1128 S. Pointe Premier
BUILDING PE~MIT Nb. BLi>:2004~02523
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BUILDING DIVISION
200 S. ANAHEIM 6LVD:
(714) 765 - 51.53
INSPECTION REQUEST LINE:
(714) 765, 4626
CENSUS CODE,: 434
QUARTER SECTION: 287
, '
APPLICANT: DARRYL GENTRY
OWNER INFORMATION: CONTRACTOR INFORMocTiON:
Premier, Pointe AMERICAN PACIFIC HO"_1F.S, INC
1128 S Paint Premier 4959 PALO VERDE ST#BV,
ANAHEIM, CA 92807000,0 , MONTCLAIR, CA 917630GOO
JOB DESCRIPTION:Build 40 sf of 51t 6":high'retainingwall per approved pia,,;
VALUATION: 400,00 !
I OWNER-BUILDEFJOECLARATION
I hereby affirm under p~naltyof perjury that 1 am exempt from :the. ContractC?,:.;G License lawfor t,he following reason (Sec. ~031 :5Business and
Professions, COde:, ariy city or county yvhich req uires a permit to construct, a~(~r, improve, demolish or repa ir any ~tructure, prior:~o it> issuance, also" .
requires the appli~,nt for suc,h permit to file asig!1ed stateme:nt th.~t he is Iic~tnsed pursllant'tQ~he,provisions oftheCo!ltraCtor's I.jcens,e La..y(Chapter
9)(com~encing with Sectiol);7QQO o.f Oivision;3 of "the Business and Prcfess!pns Code)or Jhat he,is exempt therefrom and the basi's for the alleged
exemption.' Any violation of Section.70~1.5'by any applicantJor,a per!"'lit sutje:::ts the a:pplicant to a dvil ,penalty of not more than five hundred dOllars
($500). '. . . . ...' . .' .' J' .' " . .
01,. as owner o(property~ or my employees with wages ,as. their sole corn;;~nsation, will do the worK, and the structure is notintenc{eri orofferedfor
sale (Sec. 7044 Busiri_ess and.Professions Cod~; The ~ontractor's licElnse!,t<3w_does not apply to an owner of property- who builds Cir improves -
. there9r1, and who does' s.udl.work himself or herself or through his or h'ero...J:lem ployees, pt:ovid(:Kj that such improvemel'""!ts are.not inten<:t_ed or
'o.ffered for'sc:.le.-:,'If, however, the building or improvement is sold with one yi~r of compl~tion, the owner-,builderwill have the burden of proving that he
didnotbuildor'!mpr.oveforthepu.rPos.eofsale).", " "', ',:, ,', ,"" ..:' '
o .1, ;as the owner of the property;, am exdusively contracting wittllicens~d:':ontractors to construct the project (SeG-. 7044. Business and Professions
. Code: The Contractor's Licimse Law does no't apply to an owner of propert./w ho builds or improves thereon,. and who oontracts Jor such projects w~h
a contract.or(s) licensed pUFsuant to the Contractor's License Law),'l .
D.J am exemptunder Sec. . _ . ,B & P.C. forthis reason: J
,'Date: ,.' . 9wner:' -
TYPE OF PERMIT
RetainingWalls CITY
DATE: 6/21/2004
JOSADDRESS: 1128 S POINTI;PREMIER
LEGAL DESCRIPTION: TRACT 13760 LOT,10 POR OF LOT,
ARCHITECT/ENGINEER INFORMATION:
DALE L FORBES
1800 EO- 16TH STREET
"SANTA ANA, CA 92701.
PROCESSED BY: ODC
RKER'S COMPENSATION DECLARATION
I hereby affirm. u r penalty of' pe~uryone of. the following declaratIons:
'. I
o I ~av: . nd wi!1 maintain a certi~cate of consent to self-insure-forworke~:s compensation.'
as pro' ed for bY.Section 3700 of the LabOr Code, for the pelformance oftii9_WC'rk forwhidl
thf rmit is issued. ,
I havliand wili"maintain worker's compensation in~uran,ce,- as required-t~1 Section'37006f
the Labor Code, for-the performance of the work for whiCh this permit is iS$i.!'1d. Myw"orker's'
Compe_nsatiOn insurance carrier.' andpblicy are: '" '
Carrier: ,STATE FUND Policy Number. 164350;'-2003
;,. .
This section need not be comp.leted if the permit is ior one hundr~ dollars ($1-~~'j ~r-les_5.
: 0 I certify that in the. performance, of the w~k for .which tl]is permit is _iSS~_~d~_,I~hall'nOt
. employ any person,in any manner: so ~sto become subject-to the worker'~:.,:..:jnipensation laws
of Califoniia, and agree that if fshould. ecome bject to the worker' co;p.:~nsat;on
provisions' of Section 3700 ofth~ Lab r Cod . I sh II forthwith o~p' with~'h'!;$e' . 'isions. .
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"
Date: 6/21/2004 Applicant:
WARNING: FAILURE TO SECUREWOR 'S COMPE SAT
UNLAWFUL, AND SHALL SUBJEcT AN EMPLOYER TO IMINAL PHil'.,):/ES AND CIVIL
'FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDiJlON TO THE.
COST OF CO~PENSATION, DAMAGES AS PROVIDED FOR IN SECTIQ'~37060F THE'
LABOR CODE, INTEREST AND ATTORNEY'S FEES. ..
I CONSTRUCTION LENDING AGENCY
I hereby"affirm under penalty_of perjury that there isa construction lendin.q;r~~:1cyfor the',
performano;u:ifthe work forw-hich this permit is issued (Sec.3097.Civ.C):' . ,
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I certify that I have rEtad this application and state'that the above information is correct.. I
agree to comply with all city ordinances and state laws relating to building construction, and
herebyauth representiv.es of.this ci 0 enter upon the abpve mentioned property for
inspe n s.
Date: 6/21/2004
, Signature 0 Appli t or Agent
The permit shall expire limitation and ,become nllll and void if. tht bllilding or
wOrk has not passed final inspection 365 days from the date of pllrmit issUance. A
new permit is reqllired to commence or continlle work.
~,
. LICENSED CONTRACTORS DECLARATION I
. I hereby affirm under penalty_of perjury. that I am
Iic"ensed under provisions of chapter 9 (commencing
withSection7000)qfm ' 30.fthe Business nd
. Professions Co e.
6/21/200
Date:
7
NUMBER
785551
TYPE B,
EXPIRATION DATE
. fO/31/2004
Construcion Types: '
VN, .
Fire Sprinklered?
NO
Fees paid-for Pe.rmit: .
Total:
84.87
INSPECTION RECORD
: , . .
, '. . INl;~ECT10N " .DATE . INSPECTOR
'. Temporary Power Pole. . .: .
Plumbing (DrainlWaste Pipe) ..... .
EIeCitical Grciund ElitctrodelUfer . .'
<backl!'OI'I1l$rrrenChes (Footings). . .' . : .
ClOnot install subfloor.or.pour floor slab until the . .
following applicable items hilYe been signed; , .
Piumbing(Water l'ipll;$prinklervalves) .
Mechanical (GrOUndvvOrk) '. .'
,1::1ec:tric:a1 (UndergrlH'nd Condu it) .'
Pre,slab (Compac:tionlM!ll1lbrane.Reim.j
Underpinning(F1cxir JOist/Gi rders) . " . .
. Do'nO! cover or co.ncaal the \iIIork below until the
:fcjllowing applicilble item.s have been signed: .' . .
'.
'. 1stFloor Shear..' . . . .
Firesprillkll!r (Rough) . . '" .
. 2nd Floor Shear'. .... . . . :' .
~of (Sheathing/Diaphragm/Frame) I. .'
. Masonry (RelnfJBond BeamlPre,Grout) .
Rough Plumbing (Top Out) . .. .
Rough, Mechanical ..' ..,.. .' . .
. ROllgh Electric ,wall) '. . .
Rough Electrical .- . . '. .
Framing .', {Only after PIb'J.. Eleo.. Meoh.. aDd Fire! . .
In.sulation (SoundlEnergy) . .... . .'
po not tape '''plaster' unti.1 the lollowi"'g applicable
I.tems have been Signed: . . '. '. .' '. . .
Drywall '. . .' ..' .
Penetrations (Fire Rated) Electrical. . . .
Penetrations (F.re Rated) Mechanical . '. .
.
Penetrations (Fire Rated) Plumbing
Interior Lath . . .
.
Exterior Lath .'
'.. " GENERAL ITEMS
Exterior Plaster (Brown Coat)
.-T -Bar ElectriCal . . . . . .
T-Bar MeChanical . .
T -Bar Structural . . . . . . . .
Sewer. . .' '.' '. :.
Water Engineering Back.f1ow '. . . .
Water Service
FINAL INSPECTIONS' . , Dale .' '.Inspector.'
Electrical Final .' .
. . .... " ..
Pllnnbing'Final .
, .
Mechanical Final '. . . .
Gas Test .. .
. . .: ' .
Engineering/Grading Final 765-6126 .-- .
Fin! Dept. Final i~5-4040 . ['
. " . .
Water Engineering 765-5268 .'
Sub ListlBusinessL.icense 765.5.19 .' .....
.' . .
Zoning '765-5.139 . I '. - '.,
Building Final. ~ast Inspection. On!~1 6~.cir k~~~
. . .' fter Abov.. Complete). r-"f '~"'-
..
Mechanical Inspections
Plumbina Inspections'
. Electrical Inspections