705 S. Yana Dr.
TYPE OF PERMIT.
Residential Addition
."";~_.-:.- .
tf~~;;~t~~~,.. .
CITY Qi'1f~N~HEIM
\;~U':~~/
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
. INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION:. 21
8UILDlNG PERMIT NO. BLD2004-02527
DATE: 7/1 5/2004
JOB ADDRESS: 705 S YANA DR
LEGAL DESCRIPTION: N TR 2876 LOT 50
CONTRACTOR INFORM(TION:
TCR CONSTRUCTION
24502 CHAMALEA ,
MISSION VIEJO, CA 9268i: 000G
BUSINESS PHONE: 948 49~i'0864
JOB DESCRIPTIONAdd loft, bedroom, 2 baths to 2nd floor (52851) and add 6~:)sl to 1st floor (112851 total) (re"ew expired pic) refer to BLD2002-03925)
- II
VALUATION: 200,000.00~.i,_. PROCESSED BY: MJL
I. OWNER-BUILOEf,:0ECLARATION . ==::J
I hereby affirm under penalty of perjury-that I am exempt frem the Cor.tracto~'(;, licElnse Law for the following reason (Sec. 7031.5 Busines~ and
Profession~ Code: any city or county which requires a permit to COi'lstruct, a~,~;r. ;mprQ.....p.. demolish or repair allY structure, prior to its is.-::l2anr-.e. also
requires the applicant for such permit to file a signed statemer.: that hI: j5ljC':;.':;:?~'Co pursear'Jt to the provi:'!('Ins of the Contractor's' Li.:.:ense Law (Chap!dr
fJ}(comr.1enck-:g with Section 7000 of Division 3 of the Business and Prcf&3.5i<1~ Code) or that he is exempt therefrom Glnd the, ba~is for the:: alleged,
exemption. Any v:clation of Secti0tl 7031.5 by any ::lpplicailt fOi 3 pam:;! SLI!;/::cts tile applIG,"~nt to a dvil pen31ty of not more tt,.1n five nUiidred dollars
" ($500), . ~ . . ..
D I, as owner of property, or my ~mployees wit11 \'J<.:g,.;s as their :;010 COIT1pr~ri~aiicf1", will de the wo:-l\ and tho structure is not. intended or offered ~cr
sale (Sec, 7044 Business and Professions Cor:le: 7he' Contractor's U-::ens~ '(,r.'" dO<3$ not applytn an owner of pr~!=,erty who builds or improves
thereon, _~nd vvho does such work himself or herself or ~l~rough his Oi t;~r O\.,:'!>;-~pl()yees,'provided that such imp rOve mE:nts are not i!1tended Q.r
offered for sale. If, how,ever, the 'building or improvemEnt is sold with cne Y~'~;f" ';::f cCf.:pletion, the Qwnel~huilder will have the bUl,den of proving that t\e
did not blJild or improve for th'e purpose of s31e). . .)":,' . .. . .
o I, as the owner of the property, am exdusiVfo~ly cor.trariing with iicense..i::'i)'!trai;::.:)(s to con"3truct 'the ~jr.:':ie~t (Sec. 7044 Busin~ss and Professiori$
Code: The Contractor's License Law does not apply to an owner' of r.;~opE:ri:)-"~':1() b:j:lds or ilnproves tnereo~, and who rontrar.ts for sudol projects with
p~ontractor(s) ~ice:1Sed pursuant to the Contra~tor's License LCiW).. '~ .
U I am exempt under $ec. .. ..8 & P.C, tor this reason: --t' _. _____~-
Date: Ovmer: ~ ~~~":'.:- ___ _
I WORKER'S COMPENSATION OECLAJ:!ATlq!L___.(_...__~ I LICENSED CONTRACruRS DECLARATION I
I hereby affirm under penalty of perjury one of the foUowing declar;?-Hc-rrs:. .~.;~ l-4hereby atnrrn unde~ IJl3l1alty of p jury that I am
o .1 have and will maintain a certificate of consent to self-in~uie f(;r\liOrk~";~'::;O!-;"'JPt-:msation. I -licensed under provi ' .~ f chapter \c . encing
a~ provid~d, f~r by Section 3700 Of. the Labor Code, for the pe.1ormance oftt-:! \""~'l'k ~cr wr;ic,'1 I
~h permIt IS Issued. . r I
,I have and will maintain worker's compensation insurance, as iequireC: t;J'; S~c~i()n. 3700 qf 7115/20.0
. e abor Code, for the performance of the- work for which this perm. !t :::; is'SU!r.-i. '-1yw,;rker'3 I Date:
Compensation insurance carrier and poliCy are: .. t,.
.. Carrier: STATE FUND Policy Number. .229-0i)12:l7[~ I
This section need not be completed if the pennit is for one hundred dollars ($1(;r.;~..;: :~-SS. I
o I certify that in the perfonnance of the work fOr which this permit is ISSUC'i, I s,...ail nct I
employ any person in any manner so as to become subject to the w~ er's c.C:'1peI1SatiOl! laws
of Califomia, and agree that jf J should become subject to the work .l;.-cOrr,pe 1sc-tlon
provisions of Section 3700 ofth or COde, I rt.+ Iy WIth fl;n~e prO'!fSIO:1$. Construcion Types'
\ VN, ,
Date: 7/15/2004 Applicant .,. Occ\.lpancy Group:;:
WARNING: FAILURE TO SECU ORKER'S PENSATION COVi"R;:Gf' IS R3, , , ,
l UNLAWFUL, AND SHALL SUBJECT eYER TO CRIM INAL PENAlin=s AND CIVIL Fire Sprinklered?
FINES UPTO ONEHUNDRED THOUSAND DOLLARS ($100,000), IN ADDCtl0N TO THE DwellinQ Units:
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI()~.1 ''''06 OF THE. LivinQ Area:
LABOR CODE, INTEREST AND ATTORNEY'S FEES. ~~. .'.
I .. CONSTRUC::!:'?N LEr-.tDING AGENCY.. ._,_____ 1
I here!::'.' :affirm undp.( ~~~U:v of oeril!rv tl--~t ~.r:~:-e i,,:_~ .~.:;q'Si.-;_~r;l;o:",; !<=":".lj,,C!.,...._~~_!".. .ho:. r. ~.....,""-'-."'""________._~.....__ ____+~....,..
-performance of tile work TO~ whict,-thiS perrTlit'ls issued (8so.3097 .Giv_C):~ - ~ ~ .!
Lender's Information:
.APPLlCANT: DON TROTTER
OWNER INFORMATION:
William R Smith
. '/05 S Yana Dr
Anaheim, CA 92804
ARCHITECT/ENGINEER INFORMATION:
ROBERT JTRIVtSON
16825 BIXBY AVE
BELLFLOWER, CA 90706
NUMBER
350556
TYPE
EXPIRATION DATE
12/3112004
fl
NO
1
.1,128
.:.;....;..-,.-4
I certify that I have read this application and state thet the above information iB correct. I
l agree to comply with all cityordinan~ ate laws relating to building comtruction, and
hereby e rep t~is to enter upon the above mentioned property for
insp IOn pur
. C Date: 7/15/2004
8ig, ture of
The per .tshall expir limitation and become null and void if the l)uilding or
work has no .sed 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:
3.474.81
INSPECTION RECORD
. INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe) ..
Electrical Ground Electrode/Ufer .
SetbacklFormsrrrenches .(Footings) 91tH"., ~
Do not install subfloor or pour tioor slab llnlll the
.following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork) .
Ek!ctrical (Underground Conduit) .
Pre-slab (Compaction/Membrane.Rei nt.
Underpinning( . . istlG;rder~ . (d{' ~It. '<f ~ -"I
Do not cover or conceal the work below until tfie .
.following applicable items.have been signed: .
1st Floor Shear . . U)
Firesprinkler (Rough) . .
2nd Floor Shear .
Roof (Sheathing/Diaphragm/Frame)
Masonry (ReinfJBolId BeamlPre-Grout)
Rough Plumbirig (Top Out) . .
Rough Mechanical .
Rougn Electric'" (Dry Wall)
Rough Electrical
Framirig , (Only after Plbg., Elec.. M,ech.. and Fire)
Insulation (SoundlEnergy) ::>IF- . .
Do not tape or plaster until the fdllowing 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 Fina"1
Date
"TL-
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
.Fire Dept. Final 765-4040
Water Engineering 765-526.8
Sub ListlBusines.s License 765-519
Zoning 765-5139
Building Final fLast Inspection- Only . v(
After Above Complete) Oi
. PARTIAL INSPECTIONS. . ~
.~ BU. i1d.'"''';.''.tions ....... ...... ~(W. .....
~~~~~.~~?J,t~!:-~
~Z~~:~~1:J~:~
j
j
1K~
. Mechanicallnsoections
Plumbinq Inspections.
. Electrical Insoections
D~M kJ Y AiE.t L..L-
INSPECDON REPORT
PAGE
OF
CA-'71:E.. 9 - :< '8 "<7'
PROJECfNAME: o,,,RCIIX 5/11;77-1 ~6S
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NAME: (PRINT) .{)#'NV IVe..,.-L'--G
CERTIFICATION NO.: ,,/.s-.8'7~ / - g~
SIGNATURE:
-
CertifICation of Compliance: All work, unless otherwise noted, complies with the approved plans and specifications and the
unifonn building code.
. ,
City of Anaheim
Building Department
200 S Anaheim Blvd.
Anaheim, Calif. 92805
Attn.: Building official
As Owner of record for the project located at 705 s. Yana dr. in the city of Anaheim
permit no. 2004-02527
I accept ICBO licenced Mr. Danny Neil as the Deputy inspector for the proposes of overseeing the all
Concrete and epoxy injection work required on the above referenced project and shall pay
all invoices presented to me, for payment of this Work.
Sincerely, Dorothy Smith
Prop&~~~
9/28/ 2004
Date
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