390 S. Peralta Hills Dr.
BUILDING PERMI, "jC.'8LD2004-00202
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~~~E~~~:~~~: 390 S ~ERAL TA HILLS DR <!'i:./1
LEGAL DESCRIPTION: PARCEL MAP 15-19 PAR 1 POR OF PAR ,I
(.
TYPE OF PERMIT
Miscellaneo'us
CITY'
BUILDING DI'.'ISIOi I
200 S. ANAHEIM BLVD.
(714) 765- 5153 ,
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: UNK
QUARTER SECTION: 162
CONTRACTOR INFORMNnON:
KEN THOMSON
2903 SATURN ST #B
BREA, CA 92821 0000 I
, BUSINESS PHONE: 714 5'1')-8060
JOB DESCRIPTIONAdd free standing fireplace in rear yard (Iennox Is0-43) '. I',.
'VALUATION: 1.800.00 . 'L '. PROCESSED BY: MJL ,
I OWNER-ElUILDE!?DECLARATION I
I hereby affirm under. penalty of:perjury that I'am exempt from the'Contract~<~-License Law,forthe'following reason. (See; 7031.5 E3usiness and
Professions Code: any city or county which requires a ,permit to construct, ar.f, ,'f,'improve, demolish or repair any structure, prior to its issuance,' also-
requires the applicant for s~ch permit to file a signed statement that heis licf:"sed pursuant to the provisions of the Contractor's Ucense~aw (Chapter
9)(commencing with Section 7000 of Divisia:n 3 .of tf1e Business and ProfE!S$r: Irs'Cade) or that he is exempt.therefram and the basis for th'ealleged
exemptian. ~y violatian .of SE"cti~n 7031.5 by any applicant for a permit subectsthe applicaiit to a'dvil~naltyof n.at mor,;, thon five hUI)~re~:dallars' .
($500)., .' e,<",', .,'.. .
. 0 I; as ,Owner .of property. .or my emplayees wit:, wages as their sole comt.j?'(lsati.on,.will dathe wark, and the structure is J~ot !:1tended .or aff~r-ed far
sale {Sec. 7044 Business and PrafessibnsGade:- The Contractor's License,~t~\.daes not applyto.an owner.c>fpr:aperty who builds ci"}mpraves"
therean, and who does sum work himself .or herself arthraugh his or her av::i>.emptayees, provided that such improvementsarCc!1ot intended .or,. . __
offerc.d forsale. If, however, the buildir.gcr improvement is sold with .one ya;~~of .oompleti.on, the, awner-~uild('r.will have th~:burden afpraving that he
did nat build .or imp rave for the pLlIpOSe .of sale)..' ,J ., ~ ',~ " L ,,',
. 0 i" as the awn~r"afth~ property"am exdusively cantracting Wiih.licens~~ntradars ta canstruct th"e p"r'.o;~ct (See. 7C44S'usiness .and Proressiprrs "
Cade: The Cantractar's License Lawdaes nat apply to an owner .of praperty,.vho builds .or imprc:\'es th2renn, .and.. who oontracts.forsuch p~aj,;cts:with .
"E1ont~ct~Jr(S)li~ensed PursuanttatheCantractar'slicenseLaw). r " . ,:"." ,," -
I am exempt under ,B & P.C. for this rea.son:. ---'--t' . . . , , ,
Date: ner: ' ,
.,
W RKER'S COMPENSATION DECLARATION S' ~
I hereby affinil undar penalty of perjury One .of the fallawing declaratians:: ~
D. I have arid will. maintain a certi'ficate of oonsentta self-Insure far warkerA compensatian, .
as pravidep for by Sectian 3700 .of the Labor Code, far ihe perfarman~ aft:~~ 'Nark far which
this permit is issued. . I
[]' I have and wiU maintain warker's campensatian insurance, as requirsd bIt Secticn3700 .of
thn Labar Code,. forthe perfarmance .of the wark far which this 'permrt is'iss.o1:!'~' My worker's
Compensation insurance carner. and policy ar~: ~,'t."
C,:urier: '. Palicy Number:.. ..t:q.,~ .
This section need not be completed. if the pennit is for one hundred daliars {$1,€~if* less~\
. D ,I certify. that in the perfonnar.qe .of the work far which this permit is issu~~i~':~an'-~ot .
emplay any persan,in any manner,so as to became subject to the worker's v"~,~.p.ensatlan laws
of Califarnia, and, agree that if I s~.ould became subject ta the warker's camP::,:~$'a~an . .
::.:~i:~:;~o::tio~n 37 ~P::i::t: ab?r Code, I s h.all fO~. m.p. i~~:~.i)..jb...'.p. r..O...:i,"ions. .
WARNING: FAILU . SECURE WORKER'S COMPENSATION CO'lEF;'.',GEJS', .
UNLAWFUL, AND HALL SUBJECT AN EMPLOYER TO CRIMINAL PEI':!'::nE~AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN AD,;r;lON TO THE
COST OF COMPENSATION, DAMAGES.AS PROVIDED FOR IN SECTI0t1::iZP6'OF THE
. LABORCODE,.INTEREST AND ATTORNEY'S FEES.': ". .
i .' CONSTRUCTI(lNLENDING....GENCY... .J.....
_, '.~..,..~..,~,--_,-_ ._.-,,-__.h--.-'_'c''.:__,_''-"'..,---/~,..~.,.'='""__"_',,~~".., ~'~,' "'''...,,:'''_~~.''' _'_.__' ____~....._', .._~
J :--"'3reoy affirm under penalty of perjury that there:is "8 canstructianlend:ing .at;ency far the
perfarmance .of the wark far which this permit is issued (See.309? .Civ.C):
Lender's Infarmatian:
APPLICANT:
OWNER INFORMATION:
David A Kohn
400 S Peralta Hills Dr
Anaheim,CAg2807
ARCHITECT/ENGINEER INFORMATION:
,
LICENSED CONTRACTORS, DECLARATION
I hereby. affirm under penaltyof perjury that I am
licensed und rovi$io~sof chapter 9 (cammencing
with se.cr" 7 00) .of Di:vs~the. susiness.and
Professions e . lJ.-'\. \ 1'\.cJ\;V.Ja)~,
1/22/2004
Date:
Cantractar
NUMBER
406701
TYPE
TYPE
EXPIRATION DATE
5/31/2005
B
HIC
Cari.struCian Types:.
VN, .
Fire Sprinkle red?
N"O
I' certify that I have read. this applicatian and state that the abave infarmation is carrect. I
agree taoo, 'p1y with all. city .ordinances and state laws relating to buDding constructi.on, and
hereby thorize 'represeritivRXes of t is city to enter upo..i1 the above m.enti~ned property for
" inspect. ses.... , (\. "
, .. ' .' / 0-- Date, 1/22/2004
Signature of Applicant .or Agent .
The. permit shall expire by limitation and become null and void if the building or
wOrk has notpasS!!ltfinal inspection 365 days from the date of permit issuance. A
new permit is required to-commence or continue work.
. . ~~
Fee$ paid for Permit:
Total:
90.13
INSPECTION RECORD -. ":~~':JO.
. FINAL INSPECTIONS , : Dale' In~eclor ".
. INSPECTION' . . DATE INSPECTOR . ElllCtrical Final . . II-uTo IV 1/'IOh.', .
Temporary PowerPole . Plumbing Final .' . 7 .....
. .
Plumbing (DrainlWaste Pipe) '. / '.' .' . I
Electrical Ground Electrode/uteI'. . 1) A~ / Mechanical Final . .
. Gas Test. . . '.
SelblicklFormsrrrenches (Footings) -'2-?,iJJ, 1/' . . .
. Do not install subfloor or pour floor slab until the /} EngineeringlGra'dingFinaI765-5126 .
following applicable items have been signed:. .' '.' .
Plumbing (Water Plpe.SprinklerValves) . . V .. Fire Dept. Final 765-4040
.
Mechanical (Groundwork) . . . '., WaterEngineering 765-5268 '.
. Electrical (Underground Conduit) . . . .
Pre-slab (Compaction/Membrane.Reinf. . Sub List/Busin.ess License 765-519 .
Underpinning (Floor Joist/Girders) Zoning 765-5139 .. .
.. . .
Do nol. cover or conceal the work below until. the . Building Final~a.t h,.peclion- Only tit-day '#
following applicable items have been signed: u. fler Above Complete). . '.. .
'1st Floor Shear .,.. . . '. PARTIALINSPECTIQNS. . n,/(IV I
Firesprinkler (Rough) .
2nd Floor Shear . . . . C' Bui1dln.'n..~;OM . t' . .. ~..~
Roof (Sheathing/Diaphragm/Frame) . ._ n .'
Masonry (ReinfJBond BeamlPre-Grout) '],2.,1 Q,.L '2- -/3 -., Y rao{)~6 I/i:~ ..... v
Rough Plumbing (Top Out) " ~ . .
Rough Mecha.nical .. . .' ~
KOugh ~ectrical (Dry Wall) . . .
. ,. . , .
Rough Electrical . . r
Framing (Only after Plbg.. Elec.. Mech. and Fire) ......~A . .
Insulation (SoundlEnergy) . . . .
po not tape or pla~ter until the fOllowing applicable'. MechanicallnSDections
. dems. have been signed:,. '
DiyWall . . . . ..
. .. '. . .
Penell"atlons (Rre Rated) Electrical . . ...
. Penetrations (Fire Rated) Mechanical c- .
Penell"ations (Fil1l Rated) Plumbing .
Interior Lath . . . . '. '.
Exterior Lath . . . Plumbina InsDections . .'.
GENERAL ITEMS . . .' .'
Exterior Plaster (Bl'O\Nn Coat) . . . .
. .T -Bar Electrical .
T -Bar Mechanical . '. .'
. . .
T -Bar Structural' . . . . .. . .
. . .
Sewer . .
Water Engineering BackfloW ElectricallnSDections .
.
Water Service .-c
. .... '
/'