1200 S. State College Blvd.
'''i~~
""'-~~...,..
BUILDING PERMIT NO.
BLD2004-0017 4
BUILDING DIVISION
20o'S.ANAHEIM BLVD.
(714)765-5153
INSPECTION REQUEST LINE:
(714) 765 -4626
CENSUS CODE: .. .437
QUARTER SECTION: 110.
TYPE OF PERMIT
Foundation Only
APPLICANT: JIM SHEA '\
OWNER INFORMATION: CONTRACTOR INFORM,hION:
JonnieHofer TED JOHNSON PROPA;:~ CO
1200 S State College. Bivd 5140 N ELTON ST 'j
Anaheim, CA 92806 BALDWIN PARK,CA g,n,OOOo
,.. '.. . BUSINESS PHONE: 526 ~M-1222
"OB DESCRIPTION:lnstaIl499 gallon above ground LPG (propane) tank. ( .
VALUATION: .. . . 2.000.00. . .,.\ .. PROCESSED BY: ODC .
I.. . . .. OWNER-BUILDEl;;! D~CLARATION. .... . .. . ... .. .
I hereby affirm under penalty of perjury that I am exempt from the Cont:-iJ.,:tc,'ls, License :"9W for the following .rcason (Sec. 7031.5_ Businesc and .
,Professions Code: any city or county which requires a permit -to cor.c_truct, ati;. :mprove, demoli5h or repair any structure, prior to its iss'uance; also'
requires,the' ~pp!ic:a.ntfor~uch permit t~,~I~ a signed state.ment th,at he i,~:ik":1"'se'1. ~ursuant to,the.provisions of the Con1ractor's,Li~~nse La~' (Chapter
. 9)(cC'mmenclng wlthSecbon 7000 of DJVlSlOn 3 of the Busmess and P:"o~.\3:~s..~'ns Code) or.that he IS exempt th!Jrefn~M and the,baslsJorthe'aHeged
exer'!"llJtion. Any violation of Se~tion 7031.5: by any applicant for a pe_rmit ::l.Jl~I~.':-f~ ~~t~ ~p'~~icant to a civil penaity of not mere.than five hundred. dollars,
($500).... . 'J. . . . .. ...
[] I., as: owner oj pr()perty ,or' my. employ-ees wi.th wages as thf!i: ,5('1la cc~n~~.-~l~::z:.t::.:~, will do the WOf k, and th6 strl:iGture is, not intended Of of.e:'"6~ for
sale' {Sec. 7044 BU,siness and ProfessionsCdJe: The Contr::!ctor's Ucef\~:;~'Uwdoes not apply to an O\'\ine.r ':If property who builds .or improves " '.
~her':.lo:"l, Clnd who ~ces such-work himself or herself .or through'his cr hfli O_\~~ f:nl~luyees. ,pr,:,vided,that such Improvements arq:--..ot !;~t~;-;tied pr'_ .'
offered for sale. If; however. the buildin!J orhl1provement is sold with ~J"'!i'< v::1r of completion, the ewner-builder....'iU h;,lye the burden of pro'ltlng. th2t he
didnotbu1Idor'improveforthe,purposeofsale).'] '..-- .'.. . .. .' ,. "
o . I. as the ownerqfthe property, am exdusively contrcfcting wj:;l-i}~,t.::-.c.,~-:'h:)r:tr~ct:x:. t9 cor.struct' the projec.t (Sec. 7044 l3ue1ne&s and F'r.ofeSsions.'
Code: TheCol}tractor's ~icense,Law does not aJ;ply to an owner .of ....rop'-':.:i.~1h ~6 buifds.,or improves the-reon; arid ..~ho co.ntr~c~ for suct_~ projECts with
[,l.J?Cl1tractor{s) licensed pursuant tathe COlitractor',s licenS;e Law). , f'" .
_J .1 am exempt under Sec. ',' . ,B & P.C. rOi t;,is ..eason: -..--..!t-L'
. Cale: Owner: . - .;,,":;'.._J,~- .
L ... . WORKER'S COMPENSATION DECLAR~TiO!!-~ J .. J I-!=ICENSED CONTRACTORS DECLAP-ATICtr-J
! ilereoyaffirmunderpe1"laHy of perjury one of the fciiowingdeclarations: -, I I hereby affirm und3r pena:t'l of perjury that I am
D J'have and wiUn'\aintaln -a certificate of con.sent to -self-'insure fcr...vor~n,::t ';on:;:lensat;.oI'1, I licensed under provisbns of tha r 9 (cornrnencing .
ClS provided !Oi by Section 3700of.the Labor Code, for I~e perforrnan~: cf 'J;;,} wOlk Iorwhld1 I with Section ~o ) of Divs:or. 3 f .he Business ::Irid
thIS per . IS issued. '. ,.n ' I profe5sio~-o.
have and :~i11 maintain worker's"compdns~tjon insuiance,: -as reqLir~,;i :)ll_Gf!~t;6~,~r!Oo of 1r:!1/2001\.
the Labor Code. for the performance of the work for which ~his permit isj~~:';1.-;; fI'lv wori(er's Date:-
Compensation insurance carrier"C1Ind policy are: '.. ..... ~ .,!.. ,
Carrier: STATE FUND .. Policy Number. 3'IQ.-I.o'0C1'31 .
. . .1
This section need not be conipleted if the pennit is for one hund,rect dollars ($1 p;j :-r'l~s.
D . f certify thatin the perfonnance ofthe !vor~ for which this_ permit is iSS~'3:il:: sh:;.il nr::t.
employ any person in any manner so as ~o become subject to theworke(sjc:,J,r.per.sati.on laws
of Califomia, and, agree that if Ishouldbecomesubjedto e\ orker's.co!f.p;;,1,\~atjon
prOVisi?~S Of.sec.tion 3700 ~fthe L.ab~r C9'je, I shan forth .t comply With11.::~.;S~ provleions.
Date: 1/21/2004 Applicant: ~ _ _,' , .. .
", " - . - ::
WARNING: FAILURE TO SECURE WORKER'S COMPENSATiON COVGc,U,GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMIN/\L PE;;''t:"i'iES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100.000), IN ...tI'~;iijQNT9 THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR iN :;;ECTIo." ~706 Of' THE
LABOR CODE, INTEREST AND ATTORNEY'S rEES. ~:,: .,
I . . CONSTRUCTION LENDING AGENCY ..=-_
~here.bv Gffir~ und3rp.7~1ty of. pe~j~iy th?t !h~r~- is a c~~~n~tt~~rl'l~r:~~~g' ;.Y::~_:C:if~;tl,."'e
--,:,~:,'d..::-,\~:,~~:-.;.f~:;;:-.,:~;-;~;.:::,,. '....h,.:.:i.:.,~~-.:.~,ji;;~ i.,:, ;.;,;:;;":cu ,..............:.".'-..;:;..--.1,.;}. ,J -.--
Lender's Information:
ARCHITECT/ENGINEER INFORI\AATION: .
1
Contractor
NUMBER
605151
. TYPE
TYPE
EXPIRATION DATE.
1 O/~1/2004
C36
HIC
Construcion Types:
VN, ,
Fire' Sprinklered?
. NO
I
!
.' ,"~
-,,--".:...-<0-_,
'.. .,
I, certify that I have read thi's application and state that the above information is'correct. I
agree to oomply wnh all city.or.dinances and slate laws relating to bunding construction, and
hereby a rize represehtiv --. if this city te enter upo'n the above mentioned proPerty for
i n urposes. .
Dat~: 1/2112004
Fees paidf.o.r Permit:
Total: .
157.96
Signat of Applicant .or Agent
TIle permit shall'expire by limitation and become null and void if thu building or
.work has not passed final inspeCtion 365 days from the date of permit .issuance. A
new P!ll'mit is. required to commence or continue work. .
, ' 'INSPECTION RECORD , FINAL INSPECTIONS Date' " Inspector '
, , '.' ' INSPECTION DATE INSPECTOR Electrical Final . ? "'3'6" . hi. )"tJoA-
Temporary Power Pole Plumbing Final , . .' .'
Plumbing (DrainlWaSle Pipe).. . Mechanica'IFinal '.
X Electrical Ground Electrode/Ufer . I' .
SetbacklFormsfTrenches (Footil)gS) ~7./_D( / :r Yh,,/}... . Ga);cTest. . . . .
Do not install Subfloor or pour floor slab until the. Englneerjng/Gradlng F,inal 765-5126 '.
following applicable items. have been signed: .
Plumbing (Water Pipe.Sprinkler Valves) , . , Fire Dept. Final 765-4040 ' .' 7,_)4.00/ 'JI2;Uk
Mechanical (GroundwOrk) , Water Engineering 765.5268
Electrical (Underground Conduit) Sub List/Business License 765.519 . ....
" PI9-slab (Compaction/Membrane.Rei nt. ' . .
Underpinning (Floor Joist/Girders) Zoning 765.5139 . . ' .
. , ,
Do not cover or .conceal the work belOW. until the , ~ast Inspection-Only I :Io.o~ ~/~ .\c
following applicable items have been. signed; Building Final
. .' . fter Above Complete)
1 st Floor Shear . ' " . " PARTIAL INSPECTIONS /
. '
Filllsprinkler (Rough) , Buildina Inspections
2nd Floor Shear . .
Roof (SheathiriglDiaphragmlFrane) , , .
Masonry (ReinfJBond BeanlPre-Grout) " .
Rough Plumbing (Top Out) .'
Rough Mecl)anical ' . . . : , "
, I KOugh 6ectrica/ {1.lI'y Wall/, , . ' .
. "
Rough Electrical , .
Framing ,(Only after Plbg.. Elec.. Mech :andFire) , ,
InsulatiOll (SoundlEnergy) ,'. Mechanical Inspections
po not tape or pla~ter until the following applicable
Items have been signed:" .' '.
Drywall . '0' . '.' .
Penetr_ions (Fire Rated) Electrical ' .
, . ,
J>enetrations (Fire Rated) Mechanical ' , .
Penetrations (Fire Rated) Plumbing , . .
. , . . '
'. Interior Lath . , Plumbina Inspections
Exterior Lath . "", .,
.' . GENERAL ITEMS " .
. .
Exterior Plaster (Brown Coal) " .
T 'Ilar Electrical' , .' .
T .Bar Mechanical , ,
, , , . .
'. T-Bar Structural "
Sewer ',' '.
Water Engineering Backflow " '.
. Electrical Inspections
Water Service : '. .
l