495 S. Paseo Bandera
TYPE OF PERMIT C
Residential Addition . ITV
DATE: 4/15/2005
JOB ADDRESS: 495 S PASEO BANDERA.
LEGAL DESCRIPTION: N TR 8672 LOT 12
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 186
BUILDING PERMIT NO. BLD2005-00657
(APPLiCANT:GARRY AND. ERSON
'PWNERINFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
Garry F Anderson
495 S Paseo Bandera
Anaheim, CA. 92807
JOB DESCRIPJION:Add bedroomlbath and 1/2 bath to ex!.
VALUATION: . 32,600.00 PROCESSED BY: FAN
I OWNER-BUILDER DECLARATION I
I hereby affirm under penalty of. perjury that I-am exempt from the Contractorls ,ucense Law for the.following reason '(Sec. 7031.5 Business and
Prof~ssi9ns Cod~:-any city or count~whi<?h req~ires a permit to constru?t, ~lte~ improve, dem?llsh or r~~air.any structure, prior to. its issuance, also -.
reqUIres the ,apphcant for such penT"t to file a sIgned st8;tement that he IS hcen~d 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 sutije<;ts the applicant to a civll penaltyof not more than five hundred dQllars
($500). . :. ..'
o /, as owner of property, Qr.my'employees with wages as their sole compensation, will do the work, and the structure is not intended oroffered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License La\V does not apply to an oWner of property who builds D'r improves
thereon, ,arid who does such work himself or helSelf,or through his or her own ltmployees, provided tliat such imProvements are.not intended or ',,'
.offeredfor sale. If,.however, (he building .or improvement is sold wit~ ohe yearpf cOmpletion, ~e 'owner-buifder w"l have tt)e burden Of proving thathe .
~i not build or Improve for the purpose of sale). i . . ..' :..
\ - I, - as 1he owner .ofthe property, a.m .exClusively contracting with licensed cc}1tractors to construct the project ~Sec.7Q44, B. usiness atl?'Pr9fessions
e:' The Contractor's License Law does not apply to an owner of propertyw~lo builds or improves thereon, and who contracts for such projects with
~ontractar{!:?) Ucensed ~rsuant to'heContractor'sUcense Law). . ..\ . . .
U I .exemp under Sec. . B & P.C., for . ra son; , '~'.. "
Date: . OWner: \ .
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that' am
licensed under provisions of chapter 9 {commencing
with Section 7000} of mvsion 3 of the Business and
Professions Code. .
4/15/2005
Date:
Contractor
WORKER'S CO ION DECLARATION
I hereby affirm 'under penalty" of perjury on of the following declarations:
o i have and will maintain a'certificate of consent to selHnsure for worker's e,bmpensation,
as provided for by Section 3700 of the Labor Code, for the pertormance of the Wolk for which
this permit is issued. ". . . . i . . .
o I. ~ave and will.maintain Worker's .compensation insurance, as required by ~rection. 3700 of
the Labor Code, for the performance of.the work for which this permit is issue9.; ~yworker's
Compensation insurance carrier and-policy are: .
Carrier: Policy. Number.
ihi. section need not be completed.if the pennit is for one hundred dollars ($1 00) Or ress.
: I certifY that in the performance of the work for which,this permit is issued,'j shall not .
.ploy any person in any.mannerso as to become subject to the .worker's compensation laws
of Califomia, and agree that if I should become subject to the worker's compensation
provisi'onsaf Section'S700'of the La\=>or Cod I shall.forthwith comply with thos'~ provisions.
Date: 4/15/2005 . Applicant:
WARNING: FAILURE TO SECURE. ORKER' COMPENSATION COVERAOE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED lHO SAND DOLLARS ($100,000), IN ADDI1lON TO THE
COST.OF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3'106 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .
CONSTRUCTION LENDING AGENCY
I hereby affirm under. penalty of perjury that there is a construction lending ageflcyfor the
performance of the work for which this permit is isSued .(Sec.3097 .Civ .C): ' , .:,
lender's .Information:
__-.-.c.._..__..____.. .. __ . . . . 1 .-
j certify that I have read this application and state that the above information is. correct. I
agree to comply with all city ordinances and sl:atelaws relating tobu!lding construction, and
h reby authorize representives of this city to enter upon the above mentlo'ned property for
ectio , urp6se~.
NUMBER
EXPIRATION DATE
TYPE.
Construcion Tvpes:
VN, ,
Occupancy Groups:
R3" "
Uvinq Area: 485
--:
, . 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 permit is required fo commence or continue work.
Date: 4/15/2005
. F~s paid for Permit:
. Total: 1.665.30
.i
INSPECTION RECORD
.. . .
. . . INSPECTION , DATE . INSPECTOR
Temporary Power Pole . . .. .
Plumbing (Dl3inlWaste Pipe) .
Electrical Ground Electrode/uter. A
SelbacklFormsfTrenches (Footings) <; ~-b~
Do not install sub floor or pour floor slab unlTI the
following appiicable items have been signed: . .
Plumbing (Water Plpe.Sprinkler Valves) .
MechaniCal (Groull\lWOl'k)
Electrical (Underground Conduit) .4
Pre-slab (COmpaction/Membrane.Reint. ~;. ~.....<('
Underpinning (Floor -Joist/Girders)
Do not. cover or conceal the woll< below until the
following appiicable items have been signed:
1st Floor Shear . il!1~~ "f_~~c.A .
Firesprinkler (Rough) .
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frane) .tV'\"~ '\"
Masonry (ReinfJBond BeamlPre-Grout)
Rough Plumbing (Top Out) v'
Rough Mechanical I.... .
Rough f:l8Ctr II)
Rough Electrical IV . ...
Framing (Only after Plbg.; EJec.. Mech.:and Fire) ,,\,
Insulation (SoundlEnergy). . Iltll:l\,K. ~.;-'^ .
Do not tape or plaster .untilthe following applicable
items have been signed: ..
Drywall . f,
Penetrations (Fire Rated) Electrical . ,
Penetrations (Fire Rated) Mechanical.
Penetralions (Fire Raledl Plul11bing
Interior Lath . ... .._(I,n/,
exteriOr Lath
. GENERAL ITEMS. I'T,.. .
Exterior PiaSter (Brown Coal) , b-?C>t)j'
T .Bar Electrical
T.Bar Mechanical .
T.Bar Structu.ral .
Sewer
WalerEngineering Backflow . ..
Waler Service
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 76505126
Fire Dept. Final 765-4040
Waler Englneerinll765-5268
Sub List/Business License 765-519
Zoning 765-5139 .
Building Final. (Last Inspection- Only
After Above Completel
Date
Inspector
1J;(i!
PARTIAL INSPECTIONS.
Buildina Inspections
. Electrical Inspections
Mechanical Inspections
Plumbina Inspections.