3638 W. Savanna
TYPE OF PERMIT, . CITY
Reroof
BUILDING DIVISION
200 S. ANAHEIM BLVD,
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765- 4626
CENSUS CODE: 555
QUARTER SECTION: 2
BUILDING PERMIT NO. BLD2005-01059
DATE: 4/15/2005
JOB ADDRESS: 3638 W' SAVANNA ST 221
LEGAL DESCRIPTION: TRACT NO 743 LOT 24 AND TRACT NO
APPLICANT: HUN KIM
OWNER INFORMATION:
Prince Gasa PaCifiCa Properties LIe
3634 W Savanna St
Anaheim, CA 92804
CONTRACTOR INFORMATION:
GOLDEN CONSTRUCTION.
3812 FRANCEoS AVE
CHINO, CA 917100000
BUSINESS PHONE: 909 468-229~
Reroof6D squares with BUR over existing one layer; for entire building on 3638 w'Savanna
ARCHITECT/ENGINEER INFORMATION:
JOB DESCRIPTION:
VALUATION:
9,000.00
PROCESSED BY: JNJ
OWNER-BUILDER DECLARATION
I hereby affirm under pe~1ty of 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 ~ny structure, prior to its issuance, alSo
requires the applicant for such permit to file a sIgned statement that he is licensed' pursuant to, the provisionsof the Contractor's, License Law (Chapter
9)(commencing with Section '7000 01 Division 3 _01 the Business and Professions Code) or that he is exempt the.refrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a ciVil penalty of not more thaI) five hundred dollars
($500),. .
o I, as owm:ir of property, .or my employees with wages as their sole compensation, will do the work, and the structure is not iritended or offen:~d for
sale (Sec. 7044 BusJnessand-Professions Code: The Contractor's License Law 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 own employees, provided that such improvements are.not intended,or
offered for sale. If, however, the building or improvement is sold with one year otcompletion, the Owner-builder will have 'the" burqen of proving that he
did not bund or imp_rove for the pucpos~ of sale). .
o I, as the owner of the property, am exclusively contracting with licensed contractors to constru~t the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of property whq b~ilds" or improves thereon, and who oontracts-for such projects with
a contractor(s) liCensed pursuant tothe Contractor's License Law).
o lamexemptunderSec. . ,B&.P.C.forthlsreason:
Date: Owner:
I :WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perJury one of the following declarations:
o I have and will maintain a certificate of consent to self-insure for worker's Cdmpensation,
as providectfor by Section 3700 of the Labor Code, for the performance of the Wi>rk for which
%".Jin is issued, . '
,. have an<;i will maintain worker's compensation insurance, as required by S9ction 3700 of
the rCode, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier: STATE COMPENSATiON FUND
Policy Number. 564_0000065
LICENSED CONTRACTORS DECLARATION
I hereby a Irm under penatty.of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code. . .
4/15/2~ IM~' t?"Jl-
Date: 1 [k;ontractor
NUMBER EXPIRATION DATE
702267 2/2812007
TYPE B
TYPE C39
TYPE Hie
This section need not be completed if the pennil is for one hundred dollars ($100) or less.
o I certify that In the performance of the work for which this permit is issued, ( shall not
employ" any person in any manner so as to become subject to the worker's compensation laws
of California, and agree that if I should become subject toth~ worker's compensation
provisions of Section ~700 of the labor Code; I shall forthwith co'mply with those provisions.
Date: 4/15/2005 APPlica~ C .
WARNING: FAILURE TO SECURE WORKE SC PENSA TION COVERAGE is
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED 'THOUSAND DOLLARS (~100,OOO), IN ADDI1lON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES,
CONS~RUCTION LENDING AGENCY
I hereby affirm under 'penalty of perjury that there isa construction I.ending age.~cyforthe
performance of the work for which this permit is lssue.d (Sec. 3097 .Civ.C):
Lender's Information: .
Construcion.Tvpes:
VN, ,
I certify that I have read <this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to buUding construction, and
hereby authorize representives of this city to enter upon the above mentioned property for
"ect~n purposes.
Date: 4/1512005
Sig
The permit s. I e ire by limitation and become null and void if the bUilding or
work has not passed final inspection 365 days frorn the dale of permit issuance. A
new permit is required to commence or cohtinue work. .
Fee.s paid for Permit:
Total:
374.49
INSPECTION RECORD .
. INSPECTION . . DATE .INSPECTPR
Temporary Power Pale .
Plumbing (OrainlWaste Pipe)
Electrical Ground Electrode/uter .
SetbacklForinsrrrenches (Footings) . .
Do not instaU subflooror pour floor slab until the ..
following applicable items have been signed:
Plumbing (Water Plpe.Sprinlder Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit) . .....
Pre-slab (Compac:tionlMemtlrane.Reinf.) . .
Underpinning (Floor Joist/Girders) . .'
Do not cover or conceal the woll< below until the
following applicable items have been signed: .
1 st Floor Shear . .
Firesprinkler (Roughl '.
2nd Floor Shear I ~
Roof ISheathlna/DiaphlllamlFrane) j\<.;,{fT" -1\\. .
Masonry (ReinfJBond BeanlPre-Grout) I ~. . .
Rough Plumbing (Top Out)
Rough Mechanical .
I ROugn t::Iectrrc... \ury ..alii . .
Rouah Ellletrlc,,1
Framing (On~ after Plbg.. Elec.. Mech. and Fire} . .
Insulation (SoundlEnergy) . .. .
Donat tape. or plaster until the follOWing applicable
items have been signed: . ...'
Drywall . . .
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical . .
Penetrations (Fire Ratedl Plutnbing
Interior Lath .
Exterior Lath '.
. GENERAL ITEMS '.
Exterior Plaster (Bl\:lWn Coat)
T -Bar Electrical . .
T-Bar..Mechanical . . .
T -Bar Structural . .
Sewer ..
Water Engineeririg' Backflow
Water Service
FINAL INSPECTIONS Dilte Inspector
Electrical Final . .
Plumbing Final .
Mechanical Final .
. .
Gas Test '.
EngineerirlglGrading Final 76505126
Fire Dept. Final 765-4040 '.
Water Engineering 765-5268
Sub List/Business license 765.519
Zoning 765-5139 .. r\ .
Building Final ll'ast In~pection- Only ~fJ ,lotS 41. ~n~. .
. . fler Above Complete)
. PARTIAL INSPECTIONS
B~~:~~e~
r-:- . \
. Mechanical Inspections
Plumbina Inspections
Electrical Inspections