910 N. Maple St.
BUILDING ?ERMIT NO. Blo2004.02953
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TYPE OF PERMIT
Residential Addition
DATE: 7/28/2004
JOB ADDRESS: .910 N MAPLE ST
LEGAL DESCRIPTION: N TR 1721 LOT 31
CITY
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APPLICANT:
.OWNER INFORMATION:
Hamed Azizadah
91 b N Maple 5t
Anaheim. CA 92801
CONTRACTOR INFORM/,nON:
ANGEL CONSTRUCTIOiC CO INC
20700 VENTURA BLVD - STi, ff 234
WOODLAND HILLS, CA 9,":;04
BUSINESS PHONE: 8188S::'.5717
BUILDING DIVISION
200 S, ANAHEIM 8L VD,
(714) 765. 5153
INSPEC1IClN REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 38
ARCHITECT/ENGINEER INFORMATION:
JOB DESCRjPTION:Enlarge master bedroom.
VALUATION: 6,730.00
L ' OWNER-BUlh.Q.!:;6pFCLl>,RATION
I hereby affirm under penalty of perjury that I am exempt from the Contra:.-1Ci:p License law for the following reason (Sec. 7031.5 Business and
Professions Code: any dty or county which reQuires <:l permit to construct. a:t~~r. improve, demolish or r~pair any structure,"prior to its issucmce, also
requlr~s the applicant for such permit to file a s!gn~ sillte:Yl~nt that he is fj:;~::$ed pursuant to tl1e proVisions of ihe Contractor's License Law (Chapter
9)(Commencing with-Section 7,000 of Division 3 of the Business and ?fofessi~\1)5 Code) C~ that he is exempt therefrom and the basis for the alleged
exemption. ^,,,,'i'~ \fiol~~icn of S'ecti6n 7031.5 by any appiic~nt f.C;' a per;n:t suqects the apP.licant to a civil penalty of not mo~e than five hundredri011ars
($500). . , '.
[J l, as owner of property, or my employe-as wHh w"ag:::s. dS tl)G;r 8L1j~.com;:;.'~n~ation, will do ~he wcrh._: and the structure ;~ net intended or ofFererlfor
s.Jle (Sec. 7044 Business and ProfessiOns Code' "ThF; COjjtr~cbr's UCt?;r,'3c ~~il-I does not apr4yto a~ qwner'of pro~rty wt>.o bu;id~ or improves
tr..erecn. 2nd whod.:>es such work himself orne::;Aif 0.. tn(olIg11 ilis or ~a~~ G~'\.'~' em-ployees, prc\tidedthat such improve.rTlents am :1(,f intended or . .
offered for sale; ;f, hcwever, the building or improvement!::; sc:d'with on€> )'.::''1:;;'::';; ..:ompletidn, thF: oWF1er~build;;;r will have the burder. of provfng thi::it he
'd1dnotbuildorif!"!proveforthepurpose6fsa!c). .l, - ,,' ',,"
o I, as the owner of the property, am exduBive:y contrtlct!ng with ;,li:.Bn3p.=~';()ntrilclors. tv'con,:muc.t the ~l:Ojp.ct (Sec. 7044 BU51['l_eS~ :Jnd Pr'lfess!o.ns
Cede: .The Contractor's Li~l1se Law does net ::Jppiy t.J 511 o\,vner cf pl'opertYi}t~o b1jilds or improves thereon, :1rd wha contiar.~~ for <;U~l pmJecte;' with
~oP.tractor(s) Ii~ensed pursuant to [he COT"1tractor's Uce(l~ L~w). :~:! .
U lamexemptunderSec. ___ .9&Pr:.for~:1isreason: ___LL_______. ",____
Date:_____ Owner:- _"~'_'_.
'----WORKER'S COMPENSATION DECLARATION -~)X=--. - 1
.1 hereby aff:rl1l under per<aity_ of pe~liry one of the foHowing declarations: .
01 ha'vc and .......ill maintain a certificate ot consent to selHnsGre for\'Yurker(;:::c'iilPcns8t;lm,
as provided foi' by Section 3700 of the Labor Cnds, for the p0rlofn'l.Onca C.f~l.':' wr.;rk fer .\Inich
this perrr.jt is issued. . ". ' . ,~' '. _ I
o I haye and wHl r(l:Jintain wor:ker's compensation insurance, as.rcquifl':ld b~ Se;::;tion 3700 of I
the Labor Code, faithe performance of the work for which this permit is is."iui'tJ. My wCiker's I
Compensation insurance carrier and policy are:' .-:
Carder; EXEMPT Policy Number EXE~V;t<
PROCESSED i3Y: FAN
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LICENSED CONTRACTORS OECLARATION-j
I hereby affirm under lJef1:3lty of perjury tl'lat 12m
licensed under p''Gvisicnsof .chapter 9 (commencing
with Section 7000\ of I\'sic' ~ness and
Professions . .
. ..-r:?
7/28/200 _'_
Date: Contractor
ii'lis section need not ba completed if the pennit is for one hundred dcU:Jr;:; (~1'O(} en Jess.
ff'certifythat in the performance of the work for which tl1is pe(~it is i5SlI'J,~, I_Shsj'j not
employ,qny person in any manner so as to become subject to the workel'3 c':'jr.peflsation laws
'of Califomia, and agree that if I should become subject to the worker's ccrnp(~hsafion
provisions of Section 37QO of the LabOl: Code. I lall f, ,t I '." ory with th?~e proyisio.ns.,
NUMBER
740615
TYPE.
TYPE
Construcion Tvpes:
VN, ,
UvinQ Area:
Date: 7/28/2004 Applican
WARNING: FAILURE TO SECUR ER';, (; NSATION COVEF;'\GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENA'C,T!ES' AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADC>;]O~I TO THE
COST OF'COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIOr'~,C6 OF THE
LABOR CODE,INTERESTAND ATTORNEY'S FEES. '
,-
I CONSTRUCTION LENDING AGENCY __ . .
I h.ereby affirm under penalty of perjury that there is a construction h;m~ingJJr:~;l1cyfor the ,
';-,:;..~':':'r~~~:.:-.;.:f.!!":-s'~'.;';,;:-~:'~:!--;~-'~\'_~!.-':,h' ~:"r';--;::-:C-;'",;~ i::..';z:;,;,;,;',;:, {S-.;:>i:;. :::::-7-;6:.....::::;.: ,-::..L- _~'"'--k_~'----: ~,~._-.-~~-
Lenct:r's Information:' .
I certifY that I have read this application and state that the above information is correct. I
..agree to comply with aU city ordinances and state laws relating to building construction, and
hereby authorize rep sen' of t 's dty to enter upon the above mentionerj property for
inspection
EXPIRATION DATE
9/30/2005
8
Hie
100
Date 7/28/2004
299.03
Si t f Applicant orAgent
The permit shall expire by limita.tion and become null and void if the building or
work has not passedfinal inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
.Fees paid for Permit:
Total:
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole.
Plumbing (DrainlWaste Pipe) .
Eledrical Ground Electrode/Ufer .
SetbacklFormsfTrench(!S(Footings) ~ lAII J
Do not install subfloor .or pourfloor slab until the' I
following applicable items have been signed:
Plumbing (Water Plpe.Sprinkler ValVes)
Mechanical (Groundwork) .'
Eledrical (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 . .
Firesprinlder (Rough) .
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame) .q\il
Masonry (RelnfJB.ond BeamlPre-Grout)
Rough Plumbing (Top. Out) .
Rough Mechanical .
Rough l:IectrlcallDry Wall) .
Rough Electrical I. . A
Framing (Only after Ping.. Elee.. Meeh. and Fire) 'L-C>'-/ ~ of- {.
Ilnsulation (SoundlEnergy) ..' 'm(f~
Do not tape or plaster until the following applicable
items have been signed: '"
Drywall Ictlll1C<<
Penetrations (Fire Rated) Electrical
Penetrallons (Fire Rated) Mechanical
Penetralions (Fire Rated) Plumbing .
Interior Lath . . .,
Exterior Lath
. . GENERAL ITEMS ./
'. Exterior Plaster (Brown Coat) /1-11., ~
T -Bar Electrical . "'-}
T -Bar Mechanical .
T -Bar Strudural
Sewer
Water Engineering Backflow .
Water Service '.
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 ListlBusiness License 765:5.19
Zoning 765-5139'
, . . .
Building Final iLasUnspection.:Only
. After Above Complete)
Date' Inspector
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Mechanical Inspections
Plumbina Inspections
Electrical Inspections