoections
Mechanicallnsoections
Plumbina Inspectiol'ls.
Electricalll'lsDections
PERMIT {XPIRED
INSPECTION
.. . .
.NOT COMPLETED'
. DATE:~~ 0'(