2109 E. South St.
APPLICANT: ALLISON PRIDY
OWNER INFORMATION: CONTRACTOR INFORMATiON: ARCHITECT/ENGINEER INFO~MATION:
Robert M Johnson HAR BRO, INC! HANS C HANSEN '
2109 E South St 2750 SIGNAL PKWY ~ 17371 IRVINE BL#200
Anaheim, CA 92806 SIGNAL HILL, CA 90805-0;\'0 , TUSTIN, CA 92780 ,
BUSiNESS PHONe: 562 52!! 8000 ' ,.
JOB DESCRIPTION Residential Fire Damage Rep~ir. Replace less than 50% ct existing roof structure (same for same) and miscellaneous walls per
VALUATION: en9w.olfudd'dans, :1,' PROCESSED BY, JJJ
I ' " .,' . ' OWNER-BUILDE~l)ECLARATION:: "".' . ~
I hereby affirm under penat1y of perjury that I am exempt frvm the cor.trp:ct.:Jnf Llcense.Law for the following reason (Sec. 7031.5 Business and .
Professions Code: any' city or county which requires,a permit to const7l1ct. f.:!~ r,jrr.prC?ve, deir.olish or repair any structure, prior tc its issuance,. also
requires the applicantfor such permit to' file a signed statement that !1e is HcE:.;, sed pursuant to ,the provi$ipns of the Contractor's ~icense l.a\!:V (Chapter
9}{commenclng with Section 70CO af Oivision3of the Business and Profe$.:.~tfns'Co20) ~r that he is exempt thereflom and the basis f('( th:= alleged
exemption. Any viola.tion ofSection'7031.5 by any applicant for a permit :;Lib~dcts the a:-~plfcant to a civd penaltY-of not ~re than five .hundred dollars
~~ ., . ...
o ,: as ownqrofproperty, or mY,employees with wages as their $016 co..-,;::t;r.$?~jCln,... wilj do the work, and the struc;ture b not intendedor offere,~ f9r
sale {Sec. 7044 Business and Professions Code: The Contractor's License L\~:'Ndoi::s ~o( ,apply to'an ownerof property W(":Q bui!ds or ;mpr~"';'es, .
thereon, and who does such work himself or herself or throuQh his or her0wl~ ~J!lP!oyees, provided that such improvements ""I~ not intended or '":
offered-for sale, if,nowever, the buildiflg or. improvement is so~ with one y>:.~rof completion, the owner-builder wUI have .the burden of provilrg th~~t,e.
did not build or improve for the pUlpo~e of ~le}. .' _ 'l- ' . " '::
o I, as the own~r of the property, am exdusively cDntractir:.c:i,with licf!nsf'~ ~)r:troC::Ns to_ o:onstruc~ th-e projed {See: 7044 Business and ProfessiC"ns_'
Code: The Contractor's Licerosa Law does nqt apply' to an qw"cl' ~f p~op'Crt~<tJr.o builds cdmpro.ves thereon, and whc '(.o<'\tracl$ for 3ucli pro)ects\r"II'ith
tJontr~~f;t0r(S) licensed pursuant totheContractor'suce~se L:.:!VI). -G," __ _'_r.:'>' . '. ~
I am exempt"undf.!~Sec. _____ . B & P.C. forthls reaf-on. ..,...__l_~--'"' - _' - - _ _ - ....- -'.
Date.: ., OWner: ______1....,__ __
'C:::: 'WORKER'S COMPENSATION DECLARATION ~L LICENSED CONTRACTORS DECLARATION J
I hereby affir der penalty of perjury one of the'following declarations: . ~ I hereby affirm. und r penalty of perjury that I am
o , ha and wi:! maintain a certificate of ronsent to self-insure for wc;-:',L(lr;ompe:l::;atiori, licensed under provisiofi'; of chapter 9 (coMmercing
as pr Cled for by Sectior: 3700 qf the Labor: COde,_ for the performance of ti":~'';;''''Oi"k tor whidl with Section lOGO) of I-==irlrl 3 of the Bus~;.ness and ..'
thi rmit is issued. . . ( Professions C!Jde. . ~ ________
I have and will maintain worke(s compensation insurance, as' requi",~ b~Sec'jon 3700 01 8i5/2004 ~, ,
the Labor .Code, for the performance of the work for which this permit is ;&3u"_~. My worker's Date; . Contractor
Ctlmpensation insurance carrier and policy are: .~
Carrier: STATE COMP , Policy Number.046-00c.'!r92
This-section need not be completed if the pennit is for one hundred doliars ($1 O{;iorl~s;
o I certify that iOn,the.performance of the work for which lhis permit i$ 'issu~b, J' Sl1~II;..ot
employ any person in any manner so as to become slJbject to the w'orke:~s C.).ilpEths'ation laws
of Califomia, and agree that If' should become subj to the.woiker'-.... m :.bsaiiorf, .
provisions of Sec~ion ;.noo of the Labor Code, J s~a orthwlth corJ"lply . visions.
BUILDING PERMIT NO. BLD2004.03053
TYPE OF PERMIT CITY.
Repair .
DATE: 8/5/2004
JOB ADDRESS:' 2109 E SOUTH ST
LEGAL DESCRIPTION: N TR 2300 LOT 42
Date: 8/5/2004 I\Pplicant: --- . -'-'-I
WARNING: FAILURE TO SECURE WORKER'S MPENSATION COVEH'c\GEIS . ..'
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL FENAl'Tie:$ AND ~IVIL
FINES UP TO ONE HUNDRED "!HOUSAND DOLLARS ($100,000); IN ADD(T10NTO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECtIC:-l"31'06 OF,THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES, ,
CON TRUCTION LENDING AGENCY
. ,
, --
! r.erebv affj~m!J]::.cfeJ penalW_.9t .eriurvJha! there._is_a_cO('lstn;t;t:cn.lend'nn p.:<.....-~~Vf')I"i...'1e...;;_ .1.._
performance of the work for which this pc:rmit is issued (Sec.3097.Ciy.C): ..
Lender's Information:
I certify that I have r. ~ this application and state that the above information i's correct. (
agree to romp! hall dty ordinances and state laws relating to building construction, and
~ere utpuriZ r:.resentives:~eaboVementioned property lor
Date: 8/5/2004
. . 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. '
NUMBER
258441
TYPE
TYPE
BUILDING DIViSiON
200 S, ANAHEIM BLVD,
(714) 765.5153
INSPECTION REQUEST LINE:,
(714) 765 - 4626 '..
. .CENSUS CODE: 434
QUARTER SECTION: 113
EXPIRATION DATE
9/30/2004
B
HIC
Construcion Types:
VN, "
Fire $prin,klered?
,NO
Fees pa;(d for Permit:
Total:
1.021,81
INsPECTION RECORD
INSPECTION DATE . INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/lifer .
SetbacklFormslTrenches (Footings)
Do not install subfloor or.pour floor slab until the.
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork) .
Electrical (Underground Conduit)
Pm-slab (Compaction/Membrane.R.einf. .
Underpinning (Floor J~t/Girders)
Do not cover or conceallhe work below unt,Hhe
fol/o",ing appiicable items have been signed:
1 st Floor Shear . .
Firellprinkler (Rough) . .
2nd Floor Shear. . .
Roof (SheathiIlQ/Dlaphragm'Frame) ID/,/o
MaSonry (ReinfJBond BeamlPre-Grout)
Roulll1'Plumbing (Top Out)
Rough Mechanical. .. . ..
Rough f1ectrlllal (Dry Wall) . . .
Rough Electrical
Framing (Only afrer Plbg,. Etec.. Mech_. and Fire) IKI'I e
Insulation (SoundlEnergy)
po not tape or plaster. until the follOWing applicable .. .
Items have been SIgned: .
Drvwall .
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) MeChanical
Penetrations (Fire Rated) Plumbing . .
Interior Lath .
Exterior Lath . .
GENERAL ITEMS
Exterior Plaster (Brown Coal)
T -Bar Electrical . . . . .
T-Bar Mechanical . . . .
T -Bar Structural . ..
Sewer.
Water Engineering Backflow .
Water Service
-
FINAL INSPECTiONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Date
Inspector
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765'5268
Sub List/Business License 765-519
Zoning 765-5139
Building Final ILast tnspection. Only '" (A '"5
. Jllter AboveCompletej ;:> u u
PARTIAL INSPECTIONS .
Building Inspections
. Mechanical Inspections
Plumbing Inspections
Electrical Inspections