510 S. Sonya St.
Z,~~~F PERMIT CITY
DATE: 8/2/2004
JOB ADDRESS: 510SS0NYAST
lEGAl DESCRIPTION: N TR 9300 lOT 110
ElM,
BUILDiNG DIVISION
200 S, ANAHEIM BLVD,
(714) 765- 5153
INSPECTION REOUESTlINE:
(714) 765 - 4626
CENSUS CODE: ' 434
QUARTER SECTION: 54
BUILDING PERMIT NO. BLD2004.02996
APPLICANT: ROB KIM
OWNER INFORMATION: . CONTRACTOR INFORMATION:
Anthony Lucero SHORELlNEROOF.COM.
510 S Sonya.SI 17603 ERIC AVE.
Anaheim, CA 92802 CERRITOS, CA 907030000
. . BUSINESS PHONE: 56240' 6744
JOB DESCR:f'TION:Tear off shake and install 22 squares of Ea91e lite tiles :\; lb. leBO # 4660. .
VALUATION: 8,790.00. ..
L ' OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exefTlPt.from the ContractbfS:oUcense !-aw tor "the following reason (Sec.,7031.S Bu!?iness.:and
'Professions Code: any city or county which requires a permit to construct. ajf;~r,' improve, d~molish or repair any structure, Hrior.1a its issuance, also
requires the applicant for stich permit to file a signed statement that he is Ik:"~r;sed pursuant to-the;prov\sions of the Contrado~'s License, Law (Chapter
9)(commencing with Section 70qo of Divisjon 3 Qfthe Business ar,dPfofes's'~)~::; Code) or that he is exempt therefrom and.theb-asis for:thl?,~t1eged"
exemption. Any violation of Sectiort 7031.S'by any applicant for a p'ermit su~::3cts the applicant to a. dvU penaltyofnot more than five liuhdred dollars
($500).. I.. .. . .....
o I, as o~ner of property, or my employees with wages as ,their sole com~ensatiof'\, will do the work, and the structure is no(intend~ or' ?ffered for
'sale (Sec. .'044-~usiness and ProfesSions CodJ~: TI,e Contractor's Ucen5e,,~.-3w dtJes not ~pplyto an owner of property who'builds ()rimpr~wes .
thereon! and who does such work himself or herself or through his or her CJ."'.f~.:' employees, provided that such improvel'lW,nts ar~ not-intended or
offered for sale. . If, however, the building or improvement is sold with ore yetir of completion, the OWner-builder will have the burden vi pro~rn!;;J that he
did not buUd pr improve for the purpose of sale). > _. ... .;. " ' . .' '. . .' .' .~,~. . " .
. 0 I, as the owner of the property, am exdusively contracting with l:ccnsect1lolllmctcrs to construcHheproject (Sec. 7044,8\.lsilless and Pr9fe,ssions
Code: The Contractor's'Ucense.Law does not apply to a" owner of prape;t)1~'i"O built;ls or improves there(Jn~ and who contractsfor.,s~,jcl1 projects with
~n~fact.or(s) lice:rsed pursuant to the Contractor's license Law),.' '
W,.lamexemptunderSec., . .B&P.C.forthisreason:
Date., Owner:' ~:I
, WORKER'S COMPENSATION DECLARATION T
I hereby affinn under penalty of perjury one of the following declarations:- 'r ,
o I have and willmaihtain a certifi9a:te of consent to self-insure for worh:a:'~l: :~o:r:pc.;$a!ion,'
as pro.Y.ided for"by.Section 3700 of the Labor' Code. for the perf.ormance ofti\.... ~Vbrk for whim
,this perrrit is. issu~ci.. ") ,
1lP I have and will 'maintain worker's compensation insurance, as reqL:i~d b~3ectloO: 3700 of
~'Labor Code, for the perfarrnance of the work for ~bich this 'permit" is issued. M~ worker's
Compensatioh insurance carrier and policy are: . '; ..;.. .
Carrier: STATE FUND PolicyNumber. 166794~~01
...): ~:
This section need not be .ci>mpleted if the pennit is ~ on~ hundred dollars (~1.(;,:J;. ;.r'less,.
o 'certify that in the performance of the worl\ for. which this permit is j$Su~'~r'lsha II not
employ any person in 'any manner so as to' become subject to the workel/s"~ir\lP.em;ation laws
of Calitomia, and agree.that if! shOUld becom~ subject to the worker':;; 'cofl1(:ls.risation
provisions.of Section 3700 of the Labor C9de.1 shall forttiwith comply with t~~,eprovisioris.
,."., '>
Date: 8/212004. Applicant:
VlfARNING: FAILURE TOSECUR VlfORKER'SCOMPENSATION COYER,'.GE IS
UNLAVlfFUL, AND. SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENP,t.T'ES AND CIVIL
.FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. "
. ! CONSTRUCTION LENDING AGENCY,___
! h.....I:''!?~!'-~lf-jr~^')rW~Lr.c-r.~!t>q;'f Pi?rjJJ;"/.~h:.t~~~P. .1<1.-3 ~C'r:::f."!..'c!i0:""!!!~f,;'1 !?-=~L' ~,:~" .f{'.-:" ~~'~~...___ em'
performance of the work for whidl this pennit is issued (Sec,3097 .Civ .C):
Lender'S Information:
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: ODC
I
--,
. I
. LICENSED CONTRACTORS DECLARATION
I hereby affirm undei penalty ("1 perjury that I ~m
licensed under provisior,s ot chapter 9 (colTlm~ncing
with Section 7000) of OiWiOn 3 of the Business 'an~
professNJ!5i"
8/212004 ~~
Date: Contractor
NUMBER
780947
. TYPE
TYPE
TYPE
EXPIRATION DATE,
613012006
B
C3S
HIC
Construcion Types:
VN" .
Fire. Sprinklered?
NO
I certify that I have read this application and state that the above informatio.n i.~ correct. I
agree to comply with all city ordinances and state laws relating to buiding construction.. and
hereby authorize representives of this city to enter upon the above mentioned property for
. in ecf r ses.
Fees paid for Permit: .
Total:
195.63
Date: 8/2/2004
Signature of Applicant or Agent
. The permit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work. .
IN$PECTIONRECORD
INSPECTION . DATE INSPECTOR
Temporary Power Pole .
Plumbing (DrainlWaste Pipe) ,
Electrical Grtlund ElectrodelUfet . .
, .
SetbacklFormslTrenches (Footings)
Do not install subfloor or pour floor slab until 1M
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler ValVes)
. Mechanical (Groundwork) . .
Electrical (Underground Conduit) .
Pre,slab (CompactionlMembrane,Reinf.
Underpinning (Floor JoistlGinlers)
Do not cover or conceal the work below Ufttll the
following applicabl!!items have been signed:
1st Flo.ot Shear .
Firesprinkler(Roughl .
.. 2nd Floor Shear ., .!
Roof (SheathinWDiaphrajjmfFrame) Y; ~7- ...
Masonry (ReinfJBond Beam/pre-Grout) , {
Rough Plumbing (Top Out) . .
,Rough Mechanical .
Rough aectrlcaJ (Dry Wall)
Rough Electrical .'
Framing . (Only after Plbg.. Elec.'."'Mecl1.. and F"ire} "
Insulation (Sound'Energyl
po not tape or pla~ter until the following applicable
Ite,!,s have been signed: . .
Drywall . . , . ,
Penetrations (Fire Rated) Electrical
Penetrations (Fim Rated) Mechanical . . .
penetrations (Fire Ratedl Phinlbing
Interior Lath .
Exterior Lath .
. GENERAL ITEMS
Exterior Plaster (Brown Coal) .
T -,Bar Electrical ' .. , ..
T-Bar Mechanical .. '
T -Bar StruCtural .
Sewer '. '
Water Engin....ing Backflow ' , .
Water Service
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical.Final
Gas Test
Date
Inspector
Engineering/Grading.Final 765-5j26
Fire Oep!. Final 765-4040,
Water Engil)eering 765-5268
Sub ListlBusiness License 765.519
Zoning 765-5139 '
Building Final' Ilast Inspection,'Oniy
" Aller Above Complete)
PARTIAL INSPECTIONS
BuildinQlnspections ' .
Mechanical,lnspections
PlurnbinQ Inspections
Electrical Inspections
" i