1339 Masterson
TYPE OF. PERMIT
Patio Cover C ITV
DATE: 11/15i2004
JOB ADDRESS: 1339 S MASTERSoN ST
LEGAL DESCRIPTION: N TR 2515 LOT 32
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BUIlDING DIVISION
200 S. AlJAHEIM BLVD..
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 11
BUILDING PERMIT NO. BLD2004-04145
APPLICANT: RONALD CLINE
. OWNER INFORMATION:
Christophe ,J Butler
1339 S Masterson Rd
Anaheim, CA .92804
CONTRACTOR INFORIo#,TION:
CHAMPION INDUSTRI~t;
. 8522 1 HORPE AVE
WESTMINSTER, CA 926;33 bOOO
BUSINESS PHONE: 714 S'.7-6113
JOB DESCRIPTJON:lnstaIl300 square'foot patio cover and '300 squar~ foot p~tio eric:psure.
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 8,000.00 '. . --.f-.J,.. __ PROCESSED BY: IvlSM
I .'. OWNER,Bliu..DEg,QEGLARATION .
I hereby affirm under penalty of perjury that I am exempt from U~e, Contra~yIG- Licenso Law for the following_ ree-son {Sec. 7031.5 ,Ausin~ss and
P.rofessions Cede: any city or county which requires a permit to con~t;tict, ~It~r, improve, demolish or repair any structure, prior to its issuance, also
requi~es, the appUQ;f,nt for such permit to fii~ a signed 5tatement that he"i,~lhjensedpursuant to the provisions of. the Contractor's U::ense Law (Chapter
9)(commencing with Section 7000'of Divisior. 3 of the Business and Professit"iS COde) or that hE is .exempt therefr~:H'!' and the basis for the alleged
exemption. Any vblation of Section 7031.5' by any applicant fc..r... permit .;::A~:!e,:;t."i the applicant to a d\l~ penalty of net rr:ore th~n five hundred oollars
($500). . . , '.
[J J, as owner of PfO perty , or my employees with .......ages as theh s(;le ..:;c;r::dfl!iSation, wnl do. the work, and the structure is not in,tended Qt- offered for
5.al€: {Sec~7044 Business and Professiohb Code:: The- Contracto,'s 1 ;c;ej;~~f.~~w rloes not apply to an Qwner of property who bul!ds Or improyes
thereon, and who does such work himself or helSelf or through his (or her v'{'h Flmployees. provided that such ili1pm'Jemel1t~.are not intended or .
OffE\red f9f,sale .Jf.. 'howeve( the building or improv&Tnf!r.t is ~old ';.vith one y\hr'(";f cOmpletion, the "owner;'builc.i~n'V:r.l have the burJen-of proving thathc
d:dnotbuild'6ril'!'!proveiorth'p._plripooecfsaJe), <' '. -;:!, '_..~,. .... . , .' ....
CJ. !, .as the oWne~ of the propeny, am ey.dusi\l(.;>l~'" conhactir:g ',"ith iitcnce'{.co.)imdOrS to constn.,c.t theprojeef(Sec. 70211 8us!r:ess and Prqfessions
Code: The Corttrac~or's License Law docs not apply to an ovm€-r of pr'lper!.1,.~Nhtl bl.~ilrls or ir:1:>roves thereon. 'and v....ho rontraets fm' such projects with
Mor:trac::or{s} licensed pursu.ant ~o fhe Contractor's Lic.ei1Sd Law).
l-l i ?:-rl ox.empt under See -----.:.__ ,. 8 & P.C. fartn!!. iea::;on; ;{
Date: . Owner: _.____.~______~,"'-2~.__.....;__..:-_.:.. ~ _. ._
L- WORKER'S COMP.ENilATlON DECLAt,ATiON--::C::::...:_"---J I.-.!:ICENSED CONTRACTORS CECLARATiON i
! hp'rebyaffirm under pena'ty of perjury cr.e oft.he following de\-'Iar~tions' f I;...~lh"er;oy atr.rr;-: ur..oer penalty of petju,y t t I nm
[J 1 hava ar.d i'ill: ;-r13~ntaln a ce~ifrcate of OOr1sent to self-,n~ure for '.\,crk!;' )'0:;, tX'ff';r-03r.S')~lorr, , lIcenst1d .t.Jnd~l~prOV'15~rIS of chapter 9 e~Cll1g
ae provldeJ for by SedlOn 3700 01 t.h13 Laber Code for the pclfnl"man.:'(;- ~\f .2 WO~ br w'-Ilch , 'Nlth Sec.lOO . uOO} of I) 3 less and
ihi permit is issued :
. I have and will maintain worker's cornpens<.ltron Insurance, 85 reou,red h .S-,::ctRHt '-{roo Of, ~"tf \5f2
t e labor Code, fer thQ performance of the work for which this cennit :s i~5:",:'d, Mv worKer's Date:
.J
CompE;!nsation insurance carrier and policy are: \
Carrier: PoliO{ Number: EMEMPI
. f .
This. s~tion need lIot'be oompJeted if the penn_i~ is for one'humlrEO dcll3fs ~$;1C)! or less~
.0 , J certify th.at.in the 'perforrt:lanr.e of the work'Tor which this pe'rm!t i"i i~Si.:.~:d, i ~h.a'il net, I
empio:yany person in any manner so as to become subject to th~ wo' r' .: .mpB:nsatlo:1laws
of Califomia, and agree' that if I should become su'bjed to the \'j;'- r'~ ." - ';'~tion .
provisionS of SectJoI13700'o,fthe Labor Code, I $(" rt. ..-'\, -tr'l~ vitiians. Construcion ";'"vP-Nr
VN, ,
Date: 11/15/2004 Appli~n ' < ,.' Fire Sprink!ered?
WARNING: FAILURE TCH~EC . -R' ... l:PEr ...,,';TI<...H COVEn::\GE IS I
UNLAWi=UL, AND' SHALL SUBJECT.A~ MPLOYER TO CRlivllN/\L~Ei\J!~.:..TlfiS AND CIVIL
F..INES UP. TO ONE HUNDRED 1l-iOU AND DOLLARS ($..'OO..MOl, IN,'" "'~'.;"'iON.'..'O.THEI
COST OF COMPENSATION, DAMAGES A~ PROVIDED FOR).N SEoC1!GN. 3706 OF THE .
LABOR CODE, INTEREST AND ATTORNEY'S'FEES. ". .0, , .;:-' . '
'I '. '. ..' .' . CONSTRUCTION LENDING AGENCY,' ,'~ ". .'
! hereby .effirrn ,u~e,r pef\alty ,of, ~rJ.~ry th~t:~h~r~ is ~ ?~nstructi~n ~~n::ljr)g ~:~~c11~~_~_...: _ ____~._~~-'-
;:-:-r:f;::":n.:;~t;,~..~~. ~;;<;;;.: 'c':;:!"!",k.:- '~~'r'!:::;'i_.t:'::.t,:f)~r;;;;{-;<>-;:";':':,;:::>-,,,,\~-;;:c:-~;D;r';i.';f;:Gj;~-:;--!:-. - - -~'C:- -,.----:---.-. -.-
NUMBl:R
340543
TYPE
8
EXPIRATION DATE
. ,
7/3{1200~
NO
Lencer's !nfodnation:
'-
. .
Fees paid for Permit:
Total:
635.59
Date: 11/15/2004
g t ,of Applicant orAgent
The mit s xpire 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 permit is requirl'd to commence or continue work.
,.
.'
INSPECTION RECORD
,
, INSPECTION' DATE INSPECTOR
Temporary Power Pole ,
Plumbi ng (DrainlWllste Pipe) [
Electrical Ground Electrode/uter
Setb;ICklFormsrrrenches (Footings) ,
Do not install subfloor or pour floor slab until the
following applicable item" have been signed: , ,
Plumbing (Water Plpe$prinkler Valves)
Mechanical (Groundwork) ,
,Electrical (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: ,
1st Floor.Shear . ,
Firesprinkler (Rough) ,
2nd Floor Shear ' . .
RoOf (Sheathing/DiaPhragnv'Frame)
Masonry (ReinfJBond BeamlPre-Grout)
Rough Plumbing. crop Out)
Rough Mechanical . . ,
Rough t:Iectrlcal (ury wall)
Rough Electrical , , -
Framing (Only after ~lbg.. Elec.. Mech. and Fire) ,
Insulation (SoundlEnergy)
Do not tape or plaster until the fOllowing 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 (BraNn Coal)
T-Bar Electrical , "
T-Bar Mechanical. -
T -Bar. Structural
Sewer . .
Water Engineering Backflow . ,
Water Service
FINAL .INSPECTIONS , Ollte. ,1rJ6ppctor /
Electrical Final " . lIP 11n<' L.N\"" . ./
Plumbing Final, I . ,
Mechanical Final
Gas Test
Engineering/Grading Final 76506126 . , ,
Fire Dept. Final 765-4040 ,
Water Engineering 765-5268. . , .
Sub LIst/Business License 765-519 , ,
Zoning 765-5139 : /1
Building Final '~ast Inspection- Only ~ ('1, I~ lA"-.J "-/
Iter Above Complete)
PARTIAL INSPECTI )1 S ,
Buildina Inspections .
Mechanical Insoections
':.
. Plumbina lrisoections
}:
Electrieallnspecti~ns . . :', LQ
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