611 N. Lemon St.
TYPE OF PERMIT
Residential Addition C.ITY
DATE: 5/26/2004
JOB ADDRESS: 611 N LEMON ST
LEGAL DESCRIPTION: N TR 170 BLK BLOT 3
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BUILDING DIVISION
200 S. ANAHEIM BLVD
(714)765-5153
INSPECTION REQUEST LINE:
(714) 765 - 4626.
CENSUS CODE: 434 .
QUARTER SECTION: 71
"WILDING PERMIT NO. BLD2004-01724
,
','
APPLICANT: GUILLERMO PERALTA
. OWNER INFORMATION: .
Rosario. Castrejon.
.61.1 N Lemon 8t : .
Anaheim. CA 92805 :; j
JOB DESCRIPTIONAdd:271sf family 'oom to exist. SFD (HIH) ';
VALUATION: 18,239.00. .' ... PROCESSEtl BY: ODC .
~ .'. .'. . OWNER-BUILDEP:;3!>cLARATION . ." .' . . . '.
:'I"hereby affirm under penatty.of perjurythatl am exempt from tl1(3 Coritracro;~>~Dqense Law tor the folloWing reason (Sec. 7031..5 Business and
PrOfessions Code:.any city or countywhi9h requiP3s a permit to construct, a:~~<1-impnJve" demolish or repair any structure, prior to i~ issuance: aI5.0.
requires the,ap Iicant for such per,rhit-t9 fi!e a'signed statement that.he is I'C€\I~~(j pursuant .to.the" provision~ of the Cdntractor'sUcense !-aw (Chapter
9)(co~nm~n " 9.vlith .Section 7000 ('If Division 3 of the, Business and Professic;-h:Code)"or that heis exempt therefrom and thE:'l-basis for the,alleged '
e~empti . ~y '~ioJatio.rt o~ sectio~ 7031.5 by any appJica~t f~r a permit SiJl.Ji{}~~theapPlic.ant to ~ dvir penalty of-not ,more than five hun~r~d, dollars
. (50 .. . .' . .' ".' . '.'
I, ,as oWner of property, or my employees wfth wages as their ~-ole comp;~:!~,ation"Wjil. d,o the Work, and- t,he,structure ,is not intended or off~re'd for
sa:e.(Sec._?044 Businf'..ss and Professions Code: The Contractor's UcenseL~~,:i.:qoes not;applyto an owne r: of property whobuitd~ or improves
thereon,_ and who does'sum work "himself-or herself or throug!1' his or her v.wr:. ~::.h'ployeeS"piovided that.such improvements are not. Intended or.
offered'for sale." If! however, thebuilding,or improvement is solq,wiih one yaJ:j:;J1,oompl'etion" the owner-builder willha'ife 'the burdenof-provin9_that he'
'di-dnotbu~dorimprqvefbrthepurp.oseofsal'e), :\",: .~ " . ,',.:
..0 I, ~$th~ ownero~ the property, am e,xdusively'contractirig with lic~sed ~)~<tractors to construct the project (Sec_ 7044 eusiness'-~md 'Profes<)ions
Code: The .Contractor's UG€nse Law does not apply to an owner of propelTy-<j:IO DU,ilds or impro\leS thereon, and who contracts for such projects with
cntracto:-(s),licensed, pursuant,totheC'ontracta:r's License_~aw}.. ; ,'. .
a eXeml)t under: Sec.. ,B P.C. for thi
. Owner:
CONTRACTOR INFORMPTpN:
ARCHITECT/ENGINEER INFORMATION:
l
WORKER'S. C PENSATION DECLARAT _r:L."._:L
I hereby affirm under penalty of perjiiry .one of; the following declarations: i ~
o I have and will maintain' a ,certificat~ of consent to self-insu-re for, worke(~ ;:om.pens'ation,
Fl.:'~ provided for by Section 3700 of the Labor Code, for the performance of th;;'NOrk for. Which'
this permitisissued. _. . ".
. D Ihavea,nd'will maintain worker's compensation ii1surance,'a~ re~uired'h~i 3ection 3700 of
.' the 'Labor Code, fO'r the performancea:f the, work for which this permit is issue,:,. Myworker's.
CompensatiOn insurance carrier: and poiicy are:
Carrier: Policy Number: .
,This'section need riot be.Completed if the pe~it is for o~ hundr~ dollars ($100J'-~ ,less.
'D'Jcer:tifY' that in the pe_rfonnance ofthe, work for Which this permit is 'iss'':C~i i,St:?1l nO,t, .
employ any person in any manner so as to become subject to the worker's c0~,;pensation laws
of C.?lifomia, .and ~gree that if I shou Id' become' su bje ci to th e wo rker's com:>e...:;i~iti'on
provisions 'of Sec,tion 3700 of the d'S, I sh~1I forthwi P Y with-_~~',_~' provisions,
Date: 5/26/2004 . Applicant: . .' < . . '4tId .
WARNING: FAILURE TO SECURE WORKER'S COMPENSATlOW;9.YERX3E IS .
. UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAt:PENA'. i1ESAND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS'($100,000),IN A,~'_",--:ON TO THE"
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI0:".'j706 OF THE
LABOR CODE. INTEREST AND ATTORNEY'S FEES. .
I . CONSTRUCTION LENDING AGENCY _ .
I hereby .affirm~nQe.r penalty of p~rjwy that~here is a construction- iending :~~~ :r:~y for the
performanCe of t~e work for which this permit is issue~ (Se~'3097 .~iV .C): ..-l '~; .
: ,~:!' ~"!;'sln(or..rn.?~I~.,r,,:.._.-_ "'~--~""__ --'--,.- .. --,---~=--,---,-,;- .--, --.....' ,-~'~-----"-'-' ----,-
I
LICENSED CONTRACTORS DECLARATION
Iherebyaffirrfl un_der penalty of perjury that I am
licensed under provisioh5 Of chapter 9 (commencing
with'Section 7000) of Divsion 3of.the BuSiness and
Professions COde.
'5/26/2004
. Date:
Contractor
'NUMBi;R .
TYPE
EXPIRATION DATE
. ConstrucionTvpes:
VN" -
Occupancy Groups:
R3, , "
,Fire Sorinklered?
. DwelJinQ Units:
'UvinQ Area:
NO.
1
271
, . .
I certify'ttJ?t ('have read this application_and state that the above .information ir.,correct. I
agrE~eto complywith all city ordinances, and state laws relating to building cor,struction, and
hereby authorize representivesof.this City to enter upon,the a-bove mentioned property for'
insp' r ses.- . /?
L";::;-' Date: ',/26/2004
ignature of Applicant r
The permit shall. expire by limitation' an ecome null and void if the building or
work has not paSsed final inspection.365 days from the date ofpermil issuanCe. A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
551.82
. INSPECTION RECORD
.' . .
. INSPECTION. '. . i. 1.IiATE INSpECTOR J
.... . ..
. Temporary Power Pole '.'
Plumbi!l!l(DrainlWaste Pipe) . .
'Elecir'ical Groond ElectnidelUfer . .,' . . .
.' . '. . 0
$elbacklFormslTrenChes (Footings) '. ,
00 .not install subfloor or pOl1r.floor slab until the ..'
fallowing applicable'items have been signed;' . .
Plumblllll (Water Pipe.Sprinkler Valves) '.
Mechanical (GrClUOdwoI'k) . :. "
!:ledrical. (Underground Conduit) ; ,
,
t're.slab (CompactIOn/Membrane.Rei nt. .11, .
Underpinning (Floor Joist/Girders) . (.,~Vl-x ' .
!X'notcover or conceal the work below until the
'following. appli~able ilems have been signed: . . . .' .
1 stFloor Shear' . .
Firesprinkler (Rough) '. .
., . .
2nd Floor Shear' , . . .'. . . ,
ROof ($heathing/OiaphragrillFr'anej . .'
Majsonry (AeinfJBond BeanIPre-Grout) . . I
RoughPlumbing (Top Out) .' .' .
RoughMechanical ..... .: '. ,
I Rough Electrical (Dry Wall) . .c- 0
,
Rough.ElectriCaI '. '.' .. ..... tD ' . 0
Framing' (Only after Plbg, Elee. Mech and Fire) '>> Oi.' 7T-
Insulalion (SoundlEnergy). ..;c
po not tape orpla~ter until tlie following appllc"ll'le . ,"
_I,te~.s.have been signed: . . ," > " ~ l.
Drywall ...., ,OJIjJ;{"iI.'. '."- .
. Penetrations (Fire Rated) Electrical . . '.'
Penetrations (FIre Rated) Mechanieal .' .
Penetratlom; (Fire Raled)Plumbi!l!l, .. . .
Interior Lath . .
Exierior Lath . ,
'. .... . .' GENERAL ITEMS ' .'
Exterior Plaster (Brown Coal) -- . "',
T .Bar Electrical . '. : . . . ..'
T .Bar Mechanical .
T.Bar Structural, .
Sfitwe.r . , '. .
Watet.Engin'eeringBackflow '. '. .' . " .'
Water' Service' . .'
.,
=-',
, Date
lrispe~tor .'
FINAL INSPECTIONS '
Electrical Final
plumbing Final
Mechanical Final
Gas Test .
E;.girieering/GradinQ Fjnal765-6126
Fire Dep\. .Flnal .765-4040
WatetEngineerinQ 765-5268
sub 'List/Business' LIcense. 765.5,19
Zoning 765-5139
Building Final ILasllnspectiOtioOnly
". .' .' ,After Abov,e Complete)
'.' ..' PARTIAL IN.SPi:CTlONS< . . . .
BUildinZlnspeetions ................, ....... .'.
, '?l~~4 ... fY.ft- .'::J1!E4f1...xr. NM{,J~~~
...
. .
. Mechanical Inspections
".
Plumbing Inspections'
Electrical Inspections
TYPE OF PERMIT
Residential Addition C I TV
DATE: 5/26/2004
JOB ADDRESS: 611 N LEMON ST
LEGAL DESCRIPTION: N TR 170 BLK BLOT 3
APPLICANT: GUILLERMO PERALTA 1<,~VI.) ~p PJ:~l'l ~I
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
Rosario Castrejon LI bD' ~.1.." Jffi..~!. ~ ,...,
611 N Lemon St '1 rr'Wvo:-" f'<.8E. :Y
Anaheim, CA 92805 p~
JOB DESCRIPTIONMd 27151 master bedroom to exist. SFD (HIH) [Revise plan, correct sq. 1t9. -12/28J
VALUATION: 20,400.00 PROCESSED BY: FAN
BUILDING PERMIT NO. BLD2004-01724
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 71
OWNER.BUILDER DECLARATION
'hereby affirm under penalty of perjury that I am exempt rom the Contractor's license Law for the following reason (Sec, 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, atter, 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 licensed 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 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 civn penattyof not more than five hundred dollars
($500).
o I, as owner of property, or my employees with wages as their sole comf>.3nsation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License law does not apply to an owner of property wha builds or improves
thereon, and who does such work himself or helSelf ar through his or her owri employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year of oompletion, the owner-builder will have the burden of praving that he
did not build or improve for the purpose of sale).
o I, as the owner of the property, am exdusively contracting with licensed oontradors to construct the project (See. 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 sum projects with
j1..5:(ontractor{s) licensed pursuant to the Contractor's License Law).
U I am exempt under Sec. , 8 & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
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'~ compensation,
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 worf<er's compensation insurance, as required by Section 3700 of
the Labor Code, for the performance of the work for Which this permit is lssuc..-d. Myworker's
Compensation insurance carrier and policy are:
Carrier: Policy Number.
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
o I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the worker's compensation Jaws
of Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I shall forthwith comply with thuse provisions.
Date: 12/29/2004 Applicant:
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED 1HOUSAND 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.
r CONSTRUCTION LENDING AGENCY
J hereby affirm under penalty of perjury that there is a construction lending ag~ncyfcr the
performance of the work for which this permit is issued (See. 3097 .Civ.C):
Lender's Information:
I certify that I have read this application and state that the above information is correct. ,
agree to oomply 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 purposes.
Date: 12/2912004
Signature of Applicant or Agent
The permit shall 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 issuance. A
new oermit is reauired to commence or continue work.
LICENSED CONTRACTORS DECLARATION I
I hereby affirm under penalty 01 perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the BUsiness and
Professions Code.
12/29/2004
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Construelon Tvpes:
VN, ,
Occupancy Groups:
R3" ..
Fire Sprinklered?
DwellinQ Units;
livinQ Area:
NO
1
304
Fees paid for Permit:
Total:
848.97