912-932 S. LaurelWood Ln.
,-~)j-
'.
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION:
11<;-
BUILDING PERMIT NO. BLD2004-00053
TYPED!; PERMIT C ITV
RerDD(
DATE: 1/9/2004
JOB ADDRESS: 912 -932 S LAURELWOOD LN
LEOGAL DESCRIPTION:
CONTRACTOR INFORM>\T10N: ARCHITECT/ENGINEER INFORMATION:
CONDOMINIUMCONST~UCTION SERVI
1235 N SAN DIMASAVE
SAN DIMAS. CA 9177300;1~..,
BUSINESS PHONE: 626852'2110 '
JOB DESCRIPTION)ear off comp and Install 65 squares of 30 year comp.,
VALUATION: 10,000.00
I OWNER-BOILDER'DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the Contrac:tor;~pce':l5e Law for the following reason (Sec. 7031.5 Business and
Prof~sjorls Cod~: any dtyor count~whic?h req~ires a permit ,to constru~t. ~t..~r,_ improve, demolish or ref?8.ir any struct~re, prior to. its issuance,' al,so
requlf'es the apphcant for such perrrnt to file a signed statement that he IS "c~0sed pursuant to the proviSlonsoftheContractor's license Law (Chapter
9){commencing with Section 7000 of Division 30f the Business and Professii,nsOode)'or that he i3' e,,6lTlpi.therefrom and the bas!sfor the alleged
exemption~ Any violation of Section 7031.5 by any applicant for a_permitsub,:ectsthe applicant to a dvU pe.naJtyof not more than five hundred dollars
'($500). ,'i ' , ' , '
o I, as owner of property, army employees with wages as their sole comp:nsation, will do the work, and .the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor.'s License lElw does not apply to an OWRer of property who builds or improves
thereon,' al1d Who doe,S SUM work himSelf or herself or through his or'her o'llr,~ ~mployees, provided that such improvementsare not intendedor
offered tor sale. If, however, the building' or improvement is.sold with one YO:lr of completion, the owner~builder will have the burden of proving that he
did nDt bundor improve fDr the pulpose of sale). '! , '
.0 I; as the_ owner of the propeny,.am ~xdusjvely contladfng with Jicensed/:ontrac:tors to construct the project (Sec 7Q44 Susiness and Professions
Code; The Contractor's license ~w does not apply to an owner of .property .uho builds or improves thereon, and who con.tracts-.for sudl projects with
, p...qontra~or(s) licensed'pursuant to the, C~nt~ctor's liCense. Law}. ;' .
U I am exempt under, Sec. ,B & P.C. for this reason: __...._
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the follOWing declarations:
o I have and will maintain a certjfi~ate 'of consent to self~insute for worker'i' compensation,
as provided for by Section 3700 Df the Labor Code. for the performance cfth.: wal1< fDrwhlch'
,l(1~'s rmit is issued. - :!.
~ . have and will-maintain worker's compensation insurance, as required b)' Section ,3700 of
t .., aborCode, forthe ,performance of the work for which this permit is ISSUP~I. Myworker's
Compensation'inslirancecarrier and policy are: .
Carrier: VIRGINIA SURETY CO" , PDllcy Number. 005-0001 :i~35
This section need not be completed if the permit is for one hundred dollai$'($ioo) Q; less.
o I certifY that in the peifurmanc~of the work for which this permitiSjssu,~(:. )',~hall not
employ any person in any manner SQ as to become subject to the worker's,co'Ttpensation'laws
of ~a'jfon')ia, and, ~gree t.hat if r $hou Id become $U bjec:t to th e worker's :~omPe"'~ation
provisions of ,Section 3700 of the Labor Code,.1 shall forthwith comply With~t~;se provisions.
Date: 1/9/2004 Applicant: ~" ' ,
WARNING: FAILURE TO SECUR' ORKER'S COMPENSATION COVERI,GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAl.PENAL"IES ANDGIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,OOO),I~ADDmOI'(TO l"HE
CO,ST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTi6N:<706 OF THE
LABOR C'ODE, INTEREST AND ATTORNEY'S FEES." " "1 .,~<;:,'
I ' CONSTRUCTION LENDING AGENCY _
Il'1erebyaffirm under penalty-of perjury that there is a constructi~~,;1.7~lng ,?~€ncY for the
p~rf=;"~.:m:.."':? .:f~he work fc;" \':h;~ t1'l;s P~(;:';-t ;~;:;.::;:;ioe.G (G-i:..-';' ~C5~i'~~-Ci:"~-' J -. - _
lender's Information:
APPLICANT: BRIAN HOCKENBE~RY
OWNER INFORMATION:
CONQOMINIUM MANAGMENT SERVICES
P.O. BOX 5022 '
UPLAND, CA 91785
PROC,ESSED BY: AEM
. LICENSED CONTRACTORS DECLARATION.
I hereby affirm under penalty of perjury that' am
licensed under provisions of chapter 9 (commencing
with Section 70GO) of Divsion 3 of the Business and
~/:~os;~D~ode'f?~ _ 5?<~' ?
Date: r,-. _ Contractor' -
NUMBER EXPIRATiON DATE
691243 6/30/2004 .
, TYPE B
TYPE C39
TYPE Hie
Construcion Types:
VN, ,
Fire Sprinklered? .
, NO
,.;
J certify that J have react this application and state that the above information-is correct. I
agree to oomply with all city ordinances and'state laws relating to'building comtruction,and
hereby authorize representives of this City .to enter upon the a bove mentioned property for
, ins~ion purpo~, " '
~(?_____ ,"~' " ' . Date: ,1/9/2004
Signat e of Applicant or Agent
The p~mit !ihaJl expire by limitation aild beCome null and void if the building or
work has not passed final inspection 365 days from the date ofpermil issuance. A
new permit is required to commence or continue work.
Fees-paid for Permit:
Total:'
209.83
INSPECTION RECORD
FINAL INSPECTIONS
,",'
,O..ate
Inspector
" ..' " , Electrical Final ,"'. ",
' ,INSPECTION DATE INSPECTOR
Temporary Power Pole Plumbing Final "
Plumbing (DrainlWaste Pipe) , ' , ' ,
Ele,ctrlcal Ground Electrode/Ufer , Mechanical Final ' , "
Gas Tesi ,
SetbacklFormsll'renches (Footings) ',' '
Do not install sublloor or pour 1I00r slab unt; I the Engineering/Grading Final 765-!!126 , ,
folJowing applicable' items ,have been signed:,
Plumbing (Water Pipe.Sprlnlder Valves) Fire Dept. Final 765-4040 " ' ,
Mechanical (Groundwork) Water Engineering 765-5268 ,
"
Electrical (Underground Conduit) ,
Pre-slab (Colllpaction/Membrane.Reinf. Sub LisllBu$lness License 765.519 ,
Underpinning (Floor Joist/Girders) Zoning 765-513& ' ,
Do not cover or conceal the work below until tne " Building F'lnal ' ~ast Inspection-Only' 1-P3'DSV lA,/I.;n.,
following applicable items have been signed: , , ,fter Above Complete;
1st Floor Shear' , , PARTIAL INSPECTIONS U 'j "
, Flrespdnkler (Rough) , ,
2nd F,loor Shear , 1 Buildina Inspections
, ,
Roof (SheathlnglDlaphlllgm'Frane) '6)1 --"-- .. , " ,
Masonry (ReinfJBond BeanlPre-Qrout) f , < /
.
Rough Plumbing (Top Out) , "
Rough Mechanical " , , ,
, Rough ~ectricallLlry Wall) , , "
Rough Electrical " , ,
Framing (Only after Plbg.. Elec.. Mech. and Fire;
Insulalion (SoundlEnergy) , , ,
po not tape or pla~ter until the following applicable MeehanicallnSDections
Items have been sIgned:' ',' '," ,,' i
Drywall' ' " , ,
' '
Penetrations (Fire Rated) Electrical , " ,
Penetrations (Fire Rated) Mechanical ' ,
Penetrations (Fire Rated) Plurllblng , ' ,
Interior Lath , , ,
Exterior Lath , Plumbinq Inspections
GENERAL ITEMS ' I ' ' ,
,
exterior Plaster (Brown Coat) , I ,
T .Bar Electrical . I ,
T.Bar Mechanical "
, .
T.Bar Structural, ,
'Sewer ' ,
Water Engineering Backflow Electrical Inspections
Water Service "