6092 E. Silverspur
APPLICANT: MARK V ANDREWS
OWNER INFORMATION: CONTRACTOR INFORf..;ATION:
ROdney H Shimasaki ANDREWS CONTRACT.NG, INC
6092 E Silverspur Trl 390010 MIRALoMA AVE #,\
A~aheim, CA 92807 ANAHEIM, CA 92806000)
JOB DESCRIPTJONNew 300sf balconyldeckwilh stairs.
VALUATION: 22,000.00
I .... . "_ . . OWNE~.BUltD.:i:]:DECLARATION .
I h~rf'by affirm under pep.3~ of perjury that I am ("~X1;>;npt~jf).m tf1() CO!1t'-;;!r"t~(s License law for the fol owing reason ( ec. 7031.5 Business and
Pro1e~sicn~ Cofje: ;Jny tity or cO'Jntywh:ch req1llros 9 perrliit'~O. r.onslri;:,;~.: c.;"j;~;, imp~ove, demotlS:h or repair any structure, prior to its i~uance. also .
l'cql.::r~f {he 2l~'PliG:lnt 'io~ s!,Ir.!1 p'e:rna to ril~e $~;:ned Btatt.~I1~mt tr,~t he, i-: :ic'~'nsed pur$uan~ to the provisions of.theCo.ntraaor's license Law (Chapter
9)~-=~~'":);~:~nc;:ig,w:tt~S~ctkm !OO:Jof Dlvis!:" 3-~~fti1S a::l$!:lt..:$ ~:r,,~ P,~(c_s11sns Code) ,or~hat he is e?,_~mpt therefro,:" and the basis.for t~e,alleged ,
a~~;dj~'O(J.' t-.ny ....tc:llatt(,1'\ of S~-c1.ioo 703'.,I.:J,PY' c~y <-pplic?nt ror ri pc:rm:~-s!..:.t~C~S the a~p.llc;ant to' a avn penalty of not more,1han five hundred donars .
o i, as ownerjjf propeny, (:ir myempJoyees'~ith wages as thew Sole COmh:ln~Dti6'1' wHl do the work, ,and th~ structure is not intended or offered for
s~le (Sec. 7044 Busines,s and Professions-Code: The Contractor's Licer.s~9~aw does not apply to an owner of property who builds or improvee'
thereon, and WhCd'oes sum work himsetfor herself or throug~ his or her 0V~:' employees, 'provided that such improvements are not intended or ..
offereq. for sale. If:-however, the building or improvement is sold with one :';f~r of completion, the oWner~builder will have the burden of proving that he
did notbuR.d or improve for the purpose.of Sale). " '~.' - _."
o ,I, as th~ owner of the property. am exdusively' contracting with Iicens{:;\r..ontf<3-Ctors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's Ucense Law does not apply to aq owner of ~ro?Qlt:+.f.Iho'builds or improves thereon,and whQ contracts for such projects with
-~ontractor(s) licensed Ptlisl!.:::r~[,totheContractor's License law}. ..;.: .. '
U tall} exempt under Sec., . " B &. P.C. for this reason: !!
Date: OWner: : ~
'i:
I" WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe~ury phS of the foilo'(<ing declarations: .
o I haVe and will maintai':l a certificat'e 'of consentt6setf-insure for'work~if.comp.em~ation"
a~ provi or by section 3700 of the Labor Code, f9r the performance (}f j--.p work for which
t is , rmit.is issued. . ' ' ;
I have and will maintain WO,rker's compensation insurance, as roquirac t;;, 3€ction 3700 of
'. the'LaborCode. fot the performance of the work for which this permit js.-'issu\.d. My worker's.
Compensation insurance carner and policy are: f
Carrier: STATE COMPo FUND. . Policy Number. 17135~~i)'1 .
This section need' not be completed if the permit is for one hundred dol/a..." ($"<: '" less.
,0' certify that in the performance of the work for which this permit iS1~~t.~'~~J~a" .net .
employ any person in ~ny manner so as to. become subject.to the workE:!:'s~~mp'ensation laws
of Califomia;,. and agree that if I should.be9ome subject to theworker's:~o;;';:-;:'f~.a.tiorl'
provisions 6f Section 37000fth'e LabOrGod~II)>~""lhC.wnP#Withll'ro provIsions.. .
Dale: 11211Z004 . Apphcanl: /' ~!iP/'a {/..- ~ . . .
WARNING: FAILURE TO SECURE WORKER'S COMPENSArlONCOVEfj~GE IS'. . .
UNLAWFUL, AND SHALL SUBJECT AN .EMPLOYER TO CRIMINAl,A'EN,01.TIE$ AND CIVIL
FINES UPTO ONE HUNDRED TIiOUSANDDOLLARS ($100,000), iN Ac'i'T10N TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIC:'; 3706 OF THE
LABORCODE, INTEREST AND ATTORNEY'S FEES. .'
I CONSTRUCTION LENDING AGENCY.
,I hereby affirm under penalty of perjury that ther~ is a construction__l.en.dlnc:?:-i~#;1pYfor ihe.
performance of the'work for which this' permit is issued (Sec.3097.Cf.J:.C):, \
_"...l.e.n,_ior'!:.J('f('_i_Tj-1:::>~~..; . . . '-
BLD2004.00022
',~
'.
CITY
OATE: 1/21/2004
JOB ADDRESS: 6092 E SILVERSPUR TRL
LEGAL DESCRIPTION: NTR 10800 LQT 31
BUILDING DNISION
200 S. ANAf-!::'!M BLVD.
(714) 765 '~:53 .
. INSPECTION 'REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECT-ION: 192'
ARCHITECT/ENGINEER INFORMATION:
DONALD K MUNENO
18951 FLAGSTAFF LANE
HUNTINGTON BEACH, CA 92646
PROCESSED BY: JJJ
LICENSED CONTRACTORS DECLARATION
J hereby a irm under pena ty of perjury that i am
licensed under provisions of chapter 9 (commencin'o
with SectiOn 7000) of Divslo 0 hi!.e~i.n.e. S '.
Professions C e. . . _
112112004
Date:
NUMBER
665400
TYPE
...TYPE
Contractor
EXPIRATION DATE
313112005
B
. HIC
Construcion Tvpes:
VN, "
Fire Sprinklered? .
Balcony / Deck Area:
:.-. --...
, , " '
I certify that I have read this applicatipn and state that the abov~ informatiol1 is cmrect. I
agree to comply with aU city ordin;ances and state,laws relating'to buUding construction, and
hereby.authorizerepUlresentiv 'UOf hZs ci . ta nter.u.pon the above mentian~:. property.(or
insp~ ..' .... '
. . ". -. . . Date: 1/21IZ004
Signature of Applicant 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 required to commence or continue Work.
NO
300
fees paid for Permit:
Total:
: 742.96 .
INSPEGTION RECORD
.' . . INSPECTION . ; . DATE INSPECTOR
T\lmporary Power Pole'
Plumbing (DrainIWaste Pipe) . .
Electrical Ground Electrode/uter '. . ,
SelbackfFormslTrenches (Footings) ,. 77.& riA .
Do not install subfloor Or pour floor.slab until the
following applicable items have been signed: .
Plumbing (Water Plpe.Sprinkler Valves) .
M~hanical (GroundWork) .
Electrical (Underground Conduit) .
pre-slab (CompactionlMembrane.Reinf. .'
Underpinning(FloorJoistlGirders) .'
[)() not cover .or conceal the wort< below until the
following applicable items have been signed:. .'
1st.Floor Shear .
Firesprinkler(Rough) .' .
2nd Floor Shear . . . . . .
Roof (Sheathing/Diaphragm/Frane) . "
Masonry (Relnf~ond BeanlPr&-GJ'()\Jt) . .
Rough Plumbing (Top Out) '. .
Rough Mechanical . .
, Rl)l\9h Electrical (Dry Wall) . .
Rough Electrical . .' 1t
Framing (Only after Plbg.. Elec.. Mech.. and File) 'd(,..()c
Insulation (SoundlEnergy) . . .'
po not tape or pla~ter until the following applicable .
,tems have been sIgned:
Dryw/JU' . . . . '.
Penetrations (Fire Rated) Electrical. .
Penetrations (Fire Rated) Mechanical . ."
. Penetrations (File Rated) Plumbing
Interior Lath . . . '.
Exterior Lath .
.' . . GENERAL ITEMS
Exterior Plaster (Brown Coat) . .
T -Bar Electrical. . . '. .
T -Bar Mechanical
T -Bar Structural ..
Sewer. .
WaterE:ngineering. Backflow
Wat"r Service
FINAL INSPECTIONS ..'" .P"tte Inspector
Electrical Final.' . . .
Plu'mbing Final . . .
Mechanical Final . . .
.' ..' .'
'Gas Test. .
Engineering/Gr3ding Final 765-6126
Fire Dept. Final 765-4040
Water Engineering 765-5263 . ".
'.
Sub I.IstlBusiness License 765-519 .
Zoning 765;51.39 '. . .
'. . . . '.'
BUilding Final~astlnspection. Only, ~.6-tlS; ~/". '^ .;; .
C' . fter Above Complete) .
PARTIAl. INSPECTIONS
. BuildinCl Inspections
Mechanical Inspections
PlumbinCllnspections
Electrical Inspections