181 S. Possum Hollow
<l.............
. . .
TYPE OF PERMIT
New Reslderltial ConstrlJction
CITY
~..._,
~.\-
f.;:i: .J>..:. ..-....
@tm j ",,,~,,,,~~;,.~t:m!1
~~: ,(;~f.~~'iV'~' ~~, .' ~
"';.~ ~. /.'~
L
)
BUILDI~GDi'JI$iOf~
20.0:8. ;\r~A,,~~j~~~~!_~'\rCl..'
(714} 795"~5r53-:'--'!"'...
INSPr:C1 iOt:.,J R::QUEST liNE:
17.14j7Q5.4626'
------.-
3l!ILDING PERMIT NO. ~\-D2'102,,03195
.
.. ~'"
. Di\ TE:1 0/28/2002 .
JOB ADDRESS: 1815 POSSUM HOLLOW
LEGAL DESCRIPTION: P BK 61PG 37 PAR 1
CENSU" CODE: .101
QUARTER 3,,0'1 tOft 202
APPLICANT: JAMES SiERN
OW~IER INFORMATION:,
. ., . j .
CONTRACTOR 1~,Jr:.of~i\-~/iC!(;f\J:
..f
ARCHITECT/E::NGJN~ER iNfC~RM/'.TION:
~j !< 18RAH'I;Vt .
PO BOX 16934
"I~V:NE, CA 9262~
.JAMES' STERN
181 S ,Pc-ssum.Hoh,y
.:\nal)eirn, CA,,92807 .
,~OB OESCRlPTtONNew684sf gl!est quarters-c'c'er 512sf gorage
I
I?
VALUATION: 67,452.00 ..1 PROCESSeD BY: CAL
C- .' .'.. .' . .. .......... . . OVmER-8UIL6si?p';(~tt.,~;\r;()r~ .. ...... .'. ..' ..... . .' I
"i:~er8bY'8.fLrm \ll1d~:H otJ{:nalty r)f perjt..p'v _~!l$.t j ,,:rrr t::<>2nlptfrornfh.e contracr'~';.I,:.;.r':cn~,)"-cd'N fc.i' the rol1owir;g .-eason ..(S~C: 10:51_' 5 Busrn'~~s ~nd ,._.-.._~
F.~0fi),s~it)P8,Gorle: any qty or'cGlJ:'ltY,w_hi(;!~ ;.z;-qUi!,eS ~l pernl;t to GOt!strL:et,' c!~.;"'" :i!~;;i(l"'.'J, d..;.ffiOHsh Dr repair .~!1Y st:~lchlre,_ prior ,toIt$!s~.'-'ar:t"e,'.atso
re<"1u-:res_tr-e_ :1~'pli~ntfor St:c:--:.pe'lTlii't0 file a ~;i9!'E:xj ~_tat,l:;!rr;6r.t th<:itilcls 'i~~r:~ed iJUr.Sli<ll'it ~o tHe p;'G\~:;lon'3 of ~he Conlr';JCi,;r's,Cj.;~'::n~"eLaw !Gh<-'lprer
'n){commn;::(;jr:,'::J\!Ji~_h S(-;Gt;r;n?'C;or;of Di\~sior. 3_:)f the 8usines,'$ a.r.d Prof-:;s~;\~';._3 C-c.r!.e; or.t:i:~,1 be IS eXE"il1pt .ther&from rmd_t.\l,e baslF, fl.:.-rtt-e alLeged,
,exenlptio Anyvio!c!tiollQf$et~ti0n 7031.5 ~y-ar:y applic<mt ior a,permit :..:l:~1.€..::;:'5 d~ea0p!::::'.:.:--I: {O a, d\o i! pen~ltj'.:;f nCJl rr:c.r;~ t:1:.H"f!Yet.!..!r:~r;,;:d',io!I:;I$
tS50L. " .'_' " . :' ' ....' . _' if.. . , , . _ . . _ _' :',' . . _':'
1",_(;1:'; oWIle:,r of pro perty , or my em:)loyz~s v~;th wages as the~r' sr.'~~ .::;cn1;::'r?r::;':'!tion, '.\'-;! '':0 th<='! work; _and .tile 5Trl.lcture,is'~~ot}ri($nd{'d :>,',orfe!~?:frlr
(Sec., 7044 Business ,a,nd Pr,ofessions Code: The Contractor's UCDIIse. 'Vi cc.:.:'..;;nc;t ~!:Jrl/ t.o (Om ,owner..:;f prop€_! ty wh,) bUIlds or i':l1 pro\les , . .
.8' .0n,;)!ld''J~ho d'o,="s s-ud)wqrk.hHflseif or hel'5Bltor through his (:f her O,Ai; : ',:mpIGve.",:<:; provided U1~~ suci~ irr.p!1:)'J(-)r~le:;ts qre ,not k::tcnC:l?fj' or , .
.: 0,fered far sale,:. If, 'tK,~..jev~r, t~a bUlidir,~' or i,rr:p~oV€:ij"!C(:l i"J so!dwith Oil:.:) Y':\tf,:Jf,?;;;,.,r)l'..:lic,n, [he tjwnl3r~bujlde1 .'will h...,'!c ~h<:i bur'de!.Ii)(:;rovir~f] tll,,;~'f:~
(.\;.! n')t b,:.Jj~dor Im!.:J(ovefor the purpose of sale),_ --. . . _.-)t _",:,': .. . :0... _ .' . ... ' ., .', _'.
LJ : I. 38',t.il~ 'owner of:the pfoperty,_arnexdusi'lely corr~r.-?ctin:J ':Nllh I;G~l"':~r:''':J~;:~:~~Jdc.<5.!C' f.c>m3lruct til~ pr':lject (~~f',c. f()44 8u;3:ir.0.'5s ,aj';ri F'n;;i.eSsi..H'!s '
GI)~e: 1 he Contr?c~c"'s UCBnse Law does not ap..... J to ~ wner o. p"U':;''':l;\,/''';!"~J vll"js (l~ : m;:;"ov,:;:s thereon, ~nd who con11~,ds F(), s~,cl-, P"f)}I:.(;f3 1.Ji1I~
;L'.:(f"llrccto.\s) lice'-I3~"Cl pUisuan~ to the C>?r,t.. 0..., L."~ sc LJ.W) i'.. .
u 1?iT'eX6~rtptt:i'deiSec. ,t3& J:'..J ,- c.. n: J---------.--.-----.--------~------~--
D.;:~e~_____. Owner: . _ _ _. ___j.;~;~:;.;...~_-.......;...-...:...--'.-~.~--- __ ._.___-___~..
,..,__~...-r.. .. ~ - --~- ... _.-~ - _..'f.. ,- ,--..-~..-.. ..- ~~._. . -.-.._.,.. ~_._-----.--..,.--.-~-
'.l;:.:___~____...._~...;..- ~'VORJ(~R'3 <;OMP ,iSl;T10N uECL.i~..B~.TI92.\. ~!L: ~::.....:..__~_.,.-:; '1 __i:.!~~NSED .COt,! rRAGT.QR~ _~.GLAf1AnON . _J
, I h-3rc~Y' :::!fit"l'fl uf!dAI p8:n~lty c'; perjury one <,f the fol1owbg d'3ciarations: i... r . j llere,b;.: arfi!'I11. w1der perc.llyof p::>:rjury tr.s.t. ! dr.
L.J ; hav~.ar;d _\:vlil maJntairl.:l.c_ertiflcatd.cfcofl:;-e!lt,tu self.-in~l;'r~ f9r.wo;-if":'.,~';C!:"'lp_=n:::.1t;'.)r:, 11l<-:.ell~erJ undel_ ;:'19vi:-;;0rl"3of.d:_~pi~r 9(,C0!~~i:-j~er.\,;''1~
a~, p:6\,jd~dfo( t,>Y: 0eCUOIJ 3ioo of tr3 Labor Code: rer the pe:f6r~an('B a"":1 ,\.",:.yr.::: f(.r 1.1LI:idl " ,::1(11 Se~tlo~ !OIJ0), bf Diysion 0 0: the 8~...,il1e"'':;;-'l"rJ
this pE::rmitisi$sued~ ' . . ~c' -:"1:)1%SIOIlS 'Axle
0_ I have and will m3ifi~fAjnwori<er'~ compensation ;i\Sur.3nce; 35 fP.:~u::>;;d .::i,~~Gn')1"j~700 o~ 1 10l2812(,02 _.....:--__~_~,~.~.~
. the -Lc.bDtC6ue,fQ" ti,ld performance of the werl::: for whiCh th,iS per!llit i:S.lf.s:.~::. M~''c'\,'orker'::; D<'Ite; Contr,J_c~ot
.Comoensat,ioninsur~n<::e_carriElr ahd policy are: ....'., -, . _ i1"_. '
Ca!rier:'. Pallc, Nun~b~~ '. ':,!. '! NUMBE8'
" I
This.!5 ' ticn n~ed.not be_ c,?mplete(j iftbe p'eiTi"litis for or:e hundreodollars {$1:)(~(~(-;4},~;'. TYPE:
. ! certify.that !D_thep~rfomlaflc~ of.the,workforv'ihit::h thisperll"it is iK~!~;,?~,}~:~JI:f'.t.J.-. .!.
to.y anyp.erson in-any m~nner so as to b{.;:Cbme.,sUbJe'~t te, ~e .!J~rker$ ('_:':t-i~,i;?~~H~n.18v~'~-I'
allf~HDla, and. agre~ th<;it If I should becQme s _;.~_to t!Ker S c::;':~:~:~~;:_;;~:$i. ': -:" 'i
provisic'1S of Section 3100 of the Labor Codt! .1 fo.rt J' somply 'JI/!ti _!_:i:;;,::i+,::.~visri';r.::;" I. (;ol1scrucion-Tvces;
. . ... . . '-:,' :<:~:~C 'j \j N;. "
Oet?: '10~2a/2002_. Applica~t: ,_ " .:.... -~.:""")i..:ii:::::_;;;:~_.;._:_-j Gccup8nsv OrotlllS:
\'vARN:NG:- FAILURE TO S~ClJREWOR ER'S CO:\rlPENSAT:'GN C'~.)"-15f:'~.'.(L~~:j:~~,',. I ~:3, U1:; ':.' '").
UN1 .A.W~Ul,.AND SHALL SU8'JECTA,"'vEMPLOYER TO CRiM,lt~AL PS:}!;',:~7~Er:-~:'~'\~-i[; CI'PL I "re ~pnr,k.ercd,
',F!NES,UPT0. ONE-HUNDRE!J" THOUSAND DOLLARS ($,100,000),- IN Ao~:/i':d~~~TCI_ tiE luv~F:ll;n!Cl tJn;v.,,;
: C()ST-OF' C:OMPENSATION, DAMAGES AS PROVPJED FOR iN SEGT'(;:.';.';:-7':;:;Ejr-' THE J LivinQ Area:
LA80RCODE,iNTERESTAND ATTORNEY'S FEES. . . '~'.'{:;'!. .' I Gar.ooArea
L. . . ...... .... . . CONSTRUCTiON LEt;:)iNG. AGEi~G'{ -..:',......}?~2.:I]. .' -1. .
I,h'ero:;-oy affirm :under p~naay-ot perjury that th8fe is a construction i.2jldi'1'Jc~;;:~,i~\;;:'i~\~::tQ~-:-"',::' ",1 '
",Z~;.?;;~:;,'1.;'~cl~.~,~J~r~ for Wh:"2:h;:.>.e'rn;ti?:~slled(Sec.289~Civc}.;.~ ."'. 'f'" .C;" .;.~
EXPIRATiON- DArE
NO
1
064
. ;372
~,,.'.'
. .
I certifY t~at.1 have read t~js application a'!1dstat~ that the"above informatioh IS correct. I
agree to,CO..r:n!:'IY with an city 6rdinan~es. ~.?t s~ate lawf> .r~lat.ing to b~ilding const~.Jction" and
hereby authorize representi ,of thi , Wto enter upqn the above-mentionea (::roperty Jor
'irispect'ibn purpose:s,
F~es paid-for P'ermit:
Totai: .
-
D'te: 1012812002
1.398.29
Sign re'of pplicant or Agen,t
The permitsh~1I e pir". by. limitation and become null and void ifthe building or .
work.has not pasSed final inspection 365 days fr~ the date of permit issuance. A
. new permit is r~quired to'coinmence-or continue wo~k. . '
, "INSPeCTION RECORD
.. ,INSPECliON ''I' , ," , ,INSPE{;TOR '."
'"'-, ,'", , DATE ',c'
TemporaryPOlNer Pole ' " ,
Plu,mbi ng (PrainlWastePipe) '. , , ' " I,
Electrical GroundElectrodelUflu, , , , "
SetbackiFormsrrrenches (Footings) , . .. ,
" Po not install subfloor or pour floor slab unti I,the " ,
foHo~ing, ,qpplicabfe"items have,beed.signed: ' ,
Plumbing (Watet'Pipe.Sprinkler Valves) , "
Mechanical (Groul1dwork)' , i '
" Ek!ctrical(Undergrollnd Conduit) , ' ,. '.'
Pre-Slab(Coinpaction(M~brane.Rei nf. , , "
Underpinning (Floor Joist/Girders) , ' ", "',' " I'
, Po not cover or conceal the work belOW untli the I',',
following appJi<;able.iterns, ha~e been signed:, ' ,,'
1511'1000' Shear, .".' .' , ", , , "
" ",
,... Firesprinklel'(Rough). " ", . , , , ",' ,
2nd Floor Shear, , '. ", ,,' /I tlL '!/L ' ,'"
," I',
Roof (Sheath ing/Diaphragrn'Frame) ,fj,7'. YI. - "
I
MasOnry (ReinfJBondBeamlPre.Grout) , . , ,
Rough Plumbing (Top Out) . "
" Rough Mechanical . . " " i " ,
. RoUiJh t:Iectrtl',a1 '....ynalll '.," " " ,," ,
Rough Elel'tril'al : 'A ' I
" Fraining (Only, after Plbg, Ele, Mech andf"lrel V#-t'J), XI~/~
Insulation (Sou nd/Energy) ,~ "S.'.:? I,
" f Ja." ,
Do not tape or plaster ,until the following applicable ',' "
items,have !leen signed:' ,,' ", " ' , i>
. Drywall, ' i" ,," . " "Ji". . {{,2:> (J,4..;, , '
"
, Penetrations-(Fire Rated) Electrical", ' ," , , , ,
, Penetrations (Fire Rated) Mechanical , ,,' '.' .',.
Pef)etrations(Fire Rated) Plumbing ,',' , " " ,
Interior Lath', " , , '" , '. ' ,', I,
, Exterior Lath' , ,',' ,', " , " '" 11-0"', / .. ;u(.., '
, ,,', . ' ".. ",'", GENERALlTEMS'-i',' "
ExteriOl' Plaster (BroWn Coal) ", "] :J}fh or " " ,,: ~ ' , .
T-Bar Electrical ',,' ' ' , " ',',', .'
T-BarMechanical " " ',' ,
T-Bar Structur"lI ' , " " ,
Sewer- . ", " , " , " , .' ",..
, Waler Engineering Backflow , " " , ,'.,
,
Water Se-rvice " '. , ' ' , ','
, " ' "
FINAL INSPECTIONS- ','
Electrical FinCiI '.
PlUmbing Final
M~chani;'-al Final'
Gas Test
Engil1lleringlGr3dingFinaI765~126,
Fir~ Pept. Final 765-4040
WaterEngine~'ing 76~-526'8 '
.sub USt'llusines,s L.icense 765"519
Zoning 765"5139 "
Building FinaliLast Inspe~tion- Only
, , " .After Above Complete)"
',P MTIAI..1NSPECTIONS
,Buildina "Inspections
Date"
.,.
.~
Me~hanical"Ii1spections
...c,
Plumbirll11nspections
ElectricallnspeCtiorls
"
/
MECHANICAL PERMIT NO.
MEC2001-00510
--------- .
/"" ' "
/"P,., ",~
cl,jt;i~cF ;~~~AH ElM
~~!~~!1G~/
BUILDING DIVISION
200 S, ANAHEIM BLVD__
(714) 765 - 5153
INSPECTION REQUEST U NE:
(714) 765 - 4626
QUARTER SECTION: 202
TYPE OF PERMIT
Other
DATE: 05/1012001
JOB ADDRESS: 181 S POSSUM HOLLOW
LEGAL DESCRIPTION: P BK 61 PG 37 PAR 1
APPLICANT:
OWNER INFORMATION:
David Vandaele
181 S Possum,Holw
Anaheim, CA 92808
Jps DESCRIPTION: Renewal of expired permit # 65980,
CONTRACTOR INFORMATION:
ARCHITECT/ENGINEER INFORMATION:
'-
E' OWNER-BUILDf:R DECLARATION
I"'herebyafflrm under penalty of perjury that I am exempt from the Contrartor 5 License law or t e 0 lowing reason ( ec. 7 .5 usiness an
Professions Code: any city or county which requires a penni! to construct! alter, improve, demolish or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that he is~icensed pursuant to the provisions of the Contractor's Ucense Law
(Chapter 9)(commencjng with Sedion 7000 of Division 3 of the Business :md 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~-: permit subjects the applicant to a civil penalty of not more than five
hundred liars ($500),
PROCESSED BY: CAL
, as owner of property, or my employees with wages as their sole co'npensation, will do the work, and the structure is not intended or offered
sale (Sec. 7044 Business and Professions Code: The Contractor's U:ense law does not apply to an owner of property who builds or improves
eon, and who does such work himself or herself or through his or her )wn employees, provided that surn improvements are not intended or
offered for sale. If, however, the building or improvement is sold with on€;year of completion, the owner-builder will have the burden of proving that
he did not build or improve for the purpose of sale).
n I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and
Professions Code: The Contractor's license Law does not apply to an ov.:ner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's li(:ense law).
o I am exempt under See, , B & P,C, for this reason: ' .
Date: OWner:
WORKER'S COMP NSATION D LARATION
, hereby affirm under penalty of perjury one of the follOWing declarations:
o I have.and will maintain a certificate of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the labor Code, for the performance 0)< the work for which
this permit is issued.
n I have and will maintain worker's compensation insurance, as required by Section 3700
OT"the Labor Code, for the performance of the work for which this permit is issued. My
worker's Compensation insurance carrier and policy are:
Carrier: Policy Number:
LICENSED CONTRACTORS DECLARATION
J hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Sedion 7000) of Divsion 3 of the Business and
Professions Code.
Date: 05/1012001 Contractor
NUMBER: EXPIRATION DATE:
This section need not be completed if the pennit is for one hundred dolalS ($100) or less.
o I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become SUbject to the worker's compensation
laws of California, and agree that if! should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I shah forthwith comply with those provisions.
TYPE:
Date: 05110/2001 Applicant:
WARNING: FAILURE TO SECURE \M)RKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100.000), IN ADDITION TO
; THE COST OF COMPENSATioN, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF
, THE LABOR CODE, INTERESTMAND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY.
Items
Compressor to 3 Hp
Residential Registers
Heating I Cooling Coils
HVAC up to 100,000 BTU
Vents under 300 (dryer, range, etc)
1
2
1
1
1
" f hereby affirm under penalty of perjury that thE(e is a constru . n lending agency for the
performance of the work for which this permit i~ issued (Sec.3097 .Civ. C):
." Lender's InformatloD.:........ ______. .. .,. .-.......it:,
I certify that J have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby authorize representives of this city to enter upon the above mentioned property for
inspection purposes.
~ ~) ~.}~ ~ Date: 05/10/2001
,. f'.Y~~
/ tgnature 0 pplicant or gent
The permit shall expire by limitation and become null and void ifthe building or
work has not passed final inspection 365 days from the date of permit Issuance. A
new oennit Is reaulred to commence or continue work.
r-ees palo Tor t"ermlt:
Total:
55.23
, I
'j
. INSPECTION RECORD
-
, , INSPECTION DATE. INSPECTOR
Temporary Power Pole .
Plumbi ng (Drain/Waste Pipe)
Electrical Ground Electrode/lifer
SetbacklFormsrrrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Plpe.Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane.Rei nf.
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work belOW until tne
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (ReinfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough 8ectrical (Dry Wall)
Rough Electrical
Framing (On~ after Plbg" 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 (Brown Coal)
T -Bar Electrical
T.Bar Mechanical
T .Bar Structural
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS Date Inspector
Electrical Final
Plumbing Final . .
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 .
Building Final ~ast Inspection. Only
fter Above Complete)
.
PARTIAL INSPECTIONS
;- Buildina InsDections
MechanicallnsDections
Plumbina InsDections
ElectricallnsDections
~~.
,
.
.
"
PERMIT NUMBER
'.' 65980
TYPE OF PERMIT
MECHANICAL PERMIT
DATE PLAN TRACK #
08/24/98
JOB ADDRESS
181 S POSSUM HOLLOW
LEGAL DESCRIPTION
P BK 61 P6 37 PAR 1
OCCUPANCY
TYPE CONST.
DWELLING UNIT(S)
GARAGE AREA
CENSUS CODE
ZONE
OWNER
OAr';;KSDALE.
ADDRESS
f':.INTHONY W
CITY
ANAHEIM
PHONE
STATE
CA
APPLlCfl,NT
VAN ,DAELE/C.S. 1.
CONTRACTOR
CONTRACTING SPECIALTIES,
ADDRESS
4091 E
CITY
ANAHEIM
PHONE
(714}630-1460
ARCHITECT/ENGINEER
LA PALMA
AVE
STATE
CA
CITY LICENSE #
48721
ADDRESS
CITY
STATE
. PHONE CALIF. REG. #
JOB DESCRIPTION
ADDITION PERMIT 47940
VALUATION PRIOR BLDG. USE
ITEM
ISSUANCE FEE
HEAT APPL.<100K BiU
RESIDENT REG. (EA.)
COMPRESSOR UP TO 3HP
HEATING/COOLING COIL
VENr. FAN < 300 CFr1
# OF STORIES
SO. FT.
ZIP CODE
92807
LNC
ZIP CODE
92807
ZIP CODE
BiI,
B4
B4
B4
B4
B4
QUANTITY
1
1
.,
..
1
1
1
TOTAL FEES
BUILDING DIVISION ,J',(
200 S:ANAHEIM BLVD,,'-
,(714~.:;r/.>~-51~:3 ','
, c.. " ....-Jt
CITY OF ANAHEIM INSPECTION REQQEST LINE
(714) 765':":H6-,
To obtain this permit, the undersigned hereby files this application and agr~is, certifies
and declares: That notice has been given me that this permit may be used only in
compliance with the Anaheim Municipal Code, and all other applicable ordinances and laws.
That this permit does not allow occupancy, and that no occupancy is permitted, of
the construction tor which this permit is issued until it has peen approved in writing by
this office for .occupancyafter final inspection.
That this permit does not allow, and separate permits are required for, any plumbing,
electrical, heating and air conditioning work. , .' .
as That a double fee will be paid for any permit issued after any work thereby allowed
has been commenced.
2d 2 \ agree that the City may enter upon theiob premises at any reasonable time to inspect
any work installed under this permit, and to otherwise act as and when required by the
Anaheim Municipal Code.
OWNER-BUILDER DECLARATION .
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License
Law for the following reason (Sec. 7031.5 Business and Professions Code: any city or
county' which requires a permit to construct, alter, improve, demolish or repair, any
structure, prior to its issuance, also requires the applicant for such permit to file a signed
statement that he is licensed pursuant to the provisions of the Contractor's UcenseLaw
(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. AnYNiolation
of Section 7031.5 by any applicant for a permit subjects .the applicant to~ civil penalty
of not more than five hundred dollars ($500).
o I, as owner of property, or my employees with wages as their sole compensation, will
do the work; and the structure is not intended or offere,d for sale (Sec. 7044 Business
and Professions Code: The Contractor's License Law does not apply to an owner' of
property who builds or improves thereon, and who does such work himself or herself or
,,-,,through his or her,own employees, provided that sl)ch improvements are not intended or.
. offered farsal.e. If, ,however; the building or impro\(ement is sold within one; year:: of-,
,1'completion, the owner-builder will have the burden'of proving that he did,not build or
improve for the purpose of sale).'' . '" "', ,.'
o I, as the owner of the property,am exclusively contracting with licensed contractors
to:construct the project (Sec. 7044 Business and Professions Code:: The Contractor's
;,,:License Lawdoes not apply to an owner' of property who builds or improves thereon, and
'~:}who cO(1tracts for such projects with a contractor(s) licensed pursuantto the Contractor's
..lice~se Law);
:.' . .., LICENSED CONTRACTORS DECLARATION . '_
,Ih'ereby, affirm under penalty of perjury 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.. .
'~enseC\assf'BC. Lie. Numbedb76753 Exp. Dat~ /30./i:f':;'
. Contractor
WORKERS' COMPENSATION DECLARATION
, hereby affirm under penalty of perjury one of the following declarations: .\ ,.
D... r have, and will. maintain a certificate. of consent to self-insure for worKer's
CPffipensatiOJ"l' ~s provided for by Section 3700 of the Labor Code, for th~ perf?rman~
of the. work.for whicr this permit is issued. . '. . ,".. ...':'
XO"ihave and will maintain worker's compensation insurance, as required by Section 3700
of the Labor Code, for' the performance of the work for which .this permit is issued. My
:,workers' compensation insurance carrier and policy number ?re: .
, Ca,de, UN teAR!! INS.
~liCy NlimberSA500"7951280
(This section need, not be completed if the':permit is for one hundred dollars1$.100)' or '
less). .,..... . .,.' .' ..... "''\-'''''v-'''
, I, certify that in the performance of the work for. which this permit is issued, I shall
notemploy:any p,erson 'in any manner so as to become $lJbiect to the workers'
c,O\TIpensationlaws of California, and agree that if I should become subject. to the 'workers'
compensationprov;isions of Section 3700 of the Labor Code, I shall forthwith comply with
those .provisions. . . , ~., . -:
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, of persons,r~sulting from
Work or activities undertaken pursuant to this permit.
'WARN'ING:. . FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS
UNLAWFUL, AND.SHALL SUBJECT AN EMPLOYER TO CRIMINAL-PENALTIES AND
CIVIL FINES UP TO ONE 'HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION
TOTHE,COST OF COMPENSATION, DAMAGES 'AS PROVIDED FOR IN SECTION 3706
qFiWE L,ABOR CODE, INTEREST,AND ATTO~NEY'S FEES. .
':' :.,',,' .' 'CQNSTRUCTlONLENDING AGENCY" , . ..
I hereby affirm under penalty of perjury that there is a construction lending agency for
th.e~'t?erformance oftge,..vQrkforwhich this permit is issUed (Sec. 3097~Civ.C):
Lend'er's Name
Lender's Address
fce'rtJfY thatl have reacfltiTsapp!".cauon anastate'that'tnea.E:iOYe~infor'maliol1lS 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.
. THE PERMIT SHALL EXPIRE BY LIMITATION AND BECOME NULL AND VOID
IF THIS WORK IS NOT COMMENCED OR SUSPENDED AFTER A PERIOD OF
".{;!;',DAYS NEW PERMIT IS REQUIRED TO COMMENCE WORK
BY ~~~~E~ ?Jht~J'
---...."'''''-.,
FNELSO
FEE
20.00
12.00
6.00
12..00
a.OO
7.00
CASHIER VALIDATION ONLy
$ 65.00
'I'
~L
PARTIAL INSPECTIONS
BuildinQ Inspections
Mechanicallnsoections
PJumbinQ Inspections
Electrical Inspections
.
.
"
.
,
INSPECTION RECORD
Type of Inspection
Inspector
Date
Plumbing (Drain/Waste Pipe)
Electrical Ground EJectrode/Ufer
Setback/Forms/Trenches (Footings)
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Pre-slab (Compaction/Membrane/Reinf.)
Underpinning (Floor Joist/Girders)
1st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mech.
Rough Elect. Walls
Rough Electrical
Framing (Only after Plbg., Elee., Mech., and Fire)
Insulation (Sound/Energy)
Drywall
Interior Lath
Exterior Lath
GENERAL ITEMS
Ext. Plaster (Brown Coat)
Permanent Electrical Pole
Construction Pole Service
T-Bar Electrical
T-Bar MeChanical
T-Bar Structural
Sewer
Water Service
Electrical Final
Plumbing Final
Mechanical Finat
Gas Test
En"gineering/Grading Final 765-5125 .
Fire Dept Final 765-4040
Water Engineering 765-5266
Sub List/Business License 765-5194
Zoning 765-5139
Building Final (Last Inspection)
.;
PERM\1 EXPR\EO.
\NSPEC1\ON
N01 COMPlE1EO~
-
.--------=
QA 1E: -
PLUMBING PERMIT NO. PLM2001-00741
~...-',f
TYPE OF PERMIT
_/'C;;~T-;'1 _-~'::.
Clnf~~~HEIM
\<~i2g/
DATE: 05/10/2001
JOB ADDRESS: 181 S POSSUM HOLLOW
LEGAL DESCRIPTION: P BK 61 PG 37 PAR 1
APPLICANT:
OWNER INFORMATION:
CONTRACTOR INFORMATION:
David Vandaele
181 S Possum Holw
Anaheim, CA 92808
JOB DESCRIPTION: Renewal permits. 65979.
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
INSPECTION REQUEST LINE:
(714) 765 .4626
QUARTER SEC1l0N: 202
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: CAL
OWNER-BUILDFR DECLARATION
ere ya Ifm u er pena yo perjUry t at I am exempt rom t e on tractor's icense aw or t e ollowing reason ( ec. 70 .5 us ness an
Professions Code: any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that he is,licensed pursuant to the prOvisions of the Contractor's License law
(Chapter 9)(commencing with Section 7000 of Division 3 of the Business ~nd 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 SUbjects the applicant to a civil penalty of not more than five
hundred dollars ($500).
~s owner of property, or my employees with wages as their sole' compensation, will do the work, and the structure is not intended or offered
Ie (Sec. 7044 Business and Professions Code; The Contractor's U;ense Law does not apply to an owner of property who builds or improves
eon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not intended or
offered for sa\e. If, however, the building or improvement is sok:f with one year of completion, the owner~builder will have the burden of proving that
he did not build or improve for the purpose of sale).
n I, as the owner of the property, am exclusively contracting with licen'~;ed contractors to construct the project (Sec. 7044 Business. and
profeSSions Code: The Contractor's license Law does not apply to anm:vner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's l:..icense law).
o I am exempt under Sec. , B & P .C. for this reaso .
Date: Owner:
WORKER'S COM ENS
I hereby.affirm under penalty of perjury one of the following declarati~:ms:
o I have and will maintain a certificate of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work. for which
this permit is issued.
n I ha\le and will maintain worker's oompensation insurance, as required by Section 3700
Of'the Labor Code, for the performance of the work for which this permit is issued. My
worker's Compensation insurance carrier and policy are:
CalTier: Policy Number:
Thisseetion need not be completed If the permit IsforOJ1e hundred dolars ($1tlO) or less.
o 'certify that in the performance of the work for which this permit is is~ued, I shall not
employ any person in any manner so as to become subject to the worker's compensation
laws of California, and agree that if I should become SUbject to the worker's compensation
provisions of Section 3700 of the Labor Code, I shall forthwith'complywith those provisions.
Date: 05/10/2001 Applicant:
WARNING: FAILURE TO SECURE V\.ORKER.S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO
THE COST OF COMPENSATION. DAMAGES AS PROVIDEO FOR IN SECTION 3706 OF
THE LABOR CODE, INTEREST AND ATTORNEYS FEES.
CON TRUCTION LENDING A ENCY
I hereby affirm under penalty of perjury that there is a construction lenciin~ agency for the
performance ofthe work for which this permit is issued ($ec.3097.Civ.C):
lend~ts!nfonn2ljon: J
I certify that I have read this application and state that the above information is correct. t
agree to comply with all city ordinances and state laws relatjng to building construction, and
hereby authorize representives of this city to enter upon the above mentioned property for
inspection purposes.
~ . /!!- /f7~ Date: 05/1012001
,. / ... / /64~~ature~Y~nt
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 pennit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
ere y a Irm un er pena y 0 perjUry t a am
licensed under provisions of chapter 9 (commenCing
with sedion 7000) of Divsion 3 of the Business and
Professions Code.
Date:
05/1 012001
NUMBER:
Contractor
EXPIRATION DATE:
TYPE:
ITEMS
Garbage Disposal
Shower
Water Heater
Lavatory
Kitchen Sink
Bath Tub
Water DistributIon (mod. existing)
Water Main
1
1
1
1
1
1
1
1
PriV'Ci:te Ga.NQ~e C;spoSdI
,
t'ees palQ Tor t"emm:
Total:
74.71
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormsfTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane.Reinf.
Underpinning (Roor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear .
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (ReinfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry.Wall) ,
Rough Electrical
Framing (Only affer Plbg., Elec., Mech., and Fire)
Insulation (SoundlEnergy)
Do not tape or plaster untillhe 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 (Brown Coat)
T -Bar Electrical
T-Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS Date, 'v l!)Spector
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040 .
Water Engineering 765-5268
Sub LisllBusiness License 765-519
Zoning 765-5139
Building Final ~ast Inspection- Only
fler Above Complete)
PARTIAL INSPECTIONS
. Buildinq Inspections
Mechanical Inspections
Plumbinq Inspections
Electrical Inspections
,
"
"
.,
"\.
DATE PLAN TRACK #
:i8/24/98
JOB ADDRESS
181 S POSSW1 HOLLO,,)
LEGAL DESCRIPTION
0> BI< 61 PO 37 F'AR 1
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714).76'.;H5153 .
INSPECTION REOUEST LI"'E
(14) 765-5161
CITY OF ANAHEIM
OS
202
"
To obtain this permit, the undersigned' hereby files this application and agrees, certifies
and declares: That notice has peen given me that this permit may be us.ed only in
compliance with the Anaheim Munidpat Code, and aU other applicable ordinances and laws.
That this permit does not allow occupancy, and'.fhat no occupancy is permitted, of
the construction for which this permit is issued until it has been approVed in writing by
this office for occupancy after final inspection. . .
That this permit does not a\lOlN, and separate permits are required for, any plumbing,
electrical, heating and air conditioning work.
That a double fee will be paid for any permit issued after any work thereby aHowed
has been commenced.
I agree that the City may enter upon the job premises at any reasonable time to inspect
any work installed under this permit, and to otherwise act. as and when required by the
Anaheim Municipal Code.
OWNER~BUILDER DECLARATION
I hereby affJrm 'under penalty of perjury that 1 am exempt from the Contractor's License
Law for the, following reason ($ec:7031.5 Business and Professions Code; any'citY,'or
county which requires a permit to construct, alter, improve, demolish or repair, any
structure, prior to its issuance, also requires the applicant for such permit to file a signed
statement that he is licensed 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 SUbjects the applicant to a civil penalty
of not more than five hundred dollars ($500).
o I, as owner of property,' or my employees with wages as their sole compensation, will
do thenwork, and the structure is not Jntended or offered for sale (Sec. 7044 Business
and Professions Code: The Contractor's license law does not apply to an owner. of
property who builds or improves thereon, and who does such work himself or herself .or
through his or her own employees, provided that such improvements are not. intended or
offered-for sale. If, however, the building or improvement is sold within One year: of
completion, the owner-builder will have the burden of proving that he did not build or
improve for the purpose of sale}. '
o I, as the owner of the property, am eXClusively contracting with licensed contraclors
to construct the project (Sec. 7044 Business and Professions Code: The Contractor's
License Law does not apply to an owner, of property who builds or improves thereon~ and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
license Law).
, " . LICENSED CONTRACTORS DECLARATION .
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter '
9 (commencing with ' Section 7000) of Division 3 of the Business and Professions C6de,
and my license is in full force and effect.
Licen~e Class ABC Lic. Number6 7 6 753 Exp. D~t&' I::tO /99. '.
Contractor
OCCUPANCY TYPE CONST. # OF STORIES
DWELLING UNITIS) GARAGE AREA SO. FT.
CENSUS CODE ZONE
OWNER
OIARKSDALE, ANTH'oNY w
ADDRESS .,
CITY STATE ZIP CODE
'lNAHE: IM CA 92807 .] "
PHONE
PERMIT NUMBER
65979,0
TYPE OF PERMIT
PLUMBING F'ERl'llT
APPLICANT
~AN PAELE/C.S.I.
CONTRACTOR
;ONTRACTING SPECIALTIES,
ADD~~SS
~091 E
CITY'
'lNAHEIM
PHONE
(714)630-1460
ARCHITECT [ENGINEER
LA PALMA AVE
STATE
CA
CITY LICENSE"
48721
ADDRESS
CITY
STATE
PHONE
CALIF. REG. #
JOB DESCRIPTION
~DDITION PERMIT 47940
VALUATION
PRIOR BLDG. USE
ITEM
ISSUlNG FEE 82
SA THTUe B2
,HOWER B2
_AVA TORY 82
<ITCHEN SINK B2
3AHBAGE D I SPOSEf~ B2
~ATER HEATER 82
~ArER DIST.SYS.(EXISTlB2
~ATER MAIN 1ST 100' 82
~RIVATE SEWAGER Bye. 82
IN!::
ZIP CODE
92807
ZIP CODE
OUANTITY
1
1
1
1
1
... .1
1
1
1
1
FNELSO
FEE
20.00
7.00
7.00
l.OO
7.00
7.00
7.00
7.00
7.00
40.00
TOTAL FEES
$ 116.00
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o ' I ,have and will maintain a certificate of consent to self-insure for worker's
compensation, as proVided for by'Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued. .
Xo I have and will maintain worker's compensation insurance, as required by Sectlon,3700
of the Labor Code, for the performance of the work for which this permit is issued.. My
workers' compensation insurance carrier and policy number are:
Carder UNICARE INS.
Policy Numbe,sA5007951280
(This section need not be completed if the permit is fer one hundred dollars ($NO) or
les$).
I certify that in the performance of the work for which this permit is issued, I shall
not 'employ any person in any manner so as to become SUbject to the workers'
compensation laws of CalJfornia, and agree that if I should become SUbject to the workers'
comperisation prOVisions of Section' 3700 of the Labor Code, I shall forthwith comply with
those prOVisions.
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 perso(l, of persons, resulting from
work or activities undertaken pursuant to this permit.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL' PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION
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 perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097.Civ.C):
Lender's Name
Lender's Address
- -'--h:ertifY;hi:lt ffiave .reaalhfs"appflCirtion ana state that 'fheaboVe' informationis-doriect-
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 abO\le mentioned
property for inspection purposes.
THE PERMIT SHALL EXPIRE BY LIMITATION AND BECOME NULL AND VOID
IF THIS WORK IS NOT COMMENCED OR SUSPENDED AFTER A PERIOD OF
. :.6-::;-DAYS NEW PERMIT. IS REQUIRED TO COMMENCE WORK
BY fJ:iN;i4!: o/~:i~
CASHIER VALIDATION ONLY
\
PARTIAL INSPECTIONS
Building Inspections
Mechanica/lnsoections
Plumbing Inspections
Electrical Inspections
,
If.."
INSPECTION RECORD
Type of Inspection
Oate
Inspector
Plumbing (Drain/Waste Pipe) .
Electrical Ground Electrode/Uter
Setback/Forms/Trenches (Footings)
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Pre-slab (Compaction/Membrane/Reinf.) ..
Underpinning (Floor Joist/Girders)
1st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reinf./8ond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mech.
Rough Elect. Walls
Rough Electrical
Framing (Only after Plbg., Elee., Mech" and Fire)
Insulation (Sound/Energy)
Drywall
Interior Lath .
Exterior Lath
GENERAL ITEMS
Ext. Plaster (Brown Coat)
Permanent Electrical Pole .
Construction Pole Service
T-Bar Electrical
T-Bar Mechanical
T -Bar Structural
Sewer
Water Service .
Electrical Final
Plumbing Final
Mechanical Finar
Gas Test
Engineering/Grading Final 765-5125
Fire Dept. Final 765-4040
\Nater Engineering 765.5266
Sub List/Business License 765-5194
Zoning 765-5139
Building Final (Last Inspection)
r(~~i;(~~\~~:'
NO\ COM?lt.\ t:.D
DfA1t.'. ------