1803 W. Victoria Ave.
TYPE OF PERMiT
Residential Addition C I TV
DATE: 4rrt2004
JOB ADDRESS: 1803 W VICTORIA AVE
LEGAL DESCRIPTION: N TR 2995 LOT 43
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BUILDING D1ViSION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714)'765- 4626 . .
CENSUS CODE: 434
QUARTER SECTION: 47
BUILDING PERMIT />(0. BlD2004-00852
-.
coNTRACTOR INFORMATION:
DOUG SMITH CONSTRU;~TION .
172Q N BATES CIR
ANAHEIM.. GA' 9280600ro
BUSINESS PHONE: .714 315-4555
. JOB DESCRIPTIONfloom Addition, 33051 living room and dining r~om extens\,ri. (HIH) .
VALUATION: 30,000.00 ',; PROCESSED BY: CAl
I . OWNER-BUILDE,&.:DECLARATION.
. hereby affirm under penalty of"perjury that I am exempt from the Contra~t9r;s,.uceflse law for the following .r.easan (Se~. .7031.5BLis,iness and
Professlo0S Code:-ar)y City or county which requ!re~a- permit ta.construct.<1~'tl',:jmprove, demolish or repair. any structure, prior-toits .issLiance, also
requires the' applieanttorsuch ~rrn;t tc,>Jile aS19n,edstatement that h9 islk-:in$ed 'pursuant to the provisions of the Contractor's LicGnse Law (Chapter.
__.9)(comilierlciIlG w;;:H B'ac:liOll 7000qf DiVIsion 3 .of-the 'cUSlr:es~Zl:.ld Profess,',bti-sCode) or th~t -he.is .exempt therefrom and the'basis for the alleged. .
ex~mption. (\-:1'1 viotatinnof Secticn 7031.5 'by any appllccmt for a permit.sU\~ects the applicant to a' dvil pena.ltypf nQt more than five hundred ~ollars
($500). .' ..... . .... '. ., "if> . . ..' . .
'0' I; as oWlJer of property, or my empl,oyeesW.ith wages as,their ?Ole comltrnsation, will.do "the work, a!ld the structure is not intended or offere:d for
~ale,($ec.7044 Business,a QdProfessions Code: The Oontractor's Ucens~ t;lw dc;les not apply. to'an .owner of property-who, builds or imprQve,~ .'
, the,reon,';.and who does such, work himself or herseJfoT thro~gh Misor tii;lr o....!r'i\~mr!,oyees, provided that such improvements are r;o\ in1enoeetor.
offere:" for ,Sale;~ If, h9wever\ the bu'ild!ng or improvement is sold with oneyE!~;( of'ccimpl_etion,J'1e,.owner-bl,lilder wUI hav~ the. burde'n af prc-Jirig'that he
did~tbuador'improve for;-thepulPoseafsale).,~_' .,:.Of;;..' ',' '_ . ",-c..".." "".'.... ..... "".
. O~c>-t)a~:'the. o~T"1.er of ti1,({property,' am' exdusively contracting with licensecJT;oontradors' to'~anstrlJct uie p~oject (Sec., 7044:Business?ru:i- Profe~_b.ns
COde: :The Contractor's License Law does not apply to an owner of p(opet~;~~ :116 buil-ds'or improves thereon, and who c,::or:ltracts for sl[Ch projects with
~ntfactor(s}licensed pursu~l1ttotheContractor's License Law). ,') ,
Lr, I am exempt under Sec. ) , B & P.C. for this reason: --4;
Oate: ';, Owner: . ,!
1.,iWORKER'S COMPENSATION DECLARATION ~j
I ,herebyaffirmt;nder penalty of perjury on-e af,the foJloW!ng deClarations:' 1";
o .I'have,and.win maintain' a certificate of_corisent to wlf-.il1sure for worKBr~ i.::omper>.saUon,
'~S provided forby'Sedlon 3700.of.the labor Code, fortheperformance of t~J')'work fo'r which
this permit -is'issued.. ." . ..-~i .
'0 I havecarid will maintain.wolker's, compensation ins~~ance; as reqUj:-e'dL~" Section 3700 of ..417/2004
the. LaboT Cbde,.for,the performance of tlie work for which this pennlt.is issll:fd Myworker's Date:
Comp€;nsation insurance carrier and -policy-are: .' . .'.: . '_'
~. ~r(~:t~~1:..:: p.'~.J:~:.':::.;t~:::::::.r~O.~.ii.S~::3I~1l1;.h~~ not ..
@!PI~~eanyperson in a oy manner so as to become s' 0 ,theker's c~mpe.nsation laws
of C.:Ilifomia, and agree that if I $houJd become sUb' ct to t ewer' :'coril~~:ns'at;on
provisions of SeCtion 3700 of the' labor Co ,I s I fort ith ~om with.t!~~''J~~p'rovisjons.
Date: 4rrt2004 . AppliCant: ." . . . .~> F .'
WARNING: F.o.ILI,IRE TOSECUREWORKER'S COMPENSATIONCOV,ER!'gE.IS .... .....
UNL~WFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL;;;i!.'NALTlES AN;;> CiVIL
FINES UP TO ONE HUNDRED TH Ol! SAND DOLLARS ($100,000); tN';@D910N"TQ THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEC'l"lPNil706 OFTHE
. LABORCODE,,1NTEREST AND ATTORNEY'S FEES. '. .' "'Ci':'.. .
.1 ... . . CONSTRUCTION lENDING AGENCY .,(:' r .. . .'
:.. the!~t:>Y8~i"IDg~e'nalty_QLt]~cU_l]sU/J_erejs a construction (BridL~..a !nc~ fcr:U~~~L____"':'-,-'
perfofrr.ance of the work forwhidl this permit is issued (Sec.3097.Civ.C):
Lender's Information:
. APPLICANT: DOUG SMITH
OWNER INFORMATION: I.k"(,
Elizabeth L O'Neal .'Ix! ^j'IJ
.1803 W Victoria Ave '\\A.\O-K ..
.Anaheim, CA 92804 .".{.
ARCHITECT/ENGINEER INFORMATION:
MICHAEL MARGERUM
Contractor
NUMBER
830338.
TYPE
EXPIRATION DATE
12131/2005
B
Construcion.Tyoes:
VN, "
Fire Spnnklered?
ljving Area:'
NO
330
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tion and state that the atiovefnforma.tjon _is correct. I
'11~ 'stat~ laws relating to buUding construction, and
dty'to enter upon toe above mentioneq property for'
Fees paid for Permit: .
Totat:
3.00
Dat.: 4f7/2004
. Signature of Applicant or Agent
The permit shall expire by Iimitationantj become null and void if the building or
. wor.k has not passe'! final inspection 365 days from tlie date of permit issuance. A
new permit i.s required to. <Xlmmence or continue Work.
INSPECTION RECORD
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INSPECTOR '.
. .'. INSPECTION
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TempQrary PQwer PQle
Plumbillg (DrainlWaste Pipe)
. Electrical Ground Electrode/Ufer
SetbacklFormslTrenches (Footings) . ~~
. Do not install subfloor or pO\lr floor slab unlil Ihe' I
fOllowing applii;able items .have been signed: . ,
. Plumbing (Water Plpe.Sprinkler.Valves)
Mechanical (GrO\lndwork) '. '.
I electrical (U!Joorground Conduit)
'. Pre-slab(CompactiOn/MllI1Ibrane.Reinf, ~-?r71' f7
Underpinning (Floor JOistlGinlers) . . y
Do not COyer or conceal Ihe wo"' below until the
fOllowing applicable'items have been signed: . .
1slFloorShear .' .
Firesprinkler .(Rough) .' .
2n(j Floor Shear '. .
Roof (Sheathing/Diaphragm/Framel
Masonry (ReinfJBond 8eamlPre-Grout) ..
Rough Plurnbing ., (Top Out)
Rough Mechanical
'. Ro.ugn B8CtrlCaI I .. .
Rough Electrical . , ~
.. Framing (Only after Plbg Elec Mech and Flrel ~ ~
Insulation (SoundlEnergy). ~ .-1
po noHape or pla~ler until the following applicable J
Items have been signed: .,
orywall . ........ \t. u.u.
Penetrations (Fire Rated) ElectriCal . . I
Penetrations (Fire Rated) Mechanical '.
PeI'letrations (Fire Rated) Plurnbing .:
Interior Lath ". '.' .... .
Exterior Lath . "
GENERAL ITE .
. exteriOr Plaster (Brown Coat) . .
T'Bar EI!lctrical. .
T -Bar M!lcha.nical .
". T -Bar Structural
. Sewer ..'
Water Engineering Backflow
Water Service '. .
DATE .
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FINAL INSPECTIONS.
Electrical Final . . '. .
Plumbing Final
Mechanical Filial
'. .' ,,' Date . Inspector
'v. ").U.t# h-z,,_
.....1-111__
(, - 2f. -d ,,:{:'lA
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Gas Test. .
Engineering/Grliding Final 7~..s12.6
.... . .
Fire Dept. Final 765-4040
Water Engineering 765-526,8, .... '.
ListlBusinessLjcense 765-519 v": .
Zoning 765-5139 . . . .. .
Building Final. (Lasl I~spect. ion- Only I Ah11"11" .A' I'
. . . After AbOyeCOmPI.etel I'll ""'" . . ~.
. PARTIAL INSPECTIONS .... '. . ~ ~(A..,I
Buildina Inspections. . '.> '" .
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-r'l!.:-a~ 4..,,-n,H-.d~'AoY'" oI<..i/.sJ'i~'. ....
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. MechanicallnsDections.
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Electril::allnsDections'
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