3135 W. Monroe Ave.
TYPE OF PERMIT, C
Residential Ad.dition - ITY
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QE~J;'f'l~H ElM
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,BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765: 5153
INSPECTION REQUEST LINE:'
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTIOW 8'
BUILDING PERMIT NO. ElLD2004.01421'
DATE: 4/30/2004
JOB ADDRESS: 3135 W' MONI'lOE AVE
LEGAL DESCRIPTION: N TR1820 LOT 132
APPLICANT: JOSE FERNANDEZ
OWNER INFORMATION:
Jo se Fernandez
3135 W Monroe Ave
Anaheim, CA 92801
JOB DES9R1PTIONAddition of a living room, dining room, and master bedrOl.t~ 963 sq ft.lhih)
VALUATION: '64,800.00. i PROCESSED. BY: CAL
I OWNER-BUILDF.,jPECLARA TION, =:J' ,
I hereby affirm .under pen.alty of f')erjury that I am exempt from the Contractc;.,b LlC.e:,~s3_La,'.' f~Jrthe fol!owing reason (Sec. 7031.5 Busir.ess and-
Professions Cod e: any dty or county vyhich requires a permit to construct, aJ1r; irflpro..Je, demolish .or repa ir any struciure, prior to i~ issuance, i:llso
.requires the applicant for such permit to file a si~ned statement that he is lio~I.~~.09d'pur'3uant to the p'rovistpns,ofthe C~ntraGtor's License Law (Chapter'
9)(commencing with Section 7000 of Divisicn 3 of .the &:siness a 110 profeG$:~lr'5 Code) or that l1e'i3 exempt therefrom and the'basis for the Dllegecf
.'~:emPtio,n. , y "iolatio,) of S":OI;OO 70315 by any aplOtioa,. ,t for a po",,,t set, 0'0',5 too apPlioonUO"d.YilPen~.ltYOf not moret"anfiV,e,.h~ndreddOllars
I s er of property, or my ~mployees with wages as their sole (;omr')r.3~licn~w!11 do ~I-Je work, and thf:stri..1ctureJs_not Intended or ':Iffered for
'" . 7044 Business and Professions, Code: The Contractor's Lic5m'~,~h,~'{.doeznctnpptyto an owner of pro.perty W;"10- builds or ilJ1pr..)ves
th ,eon, and who does such wo~k himself pr herself or through his'or hE:::" ~j",,'b::rr.P!oy~es; provid.ed that su~himp'ovements are Dqt inte'nded or .
offered forsal~.' If, however, the building or improvement is sold ...\'ith,on~ Y:"1;;)f,cOn1pjetion, tneawner.builder Will have tbe burden of,proving that he
. did not build or improve for the purPose 0f sate).' __ iL ".." ','. .' , . ,
o I, astheowner of the property, am e'xdusively tc;':t:c3cting \Vith-pcensed~.\:.ntr3ctors to construct the prOJ-=Gt (S~c. '1044 Busin:€,!>'sand ProfeSsions
Code: T!":.e,Con!rc~tor'3 License Law does n0t ~pply-to an owner of property:iNl1c',bui1ds or improves thereon, and'who contracl'3 fer such p:'"ojoctS with
.'fUiontract.or(s} licensed, pursuant to the Contractor' icellse Law). J.~ . '.
Li ,I amexerilpt under Sec. r> ( r il-isreason: _J
Date; Owner~ :-,_ .}__
I, WORKER"S COMP TION DECLARATION "". .J ,pucENSED CCI".TPACTORS DECLARA11QNl
I horeby affirm under penalty of perjury one of the foJ!owing declarations:' ". 'i" . - I hereby affirm under penaIty of perjury that lam
o I. have and wW-maintain a .certificate:of oonsent to'self-insure for worf~p',r" .;:::cmp~ils;':ti'on/ Ii~~nsed ,~nd~r provisiO~_S?f chapter 9 (co~menc.ing
as pro'videdfor by Section 3700 of the- labor Code, for the performance cftr.:~ wor',<;fon....hich With Sectlonl 000) of DlvslOn 3 of the BUSiness and
this permit is issued.' . ". . ~j P(Qfes'sions Cede.
D' 1 have ~ndwill maintain woiker's compensation insurance, as require~ t""j'Section'3700 of 4/3012004 ~
the labor Code, for the performan,?e of the work for which thi,s permit is is5U11. Mywcrker's Dote:
.Compensation insurance carrier and policy are:. :1
Carrier' Policy Number: ,~
. I
Thissection need notbe completed if the peimit is for one hundred dollars ($lijG~crles$. . . .
~ttfy'1natin the' performance of the work for which this' permit is_'iS3~e). f shall not
@loyany person in any manner so 'as to becomt;l:_subjec~ to the work~;'s ~(~~Ipef)sation -laws
of California, and agree that if 1 should become subject to the worker's CO(1';~:,satioh
provisions,of Section 3700 of the Labor Code,l shall fort .. comply with H:,)sepro'lisions.
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CONTRACTOR INFORM,mON:
ARCHITECT/ENGINEER INFORMATION:
. j
\
Contracto~
NUMBER
EXPIRATION DATE
TYPE
. Date:, 4/30/2004 Applicant:
WARNING: FAILURE TO SEciJREWORKE SAnON COVER"GE'jS .
UNLAWFUL, AND SHALL SUBJECT AN EM OYER TO CRIM INAL P.F-~IAL,:ES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000): IN'.!'Di':!TIOi'JTOTHE
COST OF COMPENSATION, DAMAGES AS'PROVIDED FOR lNSECTIG,Ji3706,:'pF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. I ':\:-i...
I CONSTRUCTION L.ENDINGAGENCY' ---::["'2'"
'J hereby -affirm unde_r pt;l:nalty of perjury that there isa c0l1strt:Jction:l~nd-inga0~r:,c~y:fc)r")pe
peno;-mance of the work for which this permit is issued (Sec. 3097 .Civ~C):. .i, _,'~'_ . .
., _!,:~:nr-'-~~~!;..J!Jf0t~20tj0~. - -~'-'-..l._~~_~,,___~,_. .;"~-------'---------:----_.'
Construcion Types:'
VN, .
Fire Sprinklered?
LivinQ Area:
NO
963
I certify that I have r~ad -this application and state that the above information i3 correct. I
agree to oomply with all city ordinances and state laY'S reiating to building cCi.struction, and
hereby-authorize representives of this city to enter u n the above mentioned property for
inspection purposes.
Fees paid for Permit:
Total:
556.48
Date: 4/30/2004
'. . Signature of Applicant nt. . '
The perinit shall expire by Iimitat, n and become null and void if the ?uilding or
work has not passed final inspection 365 d"ys from the date of permit issuance. A
new p~mit is required to commence'or continue work.
INSPECTION RECORD
. .... INSPECTION .. . DATE '. INSPECTOR
Temporary Power Pole. .'. . .
Plumbi ng (DrainIWaste Pipe) . . . .
Electrical Ground Electrode/Uter ~ . I
. SetbacklFormslTrenches(FC)Otings) . . ,
Do not install.subfloor or pour floor slab U, til the' .
following applicable items have been signed: .
Plumbing (Water PiDli.Sprinkler \(alves) . . .- c
MeChanical (Groundwork) ." I:
Electrical (Underground Con I/~ ' ,
. Pre-slab.(CompactionlMllQ!!lrane.Reinf. ~J .
. Unclerpinning(Aoor Joist/Girders) ,
Do not cover or ,conceal the work below until the. . ,
'following applicable items have been signed:,' ,
~ 1st FloOr Shear .".u. ...... ,_IA'n1J ~
Firesprinkler(Roullh) '1 . .I t
2ndF~ar ' ., ..
RoM IShealhiillllDiaphraamlFrllmlll, 11r/,I./I~
... Masonry-(flelnfJBondBellmlPre-GlO\It) \ , . . I
Rough Plumbing (Top Out) . . H6-a~ ^.. nil 1\ ' ,
Rough Mechanical .. It-t4'-04
Rougn .8ectnqallury vval'l, . 111-1:b .;; .../.I~ -
Rough Electrical', ' . . ',. ,
'J: Framlilg :(Only afterPJbg~, Ele'c.. Meth.. and Fire) , fl. ,. .;.,
'r Insulillion (SoundlEnergy) ..
'Do not tape or,pl;!ster. unlit the following applicable'
.items have been. signed:'. . '."
DrYwall' " ,. '... ,
, , ' ' . .
Penetratlons (Fire RiIled) ElectriCllI
, Penetrillions (Fire Rated) Mel:hanical .- . 'c'
Penetrillions(Fire RiIled) Plumbing .
Interior Lath .. . tII
Exterior Lath . fI;;.",.A2~
, , .. GENERAL ITEMS ...
Exterior ,Plaster (Brown COal) .' .
, T -Bar Electrical.. . ,.
T -Bar Mechanical . ...
T-Bar Structural , "
Sewer .
Wat..,. Engineering BlIckfJow , .
WaterSeritice' , . .
FINAL INSPECTIONS
Electrical Final
PIl!mbiilg Final
Mechanic.al. Final
Gas test
Engineering/Grading Final 765-5126
Fire Dept" Fin;!1 765-4040 '
Water Engineering 765-5268
Sub List/Business License 765-519
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1>
Zoning 765~5139,
Building Final (Last Inspection- Onfy'
, ' : . AfW Above ,Complete)
MechanicallnsP8ctions
Plumbinalnspections
Electrical Inspections