209 N. Siesta St.
-ct.._ '
BUILDING PERMIT NO. BLD21105-00432
TYPE OF PERMIT
Residential Remodel
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CITY. QtIiJj~Ni\H EI M
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BUILDING DIVISION
200 S. ANAHEIM BLVD
(714)765- 5153
INSPECTION REQUEST LINE:
("114) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 32
DATE: 2/18/2005
JOB ADDRESS: 209 N SIESTA 5T
.LEGAL DESCRIPTION: N TR2625 LOT 31
APPLICANT: SCOTT POLAND
..OWNER INFORMATION:
Jean L Lurton
209N Siesla 51
Anaheim, CA 92801
CONTRACTOR INFORMATlm;:
J R POLAND CONSTR,)STION INC
4195 CHINO HILLS "'KWY~138
CHINO HILLS, CA 91;'O~'OOOO
BUSINESS PHONE: 909 '\:$1-8040
ARCHITECm,NGINEER INFORMATION:
JOB DESCRIPTION: Remodel 2 bathrooms
VALUATION: . 5,000.00" .' PROCESSED BY: JNJ " .
L '. , OWNER:BUI~[)!j~ DECLARATiON . ---- _ . .
I her~by afflrm under penalty of perjury that: am exempt from the Contra{;;:.~r'c. License Law for the follo....vir:g reason (Se<':.,7031.58L!siness and
Professions Code: 'any city or' ccuntywhich requlres a perm;t to construct, p.:'iter. improve, demolish or repairaf"lY 5tructure, prior to its issuC:lnce, also
requires the appiicant for such permit to ftie a signed statemer,t that he is !(:t~n:k"!d p;Jrsuant to the provisions of lhe Contractor's.Uceri;se Law(Ct'apter
9)(c~rT1menting with Section 7000 of Division 3 of tile 8us;!,".ess uiid Profes~:cns COde) or that he is exernpt thei-efrom and ~.hG'bas:s for the Iqlleged
e~E.:mption. Any Vlolation of Section 7031.5 by any appiicant rer <> permit Sl::bjectstb<? applicant .to a civil penalty of not merE; than five hundred dollars
~~. . ~ , .
o ~,us o'..~ner <;)f proJjerty, orrny employees with: wages as their sole C~):"Ft(;5-nSc?tion, \-viii do the work, and the stn'~~tlJre ic: OIl')t _intE::ild ed ol.offered for
sale '(Soec. 7044 pusiness <'\nd Professione Cod",,: The Contractor's L!cens'ftaw doe"not'FlPply to an owner of property who builds or improves
thereon. and whp does surh work himse!fcr herself or through his or ,l€;:r f;,':'/r"t ernp!cyee::-, pmvided tr.at ~Lich_!mpro....~rnepts are.not intended or
offered for &-~I~. If, however,' the building or !mpro'lE'ment is sold V'Ji~~ GilE:.i-';;:3:-:)f r.ompletion. the owner-bL';!de~ \-"li~l !lava tile burden of proving that he
. dId notbui!d or imwov~for tl~e PI/!i.)("5e of sale). .,). .
LJ .:, as ~he,ov.:ner c,Tthe prope~.ty, <:l,TI cxdusively COilticlctir:~ with :;:~sns?\~ OJ!1tr'JCl:(:rG ~c c~:1struct the projf:rct (Sec. i'C'44 Business :=In.!:! Profess'ji)'ns
Code: The Contractor's License L;3wdoes flat ~pp!y to an Gw(\er of p"cj}i;:(;/...vr.:) bu!],:~~ or improve':> therecn, 3n1 who Q"Jnt~acts for sur;, projects_with
oontractQi(S) Jb~nsed pursuant to 1he Cc Iltractur's l !cp.~:-;e U"lw). '~'i'
l-arn ~xempt under Sec. "___ ,8 &. P.C., for this reasc.n: '-."0-- .
Date: OINner:
L:-=---=--WORKER'S CCMPENSllo.TlON DF_CLAR~TI(:~J~J--= , ~ -.J [~~~c6:,ri~c~?RS-;;ECLARATION~
I hereby qffirm under penalty of pe~ji.lry one of the iQHow:n~ deciarai.ion$:';{- "I I hereby aiU, '1'! L.:nder penalty of perjury i.h:Jt I fj;TI
[J I have and wlil maintain 2 CG[tifi6at0 of oonsent to sel~-inSl;rE: fOi \j'!(.,;i~i.+'Z C0mpS:13ation. ' li~en::ed :~mier prr.:v;,&!cI~~Jf ha (c ~r'HneilGinu
as. p.cvi"e. d.,for by Section 3700 CN,!l~,i.abor Cod?, for the petfl)(i'Pa:,Ge 0tl',il~ war}; fOi W, hld1 I'with ~,ectlo.)(l 7000) of [; .slne~s. and
.D',O',AL''::;i.^'.'.< co,_~~~.
%nrfi1!t ~s issued. .;' . -"'~ -... -
, hove anci wm tnail1tclir: worker's c:pniPe~atian inSl..iranCe, a;; re(ju1~d hi 8GcIion3/OG af, 2i181200f~'
the Labor Code, fN Hle perfor~arice of 'the work fer which thi') pem1i! !~. i3::_:,ed.' My.....orker.s I Date:
CompenMtion ins.ura~;ce carrier cond policy are: ' !
C~rder~ Policy Numher. i::XEt\'lJ'.:;t I
. Thi~ecticn need not be c.omplete'd if the permfUs for ope hlmdred dollar.s i$1(j.~,J or1e:-s.
~. I certify that il1 the' perfu nTrance cftl-,e- _work'for wh1ch this perml' ~ i~~~,"Yd. -1 sha:1 not I
. empl0y any pers<?n in any manner so as to bec0me subject to the worker's,:')mnE;n~ation laws
of Califomfa._,and agree that if I should become su ject to 1. . s ~om:':pn:;:r.:tion
. provisio.n~ -of- Section 3700 oftrle labor COde. I. lal ,it, C . iUn:',os;; p!'c'Jisilms, COlistrucicn Types:
VN,
]
Nur"iBER
6479j6
TYPE
EXPiRATION DATE
6130/2006
8
Date:- 2/18/2005 Applicant:.
WARNING: FAILURETO SECU E-WOR'- OMPENSA, iON COVEf{~GE is
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAl. PE~'Al.TIES AND CIVIL
FiNES UP TO ONE HUNDRED 'iHOUSAND 001 LARS ($10Q,OOO).IN ADCnlON TO THE
COST O. F ~OM PENSATION, DA, MAGES, AS PROVIDED PO,R IN .SF..CTIO~', 3706 OF THE,~',
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .: :..,
I CO~'ST"UCTI"N . ".IDiN~ ,;;:'-~,CY---'~---
; .._......::..-._~-=-~--~-~~--_..-.:_:..._-----_._....:..:
I h~: ~by_ ?ffi;::":"l ~;'",'i"~,~ _~ ".,~-=".~-1~.~ r_'(:::~"~:llr;.'_:,;"-::~ -=~~,~? _ ~:o...:'~::;~::-":.:=.--~~.::~_:::-:!::~;;~~ ..~4~.' '-_-:::r:!;'~.';;~- .
performance of the wO[k'for whicr-l this_ permit is issued (Sec.3()S7 .CiV:C):' .',.'
Lender's. Information:. .
. Fees paid for Permit:
Total:
,108.74
Dale: 2/18/2005
S. a e 0 Iicant or Agent
The permi s all expire by limitation and become null and void if the building or
work has not passed fi,nal inspection 365 days from the date of permit issuance. A,
new permit is' required to commence or continu~ work. .
INSPECTION RECORD
- INSPECTION DATE INSPECTOR
Temporary Power Pole, .
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/uter
SetbacklFormsrrrenches (Footings) . -
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
. Plumbing (Water Pipe.Sprinkler Valves) . .
MElChanlcal (Groundwork) . .
Electrical (Underground Conduit)
Pre-slab (Compactlon/Membrane.Reinf. - ..
Underpinning (Floor Joist/Girders)
Do not cover or conceailhe work belOW until the
followingapplicabie items have been signed: - -
1 sl Floor Shear . .
Firesprinkler _(Rough)
2nd Floor Shear
Roof (Sheathing/DlaphragmlFr;me)
Masonry (ReinfJBond BeamlPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical . .
Rougn ElectrICal (DrY wall) _
Rough Electrical .'
Framing (Only after Plbg.:Elec.. Mech.. and Fire) t:,-{r@ /7'
insulation (SoundlEnergy) .
Do not tape or plaster until the following applicable
items have ~een signed: . - .
Drywilll . - . -'l-tl)' A_ 7
,
Penetrations (Fire Rated) Electrical .
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing . .
Interior Lath . . .
Exterior Lath
GENERAL ITEMS
Exterior Piaster (Brown Coat)
T -Bar Electrical .
T -Bilr Mechanical - .
T -Bar Structural . --
Sewer -
Water Engineering Backflow , .
Water Service
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765.5268
Sub List/Business Llcense'765-519
Zoning 765-5139
Building Final (Last Inspection. .only ~ I 1
After Abov_e Completel 1 f" do
Date
Inspector:.-
./
~rl5
.),ti''';".
~V
.
. . -
,(1'/110-> ~USf&;(l-
PARTIAL INSPECTIONS
Buildinq Inspections
(..~e.
_ L-",-,\ l,
Mechanical Inspections
Plumbinq Inspections
ElectricallnsDections
t -
209 N Siesta Street, Anahiem CA 92801
BATHROOM REMODEL
SCOPE
CONTRACTOR: lR.POLAND CONSTRUCTION INe.
4195 Chino Hills Pkwy. #138
Chino Hills Ca, 91709
(909) 591-8040
Lic# B-1 647916
Replace vanity cabinets
Replace sinks, faucets, related plumbing
Install 2 lights
Install 2 new flourcent exhaust fan light combos
Relocate toilet and sinks
Add 2 receptacles
Install new whirlpool tub
Extend vent thru roof
Remove non bearing walls at closet
Build new walls where walls are removed
HOMEOWNER: Jim an Pat Maitland
.209 N Siesta
Anahiem,.CA 92801
(714)772-9344
./--
existing door
existing
window
5'.0"
bed room
pocket door
new shower with bench
hall
11'-1"
THE ISSUANCE OF THIS PERMIT DOES
NOT APPROVE VIOLATION OF ANY OF
THE BUILDING CODES OF THE CITY.
"THE HOLOER OF THIS F'ERMI"T
F'ROCEe:OS AT HIS OWN RISK.
flourcent fan-light combo
new whirl pool tub
PROPOSED
FEB 1 8 2005
BUILDING DIVISION OF ANAHEIM
APPR 1\ \
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EXISTING
remove existing non bearing walls