209 E. Water St.
TYPE OF PERMIT
Residential Addition
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.-..5153
INSPECTION REOUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 84
BUILDING PERMIT NO. .BLD2005-01574
,
DATE: 6/29/2005
JOB ADDRESS: 209E WATER ST
LEGAL DESCRIPTION: N TR 497 LOT 12
APPLICANT: LUCIANA MENDOZA
OWNER INFORMATION: CONTRACTOR INFORMATI'JN:
Antonio German
209 E Water St
Anaheim, CA 928050000
JOB DESCRIPTION;Add 2 bedrooms, bath and family room. 699 sq. ft.
V ALUA TION: 48,500.00
ARCHITECT/ENGINEER INFORMATION:
JIIN TARN LlU
1720 E. GARRY AVE.
SANTA ANA, CA 927050000
PROCESSED BY: FAN
OWNER-BUILDER Di'CLARATION
'J hereby affirm under penalty of perjury that I am exempt 1rom the Contractor's l~icense Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, alter,:limprove, demolish or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that he is licen~~d pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Profession~ Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars
~O). "\. ,
. ';, as owner of property, or my employees with wages as their sole eompeni,ation, will do the work, and the struelure is not intended or offered for
ale (Sec. 7044 Business and Professions Code: The Contractor's License la\l-l does not apply to an owner of property who buildsor improves
thereon, and who does such work himself or herself or through his or her own eJlployees, provided that such improvements are not intended or _.'
offered for sale. If, however, the building or improvement is sold with one year ',f completion, the owner~builder will have the burden of proving that he
did not build or improve tor the purpose at sale).
D I, as the owner of the property, am exclusively contracting with licensed co Hractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of prope rty wl)O builds or improves thereon, and who contracts for such projects with
ontractor(s) licensed pursuant to the Con ctar's License Law).
I am exempt un r Sec. P .C. for is rea
Be- Own .
WOR 'S C E SATION DECLARA ION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the ,,,ork for which
this permit is issued. "
o I have and will maintain worker's compensation insurance, as required by flection 3700 of 6/29/2005
the Labor Code, for the performance of the work for which this permit is issued.'. Myworker's Date:
Compensation insurance carrier and policy are: :\
Carrier: Policy Number.
.--
I I
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code.
Contractor
NUMBER
EXPIRATION DATE
This section need not be completed if the pennit is for one hundred dollars ($1 00) or less.
IrJ.. r certify that in the performance of the work for which this permit is issued, I shall not
~ploy any person in any manner so as to become subject to the workers corrpensation laws
of Calitomia, and agree that' I should become subject to the worker's compensation
provisions of Section 3700 of t Labor Code, I shall f hwith comply with those provisions.
t S'
TYPE
Date: 6/29/2005 Applicant
WARNING: FAILURE TO SECUREW KER'S C MPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJEC N E ER TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED USAND DOLLARS ($100,000), IN ADDITiON TO THE
COST OF COMPENSATION, MAGES AS PROVIDED FOR IN SECTION 3r06 OF THE
LABOR CODE, INTEREST D ATTORNEY'S FEES.
, ONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
Construcion Tvpes:
V N, ,
Livinq Area: 699
I certify that I have read 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
he by aut represen . es of this city to enter upon the above mentioned property for
insp purposes. I'
..r-_-.
y
Date: 6/29/2005
Fees paid tor Permit:
Total: 2.450.19
SIgna re of Applicant or Agent
ermit shall expire by limitation and become null and void if the building or
war has not passed final inspection 365 days Irom the date of permit issuance. A
ne permit is required to commence or continue work.
-
-" .
.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION
DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
Setback/FormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water PlpelSprinkler Valves)
MechanlcallGroundwork)
Electrical IUnderground Conduit)
Pre-slab (CompaclionlMembrane Rein!.) 7-I5.(j ,? S7;l, ...>>
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1st Floor Shear B .,B. "'-4..J ~ f-
Firesprinkler (Rough) /
2nd Floor Shear
Roo! (Sheathin!llDlaphragm/Framel
Masonry (ReintJBond Beam/Pre-Grout)
Rough Plumbing (Top Out) 'g.(a-- e<""" ~ :j!1
Rough Mechanical ; -26<..<l~' fY F ,(/A
Rough Electrical (DryWall) "'/ ~/
Rough Electrical B -18 0 l' .K
Framing (Onlyatte, PIbg., EIe., Mac."'" F"e) :>. V4 n_ ~ I~ -L
Insulation (Sound/Energy) '3/7 010'5 .I AJ:)ou. 'i;.~1
Do not tape or plaster until the foilowing applicable
items have been signed: /) A
" ~g~o{; /I' /" ,r /1
..... ~
~)?~~ ---p. Th
)-)& &j-<S-'" ./..J.
b'-a .f$.
. ..-
Y/-iw<.,.
/? t
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
/JL
"1/ 'l" ~
/,..)
~1VS'
GENERAL ITEMS
Exterior Plaster (Brown Coat) (S-3-.oo
T -Bar Electrical
T -Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backtlow
Water Service
, r4-1
/ "\
---
-~
.,
.
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765.5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-5194
Zoning 765-5139
Building Final (La,tln'pection - Only
After Above Complete)
INSPECTOR
~r
PARTIAL INSPECTIONS
Buildina Inspections
MechanicallnsDections
Plumbina Inspections
Electrical Inspections
.
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NNING DEPARTMENT
APPROVED
(l- 2--'1. 2ooS-
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DISTRICT REVIEW:
" S01l ~tarnp'..)his ~
one on a.hove line
UILOING PERMIT FOR
NY. CONDITIONS
o &.10 '(M jC} [C- LAYII +
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48.00'
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BUILDING PERMIT NO. BLD2005-02333
TYPE OF PERMIT CITY
Reroof
DATE: 7/26/2005
JOB ADDRESS: 209 E WATER ST
LEGAL DESCRIPTION: N TR 497 LOT 12
APPLICANT: LUCIANA GERMAN
OWNER INFORMATION: CONTRACTOR INFORMATION:
ANTONIO GERMAN
209 E WATER ST
ANAHEIM, CA 92805
JOB DESCRIPTION: Tear off existing and fe-roof 21 squares of composition shingles.
VALUATION:
1,600.00
PROCESSED BY: SAM
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason ( ee. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, aftel', improve, demolish or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that he isJicen~3ed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he;s exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subje::ts the applicant to a cfVn penalty of not more than five hundred dollars
($500).
~ I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
~ (Sec. 7044 Business and Professions Code: The Contractor's License laN does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-builder will 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 cont/3cting with licensed contractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with
P-Qontractor(s) licensed pursuant to the Contracto License Law).
U I am exempt under Sec. 8 .. for this reason:
fe: Owner:
WORKER'S C AT ON DECLAR
, hereby affirm under penalty of perJ ry one of the following declarations:
o I have and will maintain a certificate of consent to self-insure for worker's (~ompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
o I have and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier: porrcy Number.
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
~ertifY that in the performance of the work for which this permit is issued, I shall not
e 10 any person in any manner so as to become subject to the worker's compensation laws
of a mia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I sha forthwith comply with those rovlsions.
, .
Date: 7/26/2005 Applicant:
WARNING: FAILURE TO SECUREWO is
UNLAWFUL, AND SHALL SUBJECT A YER TO CRiMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED TH U AND DOLLARS ($100,000), IN ADDITlON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I nereby affirm unaer penalty of perjury that there is a construction lending agency for the
pertormance of the work for which this permit is issued (Sec.3097.Civ,C):
Lender's Information:
I certify that I have read 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
hereby,authorize representives of this city to enter upon the above mentioned property for
in ion purp s. \
Date: 7/26/2005
Signature of Applicant r Agent
e permit sHall expire by limitation and become null and void if the building or
work has not passed final inspection 365 clays from the date of permit issuance. A
new permit is required to commence or continue work.
ElM
BUILDING DIVISiON
200 S. ANAHEIM BlVD.
(714) 765.5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 84
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code.
7/26/2005
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Construcion Types:
V N, ,
Fees paid for Permit:
Tota.:
235,33
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Uter
SetbacklFormslTrenches (Footings)
Do not Install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane Reint.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable Items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (SheathinglDlaphragm/Frame) ~d~o. ~ -::r ~(.!AL-
Masonry (Relnf./Bond Beam/Pre-Grout) /
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele.. Mec. And Fire)
Insulation (Sound/Energy)
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) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T-Bar Electrical
T-Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS DATE
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub ListlBusiness License 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only
After Above Complete)
INSPECTOR
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing InS$ections _ -J "o.,.J2/
1-/1-0') tA)lf I"C! €Jt<- "T<&
TYPE OF PERMIT CITY
Patio Cover
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765- 4626
CENSUS CODE: 434
QUARTER SECTION: 84
BUILDING PERMIT NO. BLD2005-02742
DATE: 8/31/2005
JOB ADDRESS: 209 E WATER ST
LEGAL DESCRIPTION: N TR 497 LOT 12
APPLICANT: LUCIANA GERMAN
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
ANTONIO GERMAN
209 E WATER ST
ANAHEIM, CA 92805
JOB DESCRIPTION:lnstall 60 square feet porch, 46 square feet patio, and 64 square feet patio per plans
VALUATION: 7,500.00 PROCESSED BY: JNJ
OWNER-BUILDER i)ECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason ( ee. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct. alter, improve, demolish or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that he is ric~;ised pursuant to the provisions of the Contractor's License Law (Chapter
9){commencing with Section 7000 of Division 3 of the Business and ProfessiQIlsCode) or that he is exempt therefrom and the basis for the a.lleged
exemption. Any violation of Section 7031.5 by any applicant for a permit SubjE!Cts the applicant to a civil penalty of not more than five hundred dollars
($500). i
r>> I, as owner of property, or my employees with wages as their sole comp~'1Sation, will do the work, and the structure is not intended or offered for
~e (Sec. 7044 Business and Professions Code: The Contractor's License U.W does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own amployees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one ye.,~f completion, the owner-builder will 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 contracting with licensed 6)ntra.ctors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of property~'.ho builds or improves thereon, and who contracts for such projects with
[jontractor(s) licensed pursuant to the Contra tor's License Law).
I am e p unde Sec. , ,B .C. fo~this re: '~;
Date: . Own€!' e/: ~1
W RKER'S COMPEN TION DECLARATION "
I hereby affjrm under penalty of perjury one of the following declarations: ':i
~ I have and will maintain a certificate of consent to self-insure for worker'~-~.' ompensation,
~ provided for by Section 3700 of the Labor Code, for the performance of thework for which
this permit is issued. . ,
o I have and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the periormance of the work for which this permit is issued. My worker's
Compensation insurance carrier and policy are: '
Carrier: Policy Number.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
Ik::ensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code.
8/31/2005
Date:
Contractor
NUMBER
EXPI RATION DATE
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
!;=l I certify that in the performance of the work for which this permit is issued,l shall not
--tmrploy any person in any manner so as to become subject to the worker's compensation laws
of Califomia, and agree that if I should become ject to the worker's compensation
provisions of Section 3700 of the Labor Code, I II forthwith comply with those provisions.
,
Date: 8/31/2005 Applicant: "
WARNING: FAILURE TO SECUREWORKE 'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED lHOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending ageqcyfor the
...cetforl'l'1;:lr)('A of th~ work for which this op.!'mit is issued (Ser~3097.Civ.C):
Lender's Information:
TYPE
Construcion Tvpes:
VN, ,
I certify that I have read 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
hereby authorize representives of this city to enter upon the above mentioned property for
inspection p: ses.
\
Date: 8/31/2005
Fees paid for Permit:
Total:
701.26
Signature of Applicant or nt
The permitshall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuMCe. A
new Dermit is reauired to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormslTrenches (Footings)
Do not install sublloor or pour 1I00r slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane Reinf.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear ~ /J~
i -{6 -.?.5 "
Roof (Sheathing/Diaphragm/Frame) /"',7'\
Masonry (ReinfJBond Beam/Pre-Grout) ~
Rough Plumbing (Top Out)
Rough Mechanical /
Rough Electrical (Dry Wall) /J1/
Rough Electrical ';i 15A1S t/'P' \
Framing (Only after Plbg., Ele., Mec. And Fire) I '-/6=y, n/~
Insulation (Sound/Energy) 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) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T-Bar Electrical
T-Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
- - -
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
EngineeringIGrading Final 765-5126
Fire Depl. Final 765-4040
Water Engineering 765-5268
Sub Llst/Buslness License 765-5194
Zoning 765-5139
Building Final (Lasllnspecllon - Only 1t-4.0
After Above Complete) I
PARTIAL INSPECTIONS
:r~%f~ ed (~J~--{(
Mechanical Inspections
Plumbin9 Inspections
Electrical Inspections
~~
Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714) 999-2188
(714) 520-5741 FAX
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
NOTICE: The 90-day period in which you may protest the fee described herein will begin on the date this fee is
paid. However, if the fee was imposed by the City or County as a condition of approval for your project, and you
have received the requisite notice, the 90-day protest period began at the time your project was approved.
Rec~t?i11
Owner Information:
Name:
Address:
Elementary Di4~_'~D ,
~
High School District:
Anaheim Union High School District
(! _ I 4.-,<- "'--
,;zo4 F
v~ ,dch/~
(t ) &. n.-?
pho"p. Number:
)
Applicant Information:
Name:
Phone Number: (
.,., /'C>
l~ c2-'V7'-L "W .
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)
Property Information:
Address of Project:
Development Type: [J Residential - New
Project Name:
~..z.-
t'CKL/,
~'-.I~
[ ] Commercial
'"'\
[I Residential - Room .Addition
Type:
] Single Family
[
Multi-Family Condos/Apartments - # of units:
Commercial:
Total Square Footage:
Multiplied by Current Rate: Elem. $
H.S. $
EqualS Total Fee:
$
-$
~$
-$
Residential:
[ ] Level 1 [ ] Level 2 - ACSD Only [ ] Level 3- ACSD Only
Total Square Footage: ?' " !
Multiplied by Current Rate: Elem. $ 1.1 '2.J = $ 7ts:/
H.S. $ II-::Y = $ 1f>:; I
Equals Total Fee: $..:{ :;2 V - $/S7(). ~
Fee Waiver:
Fees Waived: [ ] Yes
(
No
If yes, reason:
Acknowledgement:
The above representations as to square footage are true. Developer/Applicant agrees that if it is later determined that such
representations are not true, Certificate sha automatically terminate and the appropriate City/County shall be notified.
Developer/Applicant Signature:
r
<<<--O/?'U',
Certification:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code
Sections 53080 and 65995.
U /:Zilos-
Date I
Actual Fees paillt.
, 40- S!).
Anaheim Union H.S. District
$
$
'1 r<;;;" j ~
'7 "{'s- . /~
Check No.
Check No.
0guLlY '1
[1 ~t-- J1( "
Distribution: City/County - Developer - Accounting - Elementary District