315 S. Mohler Dr.
~ -'-
TYPE OF PERMIT
Repair
DATE: 9/22/2004
JOB ADDRESS: 315S MOHLER DR
. '. /;i~V;",jk~&~~,;
CITY gf4'~~i.HEIM
. \~~;~t~T;~13r~i . .
...\{.,-: i-)/:,'~~:: ./
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765-5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS' CODE: 434
QUARTER SECTION: 202
BUILDING PERMIT NO,BLD2004.03566
LEGAL DESCRIPTION: SE'C 6 T 4 R 8 POR NW1/4
APPLICANT: DARREN HOWARD
OWNER lNFORMA TION:
John JCarusillo
3'15 S Mohler Dr
. Anaheim, CA 92808
. CONTRACTOR iNFORMHION:
SHORE TECH INC.
21395 VIA DEL GAVILAN
YORBA LINDA, CA nail? COO~
BUSINESS PHONE. 714 74c-1115
JOB DESCR!PTIONFoundation & n€!w slab for soil stabilization.
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 12,000.00 PROCESSED BY: KBT
I . OWNER.BUlLDER DECLARATION _
I hereby affirm under penalty of perjury that I am .exempt from the 'Contr?ctc~',s License Law for the following reason {Sec. .7031.5 Business and
Professions Code: any dty or county which re,quires a permit to construct, z:ltdr, jmprove~ cjemolish or repsir any-structure, prior to its.isstlatlce, also
requires ttJeapplicant forsllch permit to file a signedstatement that he: is Ht;e;~s~d pursuant to theproyisions ofthe Contractor's Li6ei1se Law (Chapter.
9i(commencing,withSection 7000 of Division 3 oftt)\~':_E),i.j~jri'es~El:n(j PrOft1'35i~I1S C;)d~) or that h~iS; e::<.~mpt therefrom and the basis fo~ the a~ieged
exem'ption. Any violation of Section 7031,5 by arry'.a'ppJicant for a?ermitsuiif~.;::ts the. applicant to a civil penalty of not mere than.five hundred dol:ars
($500), . . '. . . " . . .
o !,as owner of-property, or my employees with wages as their ool~ comr-~,n3ation, will do ,the work, 81)d the structure ~s riot intended or offj3red for
sale (Sec. '(044 Business and Professions Cede: The Contt'actcr's Ucer.s~ l!~H <jOss rIot apply to an owner of pioperty.who b~i\dz or improves
thereon, and who does such work himself or helself or through his or her oW;1'ernrAoyees, providedt,l)at such improvements are not intended_or
offered for sale. If, however, the build.ing or improvement is :')old wit:', OriS vetf of compltltion, theo.J..'ner-builder will have the hurdcn of proving that he
dJdnot build cr impro\Je for the purpose of sale). . Ii. " . .
[J I, as the owner of the property, am e)("dusiveiy contra ctin!) w!th liGen3~d.:6:'11tractors to (:0:13truct the project (See. 7044 Shsiness and ~r~fessfons
.CQde: The Contractor's L,icense La'N does notappfy to an owner of prGperty ~~ho buiids or improves thereon,_ and who a:mtr8cts for s,JU"l projectswah
(Ufontractor(s) licensed pursuant to the CO:1tra"t:or'sllcense Law). '._
o :amexetnptunderSs(~.' - ,.' _',B&P.C.k.rthlsreason: ~__..
Date: Owner: ' .
L WORKER'S COMPENSATION DECLARATlON i [-LiCENSED CONTRACTORS DECLARATION '1
I hereby affiml.under: penalty of perjury one ofthefoUowing.dectaratlons:, I. I-hereby affirm uhder penafty"Oi' perjury ~hat.\ am
o I have and, will maintain a certifIcate.of consentto self-ir;sUie for work,~:,.A(;orn;J6nsatj0r1, I licensed under provisions of chC:lpt-er 9'{commencing
as provided tor by Section 3700 of the Labor Code, for the performanl.X;:: of th~; ;......-,rk for which with Section . of Oivsion,3 qf the Bu..,iness alid
~. ,is ermit is issued: . , ' :,' ProJessions (;
" I haveClnd will maintain-worker's co'mpens3Hon. insurance_, a-s ft~QuirBd bY: Section 3700 ~-;f.
th_ Labor Code, for' the performance of the work for which th~s permit is i&S;.:e.:~, fv1y worker's
CompensatiOn HlSUf<;:lncecarrier and policy are:
Carrier: NO EMPLOYEES
Contractor
Policy l\lumber. ~)(EMPT:
NUMBER
" l\,f5093
TYPE
TYPE
EXPlRATlOi'J DATE
!:/31/2006
"J"his section need not be completed if the pennit is tor one hundred .dollars ($1 00) 6r I~s.
.~ certify that in the performance ~fth.e wo.rk,'for which this perrr.it is iSS,Uc9' I shall noJ, .
employ any person in any manner so as to become subject to the wOr'ker'S~0(r'lrensation laws
of California, and agree that if I should come subject to t=-te wo:1<.er's compe':1sation
proviSions of Section 3700 of the Labo e, I shall fa hw.h compiy with th(ls,? visions.
B
HIC
Date: 9/22/2004 Applican(; .
WARNING:' FAILURE TO SECUREWOR ER'S CO ,p NSATION COV"f'}:G;E IS
UNl.AWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMjNAL PE"'t'L1':tS AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN Ai1DiJ10N TO THE
COST OF CO. MPENSATION, DAM. A.GESAS. PROVI.D~.D..FO..R. IN SEC T:O.....N ,3706. OF.THE I
LABOR CODE, iNTEREST AND ATTORNEY'S FEES. 'c' ..' .. ". ..... l'
r. . CONSTRUCTiON LENDI~(f~GENCY . ..: .... .
.__ll1eF0bv C!ffinnun-::lc_r pena_!tv of perlurythClt ther€_, is_ a co"n3tn.:ction le_~d;~~},a~n~ncY~.N the I
.,ert\Si;T.ance ofthewOi\<.. iqr'Wl1lch'jh;S-P&rrrl\'(jS.!S-sue-(f\S.ec;30tr!~C!'/:t:r:-:~.'J.--- -. -.;-' - , .:
Lender's Information:
Construcioil Types:
VN, ,
Fire Sprinklered?
NO
'.'--.'"
',.".
-'-,-: "'"
I certify that I have read this application and state that the above.information is correct. I
. agree t,o rom with all city ordinances an~ state laws relating to building construction, and
h.erebyautho representives f thi city to enter upon the above mentioned property for
inspection pudP.9 s'. .
. .)'--- Date: 9122/2004 .
19nature f Ap !ieant 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 reqoired to commence or continue work. .
Fees paid for Permit:
Total:
253.25
. INSPECTION RECORD
. INSPECTION .' ..' . ' DATE' INSPECTOR
Temporary Power Pole , ,
Plumbing (DrainlWaste Pipe)
Electrk;iJI Ground Electrode/lifer . " , ,/ 'I
Selback/Formsrrrenches(Footings): .} J~ KI J... '" .
Do notinst"" subfloor.or pour floor slab until the
. following- applicable items have, been signed:
Plumbing (Water Pipe.SprinklerValves) ,
Mechanical (Groundwork) .
Electrical (Underground Conduit) . . . .'
Pre-slab (CompactionfMembrane.Reinf.
Underpinning (Floor Joist/Girders) .
Do not cover or conceal the.work below u(lliJ the .
following appliCable items have been signed::
15t Floor Shear . . .
FireSprinkler (Rough) . , .
2nd Floor Shear '. ".
., Roof (Sheathing/Diaphragm/Frane) . I.... . . .'
, Masonry (ReinfJBond Bean/Pre-GlO\lt) .
Rough Plumbing (Top Out) I . .
. Rough Mechanical . .
, KOugh l:IectriCaI (Ory wall) . ."
" Rough Electrical
. Framing. (.Only after Plbg.. Elec.. Meet? and Fire! .
Insulation (SoundlEnergy) .' .
po not tape or pla~te.r until the following applicable '. '.
Items hav.e been signed:. ..', '. . . .
Drywall " . "
.Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing , . .
Interior Lath . . . .' .'. .
Exterior Lath . . . .
GENERAL ITEMS.
Exterior i>laster (Brown Coat) .
T .Bar Electrical ..
T .Bar MechaniCal . . .
T .BarStructural
Sewer . . '. ".
Water Engineering B"cktfow . .
WalerService .
FINAL INSPECTION~ . . Date . Inspector
Electrical Final . . , . :'. .
. .
Plumbing Final . . . .
Mechanical Final ." . '.' . '. ,
,
Gas Te~t . . . , ",
Engineering/Grading Final 765-5126 , .
Fire DepL Final 7654040 .' :'.
VVaterE.ngine.ering 765-'5268' . . .
SuI> List/Business License 795-519 ..
..
;Zoning 765-5139 '. . .'
. . ..
Building Final ~ast inspettion. Only . -/Z-(j)' AJ..)JL ~
fter.Abov.e Complete)
PARTIAL INSPECTIONS'
BuildinQ Inspections..... '. . .., . '. .,. " .
'1~~~~~=~?~,/)~IG.""
MechanicallnsDectioris
,Plumbina Inspections.
Electrical Inspections
.