607 S. Velare St.
BUILDING PERMIT NO.' BLD2004-03759
TtPE OF PERMIT
Foundation Only
CITY
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 7(l5. 5153
INSPECTION REQUESTLINE:
(714)765.4626
CENSUS CODE: . 101
QUARTER SECTION: 28
DATE, 10/8/2004
JOB ADDRESS, (l07 S VELARE ST PARSONAGE
LEGAL DESCRIPTION:' SEC 18 T 4 R 10 E 9.20 AC W 18.41
APPLICANT, CHUCK WILLIAMS
OWNER INFORMATION: CONTRACTOR INFORMP.T10N: ARCHITECT/ENGINEER INFORMATION:
GRACE BIBLE CHURCH
2550 W Orange Ave
Anaheim, CA 92804
JOB DESCRIPTION;~.ew manufact~red home installed on Church propelty for parsonage. Goldenwest-Kingston MHlernennium model K662MK
VALUATION, 120,000.00 PROCESSED BY: FAN
L-- OWNER:suiiDE.'-'iOECLARATION --:
I h.ereby ~ffirm under pen~lty of perjury that I am exempt from theCo!1tractp!,~ Liceme Law for the fallowing,_ reason' (See 7031.5 Business and '.
Professions Code: any "city or county Which requires a permit to c"Orlstrtlct,a1t;: r: improve, demolish or repa ir'__any structure. prior to itS .issuanc~,a!so
re.quire,s the applicant for such permit to file ~~ signed statemeQt tt'lat he i8Iic~~:,~d pursuant to the provisions Of the Contractor's License,Law. (Chapter
9)(c(;l'!l-mencing with Section 7000 of Division 3 of the' 8usiness and Prof~:i;,=,\:::/,:::; Cede} I)'r that he is exempt therefrom snd the b<is!s for the alleged
exempt!cn. Any violation of Section 7031.5 by-any applicant for a permltsu_b~e!s the a ppl\C'3r.t to acivll pP.n~ltyof :lot m.ore. t~8n five: hundred doUers
($500). ' '. . '. . .' Z. '. '.' .
rxlli as-own~er.of property, or mYt:!,mp!oyees with wagesas their sole c(;mr~;_lsatiCq: will dO' the work, and the structur~ is !lot intended or offered for
~le (See., 7044 BU,siness and Profes,slor.s Code: The Contra~tor.s UcenseL,~~w doE:'S not apply to an OW!1er of or;:l~)erty who huHds a-r im.proves
thereon, af~{~'who does_ ~uch work hi,rnself or herself or through his or her owr~ernproyee5, providsd that such improvements are not intended or
offered for Sale. !f, however, the.buiiding- or improvement is sakI with one ye<::r of complation,~he owner-bllilder will have the bur':1enof proving that he
didnc{,?uiJd.Oiin:pr,oveforthepurposeofsale). ,'~;: , . .
o ,I, a~ the own~r oftt)e property, am exd_usivety contracting with licens<-SrJ ,~.r,tractors to c:cnstruct the;proje.ct (~~ec. 7044 Business and Professions
.Code: _ T.he Contractor's License L.aw does not _gpp!y to an owrier of -propertv'-ivho buikls or'hr,pro\Jes th-efP.on, and w;'o contracts fur Sq~-jl prcjec:s with
~J(oiltradOr(s) licen:;ed pursuant to the Cont.r:3c~or's Ucense Law).:i . ^,
~to~ am. exempt IJn(ler__~e~w~crt1 W...d>'~~~: '~1~ --,_.~-
I .. . '.WORKER'S COMPENSATION DECLARATIO~C::___ ---l ~E.NSE\) Cvl:!.!flACTORS DECLARATION --i.
I herebYCl~hrm under. penalty of perjur,;.one' of the follow:tlg GccJarations: .., ~ . I l hereby anl;m ur.de penalty of perJury-lhat I curt
[J. I have and will-maintain a .certificate of oonsenUo s~(f-.insure.for w(1ri<.er:';cpmoer;s::::t~Gn, I ,licensed.under i)rOvls\ons o,f cnaiJter9/60mm. enc.:;i"l{;
:as prOVided for by Section 3700,of the Labor Cc..'o(le. fGr thp.'perf.q!+nancc ot ti~ii :..jort~ for \l'il"l\dl wit~ Sect!on7COO) of ~ivsion 3 or the Business ""nd
.thiSD€.mitis issued. ... . ,'. ;:1 Professions COOe.
LJ '1. have and.WiII /!la.in't~ln worker's compensztion insurance, as required t':;~.'..S(JC:ion -37()Oof II 1(1/8/2004
th~ Labor Code, lor the performance of the work for whicr, this,permit is issu<:;:,; My WCTk~r's Date:
,Cctll..pensation Insurance canierand policy are: :
Cerrier: .. . P0licy Number. . .',. I NUMBER
This section need not be completed if the pennit is for one hundred doi_'ars {$1eaj-or less. . TYPE
~- I certify that in-the perfonnance of the work fOi whicldh!s ~e:(m!ti.s issubi;,I.sr,ail nnt .
employ any person in any manner so as to become SUbject to the work~r's:3;cinp~nsation laws
of Catifomia, and .agree that If I should beCOrTle SUbject to the wo:ter's cc.m;a!'lsctiori'
provisions of Section 3700 of the l.abol Code, I sllali fO{thwith compTy \o'\lith:th!.~.,e'p(ovjs:ions. Construcion Tvpes:
Dal.:lOl8I;004 Applicant: (!. t1.b~ ~ ...::__ .. " ~:C;JP;ncv Groups:
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERi,GE.!S I R3, U', . ,
UNLAWFUL, ",NO SHALL SUBJECT AN EMPLOYER TO CRIMiNAL PEN,>.l TIES AND CIVIL . .
F.INES UPTO ONE HUNDRED THOUSAND D.OLLARS ($100,OOO),IN'A..DDIHON TQTHE I
COST OF COMP<oNSATION, DAMAGES AS PROVIDED FOR IN SEe'net, :)706 Of" THE
U,BOR CODE, INTEREST AND ATTORNEY.S FEES. .'_.. ~
. L _ CONSTRUCTION LENDING AGENCY . . - I
I hereb-y 8f1'irrn under pe. nalty of p. erjuwthat tllere is a construction lendir,~(~c~, !1cy fo:' the .l
performanw of the work for which this permit is issued (Sec. 3097 .C1y .C.>:-:~_
l,.ende(~ l~i0fm8__l:ion: ___~_,_ __-~~'"-._':...L_._ _ I .
Contractor
EXPIRAriON DATE
I certify that I have r~ad this application and state that the above information is correct. I
agree to rompfy with all city orcUnances and state laws relating to building cor;struction, and
hereby authorize _r'ep~sentives of this city to enter upon the tlbove mentfoned property for
inspedionpu':!!jl ~~ Date: 101812004
. .. . Signature of Applicant or Ags'1t
The permit shall expire by limitation and become null.and void If the ~uildin90r
work has not passed final inspection 365'days from the date of permit issuance, A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
3,894.79
INSPECTION RECORD
. . INSPECTION . . DATE. INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe) '.
Electrical Ground Electrode/lifer J
SetbackfF.ormsrrreriches (Footings). 1,/I1.cI.4-
O(Y not install.subfloororpourfloor slab until the
follbwing applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
. Mechanical (GroundWork)
Electrical (Underground Conduit) . . .
Pre-slab (Compaction/Membrane.Rei of. .
Underpinning (Floor Joist/Girders)
Do not cover or concea./ the work below until the
lol/owing apP'licJ3ble items have been signed: '. .
1 st floor Shear .
FireSprinkler (Rough) .. .
2nd Fioor Shear . . .~
RQOf (Sheathing/Diaphragm/Frane) ;::-
Masonry (ReinfJBOnd BeamJPre-GfO\1t) I'!>lh~ . CJ 7"'l'
Rough Plumbing (Top Out) . .
Rough Mechaoical . .
I Kough 8ectrlca! (ury....llj
ROllgh Electrical -
Framing (Only alter Plbg. Elee.. Mech and Fire) I~ h-fo~
Insulation (SoundlEnergy) . .
po not tape or pla~ter until the following applicable
Items have been Signed: .'
Drywall . . . . .
Penetrations (Fire Rated) Electrical. .
Penetrations (File Rated) PJlechanical . .
Penetrations (Fire Rated) Plumbil!9 ..
Interior Lath . '.
Exterior Lath . .
. GENERAL ITEMS'
Exterior Plaster (Bl'l7#in Coat)
T -Bar Electrical .
T,Bar'Mechanical .'.
T -Bar Structural
Sewer '.
Water Engineering Backflow
Water Service . jl
FINAL INSPECTIONS D,ale Insp~r
Electrical Final . ~S '(Il(os ...,
Plumbing Final '). tilms 1'...... . -,.
Mechanical Final .' '") (l>11i ;:?
Gas Test 1'31 li)!?j 1--0 ~
.
Engineering/Grading Final 765-5126 '.
~.
Fire Dept. Final 765'4040 . .
Water Engineering 765-5268 ..
Sub (JstlBllsin!'ss License 7ii5-519 .
'.
. Zoning 765-5139 ,.
Building Final ~ast Inspection- Only . PI!oK '---.J .
~ . fter Above Complete)
PARTIAL INSPECTIONS
BuildinQ Inspections
Mechanical InslJections
PlumbinQ Inspections
Electrical Inspections