2300 W. Lincoln (2)
VALUATION: 50,000.00
'1 OWNER-BUILDE~DECLARATION
I hereby affirm undE;lr penalty of perjury that I am exempt from the Contractc"s License Law for the following reason (Sec. 7031:5 Business and
Professions Code: any dty or, county which, requires a permit ,to' construGt,_~~i:U, improve, demolish or repair anyst'ructure, priOr to its issuance. also'
requireS the applicant for such permit to file a signed statement that he is Ik:ansed pursu~nt to the provisions afthe ,Contrador's License Law (CI:1-apter
9)(commencingwithSection 7000 of Division 3 of the Business and Profe~,:'k::ns Code) or that heis exempt therefrom and the basis for the alleged
exempt~on. Any violation of Section 7031,5 py any applicant for a permit sl';J.1ects the applicant-to "8 civil penalty o~ not JT!ore"than five hundred dollars
($500)... . .... . .
o I, as owneJ of propertY. or n:lY employees with wages as their sole COi:':::-:~:lSation, will do ,the work, and the struct~re is_ not intended or offered for
sale (Sec.. 7044 Business and Professions Code:' The Contractor's Licens~law does net apply to an owner of prQperty who builds ot improves
thereon, and who does such work hims.elfor herself or through hiS or her ().~:rj employees. provided that such improvements are, not inten.ded or
offered for sale.' If, however.-the'building or Improvement is sold with one y,::,'r of oompletion,-the owner-builderwill have the burden of proving that he
did not build or improve for the purpose of-sale).
o I,' as the owner of the property, 'am exclusively contracti'ng with Ijcensi~':: :ontractorsto construct the project (Sec. '7044 Business and ProfessIons
Code:- TheContractor's License Law doesnot apply to an o\yner of propen:,.'Nho builds or improves thereon, and WI-.Q contracts for suqh projects with
j1Lqontractor(s)Jicensed pursuant to the' Contractor's License' ,U:lw).
U I am exempt under Sec. , ,.8 & P.C. for this reason: __._
Date: Owner:
l WORKER'S COMPENSATION DECLARATION -
I hereby affirm under'penalty ,of perjury orie of the following declarations':
O' I have 'will maintain a certificate of cOnsent t~ self-insure fOr worker'~ cc..mpensation,
as prov; for by Section 3700 of the Labor Code, for the,pelformance of t~'f:.'NOlk iorwhiCh
t . rmit is issued; . . .
o I haveand.will maintain work.er'~ 'compe~atii:m:'insurance, as required b~! Section 3700 of
the Labor Code, for-the performance of the work for which this permit is issut.J. Myworker's
Compen,sationinsurance carrier and policy are:
Carrier: STATE COMPENSATION FUND Policy Number. 0008414.2004.
l'\UILl)iNG PERM!T. NO. BLD2004-004211
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TYPE OF PERMIT
Demolition. CITY
DATE: 2/18/2004
JOB ADDRESS: 2300 W LINCOLN AVE
LEGAL DESCRIPTION: SEC 18 T4 R 10 E1/2 NE1/4 NW1/4
. APPLICANT: SHERMAN GILSON
OWNER INFORMATION:
Damos Inc
511 Helberta Ave
Red ondo Beach~ CA
CONTRACTOR INFOR:.j,\lION:
1rI REE D SERVICE 'Ce. .
.1515 EMISSION
POMONA, CA 9176600:{)
BUSINESS PHONE: 90S .:69 2600
JOB DESCRIPTION:Demolition and removai of building
BUILDING DiVISION
200 S. ANAHEIM BLVD
(714) 765 - 5153
INSPECTION REQUEST LINE:
.(714) 765 - 4626
'.
CENSUS CODE: 437
QUARTER SECTION: 33
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: ODC
I.
. , . .
. This section ne8\l not be complelf!d if the Pennit is tOr one hundred dollars ($1 DO! 01'.1<'5"
o I certify thatin the performance of the work forwhich thiS permit isisSu~j, (~hall not.
employ, any person in any manner so'as to.l;lecome subject tO,the worker's fc:npensation laws
of Califomia, and agree that' if I should b subject.to-the worker;s comflcnsation
p~visions of Section 370q ,of the Labor, II fort ithco ply Witht~t.s~:~rov-ision.~'.:
;
Date: 2/18/2004 Applicant: ...... ..~
WARNING: FAILURE TO SECUREWORKE OMPENSATIONCOVEki,GE~iS
. UNLAWFUL, AND SHALL SUBJECT AN EMPLOYERTO CRIM INACPENA' TIES AND ciViL
FINES UPTO ONE. HUNDRED 1rI0USAND DOLLARS ($100,000), IN ADEirnON'TP.THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI~ !l06 Of THE
LABOR COD E, INTEREST AND ATTORNEY'S FEES. t
., CONSTRUCTION LENDING AGENCY':.
I hereby affirm under pena Ity of perjury that there is a con$tructi2r}_I~(l_~ iJ'g'ag.: r.~YJO! tb~..'.. .._
. per!ormar.ce-ofthe worici'or wiu-chihis pt:r.TlIt'is bSlJeQ \6ec.Sui'i .C;':.C).
-Lender's InfonnatioTT:
. ,
I certify that I,have read 'this application- and state th.at the aboveinformatiOl"" :~; correct. I
agree to co y with all_city ordinances and state laws relating to building COI'l;tr'uction; and
~ereb or. r pre tives (thiS city to enter upon the above mentioned property for
i cti s.
Date: 2/18/2004
gna re of Applicant or Agent
The permit shall expire by limitation and become null and void if thl' bliilding or
work has not passed final inspection .365 days from the date of permit issuance~ A
new permit is required to commence or corrtinue work.
I
LICENSED. CONTRACTORS DECLARATION I
I hereby affirm under penalty of perjury that I am
licensed under pro-' , nspf chapter 9 (commencing
with .Sectio,n-700 of ~. n 3 [the Business and
Professions C ""'/7 _
2/18/2004 ~ _
Date: ~ontractor
NUMBER
'252618
TYPE
TYPE
EXPIRATIOro DATE
7/31/2004
C21 CRAN .
C21 HOU
Construcion Types:
VN, ,
Fire Sprinklered?
NO
I-<-'~
,',.1,_.,
',. " '~l :
,," \1' ,\,
Fees paid for Permit:
Total:
706.58:
INSPECTION RECORD
. . INSf>ECTOR
INSf>ECTION DATE
Temporary Power Pole . . .
Plumbi ng (DrainIWaSte Pipe) . .
Electrical Ground Electrode/uter ..
SettiacklFormsfTrenches (Footings)
Do not ihStall subfloor or poudloor slab until the
following applicable items have been signed:
Plumbing (Waler Pipe.sprinkler Valves)
. Mechanical (Groulldwork) .
Electrical (Underground Conduit)
pre-slab (Comr>actionlMembrane .Rei nt.
Underpinning (Floor JoistlGlrders) . .
Do not cover or conceal thework below until the
following applicable items have been signed:
1st Floor Shear .
Firesprinlder (ROUgti) . .
2nd Floor Shear . . .
Roof (SheathiIlQlDiaphragrWFrane) . . .
Masonry (ReinfJBondBearnJPr!M3rout) . .
Rough Plumbing (Top Out) .
Rough Mechanical . . .. . .
Rough Bectrical.(LJry Wau)
Rough Electrical
Framing (Only after Plbg., Elec.. Meth. and Fire)
Insulation(SoundlEnergy) . .
po not tape or plaster unlillhe following applicable
Items have- been.s.lgned: - ..
Diywall .. . ...
Penetrations (Fire Rated) Electrical .
Penetrations (Fire Rated) MeChanical .
Penetrations (Fire Rated) Plumbing ..
Interior Lath . ..
Exterior Lath ." .
.. . GENERAL ITEMS
Exterior Plaster (BioINn Coat) . ... . .
T -Bar Electrical .
T -Bar Me.chanical .
T .Bar Structural
Sewer. ....
Water Engineering Backflow
Water SerVice .
FINAL INSPECTIONS ... . Dale. Inspector
Electrical Final . . .. .
.
Plumbing Final . . . .
. ..
Mechani.cal Final. . ..
Gas Test " ..
. .
Engineering/Grading Final 765-5126 " . " ...
Fire Depl. Final 765-4040. ... .. .
Water Engineering 765.5268 . ...
.
Sub LisllBusiness License 765~519 . .
. .
Zoning 765~5139 . .
..
Building Final ~ast Inspection. Only . .
fter Above Complele) . . . .. . .
PARTIAL INSPECTIONS
Buildina Inspections
. Mechanical Inspections
Plumbina hispections
Electrical Inspections
PERMIT. EXPIRED
TN S PE CT ION.
NOT COMPLETE[)
DATE: C "f