500 N. Park Vista St.
BUILDING PERMIT NO. BLD2005-01697
.. ....--<'.-.
TYPE OF PERMIT
Accessory Building.(Shed,Garage...) CITY
DATE: 6/6/2005
JOB ADDRESS: 500 N PARK VISTAsT 113
ElM
BUILDING DIVISION
. 200 S. ANAHEIM BLVD.
(714)765 - 51-53
INSPECTION REQUE.STLlNE:
. . (714) 765 - 4626
CENSUS CODE: 438
QUARTER SECTION: 133
CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
PAUL DAVIS RESTORATION OF SOUTHERN
14670 FIRESTONE BLVD #406
LA MIRADA, CA 90638 0000.
BUSINESS PHONE" 714228-0895
JOB DESCRIPTION: Repair and rebuild damanged carport 800 square fool. Unil113
VALUATION: REF 1~"o~oe8-00020
APPLICANT: ARNOLD CORONA
OWNER INFORMATION:
Meadows-An Park
1001 Dove St #290
Newport Beach, CA 92660
PROCESSED BY: SAM
OWNER-BUILDER.DECLARATION
I hereby affirm under penalty 01 perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any City"or county which requires a permit to construct,. alter, improve, demolish or-repair any structure, prior to its issuance, also
reqLlir~s the applicant for such permit to file a signed statement that he is licensed pursuant.to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000'of Division 3 of the Businessand Professions Code) or that he is exempt therefrom and the basis for the alleged -
exemption. Any viotaHonof S~tion 7031.5 by any applicant for a permit subjects the applicant to a 'civil penalty of not 1110re than' five hundred dollars
($500). . . . . .. .
o - I, as owner of property, or my employees with wages as their sole compensation, will.do the work, and the str.ucture is'not intended or offered for
sale, (SeC? 7044 BU$:iness and Professions C()de: The Contractor's License Law does not apply to an' owner of property wtio builds orir'nproves
thereon,an~rwho doessuc~ work himself' or herself or-through, his or het own employees, provided that such improvements are not intended or
offere~for)Sale. If, howeve:"r, the building or imp'roveQient- is sold with one year of completion, the owner-builder will have 'the burden of proving that he
didnot.~uild9rirriprove for the purpose of sale)':' ':,:~,. .'~ . ' .
o I, as th_e owner of the property, am exclusively contracting with_licensed contractors to constr.uct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does notapply to an owner of property who builds or improves thereon, andwho contracts for,such projec~ with
a contractor(s) licen~ed pursuant to the Contractor's License LaW).
o I am exempt under Sec. , 'B ,& P .C. for this reason:
Date: . Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby aff:irm under penalty of pe~ury one of the following declarations:
D IlJ'ave and will maintain a certificate-of _consent to self-insure for worker's compensation, '
as provided for by Section 3700 of the Labor Code, for the performance olthe'work for which
this permit is issued.
~ have a'nd.willmaintain worker'scof!1pensation insurance, as required by Section 3700 of 6/6/2005
ftiMbor Code, for the performance of the work'for which this permit'is issued. ..Myworker's Date:
lCompensa!ion insurance carrier" and policy are:
"Earrier:STATE FUND . . Policy Number. 0007666-2004
This section need not be completed if the penni! [s for one hundred dollars ($1 00) or less.
o I certify that in the performance of the work for which this permit is issuedfi, shall 'not
employ any person in any manner so as to become subject to the worker's compensation laws
of. Califomia, and agree that if I should become sub'ect t worke compensation
provisions of Section 3700 of the Labor: Co all f hwith c . those provisions.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) at . . aM
P rofessi C e
NUMBER
510431
TYPE
EXPI RA TION DATE
11/3012005
B
Data: 6/6/2005
WARNING: FAILUR TO SEe
UNLAWFUL, AND SHA JECT AN .EMPCOYER 0 CRIMINAL PENALTIES AND CIVIL
.FINES UPTO ONE HUNDRED THOUSAND DOLLA S .($100,000), IN ADDITlON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .
CONSTRUCTION LENDING AGENCY
I h,er!3by affirm unqer penalty of perjury that !here is a constructionlenq(ng aqengYfor the_
performance of the work for which this permit.is issued (Sec.3097.C'iv.C):
Lender's Information:.
Construcion Tvpes:
VN, ,
Fire Sprinklered?
NO
I certify that I have read this application and state that the above information iscorreet. I,
-agree to comply with all ci . nces and state laws relating to building'construction, and
hereby authorize re ntives'of t i to enter upon the above mentioned property for
inspect io poses .
,
Date: 6/6/2005
Fees paid for Permit:
Total:
323.72
Signa nt
epermits e~pir 'II mit;ltion 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 required to commence or coniinue work.
, INSPJ:CTION RECORD " FINAL INSPECTIONS ~_.- . Date , ,Inspector
, , Electrical Final .. ,
INSPECTION' DATE' INSPECTOR
Temporary Power' Pole " .' , , " Plumbing Final '
Plumbing (DraintWaste Pipe) , " ,
Mechanical Final "
Electrical Ground Electrode/Ufer , '/)/ c ' ,
SetbacklFormsfTrenches (Footings) 7-/</,0 '-r/ ,l,' Gas Test
'Do not installsubfloor or pour floor slab until the / Engineering/Grading Final 765-5126
, ,following applicable ilems have been signed:" '
Plumbing (Water Pipe.Sprinkler Valves) , , , Fire Dept. Final 765-4040 '
Mechanical (Groundwork) : ' Water Engineering 765-5268
Electrical (Underground Conduij) , ,
Pre-slab (Compaction/Membrane.Rei nt. , , Sub List/Business License 765-519 .
Underpinning (Floor Joist/Girders) Zoning 765-5139 , , ,
, ,
Do not cOver or conceal the work below until the Building Final lkasllnspection. Only ricO) .~&<
following applicaole,ilems have been signed: , , , fter Above Complele) ~'..."'"
1st'Floor Shear',. , , , '
PARTIAL INSPECTIONS I
Firesprinkler(Rough) Buildina Inspections
2nd Floor ~h..~r ,~ -'
ROof .!Sbeathing/Di)PhragmlFrame) 7.'2.7. './....... J. ,,.,
Mas '",J..ond BeamlPre-Grout), { ,
Rough Plumbing (Top Out) ,', ,
Rough Mechanical , ,
Rough Becttlcal (Dry Wall) " ' , , I . ,
Rol.ign Electrical,
Framing "(Only after Plbg., Elec.; Mech.. and Fire) ,
Insulation (SoundlEnergy) ,
po not tape or pla(lter until the following applicable Mechanical Inspections
Items have been Signed: ,
,Drywall , , ,
Penetrations (Fire Rated) Electrical '
Penetrations (Fire Rated) Mechanical ,
Penetrations (Fire Rated) Plumbing . '
Interior Lath ~.'
, "
Exterfor Lath . - 74<1~alS =/ '''b'/'' Plumbina Inspections
, GENERAL ITEMS b. " , ,
Exterior Plaster (Brown Coal)
T -Bar Electrical' ,
T -Bar Mechanical ' " , . "
.' , ,
T -Bar Structural
Sewer ,
Water Engineering Backflow. EJectricallnspections '
Water Service, ,
, " ,