1211 W. Lynne Ave.
TYPE OF PERMIT
Blockwall/Columns CITY
. DATE: 11/8/2004
JOB ADDRESS: 1211 W LYNNE AVE
LEGAL DESCRIPTION: N TR 3278 LOT 65
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.. 5153
INSP"CTION REO\JES'f LINE:
(714) 765.4626
CENSUS CODE: 434
QUARTER SECTION: 66
. BUILDING PERMIT NO. BLD2004.04057
. APPLICANT: ERIK SAUVEY
OWNER INFORMATION:
Stanley E Moore
3837 Cazador Ln
Fallbrook, CA 92028
CONTRACTOR INFORMA'jl'ION:
PORTRAIT HOMES INC
265 N JOY 8T #200 .
CORONA. CA 92879 1323 .1
BUSINESS PHONE: 951 2531'7611
JOB DESCRIPTION:ln~tallation of 34 lineal feet of block wall asindic3ted on p!}ns p-er city specifications and 4 custom pilasters. (REF BLD2004-04057).
. VALUATION: 1..616.00 .~ . . PROCESSED BY: ENO
r '. OWNER-BUILDER', F.CLARAT10N . . .. . _ ~
I herebyalf!rm under penatty of perjury Ihat I am .xe"'pt from the contractq,:,.. '[jeanS. '.aw for the following reason (Sec. 7031.5 Business and
Profp..ssions Code: any dty or county which requires a permit to construct, a~_&r;'iH1p;C\.'e, dernoH~;h or repair anystruc.tuf'e. prior to its issuance, also
requires the applicant fO. r SU.ch permit to file a signed s. tatement that he is HCidlised pursu<Jnt to the provisions oithe Cor-trador's License Law (Chapter:-
9}(commeOGing with Sectiol"'\ 7000 of Division 3 of the Business and Profes~jcli.:::.Code) or ttlc:t h~ is exempt therefrcmand the basis for the alleged
e;:mption. Any violation of Section 7031.5 by.al""y applicant for a perrTlit SlJt~t'c:.s the app)jG~ni to a civil pena~y of n('lt mo'~e than fivE!.hondr~d doliars ,.
'fjO~\s owner of pro~t?rty. 0: my ~rnployees with wages as their SOle:ccr;1f:{~~ati~;, will do the. work, end tho strUGtLlrt% \:..:;not inte'hdedor o~ered for
sale (Sec. 7044 Business andP(ofes~io.ns Code: TheContr~cto('.~,Ucens/) L~\" does not applY to.an owne, of property wt-~o \:Juij~s .or:lmpr~yes
thereon, and who does such work hirnSeif or heISelf Of through his or.hcr'C,...,:-,"C':'np!oY~f:;S, prQ,,;ded that such improverr.en1s.are not intende6 or
offered fbl' sale. If" however, the building or improvement is sold with ~ne Y$1 Of ~n:pletfon, the owner-builder Will ha'Je theburdel"'\ of pro'.Jlng thf.t h~
jie! not build or improve for the purpose of sale). ~ . .. .
0- .', as tl~e owner. of the property, ,am eXdusjvel:,' Gontrading with lice(is:.::-d ~p:ltr:Elctcrs to cor,struct theprc;ect (Sec.! 7044 Busio..ess: aHQ Prcfe-ssiQ!1s
Cede: The cO.l"itractc.r's License law does not app!:: to ar. ownef of property :.!'hC bt.i!c.is or irnprcves ther~on, and who con1racts tor sUcil.orOjec~ witn
p..,COntnact<?f'(S) licensw pLifsl.mnl: 1.0 the Contractcr'$.Li~ns(' L::l\\'}. .'. .. . ,
o I ai'fl.exer~1pt llr,dsr Sec. _ ' B & P.C. for this reason. ____'{--_______ .'-'.. -.
. Date: ,Own.eT: ___L___.
r . WORKER'S COMP"NSATION DECLAI?AT!01j l-.,-....J r LICENSED CCJ.NTRAqX9.flS DECLARATION I
1 hereby affirm undp,f penaity.of perjury or:e ofthe fo!lQitving declalC):ior:s: fi. . I I t,~reby af7i(nl ur.der pen~lty of perjtlfY.ti;B;t I am
o I have and wiH maintain a Certificate of consent toseff-jil~ufe fO~)YOfk€:r'~1\;O;T:P~:;;s-~ticn, l:C<:lnSed under pro','jsions ofcha:pte 9(c.S'mmencing
as prOVIde. d fo:'" by Section 3700 of the Labo. . r CO.de, for the periormahce oftl';_~i v..'C"~ for \.;hich Winl. Sfl~tjon I ..) of D! .,3. e el!Sir. ,;e.~s and. . .
~' tr:j.<; ermit is issued. . . l. . Professl'" s ace.' ~. -i.
I I have c.nd will'maintain worker's compensation ir'surance, as required b". Section 3100 of 1i/8j20G.;. . . ___. .
he t>o, Code. forthe porformanee Gf.the work for \iVhjch this permrt :s i$3L;fl ~..:iYWClr:<er's I Date:' 'n' or .:- -
Compensatkm insurance carrier?nd policy are:. 1- j
Ca~rjet: STATE FUND. PottcY Number: 1602~~~r~f~:,. I NUMBER . EXfllRATION DATE
. . 615297 3/31/2005
This section n~_ed not be completed if the pennit is for one hun~(ed dollars(S100Jf' ff'.ss., TYPE B
~certJfy that In the performance of the work forwhich~hjs perrr"f I::; l$<';l!e~,: shell not I
p any perscn in a ny manner so as to become subJe<;t to the worKers c..:tp,.ensation law:') I
f Califomi3, and agree that if 1 should become subject to tHe worker's comP':'~1 sotian
proviSIons of Sechon 3700 of the Laber Code, I .... fa tn c Iy witn th.~~e or ....,nns I ConstrUClon Types
I- VCoI
Date: 11/8~2004 Appilcan _."'_',_ _ \. . fire'S~r'nklered?
WARNING: FAILURE TO SEG REW KER'S GOMPENgflTIONCOV - ,,(C;"." !S~.
UNLAWFUL, AND g.HALL S .JEcr AN EMPLOYER TC).C....R.'..M INAL .-_NA"nES.AND ':;:VIL..
FINES UP TO ONE HUND D '1HOUSAND DOLLARS ($100.000), IN ADD!)!ON TO THE
. COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTiC>:-l toe; OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.' .' r
, '. CONSTRUCTION LENDING AGENCY ..
__JI1.i.mbYflifirm ur'der ~l?f\::t!ty of !'\Ur~lIry_tn<,t thP'r~ ~ 3 GQ.....~rudinr; j"'.,rlinC::l':' !It:''.v_ ~,:1r tt-:"~_ ==i
performance of the work for whidl this permif is.issued (Sec: 309:T .Civ .C):
Lender's Information: .
ARCHITECT/ENGINEER !NFORMA TION:
NO
"'-,,
I certify that' have read this application and state that the above information;:; correct I
agree to comply with all city ordinances and state laws relating to bu ilding construction, and
ere authoriZe representives of thi .ty to enter upon the above mentioned property for
I ection purposes.
Fees paid for Permit:
Total:
228.24
Signa ure of Applicant
T e permit shaJ"explre by limitation ecome null 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. '
Date: 11/812004
INSPECTION RECORD
. INSPECTION . . DATE INSPECTOR
.
Temporary Power Pole
Plumbing (DrainlWaste Pipe) . .
Electrical Ground ElectrodelUfer . . '-
SetbacklFormsrrrenehes (Footings). ./~~Ic'('" ,.
Do not install subfloar or pour floor slab until the I
following applicable items have been signed: .
Plumbing (Water Pipe.SprinklerVillves)
Mechanical (Groundwork)
Electrical (Underground Conduit) ..
Pre-slab (Compaction/Membrane.Reinf.
Underpinning (1'1001; Joist/Girders)
Do not cover or conceal the work below until the
fOllowing.app'li,cq:b1e: items have been signed:. .
'1st Floor Shear.
FireSprinkler (Rough) . . .
2nd Floor Shear .
Root' (Sheathing/Diaphragm'Frame) ........
Masonry (ReinfJBond BeamlPre-Gl'O\It) ,hr;;l.s -.r;: -
Rough Plumbing (Top Out).. . /.
Rough Mechal)ical.
Rough l:Iectrical (ury Wall)
Rough Electrical .
Framing . '(Only atrer Plbg... EJec:. r::leCh and Fire)
InsUlation (SoundlEnergy} .
Do not tape or plaster until the following applicable
items have been signed:. ' .'
Drywall .. . . .
Penetrations (Fire Rated) Electrical . . .
Penetrations (Fire Rated) Mechaoical..
Penetrations (Fire Rated).Plumbil!!l
Interior Lath . . .
Exterior Lath
GENERAL ITEMS
Exterior Plaster (BlO\Nn Coat) .
T -Bar Electrical -
T~Bar Mechanical ....
T-BarStructural '. .
Sewer . .'
Water Engineerillg BackfJow . . .
Water Service
FINAL INSPECTIONS. Dale .' jJ:)spector
Electrical F.inal . .' ~lJllhr'. 1/-
Plumbing Final .1 /.
Mechanical Final
Gas Test . '.
Engineering/Grading Final 765-5126. 1 .
Fire Dept. Final 765'4040 . .
Water E.ngineering 765-5268 - .
Sub List/Business license 765-519 - .
Zonin~ 765;5139 .'
Building Final \tast Inspection- Only ?h, .if fJ 7'
'. . ." fler Above Complete)
./
PARTIAL INSPECTIONS
BuildinQ Inspections. .' .... . .' .
I/<!phs 1M~/~r. ~~pf\~N7~ ~~AS76<{; ~
. Mechanical InsDectlons
.PlumbinQ Inspections
I.