1215 S, Sharon Cir. E1
TYPE OF PERMIT ,
Re~alr
DATE: 10/13/2004
JOB ADDRESS: 1215 S SHARON CIR E1
CITY
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~It' .,; ,) ~HEIM
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BUILDING DIVISION
'200 S. ANAHEIM BLVD.
(714) 765.5153
INSPECTION REQUESTLINE:
(714) 765.4626
CENSUS CODE: , 4~4
QUARTER SECTION:' 22
BUILDING PERMIT NO. BLD2004-03806
. LEGAL DESCRIPTlqN: SEC 24 T 4 R 11 N1/2 NW1/4 NE1/4
'CONTRACTOR INFORMA[rJON:
WARD TEKCONSTRUCT!ON INC
3480 W WARNER #P
SANTA ANA, CA 92704 0000
BUSINESS PHONE: 714 9n:.~7836
JOB DESC.RlPTI9N:Fire repair living room and roof repair. :[ .
VALUATION:' 35,000.00 L
I OWNER-BUILDERpECLARATION
I hereby affjrm- under penalty of perjury that I am exempt from t~ Contractor;s Ucense Law for the following reason (Sec. 703'1.5 Business and
Profe~sions Code: any dty or county which requires a permit-to construct. alt;,jr, imr:>rove, demoitsh or repair any structure, prior to its issuance, "iiJso
reqUires the applicant for-such. permit to file a signed statement that he is Hi::ei~sed pursuant" to the provisions of the Contractor's License. Law (Chapt"er
9Y(commencing with-Section 7000 of Division 3_of the. Businessand Profes.si(lris Code) or that he is exempt therefrom arid the basis, for the-alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit sud.1?cts the appiicant to a dviJ penalty of not more than five hundre.d dollars
($500). , ' " "~ " . '" " " "" ,
o I, as owner ofpr.operty, or my'employees with wages as their sole comr>.~nsation,.will do the work, 'and the struct(lre is not intended or oft-ered for
sale (Sec. 7,044, Busi'ness and Professions Code: The Contraqtor's. Uceris~ 4~W does not appJ,Y to an owner- of property who bUilds or imprqves"
thereon, and who does such work himself or Meffielf or through his Or her OWl;; elT<ployees, provided that such improvements are'not jntend~ or._
offered for ~Je. If,'however, the buitding or improvement is sold with one yei,:-'of completion, 'the owner-Builder will ha')e the burden of proving)hat he
did not build or improve for the purpose of saie). 'U . :, ,
o I; as the owner of the property; am exdusively contract,ing with licensed r:.intraaors to construct the project (Sec.' 7044 Business:and Profe'~{ons
Code: The Contractor's License Law does not apply t9 an oWr)er'of property)::';ho builds or improves thereon, and'who contractsfor'such projects with
~ontractor(s) licensed pursuant ~o the Contractor's licenSe Law). 'i
LJ I am exempt under Sec. ,B & P.C. for:this reason: . 1:
Date: Owner:
r WORKER'S COMPENSATION DECLARATION L_-'
I hereby: affirm under penalty of perJury one of the folrowing declaraticn,s:. 'I
o I have and 'will ~jntain a certificate of consef"lt to self-insure for work~r'~ ~~inpensation,
. as provided for by Section 3700 of the Labor Code. for the performance oftr.:~ \v0rk for wh:ch
i's permit is issued, ' ' " '~; , .
, .'1 have and will maintain worker's compen~ation insurance, as required b/ Section 3700 of
t e Labor Code, for the performance of the work for which this permit is i$..'>U';I'd. Myworker's
Compensation insurance earlier and policy are: . .;'
Carrier: STATE FUND Policy Number. 0000461,;264-7003
This sectionn~ed not be completed if the pennit,is for one hundred dollars (~1.00f ~r less.
o ,'certify that iti the ~rformance of the work for which thi~ permit isj~ue,d, ~ shail not
employanyperson in a ny manner so as to become subjectt,o the wo~k.er's c9m(>ensation laws
of CaHfomia, and agree that if ,I should ecome subject w r's omp~nsatlon
provi~ions of Se~tion 3700,oHhe La or de, I shall ~ . ith pi", tr:!)se,provisions.
APPLICANT: DON THOMAS
OWNER INFORMATION:
Paul K Lam
9332 Lorna SI
Villa Park, CA 92861
ARCHITECT/ENGINEER INFORMATION: '
PROCESSED BY: FAN
LICENSED CONTRACTORS DECLARATIO~
I hereby affirm under penalty of perjury that I am,
licensed u'nder provisions oi.chapter-g. ommencing
with Section 00 of Divsion '" fth us. and
Professio e.
Contractor
NUMBER
816772
TYPE
B
EXPIRATION DATE
1/31/20G5 .,.
Date: 10/13/2004 . Applicanl.
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS
UNI.AWFUI., AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL',P'ENA;;TIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOt.LARS($100,000), IN ADD,-;lON TOTHE
CO~ ~ C""~"^=" ~"6 M ,~~~ 'rn "''''"'''''00 D' ~ I
LABOR CODE. INTEREST AND ATTORNEY'S FEES. ,!
j , " CONSTRUCTION LENQING AGENCY .' . ' _
I here!Jy affirm under penalty of perjury that there is a ~onstruction lE;nd~ng 2fi":ricyfor the .'
_.?~rf~I').c:A_.(,lth~.W(lrk T0r \:vhic~ this p.er!"r.:.~i:,!.!:::s,:.!~r.! xS~-3-9:?7..;;*.",-c.}~ ~ ~"~ I
Lender's InfOfmation:
Construcion Types:
VN, ,
Fees paid. for Permit:
Total:
499.25
Date: 10/13/2004
Signature of Applicant or Agent
The permit shall expire by limitation and becomenull 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 . . DATE. INSPECTOR
Temporary Power Pole .
Plumbing (DrainlWaste Pipe)
Electrical Ground ElectiodelUter
SetbacklFormsfTrenches (Footings) .
Do not install sUbflqoror pour floor slab unlillhe
following applicable items have been signed:
Plumbing (Water Plpe.Sprin~ler Valves)
tlleehanical (Groul'lCiwork)
ElectTlcal (UndergrllUnd Conduit) ..
Pre-slab (CompactiolllMembrane.Keinf. .
Underpinning (Floor.Joist/Girders)
Do nol cover or conceallhe work below until the . .
fOllowing applicable items have been signed:. ... .
1 st Floor Shear . .. .. ..
FireSprinkler (Rough). ..
.2nd Floor Shear
Roof (Sheathing/Diaphragm/Frane) . . .
Masonry (ReinfJBoncI BeamIPre-Gl'O\It) .11 . ..
Rough Plumbing (Top Out) . iH!;'7l4- j, ~
Rough Mechanical .. . . ,1-1.<,-
. Rough eectrK':a1{Dry Wall) fJ.IC-'<Il 11
Rough Electrical r! ...
Framing (Only aherPlbg.. clee.. Meeh and Firel IJ >It;-
Insulation ISllUndlE!lIIrgy) ... v
Do not tape or plaster until the following applicable
Items have been signed: .. ..
DryWall.. . . . . .
.Penetrations (Fire Rated) Electrical..
Penetrations (Fire Rated) Mechanical.
Penetrations (Fire.Rated) PlumI1il1Q "
Interior Llith .. " ~. ..
Exterior Lath '. II-Jb# ~;)
. GENERAL ITEMS. . .
ExIeriorPll!ster (Brown Coat)
T .Bar Electrical .. .
T~Bar Mechanical .
T .BarStructural .
Sewer
Water Engineering Backflow ...
Water Service
FINAL INSPECTIONS
!=Iectrjcal F.inal
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040.
Water Enginee.ring765-S268
Sub List/Business. license 765.519
Zoning 765.5:139
B. uilding Final ILast Inspection, Only.. I nl
. After Above Complete). .<<:
PARTIAL INSPECTIONS
BUildin~ Inspections. ... .. .. . .,' .
}/rn/j7,'1 /.Js~t.A71;,)@Lkt.'-<: tJA;l.'1
Dale.
Ins ector
1- Z'--6')
I ''Z.b...o)'
l~
1.
.~
~
MechanicallnsDection's
..Plumbina Inspections
Electrical Inspections