1309 S. Westchester Dr.
BUILDING PERMIT NO. BL02004c01584
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. BUILDING DiVISION
200 S. ANAHEIM BLVD.
(714)765:.5153 .
INSPECTION REQUESTlINE:
.(714)765-4626
. CENSUS CODE: 434 .
QUARTER SECTION:.7 .
CONTRACTOR INFORMATION:
HOME IMPROVEMENT CORNER
2026N TUSTIN AVE liB
ORANGE,CA 928650000.,
. . '. BUSINESS PHONE: 71428,"1369
JOB DESCRIPTION:lnstall 216 sq 1I alum ICBO.II 2228p patio' cover. .
VALUATION: 2,700.00
I OWNER~BUILOER!lECLARATION
Ihereby affirm underpenalty of perjury' that I am exelllpt from the Contracior'~ License Law for the following re~son ( eo. 7031.5 BUSiness-and
Professions C?de: any city or cQuntywhich require,s a permit to construct,-aa~.rtimprove, demolish or'repajrany~tructure,prior to its issuance, also,',
require$ tl:1e applican~ for-such permit to file a signed statement tryat-he is licensed pur~uant to the provisions oftheContrad:9r's License Law (Chapt~r
"9)(commencing with Secti.on 7000 of Division 3 of the Business and Professi~ns Code) or that he is exempt there,fromand the baSIS for the alleged .
. exemption. Any.violation,of-Section 7031.5 bOy' ally'applicant fora permit 5ut}ects the'applicant to a dv~,penaltyof not more than five hUndred dollars
.($500). . '.' . .' . ...... '. . . .
o I, as owner of propertyior'IT'Y empl~yees with wages as their sole comp:-rnsatlon, will do the work,' and the structure is not intended or _offered for
, sale (Sec. 7044, Busi!1ess and Professions Code:_ The Contractor's License U;lW does not apply to an owner of property who. builds or improves.
thereon, an9 who does such work himself or herself or through his or her,ow,-::elTlpfoyees,provided that sUl;:h improvements are. not intended or .
offered for safe. If, however, the !>uilding or improvement is sold with one yeir of completion, the owner-builder will have the burden of proving that he'
. did not build or improve for the purpose of sale)..' . '. . "
0;_ t,as the owner of the propeTty,am exdusively contradlng:with'flcenseJ ~ntractors to construct theproj?ct (See. _7044 BLlsiness an~ Professions
Code: The Cootr:actor's li_oonse Law does not apply to an owner of property who buUds orimprovestJ'lereor), and whooontracts for suqi,projects with
~ontractor(s) Hce~sed pursuant to the Contractor',s License Law). .. . .
U I am exempt under See;. ., . , , B & P .C:foT this reason: --'--.~
Date: . . Owner: :
I . WORKER'S COMPENSATION DECLARATION ,..
1 hereby affirm~under p~l1a'ty ofperjtiry one of the following declarations: .:: . .
[j I have and will me intain a certificate of consent to self-insure for work'3I';~ ~ompensati~n;
'as provo for by Section 3700 oft~e Labor Code,. fot the performance of th~ work for which
i ermit is issued.. .
I have and wHfmaintain woiker'scompensation it:lsurance..as requiredcji Section3700 of
the Labor Code; fo( the performance of the work for which this: permit is iSSUf~. .rv;yworker's
pen sat Ion insura nee carner and policy are: ,_ ':
. Carrier: STATE FUND Policy NUrl1ber. 238-02 C:00049Z
TYPE OF PERMIT CIT. Y
Patio Cover . .
DATE: 5fl/Z004'
JOB ADDRESS: 1309 S WESTCHESTER DR
. LEGAL DESCRIPTION: N TR 2833 LOT 40
APPLICANT' RAFAEL JARA
OWNER INFORMATION: .
Grafton Weiss' . -
1309 S westchester Dr
An~helm, CA 928D4'
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: CAL
This sectionne~ not be completed if the pennit is for one hundred dollars ($100-; or less.
, . ' " ~
o I certify. that in the, performance of the work'for which this permit. isiSsI..l,t:d,lshaU not'
employ any person in any manner-so as to become subject t t~e worker's c,~:.ni.f'ensation laws
.of Califoniia; and agree that if I should become su'bject to e worker'scompnn3ation
,provisions of Section 3700 of the Labor Code, t comply with tt'.tj::;:a provisions.,
. Date: 5/7/2004 Appllcan!:
'WARNING: .FAILURE TO SECURE
UNLAWFUL, AND SHALL SUBJE . EMP. YER TO CRIMINAl PENALTIE:S:j\ND CIVIL
FINES UP TO ONE HUNDRED.' OUSANO DOLLARS ($100,000), IN ADD'lJQN)'O THE
COST OF COMPENSATION, DAMAGES As PROVIDED FOR IN SECTION 3766' OF THE
LABOR CODE, tNTERESTANDATTORNEY'S FEES. . t1Xn> . .
f ..... . '. CONSTRUCTION LENDING AGENCY U 'c'>;S
__ I h,~re_byaffi~!TI IJnde~ peDalty of perjury .that there is~5:o.n...~t(~~~.t\o.l').I~r\djng;~~S)~OOb\3;
. pel iormance of tne worJ<-torwhfd'l ,thi,s permit is issued (Sec.30g? .Civ.C): .
Lender's Information:
I certify that I have read this application and state that the above information is correct. I
agree'to oomply with all lty ordinances and state laws_relating to building' construction, and
, her~by authorize nwes of this city. to enter upon the above mentioned property for
insp~ctio ' PQ .'. .
Date: 51712004
Signature' c.f Applicant or Agent. .
The permi shall expire by limitation and become null and void if.the building or
work has not passed filial inspectioil365 days from ttKl date of permit issuance. .A
new permit is required to commence or continue work.
l
LICENSED CONTRACTORS DECLARATION
I,hereby affirm underpenalof perjury that.1 am
licensedunderprovisions of c pter9 (commencing.
with Section 7000) 0 30fth BUsiness and
Profe.ssions C .
NUMBER.
564511. .
TYPE
TYPE
EXPIRATION DATE
4/30/2005
B
HIC
Construcion Types:
VN, ,
Fees paid for Permit:
Total:
0.50'
INSPECTION RECORD
. INSPECTION. DATE '",SPECTOR
Temporary PoWer Pole
Plumbing (Drain/Waste Pipe) . . . .
Electrical Ground Electrode/Uter . .
. SetbacklFormsrrrenches (Footings I
Do n(:lt il)Stall subfloor or pour ftoorslab until the .
. following applicable items have been signed:
. Plumbing (Water Pipe.Sprinkler Valves)
. .
""eehanical (Groundwork) . .'
Electrical (Underground Conduit) '. . .
. Pr&-slab (CompactionlMembrane.Reinf. . '.
U~derpinning (Floor Joist/Girders) . . .
'. Do not cover or conceal the work below until the .
following applicable items have b.eensigned:
1st Floor Shear . . . . . . .
Firesprinkler (l<<>u9h) . . .
2nd Floor Shear . . .
Roof (Sheathing/DiaphragmlFrame)
Masonry (ReinfJBond BeanJPre-Grout) .
Rough Plumbing. (Top Out) . .
Rough Mechanical ........
Rougn l:Iectrlcal (Dry wall) .'. .
Rouah Electrical'
Framing ..' (Only after Plbg., Elec"f.'1ech.. anq Fire)
Insulation (SoundlEnergy) . . .'
po not tape or pla~ter until the following applicable
.tems have been signed: .' ..
'. Drywall . .
Penetralions(Fire Rated) Electrical. .
Penetrations (Fire Ratedll'<lecl1anical. .
Penetrations (Fil& Rated) Plumbing .
Interior Lath' '. . . '. .
Exterior Lath .
GENERAL ITEMS
Exterior Plaster (BrownCoa/) . . .
T-Bar Electrical '.. ..
T -Bar Mechanical . .
T -Bar Structural .
Sewer.. .' . . . .
Water Engineering Backflow .
Water Service . '. .
.'
FINAL INSPECTIONS '. Date '. Inspector
Electrical Final . .':' :
Plumbin'g Final I
.
Mechanical Final .
Gas Test. .<
. '. I
Engineering/Grading Final 765-5126 . .- < .
'.
Fire Dept. Final 765-4040 '. <. ,
Water Engil\eering 765:5268 ..' . . . .'
Sub List/Business license 765-519
Zoning 765-5139 .
Building Final ~ast Inspection, Only '. .
' . Iter Above Completel
PARTIAL INSPECTIONS
. Buildina'lnSDections .
Mechanical Inspections
Plumbina Inspections
. .
, Electrical Inspections .
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,
',PERMJT:EXPIH{D
INSPECTION'"
NOT COMPLETED
DATE:.\lh{~D(