1617 W. La Palma Ave.
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CITY ~~~(~'~~)-t ElM
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BUILDING DIVISION
200 S, ANAHEIMBLVD, '
(714) 765, 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 51
aUll.DINGPERMIT NO, Blp::004-00807
TYPE OF PERMIT
Repair
DATE: 312312004
JOB ADDRESS: 1617 W LA PALMA AVE
LEGALDESCRIP,ION: SEG4 T 4 R 10 PORS SW1/4
,APPliCANT: ALOLFO, IBANEZ
OWNER INFORMATION:,
Kingsley Gates
PO 80x 130548
Houston, TK 7721.9
CONTRACTOR INFORM/,TION:
.ECONO AIR
3366 LA PALMA AVE
,ANAHEIM,CA 92806 OOOL','
BUSINESS "'HONE: BOO 50:' 2566
JOB DESCRiPTlONlns!all slucco on exlerlor duct chase
ARCHITECTIENGINEI;:R INFORMATION:
.VALUATION: 500.00 PRQCESSEOBY: ODC
I ., , ' ' , OWNER-BUiLDER: DECLARATION ' , "
I her.3by affirm under pena.lty of perjury that I am exempt from the. ContrA.G~c:fsL.rcer',se Lc:rw for the following reason (Sec. -703<; .&-Susiness and
P;of~s:Sions Code: any city or county which requires a permit to -.:::onstrur.t. ait;i;', improve, demOlish or. repa ir ,any structure, prior to its issuance', a~o,
requires the,applicant fo~ such' permit to me a slq,nscl statement that h€-is;j'C-1":'S2.~ pursuant to the provisions of the Contractor's License Law(Ch'apt~r
9)(commencing wi.h Section7000 of Division 3 of tne Business and Pr-:.fe;.;si'?!"!S Code),Qr that he is exempt therefrom z:nd the basis for the alleged
exemption, Any violation of Sectlo;l7031.5 b'l ar>y a;Jplicant for a per~it,!:;u(_~ec1$ the a:pplicant to a 'CivU penalty of not more tha!1 five hundred doHars
($500)..' .' ' . . ,,'. i . , , ".',',., .
0' l. as owner ofprope;t:;r,or my employee<J wtt" W€ges 8S theIr 3'::t)corn~~ncatH,", WIll do the work, and the structure 's !lot:ntended or offered for
sale (Sec. 7044 ,Business and Professiol1:? Code: The Con~tacj')r's U....enst'. :f:'iW aces nntapplyto an ow-ner of pro pelt,' who buHdsor improves
thereon,'and who does such wock himself or h€!l-self or thrcl!gh :1is or her 0'\0\) ~rnDl.oyee~, provided that spch ImplOveme~t~ are not intended or,'
offered fOr, Sal!;:'. If, however, the building 0rimprovement ~ s:ofd withc',~B ye-f,,. 0: -:ompletion, the owner~buijder wUl have thO:: burden,of proving ttl8thoa .
did not build at improv~farthepuiP~,s,e of 'sale). _ ' ;- ,
o I,Cls,the OWn~r of the property,:am ,8xduslvely c(.ntractir,g with licen$(;.!f(~..x'ltr3ct91':; io constructth_e prole~t(Se~. 7G44~Busjnessand-Professlons
Cede: The Contractor's License Law does not ::'pply tt} an owner' of p(operty~who cui:ds or improves th~reon, and who contracts for such projects with
~_~ontrsct,or(s)nc.epsedpursuant to the ?Oi1tractor's Ucen~e Law).' 1" ,
L-.} I am p.xempt under Sec. ,8 &.P.C..for this reason: ,!._
Date' Owner~
r WORKER'S cOllipENSATION DECLARATION :.~~-"--
I h~reb'i B:ffi~!!l,-unde(pe(lalty of perjury One of the following de~lar~tion$~' .
o i have aMd"~villmaintairl t<lcertificate of oonsenl to l:>elf..insuie tor wcrkcr:'~ ":orr1penEation,
as providE0 for, by section 3700 of the Labor- Code, for the performance of tt-~ 'NOli, :orwhich _
thiS perml: is issued. . ' .' " ," . ' .. ,';. _.:' ,'.
o I havo and wiil maintain worker'scompens&tioninsuranc~, as rEoC:~Jire:o !;of 5e:ct!oI1 ~iO,G6[
the labor Cod,$, for the performance of the work for which this permit is issu';,J. My\vcrl<'er's
Compensation insurance carrier and'policy are: ' ,;.
Carrier: STATE AJND . PoliCy Number. '171)700~~03
. (
This section,need nCJt be cOmpleted if Ule permit is for one hundrP.d dollars ($1C(~'~ ('I" !ess.
[J I certitythat in the performance of the w9rk for which t.his, perr1i(~ i&ju4,:.:i. I Sr:OI! not ,
,employ -any person in any ~anner so as tc become sut?lect Ic, thewor.~e,~-?,~~A:r,;peI1S0~ion laws
of Califomia, and agree that if I should become subjecfto the worker's~pn:};f~'r~sation
, provisions Of.~ectiotJ.3700 of the L~b6r Gl')de, I shan ~orthWith c;o~~_~~~~t:;~se p:ovisions. ," ,
Date: 3/23/2004 APPllcancX ~. ',,".' ~
WARN ING: FAILURE TO SECURE WORKER'S G~PEN SA TION coVl;?t4\<3E 1S
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE~iA.~nES AND CIVIL
F'''ES UP TO ONE HUNDRED TIiOUSAND DOLLARS'($100,r,oO), IN,ADc..-nON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECT(ok ~706 OF THE.
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .j . ,."..
L CONSTRUCTION lENDING AOENCY ,c,{ _,
I hereby affirm under penalty of perjury that there is a construction l.endirr!J ~~,cncyfor the~"
performance 'of the work forwhich this,permit isissued (Seq.3087;Ci\'<C)~-; ,
~~~~~o:-'-?- It.fC'rrir:.tion~ ' ',' ~ ~ ,-,.;-- - - ~ -;:--..._-'- . ..~"'"" '~...
, -
LICENSED CONTRACTORS'DECLARATiON.J
I ,hereby :affi~m under psnalty ot peijury that I am
licensed under provisions of chapter 9 (commencing
;~;,~~~~~,~,;Of~e~~.d ____. '
, 3123i20U~ I'> ,
Date;-~-:'..... . . ContrJ3ctor" . .' , '
NUMB2R
445220
TYPE
TYPE
TYPE
EXPIRATION D'" TE
.. 212812006
ClO
C20 HT AC
HIC
Construcion Types:
VN, ,
Fire SDrinklered?
NO
i Ged,ifi-ii'iat I have re~d this applicatIon and Slate that the above inTorma":l n ;.~---:correcL'1
agr~eto-complywith all city orpinances an:1 state laws relating tobuilding cDr::;truction, and
hereby authorize representives-of this ci to enter upon the above mentione,:1 property fOI
i spection.po' sas, -
;?::
Fees paid for Permit:
Total:
58:45
Date: 3/23/2004
. nature of Applicant or Agent
The p,ermit sh expire by limitation and beCome nu r 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.
INSPECTION RECORD
. INSPECTION Ol!TE .INSPECTOR .
.Temporary Power Pole
Plumbing (DraiJllWaste Pipe) ....
ElectriCal Ground Electrode/uter
5elbacklFormsrrrerichtlS (Footings} .'
Do.not install sub floor or pourIloor slab until the
following appliea.ble items h~ve been signed:.
Plumbing (Water PipeoSprinkler Valves)
MechaniCal (GrOUndwork) .
Electrical (Underground Conduit) . '.
Pre-slab (CompactionlMembrane.Reinf. .' .
Underpinning (Roor Joist/Girders)
p"not~ver or conceal the wOrk below until the
following applicable items have been signed:
1 st Floor Shear .' . .
Firesprinkler(Rough) . . I
2nd Floor Shear '. .
Roof (SheathiI19'DiaphragmlFr3lJ\e)
Masonry (RelnfJBond BeamlPreoGR!tit) .
RoughPlumbing' (Top Out)
Rough Mechanical '. .
ROugh l:Iectncal au)
Rouch Electrical ~
Framing (Only aft.er Plbg: Elec.. Mech andF'ire)
Insulation (Soundi!:nergy) .
po not tape or pla'?ter until the following applicable
Items haVe been signed: . , .
Drywall . . .
Penetrations (Fire Rated) Electrical '.
Penetrations IFireRated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath' . . . , ......"'"
Exterior lath ' 1<",117.11-
GENERAUTEMS . .
Exterior Plaster (BlOWn Coat) .
T -Bar Electrical . . "' f
T -Bar Mechanical . . .
T 'Bar Structural
. Sewer . .
Water Engineering Baekfl.ow .
Water Service
FINAL INSPECTIONS . r ,
" Date Inspector ,
Electrical Final . .
Plumbing Final AlA '.
.~ .;-. I
Mechanical Final , ~''2.)~O'' . \..J# ,L
.'
Gas Test #/J, . . ". .'
,
Engineeril19'Grading Final 7~-5126. "
Fire Dept. Final 7654040 '.
Water Engineering 765.5268 '.'
Sub 'list/Business license 765-519
Zoning 765-5139 .
,f
Building Final Itast hispection.Only . 1j/~ft( "/~II
. I
ft.r Above Complete)
,
PARl:IAL INSPECTIONS
Buildind Inspections
ktfrJfJv
Mechanical Inspections
'. Plumbina Inspections,
Electrical Inspections