121 S. Summertree Rd.
,..OILDING PERMIT. NO.
CITY
ElM
BUILDING DIVISICN
200 S, ANAHEIM BLVD.
(714)765 - 5153
. INSPECTION REQUEST LINE: .
(714) 765 - 4626
. CENSUS CODE: 434
QUARTER SECTION: 191
BLD200s.01042 .
<
TYPE OF PERMIT
Residential Addition
"
DATE: 4/14/2005
JOB ADDRESS: 121S SUMMERTREE RD
LEGAL DESCRIPTION: N TR 8409 'LOT 23
APPLICANT: JOSE GUZMAN
QWNERINFORMATION:
MiChael R Ricci
121 S Summertree Rd
Anaheim, CA 92807
CONTRACTOR INFORMATION:
.J 0 R CONSTRUCTION
4446 FRANCIS AVE
CHINO, CA, 917100000'
BUSINESS PHONE: 909548:3230
ARCHITECT/ENGINEER INFORMATION:
JOB DESCRIPTION:Add 54.1 to exist. SFD
VALUATION: . 3,900.00
I OWNER-BUILDER I}ECLARATION
I hereby aff.irm under penalty 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, a'lter. improve, demolish or repair any structure, prior"to its issuance, -also
requires the applicant for such permit to file a signed statement that he is lleen'sed pursuant to the provisions of the Contractor's License Law (Chapter
9)(comm~ncingwith Section 7000 o(Division 3 of the Business and professio~s Code) or that he is exempt therefrom and the basis' fpr 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 than five hundred dollars
($500). .'. '. . . i . . . . .
o I, as owner of property, or my employees with wages as their sole compeflsation, will do the work,and the structure is' not intended or offered for
sale (See; 7044 Business and Professions Code: The Contractor's Ucense La'w does not apply to an owner of property who builds'or improves
thereon, and Who does such work himself or heiself or through his or her own employees, provided that such improv.ements are not inten,ded or
. offered forSGlle. If, however, the 'building or improvement is sold with one year of completion, the owner~biIilder will have the burden of proving.that he
did not build orimpro\:,e for the purpose of sale). " .': . " . , _', _ '.
o I, as the owner of the property, aril"exclusivelY contracting with licensed omtractors to construct the project (Seic. 7044 Business and Professions'
Code: The Contractor's License Law does not apply to an owner of propertY~ho builds or improves thereon, ahd who contracts for such projects -with.
a contract,ar(s) licensed pursuarit to the Contractor's License Law). " . .
o 'I a.m exempt under Sec.. . . ' , ,B & P.C. for this.reasa'n:
Date: ' Owner:
I . WORKER'S COMPENSATION DECLARATION
I 'hereby affirm under pen~i.lty of perjury one of .the.f~lIowing declarations: ,
'0 I have and Will maintain a certificate of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code,. for the performance of.the,work for whi.ch'
this permit is issued. '
~ I have a.n.d-Will.maintain WO. rk. ~r'$ com. pens.atiO. n insurance, as required by Section 3700 of
t , Labor Code, for the performance of the work for which this permit is issued" Myworker's
C mpensation insurance carrier and policy are:,. :.
C rrier: EXEMPT '. Policy Number. EXEMPT, .'
. . .
~'s ~ecti9ri need not be completed if the'permit is for one hundred dollars (S100)_l?'" less.
I certify t,hatin the performance of the work for which this pe,rmit is issued, I shall not
plo,Y any person in any manner.so as to beCome'subject to the worker's compensation laws
f Califomia, ahd agree that if I shouldbecome subject to the worker's compensati9n
provisions of Section 3700 pfthe 'Code, I s,hall forthwith comply with tho~e provisions.
PROCESSED BY: MSM
, LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
. licensed under provisionsof chapter 9 (commencing'
with Section 7000) of Oivsion 3 of the 'Business and
professi~ode. YJ r' .
4/14/200 . .~/~
Date: . , Contractor
NUMBER
686913
TYPE
TYPE
EXPIRATION DATE
10/3112005
6
C29 MAS
Date: 4/14/2005 Applicant:
WARNING: .FAILURE TO SECU.RE ORK 'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJEc:T N EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNqRED THO SAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI.oN 3706'OF THE
LABoR CODE, INTEF.lEST AND ATTORNEY'S FEES. . .
CONSTRUCTION.LENDING AGENCY
1 hereby affirm tinder penalty of perjury that there is a construction lending agency10r the
performan.ce of the work for which this permit is issued (Sec.3097.Civ.C): .
:Lender's Information:
CQnstrucion Tvpes:
VN"
Fire Sprinklered?
LivinQ Area:
NO
54
L.,
I certify that I have read this application and state that the above information IS correct. I
agree to comply with all city ordin'ances and State laws relating to building construction, and
here authorize representives of this city to enter upon the above mentioned property for
i ion pur~ose~.~
Si flature of Applicant or Agent
The permit shall expire by limitation and become null and void it.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.
Date: 4/1412005
F~es paid for,Permit:'
Total:
704.84
INSPECTION RECORD
INSPECTION . DATE INSPECTOR
Temporary Power Pole.
Plumbing (DraiillWaste Pipe)
Electrical Ground Electrode/uter /
SelbacklFormsfTrenches (Footings) ~~ .f,./, /
Do not instalt,subfloor or pour floor slab until the.
following applicablE>. items 'have been signed: . .
Plumbing (Water Plpe.Sprinkler Valves)
Mechanical (Groundwork) ..
Electrical (Underground Condu it) . .
Pre-slab (CompactIon/Membrane.Reinf. Vti'--l>f" It
Underpinning (Floor Joist/Girders) .
Do not cover or conceal the work below until the .
following applicable items have been signed: ..
1st Floor Shear .
Firesprinkler (Rough) , ' . . .
2n!l Floor Shear . .
Roof (SheathiIllllDiaphragmlFrame)
Masonry (RelnfJBond BearnlPre-Grout) .
Rough Plumbing (Top Out)
Rough Mechanical
Rougn t:!ectr aliI . ' ,/1
Roligh Electrical v/ ....."" kc
Framing (Only after Pltlg.. flee.. Mech.. and Fire -" AC ./ .
Insulation (SOIIndlEnergy) . '-I' u< ./
Do not tape or pla>;ter until the follOWing applicable.
items have been sign,d: ", -' .
Drywall ; .' . ~. 24-C)5 C. S'il 5>1-
Penetrations (Fire Rated) Electrical .
Penetr3tions(Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath . .'
exterior Lath . . K'- L't"
. GENERAL ITEMS .
exterior Plaster (Brown Coat) . .' .
T-Bar Electrical
T -Bar Mechanical
T -Bar Structural '. .
Sewer
Water Engineering Backflow . .'
Water Service
FINAL INSPECTIONS Date .'In~ector
Electrical Final' l1-I~)o) -r:
Plumbing Final.' .' .'.
'Mechanical Final . ,
Gas Test . .
, . . '.
Engineering/Grading Final 765.s126
Fire Dept.Final 765-4040 . .
Water Engineering 765-5268 .
. '.
Sub List/Business .License 765-519 .
Zoning 765-5139 '. .'.
Building Final ~ast Inspection- Only' \7A'\lo( "(. ~C nD
fter Above Complete)
PARTIAL INSPECTIONS
.Buildina Inspections
Mechanical Inspections
Plumbinalnspections
ElectricallnsDections