711 N. Modena St.
\
"
BUILDING PERMIT N<;l. BLD2004-04089
CITY M1&\.iEIM
" ,ii~,:i~~~~~~~~~;; "
, BUILDING DIVISION
200 S, ANAHEIM BLVD,
(714) 765 - 5153
INSPECTION REQUEB,L!NE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 25
TYPE OF PERMIT
, Residential Addition
DATE: 11/9/2004
JOB ADDRESS: 711 N MODENA ST
LEGAL DESCRIPTION: N TR 2296 LOT 65
APPLICANT: KATHRYNDAO
OWNER INFORMATION:
KATHRYN DAO
/11 N, MODENA
, ANAHEIM, CA 90801
JOB DESCRIPTION:Add 493s1 to exist. SFD and 289s1 patio co'}er
.VALUATION: 15,830.00 !.~.__
L- _ OWNER-BUIL[}F-'~( DECLARATION
I nereby affirrnunder penalty of perjury that I am exempt from the Contr?~C!0'::'S Uce:lseW~ fodhe follqwing reason (Sec. 7031.5.8usi:1P.SS a'od.
Professions COde: any city or county which 'fequires a p~rmit to constr~t. <:!;!er,.improve, ~,e01C)lish or~epair any ::;l.ucture, pnor to!es issu2nce,'al~?
. requires the applicant for such permit to file '8 signed statement that he !s,\k::i~!)sed pursuant,t\? the provisions of the Contractor's UcenBe Law'{ChrJpter
9)(comrnen,cing with Section 7000, of Division 3_of t:1e Business andProfes;",pns Code),or t~~tfie is_ exempt trei'E:lfrom and the basis forth_e alleged
exemptian. Any vioja~icn of Section 7031.5- by any applica.nt for a permit sul,tlccts the app!icant to a dvil penalty of nc,t more th9n five hundred dollars
~?)~s'owner of ~roperty, or my~, mplOy~es with wr.ges as t,'he:r, sole comJ.osotion, wi!ldo fhe ~ork, and the olructur. i~ not inlcnped or offered for
~e (Sec, 7044 BLlsinessand Professibns Code: The Cont.rf';_ctor':>UCen~e ~aw does noi.app!yto an owner of prciperty who. builds or improves. :
thereon, 'and WllO <.loes SU~ work ~imself or nerself c( throughhl.s or h,~rov~1"employee~,jii'6vid~d that such improv~ments are liot intendedor ,
offered'for &lIe, If., howE;:ver., the buikHng cr lmproverner.t is seld '.vith one yt(:rof ~mpJetion, the owner~builder will hz:ve, the bIJrden of rrovingth8t he
ndidnctbuiidorimproveforthepurPoseofsaie), ;{, ( .,.....6. >'
______ !, as the owner of the prcper1'f, am exc:lus:veJy contracting with lir.ensG..:t;i0ntradcrs to ccnstruct the pr(~(lct (S,ec. 7044 Busines$ =31},cLPn.)fessio'ns
Code: The Contractor's License Law does net apply to Rn ownl'-I' of ~;op.:;rt\~'flho bu~ds .or Ir,'p;\:)'/es thereon, snd WhO colirracts for slich p~oJects with
[j?ntractor(s) licensed .pursuant to the ContraGtor's lIce~se Law), , ; ,
I am i1efAl~nder Sec. __ . B &~' ,f;J::;!tus r~ason: ____
DateX- ~()..\ Owner:)( 'U . __I:. _,
L. ' _ WORK~R'S COMPENSATiO DECLARATICN L__~--1 I L!CENSED CONTRACTORS DECLARATION i
I ~i~feby affirm under ~enaltyof perjurj .one of the fcllowing dcc!ar<'!tions: . :.;~' ",. I he!'t::by affirm ,tl~der penfifty c:.f perjU~f-th~t l:am
[J1'havs. an,oj Will maintain r:l certificate of oonsent to selt~in.:3ure for \A:O;kcj~1-"f ccrnp?nsc:;tion, '1 lIcensed under prov,s:cn$ ,)f c~i:!:pt€r 9 (COOlm3nClr.,9
as provided for by'Section 3700 of the Labor Code, for the ~rformanr.e cf t~;:'e \'VO:K fo; whidl ,^,l~h Se~tio.n 70'00) of"Divsion:3 of the Bt1~iness ane;,
, tt"iis permIt is issued" .'.~ I ProfeSSIons Code, . ,
o l.t)a....~andWil\ maintain wOi'ke r's co""pensatic'll insu.rance, [.lS ~qu!r!:!cl t',v S:3c':1on 3HJO of 111/9/2004
thp. Labor Cede, for the performarl.ee of the work for wnlch this permit,is iSStJd, MywofkE:r's Date: COrltr~ctor
Compensation insurance carrier and policy 'are: . I
Carrier: ,Pclicy Number. ~ '1 NUM3ER
, ,
This,section ~eed not be compJetedlfthe pe!l11it is fcrone hundred dC!lars.{$1~)'h OO:,I,~s. ,'_*'(P~
~- j certify,that in the perfcrrnanceofthe work for which this permit is i:-;SIH,~,"'1 :sha!! not' . >
~bY any pertan in any manner so as to become subject to the workE!l~s c~r.iijj~eflsation lawS
of Califcrnia,: and agree that if I should become subject to the wcrkGr's ccm~';.:'<.sd:cn' .
. provisions of Section 3700'ofthe Labor COde, I shalf forthwith comply ",!ith n'::oi~.).prOVjSicnS, '
:;~N;~~;2~~~LURE T~P;~~C~"tO"KER'S 'M:'ENSATION COVEI,.~GE.i$ - . -
UNLAWFUL, AND SHALL SUBJE~"\.~ EMPLOYER TO CRIMIN;'.L PEN^i:TI.ES~ND CiVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADCmON TO THE
COST OF COMPENSATION,DAMAGES AS PROVIDEu FOR iN SECTtOi-: 3mB OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. . >
I CONSTRUCTION LENDING AGENCY __
I hereby affirm under penalty .of perjury that there is a ccnstruction lend_jng Z!~.~~:lcY~9r' the
pe:rformapc.e, of the work forwhic:hcthis pennit ie iSSl!ed (S ec.. 3027 .CiV,~): ., .'
~~....:c-;'-:::- !;:;i~:;-;",ll::o;~:-_.-'-- ::.---- '""'-
. ' ,i
CONTRACTOR INFOm,l;'.TION:
ARCHITECT/ENG.INEER INFORMATION:
PROCESSEfJ BY: MSM
EXPIRAnON DATE
Construcion Types:
VN, ,
Fire Spriilklered?
Uvfnq Area:
Patio Area:
NO
493,
289
, .J
I certify that I have read this application and state that the above information is correct. I
'agree to oomply with all city ordinances and state laws relating to building cc~truction, and
hereby authcr'ize representives of 'this City to enter upon the above mentioned property fo-r
'ns dion purpo ,
Fees paid for Permit:,
Total:
2;146.52
Date; i 1/9/2004
Sign ture of Applicant or Agent
The permit shan expire by limitation and become nun and void If the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required, to commence 01' continue work.
, INSPECTION RECORD
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Dale
Inspeclor
, ' INSPECTION DATE' INSPECTOR
,
Temporary PO,wer Pole ~. F ' I
Plumbing (DrainlWaste Pipe) fu",,'f 5[',,1-
EleCtrical Ground Electrode/uter ' ' I~-''''c(
SelbacklFormslTre(lches (Footin!lS) , ~-t -0'1' ~...'\:/,
00 nol inslall sUbflQor or pour floor slab unlillhe , J','
following applicable items have been signed: ,
Plumbirig (Water Plpe.Sprinkler Valves)
MeChanical (Groundwork) " "
Electrical (Underground C '
Pre-slab (Compaction/~ernbrane.ReI~ fl..'....f \.
Underpinning (Floor Joist/Girders) /
00 not cover or conceal the work b,elow until the ,
10110""in9 apRliGi3ble items have been,signed:' , ,
1st Floor,Shear' I'
FireSprinkler (Rough) , ' , " ,,'
2nd Floor Shear ,
Roof (Sheathing/Diaphragm/Frame)
Masonry (ReinfJBond BeamlPre-Gl'O\It) I, ' ,
Rough Plumbing (Top Out) I
Rough Mechal)ica,l "
, I ROugh BllCtricallU<Y ....11) " I, ,
Rouch Electrical ' , ' , , , ,
Framing {Only after Plbg.. Elec, , Mech; anq Fire\ , ~, I
InSUlation (SoundlEnergy) , UP"'"
Do not tape or plaster until the following applicable' ,7
. items have been signed:. , " . ' .
Drywall , fEn-</'
,Penetrations (Fire Rated) Electrical ,
Penetrations (Fire Rated) Mechanical ,
Penetrations (Fire Rated) Plumbing
Interior Lath . ,.' , '/I F
El!terior Lath ' 1-J..II"f) 'A'I/~, ,p
GENERAL ITEMS 'A"l_
Exterior Plaster (Bra.vn Coat) .-ID...e:B cr-
T -Bar' Electrical L../
T-Bar Mechanical ,
T -Bar Structural " ' ~ ,
Sewer ")' n-r. co~ ,,"'JY/. .Ie",
Wa,ler E/lgineering BackfJow ' , ~, E
Water Service
Mechctnicaf FinaJ
Gas Test
Engi.-ring/Grading Final 765-5126
Fire Depl. Final 765-4040
Water E,ngineering 765-5268
Sub List/Business License 7ii5-519
Zoning 765-5139 '
Building Final ILasllnspeCtion. Only , -<3, J.
, " ' After Above Complele) l'
, PARTIAL INSPECTIONS
.
Buildina Inspections'
1<.'
Mechanical Inspections '
lumbina Inspections
lectricallnsDections