831 Modena
TYPE OF PERMIT CITY
Residential Remodel . ,
DATE: 6123/2004
JOB ADDRESS: 831 N MODENA ST
LEGAL DESCRIPTION: . N TR 2296 LOT 52
BUILplNG DIVISION
200 S,ANAHElM BLVD,
(714)765 - 5153,
INSPECTION REQUEST LINE:
(714) 765 -4626
. .cENSUS CODE: 434
QUARTER SECTION: 25
BUILDING PERMIT NO. BLD2004-02294'
APPlICANT:DOUG\.AS METCALF
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
Douglas Metcalf
831 N Modena St
Anaheim; CA 92801
. JOB DE3CRIPTIONRenew expired permils #19969 & 18313 for bay window, (2) decorator windows, interior alterations and acld pre-fabfireplace,
VALUAi:lON: . 3,500,00 PROCESSED BY: DOR'
I OWNER-BUILDER DECLARATION I
I hereby affirm under"penalty of perjury that I am exempt from the, Contractor's ticense Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county'which requires a'permit to construct, alr~r, improve, demolish or repair any struc~ure, prior to .its issuance, also
requires the applicant for such permit to,file a signed statement th.at he is licel'lsed pursuant lathe provisions of the Contractor's License Law'(Chapter
9)(commencing with Section]OOOof Division 3 of the Business and.professi:)rs Code) or that he is exempUherefrom and the basi's for the; alleged
exemption. ArYy violation of Section 7031.,5 'by any applicant for a permit sUb.,ects the applicant to a dvil penalty of not more than five hundred dollars
~~. . '.
0,1, as ow.nerof-property,:ormyemployees with wages as their solecomp.-".!nsation, will do thework,and'thestructureisnot intended or offerec;t for
sale (Sec. 7044 Business and Professions Code: 'The Contl'actor'~ ~icense L.3W does ,not apply to an qwner of pro perty who builds or improves
thereon, and who does such work hiniselfor herself or through hiser.her owri employees, provided that such improvements are not intended or
offered far sale. If, however, the building or.improvement is sold wlth one,ye\lr of completion, the owner~bul\der will have the burdenof proving' that he
did notpuild or improvEdorthe purpose of sale). ."" '. .'
o I, as the owner of the prap~rty, ani e~dusively contracting-Wit~ Ik;e~led (A)ntractors to construct ~he proje~t (See. 7044 -Business'and Professions,
Code: The Contractor's License law does not apply to ,an owner of pfOp~~tY'Nho builds or improves th,ereon, and who contracts faT such, projects with
. ,a.!(ontractor(s) licensed pursuant to the Contractor's' License Law).. ,~. ~ .
.U I am em under Sec.' " B & P. . far this- :
Date: Owner:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty. of perjury that I-am
licensed under provisions of chapter_9 (commencing
with Sectio n 7000) of Di\ision 3 of the Business and
Professions Code. '
6/23/2004
Date:
. Co.ntractor
WORKER'S COMPEN TION DECLARATION
I hereby'affirm under penalty of perjury. one of the fallowing declarations:
D f have a'nd will hlaintain a certificate of oonsen-t to Self-insure for. worker'; co.mpensation,
as provided for by Section 3700 of the LabOr Code, for the pe.rrormanoe of te. work fOr which
this permit is issued. .
o I have and will maintain'wo'rl<"er's compensation insurance, as' requiredt;.~~ Section 3700-6f
the labor Code, for the performance of the work for which this' permit is issu.',d. My worker's
- Compensation insurance carrier and polioy:are:
Carrier: '. PoliCy Number. .
,This section ne.ed not be completed ifthp. ~rmit is -for one hundred dollars ($10t'l or less.
D. .l certify that in the perfolTT\ance of the work for which this permit is" issue.I,-1 shall not ..
employ any person in any manner so as to 'become subject to theworker's cc.;npE!nsation ,laws
of California, and agree that if-I.should become subject-to theworker'$ compensa,tion '
. provisions of Section 3700'ofthe Labor ode, J shall forthwith compjY.with1h~'se'provisions. .
KDate: 6/23/2004 APPlicant: ' ..;L .' ,:-;:.'.
. 'wARNING: FAILURE TO SECUREWORKE' COMPENSATION COVERAGE:ol '
UNLAWFUL, AND SHALL SUBJECT,AN EMPLOYER TO CRIMINAL.PENALrlES"ANOCIVrL
FINESUPTO ONE HONORED 1HOUSAND DOLLARS ($100,000). INADmnol'L'<rO THE
COST OF-COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3701f,QF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. ' .
,. , CONSTRUCTION LENDING AGENCY
I. ~ereby affirm under penalty of perjury that there js.a constr'uction lend}~g~ag~"!n.cyfor the
,p~rforrl')a_tlce .ofthe work for which this permit is issued (Sep.3097.ciV:C):^"
.'t~!)E:r's -!nfCir:rmt;~.,: '
NUMBER
EXPIRATION DATE
TYPE
Construcion Types:
VN, ,
".
I certify Ih~t I have read this application and state thaU.h.e above information i.s correct. J
agree to comply with aU city ordinan,cesand ~5tatelaV'Js relating to building ,con~truc1ion; and
hereby authorize representive$ of this city to enter ~pon-the above mentioned property for
. inspect~nfi'=~_X A L 71t. L _ >7# Date: 6/23/2004
"', . .vo ~nature of Applicant or Age; ~.
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 permit is required to commence or 'continue work.
Fees paid for Permit:
Total:
0.50
. INSPECTION RECORD
.'INSPECTION . l' .
. .' DATE , INSPECTOR
Temporary Power Pole . . .. I
Plumbing (DrainIWaste Pipe) '" I
ElectriCal Grciund ElectrodefUfi>r . r
S<<backlFormS/TrenChes (Footings) . I "
Do not instaUsubflool'or pour floor slab until the r .
following applicable items have been signed'" .
P/un1b1ng (Water Plpe.Sprinkler Valves) . I .
Mechanical (Groorldwork) .. I . ." .
Electrical (Underground Conduit) I . .
PIIl,.stab (Compaction/Membrane.Reint. .1
Underpinning (AoorJ(listlGirtlers) j .
uo nat cover or conceal the work. below until the I .
'following applicable items have beEin signed: . . .
1slFloorShear. I .
Fil&sprinkler (Rough)' " '. .1
2nc! Floor Shellr .. I
.ROof (Sheathing/DiaptuagmlFrame) . . I
Masonry (ReinfJBondBean/Pl'e,Grout) I "
Rough Plumbing (Top Out) I '" .
Rough Mechanical . . . . I. .
KOugh t:lectnc . ..all) II .
Rough Electrical I .' . '.'
Fral'riing'(Clnly afteiPlbg.. Elec.. Mech. and Firel I
Inwlation(SoundIEilergy)' .' : . . I
Do not tape or'plaster until the followi;'Q applicable' . ,.
items have been. signed: .' '.. ..... I
Drywall . '. I
Penetrations (Fire Rated)Electrical I
Penetrations (Fire Ratec!).Mechanical:' I
. Penetrations. (Fire RatedJ Plumi!ing . I
Interior Lath .,' . . I
Exterior Lath '.. I .
, GENERAL ITEMS I
EJderioi' Plaster (Brown Coat) . . f . .
.T.Bar EleCtrical . . I
T.Bar Mechallical I .
T.Bar Structural . . . I
Sewer.. . '. I
Water Engineering Backflow . . I .'
Water Service , . I'
.,' .. .
.
FINALINSPECTlONS ....: Dale Inspector
ElectriCal 'Fillal . '.' . '. . ". .
Plumbing .Final .. " . .
. . . .'.
. ." ....
Mechanical'Flnal . . .
GasTest . .' " ....
."
Engineeriog/Gradlng F.inal 765-5126' ..' .: '. . .
'.
Fire Dept. Final 7654040 . . 1 .' .
. .
Water Engineering 765,5268 . .' ."
. .
SUb List/Business License 765.5.19 , ..'
.- , '. '.
Zanlng765-5.13!f " c". .. '.
'.' , ~ast fnspection':Oniy . .
Building Final ,.' " . '.
.... . Iter Abo~e Complete).
. '.. ..... . PARTIAL INSPECTiONS
Buildinalnspections
. Mechanical Inspections
PIUlnbifn:/ inspections
ElectricallnsP9ctions
rERMIT' EXPIRElJ'"
INSPECTION. .'. .
NOT, COMPLETED I.'
DATE:I~5-C(p
~,
.
CITY or:; ANAHEIM
'"' , . ~"~BtJli:b;i~G"piFit1i'i .. ';
'~ . . .... ..... ... . '/;"<J
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TYPE OF PERMIT
'~.,
BUILDING DiVisION
200 S. ANAHflM BLVD,
. . (714)254-51.53
INSPECTION FlEQUl!ST LINE
~, .,
(714)254-~.161
"
..
r, the "above mentioned contractor, hereby affirm that I am licensed under
provisions 'of Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code, and my license is in full force and effect.
License Class
State
Lic. Number
Exp. Date
~,*",
~1JIw
WORKERS' COMPENSATION DECLARATION
I, the abovementioned applicant, hereby affirm that I have a certificate of con-
sent to self-insure or a certificate of Worke t-
tied copy thereof (sec. 3800 Lab. C) PoJicy
Company
Certified copy Furnished Exp. Date
J, the above mentioned property owner, certify that I am exempt from Section
7031.5 of the Business and Professional Code, Division 3, Chapter 9, Contractors
License Law under the Section; Owner: Section 7044 0 Minor
work under
7053 0 Other.
f"
,i ij , J
I( /.!",i,r,r",/ /) Ji If "14- '
SlGNA:UAE (.!}ROPE. OWN .. t DATE" ,
NOTICE TO APPLICANT:" Jf after. making this Certificate of Exemption
you should become subject: to' the Workers', Compensation provisions of
the, labor. . Code, yoU must forthwith comply with such provisions or
this permit shall be deemed. re\Joked.
ITEM''',
Lender's Name
Lender's Address
J certify that I have read this application and state that all of the
above information is. correct. I agree to comply with all city ordinances
and state laws reJating to building construction and hereby authorize
representatives of this city to enter upon the above mentioned
property for inspection purposes.
I hereby agree' to indemnify and hold harmless the City of
Anaheim, it's officers and employees from any liability for damages
incurred by any person, or persons, resulting from work or activities undertaken
pursuant to this permit.
The permit shall expire by limitation and become null and void if
this work . is not commenced or commenced and suspended after a
peri()d of mk1!m~~ days. N~w permit is required to commence work.
QUANTITY
Bl 1
MICROFIU1 FEE (PER SHEETl EO 2
BUILDING PSRMIT FEE Bl
FJASIC PLAN CHECK FEE f.'5
STATE TAX CATAGORY #1 B9
u. .""
I SSlJANCE F'E:E
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec. 3097
Civ.C):
1
1
1.
FEE
2<'.00
2.00
45.00
29.25
.50
II
By /. U""/::",, '
OWNER-AGetilT-BUILDIOJ:l-QFACER
,
{2/ /1-/ '1J-
^'
CERTIFICATE OF OCCUPANCY
TOTAL FEES
$: 96"75
This structure has' been inspected and is in compliance with the applicable
proviSions and ordinances of The City of Anaheim.
Any change of occupancy group requires renewal of this Certificate.
TEMPORARY OCCUPANCY GRANTED
UNTIL:
Classification:
BY:
Group_ Type_No. of Storie-s,----Use Zcne_PermitNo._
DATE:
By;
Dale:
BUILDING OFFICIAL
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CITY OF ANAHEIM, CALIFORNIA
Planning Department
Building Division
March 30,1998
'Doug Metcalf
831 N. Modena Street
Anaheim, CA 92801
Re:
Extension of Building Pennit #19969
Building Pennit#183 18
Mechanical Pennit#18315
Mechanical Pennit #11970
Plumbing Pennit #18314
Electrical Pennit #18317
Dear Mr. Metcalf:
We have again reviewed your written request to extend the above mentioned pennit for your project
located 831 N. Modena Street.
Please be advised that the Building Division Manager has the discretion to extend pennits. After
reviewing your request and taking your hardship into consideration, we have extended your pennits for
six additional months from the date of your last written correspondence. Therefore, your permits will
expire September 12, 1998. Due to the fact that we have extended your pennits already and there will
be upcoming building code changes, we will not be able to extend these pennits after September 12,
1998. This is your final extension.
We look forward to serving you in the "Anaheim Way." Please do not hesitate to call me if you have
any other questions.
Sincerely,
r(/'~
Julie A. Seay
Building Division Manager
JAS:md
cc: Chris Lee
File
P.O. Box 3222, Anaheim, California 92803 . (714) 765-5153 . FAX (714) 765-5280 . www.anaheim.net
~
~
,,-
,,,CI'FY.OF ANAHEiM
"7,'. '.i.~~; Di:l~0pO~1i';;r' "\.
t;;;\/i,~c;".I'l::d1>'/:::':CL,:"z1:::""~'~' t....j.>::z:jZf..LtLt-L::t2:\;.,?:;Ai:Z<L+;S:;~',
TYPE OF PE~tT '1;.
....;'.
,/ ;;,.,,~,~..~ c,.
BUILDING DLVJ$10N
. .20o-S. ANAHE(M.8LVD.
. <t"i4\,'V.1i4,.51.53
INSPECTION'REQUEST UNE
<714 16l.
/~<..
,';;;" )
.
'.'~f
1;.0.
~' .:.r.
,.
I, the above mentioned contractor, hereby affirm that lam 'licensed under
provisions of Chapter 9 (commencing with Section 7000) of, Division 3 of the
Business and Professions Code, and my Hcense is in full fqrce')\nd effect.
Uce(lse Class
State
Lie. Number
Exp, Date:
WORKERS' COMPENSATION DECLARATION, "'.
I. the above mentioned applicant, hereby affirm that I have, a certificate of con':
sent to self-insure or a certificate of Worker' e 'Or' a c' -
fled copy thereof (sec.38QO Lab. C) Policy N
Company
Certified copy Furnlsh~d,Exp~Date ~~f~~~~~~~~1~
I, the above mentioned property ow~r, certify that I am exempt from Section
7031.5 of the: BUS,i~ssand Professianal.code,'Oivisian 3, Chapter 9, Contractors
LIcense laIN under"-the-foltowing..Section; Owner: Section 7044 0 Minor
work under $200: Section 7048 0 Employee working for wages only: Section
..., 'W_~'.~"~lll!'~'~9~_'WPrll:-"-~
70r,::,~the"R'tt.~t:~p~:P. '?itc .~...... ;~~;ij')l1!~!!!}i!~:
, "'f0,- .."" 1 ID).?/jq4-
SIGNATURE (P PERrY OWNER OR AGENT) I DATE'
NOTICE TO APPLICANT: If a.fter making this Certificate of Exemption
you ,should become subject to the Workers' Compensation' provisions of
the Labar, Code, you must forthwith comply with such provisions or
this permit shall be deemed revoked.
D
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
performance of the work' for which this permit is issued ($ec. $097
Civ.C);
ITEM,"
ISStIF\NCE: PEE ....,""~A..'.
BUILDING PERMIT FEE
BASIC PLAN CHECI< PEE
STATE TAX CATAGORY #1
QUANTITY'
FEE
'Fif
Ell
135
B9
-1.
1
1
1
- .'-20': 60..'
70.00
22.75
/toO
Lender's Name
lender's Address
I certify that 'i have read this . application and state that all of . the
above information is correct. I agree to comply with alt city ordinances
and state laws relating to building constrUction and hereby authorize
representatives of this city to enter upon the above mentioned
property for inspection purposes.
I hereby agree to indemnify and hold. harmless the . City of
Anaheim, it's oHicers and employees from any liability for damages
incurred by any person, or persons, resulting from work or activities: undertaken
pursuant to this permit.
The permit shall expire by limitation and become null and void if
this work is not. commenced or commenced and suspended after a
period of ~~1[~~ days. New permit i~ required to commence work.
By
I Oh I h.
lOflrE I
CERTIFICATE OF OCCUPANCY
TOTAL FEES
$= 113,,25
'This structure has been inspected and is in compliance with the applicable
p;evisions and ordinances of The City of Anaheim.
My change of occupancy group requires renewal of this Certificate.
TEMPORARY OCCUPANCY GRANTED
UNTIL:
Classification:
BY:
Group_ Type_No. ofStories_Llse Zone_PermitNo._
DATE:
By:
Date:
BUllOlNG OFFICIAL
\
\
,
CITY OF ANAHEIM, CALIFORNIA
Planning Department
Building Division
March 30,1998
Doug Metcalf
831 N. Modena Street
Anaheim, CA 92801
,
Re:
Extension of Building Permit #19969
Building Permit#18318
Mechanical Permit#18315
Mechanical Permit #11970
Plumbing Permit #18314
Electrical Permit #18317
Dear Mr. Metcalf:
We have again reviewed your written request to extend the above mentioned permit for your project
located 831 N. Modena Street.
Please be advised that the Building Division Manager has the discretion to extend permits. After
reviewing your request and taking your hardship into consideration, we have extended your permits for
six additional months from the date of your last written correspondence. Therefore, your permits will .
expire September 12, 1998. Due to the fact that we have extended your permits already and there will
be upcoming building code changes, we will not be able to extend these permits after September 12,
1998. This is your fmal extension.
We look forward to serving you in the "Anaheim Way." Please do not hesitate to call meifyou have
any other questions.
Sincerely,
r(j,~
Julie A. Seay
Building Division Manager
JAS:md
cc: Chris Lee
File
P.O. Box 3222, Anaheim, California 92803 . (714) 765-5153 . FAX (714) 765-5280 . www.anaheim.net
~
~
,
.-'
---------
BUILDING ~Di'i-;SiON!.'"
200 S. ANAHeiM BLVt1.
(714)~54-5153
JNSPECTION REQUEST LINE
b b!j.) 254-5 .
;;,,">~J^
.
LICENSED CONTRACTORS DECLARATION
CASHIER VALIDATION ONLY
J, the above mentioned contractor, hereby affirm that 1 am licensed under
provisions of. Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code, and 'my license is in full force and effect.
State
Uc. Number
Exp. Date
QUANTITY
FEE
license Class
WORKERS' COMPENSATION DECLARATION
I, the above mentioned applicant, hereby affirm that I have a certificate of con-
sent to self-insure or a certificate of Worker' t-
fied copy thereof (sec. 3800 Lab. C) Policy N
Company
Certified copy Furnished Exp. Date
I, the above mentioned property owner,
7031.5 of the Business and Professional Code, 3, Chapter 9, Contractors
License law under the following Section; Owner: Secti.on 7044 0 Minor
work under $200: Section 7048 0 Employee working for. wages only: Section
~mRii"K"ffi,'l"l""~'[t7""l1fJ.".""rw""fll:"~~~~$.t'tl0hl'il" nITPITm"~m'il!!'il!!'ITmll
7053 0 Other' <:;;:;,'>:1;;.;; , ", ."':: '. .' ;::;,: 'In't:tfJ/:; " i,j/;;'d!,,'i::.h!
.. 0,,,. .", .. """ . ,'" .-' -""". "" '''''~ .."
"N"h,'''N'''., _ 'N',"',.""",. _""".<<M,,A:., ,...'.__'....' _......___.'""""',":,. "___.."'__<<,''',_,,
.(t, . & V'V f I
iI/"<"/d. ~ A ,1(r.='''',."./. 1'\
SlGN~TURE (P.~OPERT OWNER OA'AGENTT {'
" IJ .
NOTICE, TO APPLICANT: If after making this Certificate of Exemption
you ;: should become subject to the Workers' Compensation provisions of
the 'Labor Code, you must forthwith comply with such provisions or
this permit shall be deemed ~voked.
CONSTRUCTION LENDING AGENCY
, hereby affirm that there' is a construction lending agency for the
performance of the work for which this permit is i$sued (Sec. 3097
Civ.C):
ITEM
.-\..,......,
I SSU{,NCE: FEE:'
HEAT!NG APPL. <lOOK BTU
COMPRESSOR UP TO 3 HP
HEATING/CeOLING COIL
134
134
64
1
1
1
2ci~oo
12.00
12.00
8.00
Lender's Name
Lender's Adclre$s
, certify that I have read this application and state that all of the
above information i$ correct. I agree to comply with all city ordinances
and state laws relating to building construction and hereby authorize
representatives of this city to enter upon the above mentioned
property for inspection purposes.
I hereby agree to indemnify . and hord harmless the City of
Anaheim, it's officers and employees from ahy liability for damages
incurred by any person, or persons, resulting trom work or activities undertaken
pursuant to this permit.
The permit shall expire by limitation and become null and void if
this work is not commenced or commenced and suspended after a
period of rtm?lrS'OTJ days. New permit is' required to. commence work.
'",;r>"",,:l,,'H
P~1~ ~;( 3/tf/f7
--.j N "-J&:i:T'{j
By i 0"'7.--//~' /
'~bWNER-AG T-BUILD R..QfFICER
CERTIFICATE OF OCCUPANCY
TOTAL FEES
$' 52. ()O
This structure has been inspected and is in compliance with the applicable
provisions and ordinances of The City of Anaheim. ,
Any change of occupancy group requires renewal of this' Certificate.
TEMPORARY OCCUPANCY GRANTED
UNTIl:
CJassJlicatJon;
BY:
Group_ Type_No. of Slories_Use Zone_PermiINo._
DATE:
By:
Date;
BUILDING OFFICIAL
.
CITY OF ANAHEIM, CALIFORNIA
.
Planning Department
Building Division
March 30, 1998
Doug Metcalf
831 N. Modena Street
Anaheim, CA 92801
Re:
Extension of Building Permit #19969
Building Permit#18318
Mechanical Permit#18315
Mechanical Permit #11970
Plumbing Permit #18314
Electrical Permit #18317
Dear Mr. Metcalf:
We have again reviewed your written request to extend the above mentioned permit for your project
located 831 N. Modena Street.
Please be advised that the Building Division Manager has the discretion to extend permits. After
reviewing your request and taking your hardship into consideration, we have extended your permits for
six additional months from the date of your last written correspondence. Therefore, your permits will
expire September 12, 1998. Due to the fact that we have extended your permits already and there will
be upcoming building code changes, we will not be able to extend these permits after September 12,
1998. This is your final extension.
We look forward to serving you in the "Ana..':ieim Way." Please do not hesitate to call me if you have
any other questions.
Sincerely,
~(j.~
Julie A. Seay
Building Division Manager
JAS:md
cc: Chris Lee
File
P.O. Box 3222, Anaheim, California 92803 . (714) 765-5153 . FAX (714) 765-5280 . www.anaheim.net
IilIiIliI
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. crr:~ OF ANAHEIM
"':)":'::?-'?1k:.\- ":'~<<'>~'7<7?'/?'.~-::'\/':;1":"::<?:' :'-:>>->>\'Ilf:'-:/>i";.Jt.:::'<':;:'ff':::Y:'/i
'. :.' ;I,...tJNBINGPl.1>~Mn '. i
L:::i< c.::",> t,LS;:L>::,;:",~:_<:::,.;,:i:::~t;{:>lA;,~::- <::;i::::;::;;;: A::.';;;,;;
_ ..,~." TYP~ OF PE;f1tv1IT.
, BUILDING DIVISION
200 S. ANAHEIM BLVD,
(714)254::>153
INSPECTI~N REOYFST~qIl'E
(714)254,~5161
LICENSED CONTRACTORS DECLARATION
Ucense Class
State
Uc. Number
Exp. Date
CASHIER VALIDATION ONLY
~~7
I, the above mentioned contractor,'hereby' affirm that I am licensed under
:>rovisions of Chapter 9 (commencing with Section 7000) of . Division 3 of the
ausiness and Profes~ions Code, and my license is in full force and effect.
WORKERS' COMPENSATION DECLARATION
I, the above mentioned applicant, hereby affirm that I have a certificate of con-
sent to self~insure or a certificate of Worke cert-
lied copy thereof (sec. 380QLab. C) Policy
Company
Certif[ed copy Fwnishe~Exp, qate
I, the above 'mentioned property owner,
7031.5,of the Business and Professional Code, 3;Chapter 9, Contractors
Ucense Law uOOer the following Section;' Owner: Sec}ibn. 7044 0, Minor
work under $200: Section' 7048 0 Employee working for' wages only: Section
705~O othe" 1il\~~m!;(;1r:r~f~I\!\!~lf~1l!!\lr1)!\\\l~IIi\1ill\\~;
',tb[{f, :b;;J?1~~..>' /oh / #4
SIGNATURE OPERTY OWNER OR AGENT} DATE'
NOTICE Tb APPUCANT:.;tf after making this Certificate of _Exemption
you should become sUbject to",the Workers' Compensation provisions of
the Labor, Code, you. must forthwith.. comply with such proviSions .or
~~ ~ermit shall be deemed revoked.
ITEM,
QUANTITY
1
1
1
B2 1 5.00
. ,.' t'IS?\rrJ).
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~O\ CO
np.."\ 't.:
FEE
16;60
7.00
7.00
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec.' 3097
Civ. C);
SUPPLEMENTARY PERMIT FEE B2
WATER HEATER Bl
WATER DIST.SVS.(EXISTING)B2
GAS SYSTEM (1-5 OUTLETS)
Lender's Name
Lender's Address'
I certify that I have read this- appliCatiOn' and state that all of the
above information is correct. I agree to comply with all city ordinances
and state laws rela.ting to building construction and hereby authorize
representatives of this city to enter upon the above mentioned
property for'inspection p!,lrposes.
I ,hereby agree to indemnify and hold harmless the City .of
Anaheim,' It's' - officers . and employees from any liability for damages
incurred by any person, or persons, resulting from work or activities undertaken
pursuant to this permit.
The permit shall expire by limitation and become null and void if
this' work '.is not commenced or commenced and suspended after a
peri~d of ~i~~~l days. New permit is required to c,ommence work.
By
4:4.J! lL::ll,Q.~~ k~ / h
DATE:
CERTIFICATE-OF OCCUPANCY
TOTAl::: FEES" ,
'."\
$ 29.00
This structure. has been inspected and -is in compliance with the applicable
provisions and ordinances of The City of Anaheim.
Any change of occupancy groUp requires renewal of this Certi1icate.
TEMPORARY OCCUPANCY GRANTED
UNTIL:
ClIlssifioation:
BY:
Group_ Type_No. of $lories_Use Zone_Permil No._
DATE:
By:
Date:
BUll-DING OFFICIAL
CITY OF ANAHEIM, CALIFORNIA
Planning Department
Building Division
~
~arch 30, 1998
Doug Metcalf
831 N. Modena Street
Anaheim, CA 92801
Re:
Extension of Building Permit #19969
Building Permit#18318
Mechanical Permit#18315
Mechanical Permit #11970
Plumbing Permit #18314
Electrical Permit #18317
Dear Mr. Metcalf:
.
We have again reviewed your written request to extend the above mentioned permit for your project
'located 831 N. Modena Street.
Please be advised that the Building Division Manager has the discretion to extend permits. After
reviewing your request and taking your hardship into consideration, we have extended your permits for
six additional months from the date of your last written correspondence. Therefore, your permits will
expire September 12, 1998. Due to the fact that we have extended your permits already and there will
be upcoming building code changes, we will not be able to extend these permits after September 12,
1998. This is your final extension.
We look forward to serving you in the "Anaheim Way." Please do not hesitate to call me if you have
any other questions.
Sincerely,
?(j.~
Julie A. Seay
Building Division Manager
'JAS:md
cc: Chris Lee
File
P.O. Box 3222, Anaheim, California 92803 . (714) 765-5153 . FAX (714) 765-5280 . www.anaheim.net
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THE ISS rICE OF THIS FER:.:ii DOES
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THE aUI DING OODES OF THE CITY.
THE H DER OF THIS PERMIT
PROCEE AT HIS OWN RISK.
Eel 41994
aUILOIN DIVISION OF ANAHEIM
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THE I~SUAiiE OF TJi1S P;;il;.;n DOES
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THE HOL ER OF THIS PERMIT
PROCEEDS ~T HIS 0\'111 RISK.
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THE ISSUANCE OF THiS PERL;!T DOES
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OCT201994
BUILD NG DIVISIOII OF AN:,::::1.1
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THE ISSUANCE OF !ii;S FER',iiT vOES
NOT APPROVE VIOLATION OF ANY OF
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THE HOLDER OF THIS PERMIT
PROCEEDS AT HIS OWN RiSK.
OCT201994
BUILDING DIVISIOP! OF Ari:":::''.!
APPROVED
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BUILOING, PERMIT NO, ' BLD20G4.02291
B.uILD'ING DIVISION
200 S.. ANAHEIM BLVD,
(714) 765 - 5153 '
INSPECTION, REQUEST LINE:
(714)765,4626
. CENSUS CODE: 434
QUARTER SECTION: 25
TYPE OF PEI1MIT
Patio Cover . CITY
DATE: 5/28/2004 , '
JOB ADDRESS: 831 N MODENA ST
L,EGAL DESCRIPTION: N TR 2296 LOT 52
· 'APPLICANT: DOUGLAS METCALF
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
Douglas Metcalf
831 N Modena SI
Anaheim, CA92801
JOB DESCRIPTION:lnstaIl486 sq It patio cover,
VALUATION: 4,860.00 , PROCESSED BY: CAL
I OWNER-BUILDER pECLARATION, .
I hereby affirm under penalty of perjury that I am exempt from the Contractor'3 License Law for the follOWing reason' (Sec. 703.1.5 Business and
: Professions Code: any ci~ or county Which requires a permit t6 construct." aIV~r,. impr6v~. dem61ish or repair any structure, prior to its issuance, also
requires the applicant for such permifto"fiIe a signed statement that'-De is lice:'sed-pursuant to the provisions of the-Contractor's licen~_eLaw (Chapter ~
9)(~ommencjng with Section 70aDaf Division 3 of the Business and ProfGSsir:nsCode) br that heis ,exempt therefrom and the basisfor,the alleged
~~~tlon.Any violation of Section, 7031,5 by any applicant for a permit SUbj,,~cts the a PPlica, nno a, civil penalty 01 not mor,e t~.a.n:,fiv~,hun,'~,red, dollars ,
~ I, as ownerof property"ormyemp1.oyees with, wages as their sole comp-:;..sation, will do the work, and,the structure is not intended oc offered for .
sale (See, 7044"Susiness and Professions Code: The Contractor's License.L3w does not apply to an owner of property who' buildS or improves, '
thereon, and who.does suchworkhimselfor herself or through hiS or her 0Wi" employees/provided that such improvenients are not intended or' ,
offered for sale, If, hovyeve.r, the building or,improvement is sold 'tlith one yem of'cOrrlpletion, the owner-:buifder will have the burden of proving that.be.
did., not.bu i1d .orimprovefor:lhepurpose of sale),
,0 I,' as' the owner of the prope'rty, 'am exdusively contracting with licerised 'oohtractors to constructthe project (See. 7044 'Busi"ness and Professions
Code: The Contractor's Lipense.Law does not apply' to an owner of property:^;~O bui~ds, or improves tt;lereon, and'who contracts for such projec~ with.
'~~ntract.o!(s)'ncensed pursuant.to the Contractor's License Law). ",: "-
U '1 am exempt under Sec. " . P.C. for his reason:' _.
Date: Owner:
WORKER'S COMPENSATION DECLARA: ON ,~_---1
I hereby affirm under' penalty of perjury one of the following, declarations:, ,
,0 I have and will ma'intain a certificate of consenUoself-irisuJe forworker'~;compensation,
a-$,provided for.by Section'3700bfthe Labor Code,' for the performance of th':~ work forWhid1
this permit' is issued. '
"0 I have and will maintain wort<:er's compensation insurance, ~s, required b~' Section 3.700 of
the'Labor Code, for the performance of the' work, for !Vhich this permit is issued. My worker's
" "Compensation, ins\.lranc~ Carrier and po Ii c.y are: .
~arrier: " . Policy Numb~r: , " .
~.section need n~,be completed if the. pennit is for one hundred ~ollars ($too; or Jes~
I certifY that in the perfo'rmance of the work for which this permit is:.isSJJed, I shelll not
" plo,y any person in any manner so as' to bec~me subjept td the wor~e~ffi;__ccmpensatiori laws
of California, and agr-ee that.if I should become sUbject tothework.er's compensation
'provisions at-Section 3790'<?fth~ ~bor'Code, I.shall fort Ith complywith'th,)se prO~isions.
, LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that lam.
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of tlie Business ancJ
Professions Code. .
512812004
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE'
Date: 512812004 Applicant:
'WARNING: FAILURE TO SECURE WORKER'S COMPENSATION, OVER,GE IS
. UNLAWFUL, AND SHALL SUBJECTANEMPLOYER TO CRIMINAL F'E"NALTIES AND CIVIL
FfNESUPTO ONE HUNDRED THOUSAND DOLLARS ($100';000), IN ADDI'nON TO THE '
,COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTlo" :J706 OF THE
. LABOR CODE, INTEREST AND AttORNEY'S FEES, ' ,
I ' CONSTRUCTION '-ENDING AGENCY ,
1,.t1er~,l?~a~irr:t;'lI,~der penalty: of p.~rjury .tl:1at there: is a c.~f)~!uc~ion:t~r:d!hg',:a~6,ricyfo! th~ "~"
,,'.oe'riorcni;:ince.'of:the w(\ck for. whiddhis 'oermit is is~ed (8pt.:~097 .Giv.C}::: ; _..i.. . .,<".
Lender's Information:
Corrstrucion Types:
VN, , '
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I certify that I have .read this application and state that the above information is correct. I
agree to oomplywith all city'ordinances and state laws relating tobuildingconstruction, and
hereby authorize representives of this city to enter Upon the above mentioned property for
inspection' purpo
Fees paid f,or Permit:
Total:
0.50 '
Date: 512812004
Signature of Appli,cant or ent
The permit shall expire by limitation and become null and void if the building or
work has ,not passed final inspection 365 dllYS from the date of permit issuance. A.
, new permit is required to commence or continue work.
" , "
FINAL INSPECTIONS . Date Inspector
Electrical Final' '. . . . .'. -c-
'. .. . .
Plumbing .Final . ','., '.'
Mech.lmical Final ~ .... "
.' . . .
Gas Test " .... .'. " "
Engineering/(iraCIing Final 765-5126 . .. .. .
".
Fire Dept, Final 7654040 '.
Water Engineering '765.5268 , . '. . ....
subi.istiBusine~Sl,..ii:e~se 765.5,1& I. ~
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. Zoning 765.51.39 . . -c
" .. .
Building Final ~ast Inspection- Only ','
'.' ' fter Abov," Complete). .
INSPECTION RECORD
. '.'
. " , , INSPECTION.
Temporary Power Pole. .
PlUmbing (DrainlWaste Pipe) ."
Electrical (;rOund Electrode/lifer .
. Selba.cklFormsfTj'endtes (Footings) .
[lO not install subfloor or pourfloor slab until,the
following applicable items have been signed!
plumbing (Water Pipe,Sprinkler Valve!!) .'
Mechanical ((;rouncfwork). , , . ..
!:lectrical (Underground conduit) , ' .
r PAl-slab (Compaction/Membrane.Reinf. ".
Underpinning (RoorJoist/(ilrders). .' .
~ not <:over orcon~al the woll< below unt.1 the
following applicable items have been signed: .
1stFlporShear'>, '. . I. .
, FiAlllprinlder (Rough).' .
2.nd Floor Shear i ' . . .',
ROof ($heathing/DiaohragmlFrane)
MaSonry (RlliinfJBond Bean/Pre:Grout)
.
RpughPlumbing. (Top Out). ,
. Rough Mechanical . '
, !'COlJ9h t:lectrlCaI all).
Rough Electrical ' ,,' .
Framing '(Qnly'anerPlbg...Elec:. Mech and Fire)'
In$Ulation(SoundlEnergy).. ". . .
pp not tape or.plallter until the fpIlOw,..g applicable
.,tems have been signed: . . . . . . ' ,
Drywall.,.,.."., . . .
'. Penetr.atipllS (Fire Rated) Electrical ....
Penetrations (Fire Rllled),~chanical . .' . ',' .'
PenetratiOns (Fire Rated) Plumbing. .
Interior. Lath . '.
Exterior I,..ath , " . '. .
. . .... (iENERALlTEMS
ExtilriorPlaster(Brown Colll)
.T .Bar Electrical
T.Bar Mechanical "..,
T,Bar Str!,ctural.
Sewer . . '.
Water Engineering Backfl.ow
Water Service " '. : .
. .
DATE
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. ..., . ..' PARTIAL INSPECTIONS
BulJdinaJilspections
. ..' .
. Mechanical InSDections
, Pluinbinalllspections
.
. Electrical Inspections .
'.
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.DATE:
\ ':l-'90..-o6
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Solid roof covering
Lattice cover
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FRONT VIEW ELEVATION
~~"~~ 'i~'~;\:~::"'-.':~ "'~r~
"-('"
Footings:
Posts:
Headers:
Rafters:
gL inches square x 12 inches deep
---f::z-"x t. (or) two_"x_"
---.!i-" x -/2.-" spaced " on center OR
Two _" x _" spaced "on center
--1_" Rated plywood sheathing with exl. glue
_" x _ solid wood sheathing
Solid Roof:
With
Lattice Cover:
_" x_" spaced
RAFTER SPAN: #2 Douglas Fir
Lattice or solid roof.
Rafter Rafter Spacing
Size 12" o.c. 16"o.c. 24"o.c. 32"0.c.
2x4 13' - 0" 11' _61' 9'.6u 8' -0"
2x6 19' -0" 17' _ 0'1 13'..9" 12' -0"
2x8 20' -0" 20' _011 17' - 6" 1S' - 3"
2xl0 20' -0" 20' _Oil 20' -0" 18' - 6"
2x 12 20' - 0" 20' -0" 20' -0" . 20' -0"
roof covering
" on center
Max. span of
rafter with a
2' overhang
~dhl2x4
%<:,:,:""",:::~,;;,./;.:
4x4 #2
Building Division Approval
THe: ISSUANGIi ~F .;1'H)~YE::kMI=t: b;\O}I:OS
NOT Af'Pf\OVE VIOLATION OF ANY OF
THI:: BUILDING .CODES; _OF tHE CITY
THg: HOLDER OF THIS PERMIT
PROCEEDS AT HIS OWN RISK.
05 ?-S' Q5.7Z00
fo~wr~1 ~f A~MENT
I Ar'Pi',OV:::D
\ DATE >-2$-01
BY ~__AC"'ION (~)
(lnit;al~l
FLOOD ZONE )(
MAY 2 R 1DOl
6!JIL);lING DIViSiON of' ANA
fSW !'II F' F' F'HJV g:
BY
HIS~C DISTRICT REVIEW:
tfut,.o( See st?m? tbis pete
Circle one on ebove line
SEE BUILDING PERMIT FOR
ANY CONDITIONS
Is C4.fb-r as &'----..
Up to 8 ft. )}~i;:~~i .;i;i~;~;f/ \~:::l~~~r:0: lli1~1~~&-
,-?,,:,5~-9",.'.' 8~,;.(itW_'~ ;'];:l()~;f~,\4? M;,H;BUlt:'
Up to 14 ft. ~<;~6;-3" 9'-3" '''i2'-3":&'':;:;--.15;.:o,,:&-'
Up to 20 ft. W-.i~~~::\' '::~':i;~i€i(; :;*,:igt~7;;\B: i;:i~~~zW ru;'1;;~it: %!!L't
SIZE OF FOOTING: 12 inches square and 12 inches deep unless otherwise noted per footnotes:
1. May set on exiSting 3 112" slab. 2. 18" square. 12 inches deep. 3. 21 inches square - 12 inches deep.
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SQllARE FOOT PATIO COVER
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