1211 S. Loara St. 15
~~~rOF PERMIT CITY
DATE: 12/21/2004
JOB ADDRESS: 1211 SLOARAST15
LEGAL DESCRIPTION:
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 766 - 5153
INSPECTION REQUEST LINE: .
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION:
BUILDING PERMIT NO. BL02004-04472
APPLICANT; KATHERINE
OWNER INFORMATION:
WISLSON
CONTRACTOR INFORMATION:
ROBERT'S CONSTRUCTI~)N,.INC
11779 CARDINAL CIR:
GARDEN GROVE, CA 928';:-0000
BUSINESS PHONE: 7145:;7;.7200
JOB DESCRIPT10N:Restoration of fire damage minor framing and drywall dr:m~ge same for same construction. (REF;, INV2004-00085)
ARCHITECT/ENGINEER INFORMATION:
1
I OWNER.BUILDER PECLARATlON
'hereby affirm under penalty of perjury that I am exempt from the Contractor''-;''Ucense law for the foJlowingreason(Sec.703"1.5Business an<t
Prcfessions.Code: any city or county which requiresa permit to construct, altd:-,. improve, demolish or repair any structure, prior to its iss'uande,.also'
requires the applicant for such "permit to file a signed statement that he is liceir"sed pursuant to the provisions of the Contrador's License-La~i_ (Chapter
9)(commencing with Sectlo-n 7000 of DivisiOn 3 ,of the Business and ProfessichsCode) or: t"at he;s exempt therefrom and the basis'(orthe alleged .
exemption. Arty vblation of Sectiql1 7031.5 by any applic~nnor a permit sutib:,l<; ,tlie applicant to a civil penalty of not mere than five hundred doJ!ars
($500), . .;'. . .... .> . .
o I. 'as owner of property: or my employees with wages as i;heir ,sole (;Omp4!I:,sat;Q11, will do the work, and thes'tr;JcturE> jS no! intended 6r offered for.
sale (Se'c. 7044 Business ,~nd'Professions Code: T~e Contractor's G.cense 4th. -906$ f10t apply to an owner of property V'iho buHds'o.r improves
theraon, and who does such work himself or helSelf ot through his orher_owrVtln\p1oyees, providedthat such improvements arer.()t interiOed or
o~ere d fo~ sa Ie.. If, hOW. eve" .the build in. 9 or improvemen. tis scldwith one y.,::..I},.,_.CfC';.:;lnle:tlor-, ,the. '''./n<-. .f".bu ilc:l'Elr w"lhave the. .buldEi,n,'J_f. r".'.fOYing that he.
dId not build O(lmprove for the purpose of sale). . . . . ,.' .' . ' .
o I, as the owner of the property. am exdusively contra~jJlg with licensed ')1 J"i:::adol s: to cunstruct the project (S% 7044 Business ai1dPrcfessions
Code: The Contractor's license law does not apply to an owner' of property .~o build.:; Or' imp!'oy<:s ~herebn, and w~.o conkacts-foi suCh projects witl)
~ontractor($), licensed pursuan~ to .the Contractor's license ~a'N). ~}- _. ." . .
LJ I ar:n exempt u[1der Sec. . . B & P.C. for this reeBon: .___.V__.... . .' '. .
Dale: Owner:' . ~-. '-.. ' .
I WORKER'S COMPENSATION DECLARATION . ~j=_":-=-'!
I hereby affirm under penalty of perjury on'e of the following declarations: ~.
01 have and will maintain a certificate of cOnsent to self':jnsure forwof!<er'~;':'vmpe:i1";ation,
as provided for by Section 3700 of the labor Code, for the performance of th~ :t:~Hk ~or whkh
.. this permit is issued;' .; ,
~I have and will maintain worker's compe.nsation insurance, a$ :~qu;,ca b~~ ~;~ctJon 3700 .of
ID1"e'Labor Code, for the performance of the 'work for which this permit lo:; is:;:l..-;.:t .~Ayworker's
Compensation insurance carrier and policy are: " . '. I
Carrier: STATE COMP, INS, FUND .. Policy Number. 046-00 U;';!f GL1.&781.2003
l11issection ne_ed not be completed if the pennit is for. one hundred dollars ($100i;ltt~s. .
. ~ cert.ifythat in the performance of the work for which this permit ~.s isSOJ~~~~ I :~haU not
ploy any person in any manner$O as to.become subject to the worker's c~"l;pel1-~aticn laws
f Califomia, and agree that if I ,should . om ~ dto the worker's com~~~;;)ation .
Provisions of Section 3700 of the labor 0 ,I hall to hwith comllly.wrth tMi' ~e orovisicns.
. / I .
, I' .
Date: 12/2112004 Applicant'
,.
WARNING: FAILURE TO SECURE SATION COVER(GE IS
UNLAWFUL, AND SHALL SUBJEC AN EM 'YER TO CRIt>AINAL PENAC:"ES AND CIVIL
FINES UP TO ONE HUNDRED CUSAND DOLLARS ($100,000), !N ADD"'WN TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI0l'<,,~70$ OF THE
l.ABORCODE, INTEREST AND ATTORNEY'S FEES. .,..
C CONSTRUCTION LENDING AGENCY ..' _~.J .
t h~"'f::h'J ""ffirf'l'l_lJnder: pp.naitY.ofpe:"J;il'}',th,."J_then~.ic;._a ('-')f!dfticth" '''!.nd;p~ ;~~:.L~c.y_ for ~!-'!~ !
performance of the work forwhidl this permit is issued (Sec.3097.Civ_C): I
Lender's Information: .
VALUATION:
20,000.00
PROCESSED BY: ENO
I:
;
J
. . /0....
V~~....L..
Gontrb' ..
EXPIRATiON DATE
5131/2006
B
Construc;on Types:
VN, ,
Fire Sprinklered?
NO
. Fees paid tor Permit:.
Total:'
340.01
Date: 1212112004
t or Agent
The ermit s expire by itation and become null and void if the building or
war has not passed final inspection 365 days from the date of permit issuance. A
ne I permit is required to commence or continue work.
FINAL INSPECTIONS
Electrical. Final
PJumbingFinal
Mechanical Fimil
Gas Test
Engineering/Grading FinaI765-5126
Fire Oept: Final 7.65-4040
Water Engineering 765-5268
Sub LiSt/Business. License 765.519
Zoning 765-5139
BlliidingFinal (Las! Inspection. Only
Mer Above Complete)
PARTIALINSPECTION$
. Bulldinq Inspections
INSPECTION RECORD
. '. .'
. . 'INSPECTION . DATE INSPECTOR'
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer . .
SetbacklForrilsfTrenches (Footings)
00 not install sub floor or pour floor slab until.the '.
following applicable items have been signed: .'
Plumbing (Water Pipe.Sprint"er Valves)
Mechanical (Groundwork) .
Electrical (Underground Conduit)
I P"':5lab(Compaction/Membrane.R~nf. . .
Underpinning ("'oar Joist/Ginlers)
00 not cover or conceal the work below until the .'
following applicilble ilems have been signed: . '.
1 st Floor Shear. . ,. .
Firesprinkler (Rough) .
2nd Floor Shear . . .
Roof (SheathinglOiaphragnVFramej
Masonry (ReinfJBond BeamlPre-Grout) . .
Rough Plumbing (Top Out) .
Rough Mechanical. . 1/.3/1 .-- / 7:
i ROugh Electrical ( II) . .) /.
. Rough Electrical . . ..... .~. I.'
Framing' (OnlyafterPlbg., Elec.. Mech.' and Fire) ri-3 __ /)",- I.
InS\llation(SoundlEnergy) .'. . flit, ,r 7~'
'po not tape or pla~ter until the following ,applicable' - /' '. .
Items have been Signed: -.' " .
Drywall IJI;~/ /_.l'~
Penetratl~ (Fire Rated) Electrical' r
f>enetratlons (File Rated) ~chanical . . .
Penetrations (Fire Rated) Plumbing " . .
Interior Lath ." . . . . .
Exterior Lath
GENERAL ITEMS .
Exterior Plaster (Brown Coat)
T -Bar EtectricaJ .
T-Bar Mechanical, . .
T -Bar Structural , . .
Sewer . .
Wate.r Engineering.Backflow . .
Water Service . ..'
.
Mechanical Inspections .
Plumbinalllspections
Electrical Inspections .