1255 Piedmont Dr.
,..;
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714)765. 4626
CENSUS CODE: 434
QUARTER SECTION: 194
BUILDING PERMIT NO:' BLD2003-03377
TYPE OF PERMIT
Residential Remodel C I TV
DATE: 11/25/2003
JOB ADDRESS: 1255 N PIEDMONT DR
LEGAL DESCRIPTION: N TR 7422 LOT 48
APPLICANT: CHARLES CHAPIN
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
CHUCK CHAFIN MORTEZA OREIZY
1255 N Piedmont Dr 22885 SAVI RANCH PKWY #A
Anaheim, CA 92807 , YORBA LINDA, CA
. JOB DE~CRIPTIONStorage ~bove the existing attache~ garage.(built withqut r:'erT!lit; investigation inspection conduc.ted.)BlD2003-02378.
VALUATION: 8,000.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor':~ 'License law fo-r the following reason (Sec. 7031.5 Business and
. Professions Code: ,anycity,qr county which requires a permit to construct, a It(! r, 'improve, demolish or repair any structure, pri9rto its issuance, also
requireS the applicant for such permit to fite'a signed statement tha.t he is licel1~d pursuant to the,provisions of the Contractor's license law (Chapter.
9)(commencing with Section 7000 of pi vision 3 of the Business,and Professicns Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of.5ection 7031.5. by any applicant for a permit subj'3cro the applicant to a civil penalty of not more than five hundred dollars
~~~, '. '
D I, as 'owner of property, or my employees with wages as their sOle com~~risation,' will do the -work, and_ the structure is not intended' or offered for
sale (Sec. 7044 Busin.ess and Professions Code: The Contractor'sUcense l~'W does not apply to an owner of property who.builds or improv.es
thereon, and who does such'work himself or herself or through his or her o\',,~:~mployees, prQvided that such improvements are not intend~ or .
offered for sale. If, however, the'building or improvement is sold with one yet-r,of completion, the,owoer-builder will have t!1e burden of proving,that he
i!. .tbuild or improve for. the purpose of sale). .,. '. n, .'. " "
" I,: as" t, h~ owner of the property, am exdusively contracting with licensed (~c..ntractors to con,struct the project (S'ec. 7044 Busines, s and profe, ssions.
e:'.' Tlw Contractor's License Law does not apply to an owner of propertywfio builds or improves thereon, and who contracts for such' projects with
~ontractor(s~ licensed' pursuant to'the Contractor's License Law). .
U I am eXflmpt under Sec. ' .' . ,B & . " for this rea !'n:
Date: ,Owner:'
WORKER'S COM ENSATION DECLA ION
, hereby affirm uri,der penalty of pe~ury one ofthe following declarations:
D,' -I'have and will maintain a certificate ofronsentto self-insure for worker'b compensation,
as, provided for by Section '3700 of the labor Coete. for the performance of th~'" wQrk for whim'
this permit is' issued. . ,
o I have a~d-will maintain'worker's compensation insurance, as required ~/Section37000f
the Labor Cod'e', for. the. performance of the work' for which this permit is issu~.j. My worker's
Compensation inSurance carrier and policy are: . I
Carri~r: Policy Number: .
PROCESSED BY: CAL
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I all1
Iic~nsed under provisions of chapter: 9 (commencing
with Sectk:>n 7000) of Divsk:>n 3 ofthe Business and
Professions Code. . .
11/25/2003
Date:
Contractor
NUMBER
EXPIRATION DATE
This n need not be complete~ifthe pennit is for one t:lundred dollars ($10~' nt:.I.eS5.
I certify that in the performance of the work, for which this permit is issu~.J:..fshall not
e toy any person in any manner'so as to become subject.to the worker'sccnipensation laws
of California, and agree that: ifl should become subject to the worker's cOmf;:::i$ation
provisiohs.of Section 3700 of the Labor Code, hall forthwith comR ith tt))se provisions;
, ,
TYPE
Date:'11/25/2003 Applicant:
WARN ING: FAILURE TO SECURE WOR R'S COMPENSA
UNLAWFUL, AND SHALL SUBJECT AN' EMPLOYER TO CRI INAL PENAtTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDI"jlON TO THE,
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE'
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
, ,CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perj4ry that there isa construction lending,a,gtl6pyfor the
performance of the work for whim this permit is issued (Sec.3097 .Civ.C):;',~::2. .0..0:.:.:......:.,.... -_/~
lender's Information:
Construcion Types:
VN, "
Fire $prinklered? NO
I certify that I have read this application and s~te that the a,bove information i3 correct. I
agree to Comply with all city ordin'ances and state laws relating to bunding construction, and
hereby author' representives of thi citylo enter upon the above mentioned property for
inspection ses.
Date: 11/2512003
Fees paid for Permit:
Total, 464.68
ignature of A
The permit shall expire by r itation arid 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.
INSPECTION RECORD
INSPECTIOI> DATE INSPECTOR
, Temporary Power Pole ,
Plumbing (OrainlWaste. Pipe) "
Electrical Ground Electrode/Ufer ' ' ", "
SetbackiFormsfTrenches (Footings) , ,
Do not install subflooror pour floor slab until the ,
following, applicable ,items have been signed:
Plumbing (WaterPlpe.Sprinkler Valvlls) ,
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (C!lmpactionlMembrane.Reinf.
Underpinning (Floor Joist/Girders) ,
Do not covllr or conceal the work below unt,lthll "
followi~g applicable items have been signed: ,
1st Floor Shear"
Firesprinkler (Rough)
2nd Floor Shear , , , ,
Roof (Sheathing/Diaphragm/Framll) , ,
Masonry (ReinfJBond BeamlPre-Grout)
Rough Plumbing (Top Out) "
Rough Mechanical
Rough lZIectrlCaI (Dry Wall)
Rough Electrical' , , , ,
Framing (Only after Plbg., EJec.. f,,'lech.."and Fire)
Insulation (Sound/Energy) ,
Do not tape or plaster unti,l the following applicable
items have been signed: . . ,
Drywall ,
Poolllratlons (Fire Rated) Electrical "
Poolllrations (Fire Rated) Mechanical
Pooelrations (File Rated) Plumbing
Interior Lath , . ' , ,
Exterior Lath
, GENERAL ITEMS
Exterior Plaster (Brown Coat)
T -Bar Electrical
T.Bar Mechanical ' ,
T-Bar Structural
Sewer, ,
Water Engineering Backflow
Water Service
FINAL INSPECTIONS
Electrical. Final
Plumbing Final
Mllchanical Final
Gas Tllst
Engineering/Grading Final 765.0126
Date
Inspector
-; --.
'--;It
- 1.. 7- or-!
.It>~~'f ,1/~l::--
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-519
Zoning 765-5139
Building Final ILastlnspection- Only
, After Above Complete)
PARTIAL INSPECTI NS
Buildina Inspections
Mechanical Inspections
Plumbinqlnspections'
Electrical Inspections