241 S. Summertree Rd.
TYPE OF PERMIT
Residential Remodel C.ITY.
DATE: 5/19/2005
JOB ADDRESS: 241 S SUMMERTREE RD
\.EGAL DESCRIPTION: TR 8905 LOT 5 AND POR LOT A
ElM
BUILDING DIVISION
200 S. ANAHEiM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 191
BUILDING PERMIT NO. BLD2005-01493
APPLICANT: LOREN RUSSAKOV
OWNER INFORMATION: CONTRACTOR INFORMATION:
Loren Russakov
241 S Summertree Rd
Anaheim, CA 92807'
. JOB DESCRIPTION:Remodel closet to add shower to half bath.
VALUATION: 600.00
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: SAM
. OWNER-BUILDER DECLARATION
I hereby affir.m under penalty of perjury t at I am e.xempt 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. altet, improve, demolish or repair any structure, prior to its issuance, also .
requires the applicant for such permit to file a signed statem~nt thathe is Hcen'~d pursuant to the provisions of the Contractor's, License.Law (Chapter
9)(commencing with Section 7.000 of Division 3 of the Business and Professiods'Code) or that he is exempt therefrom and the basis tor the alleged
exe ption. Any, violation of Section 7031.5 by any applica~t for a permit .SUbieyts the applicant to a civil penalty of not more than five hundred dollars
($ 0). ,...
I" as owner of property, or my employees with wages as their sole comperlsation, will, do the work, and the structure is not intended or offered ,for
$ Ie ( c. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds'or improves
treon, and who does such work himself or herself or through his or her own ~mployees, provided that Such improvements are not intended or.
o red for sale'. It, however, the building or improvement is sold with one yearjof completion, the owner-builder will have the burden of proving that he
~did not build or improve for the 'pu rpose of sale): ';
[J I, as the owner of the property, am exclusively contracting with licensed CC;ntractors to construct the project (Sec. 7044 Bl,Isiness and Prafessio'ns
Code: The Contractor's License Law does 'not apply to an owner of propertywJ1o builds or improves thereon, and who contracts for such proje6-ts with
,aJfontrac:tor(s) licensed pursuant to the Contractor's License law) .
U I am exempt under Sec" ,&. r this rea :
Date: Owner:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty ofperyury that I am
licensed under p'rovisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the BUsiness and
professions Code.
WORKER'S CO NSATION DECL RATION
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~6mpensation,
as provided for by Set:tion'3700 of the Labor Code, for the performance of the \vork for which
this permit is issued. j
o I have and will maintain worker's compensation insurance, as required by $ection 3700 of
the Labor Code, for the performance of the work for which this permit is issued. Myworker's
Cornper.\sation insurance carner and poliCy are: \
Carrier: Policy Number. .
. . I
tion need not be completed Itlll. pelT1llt is for one hundred dollars ($100) Or less.
rtify that in the performance of the work forwnich this permit is issued,.\ shall not
10 any person in any manner so as to ,become subject to the workers.compensation laws
C ifomia, and agree that if I should become subject t e worker's compensation
ovisions of Section 3700 of the La , I all f c ply with os~ provisions.
Date: 5/19/2005 Applican .
WARNING: FAILURE TO SECURE
UNLAWFUL, AND SHALL SUBJECT N EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES U PTO ONE HUNDRED TH USAND DOLLARS ($100,000), IN ADDITlON 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 age,ncytor the
performance, of the work for which this permit is issued (Sec. 3097.Civ.C):
Lender's Information: .
5119/2005
Date:
('-'
Contractor
NUMBER
EXPIRATiON DATE
TYPE
Construcion Tvpes:
VN, ,
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinan s and 'state laws relating to building construction, and
hereby authorize' rep ntives of ci to enter upoIl he above mentioned property for
inspection purp
Date: 5/19/2005 .
Fees paid for Permit:
Total:
304.42
. Signature of. pplicarit 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 to commence or continue work.
.' ,
-
, INSPECTION RECORD
INSPECTION DATE INSPECTOR
.
Temporary Power Pole, ,
. Plumbing'(Drain/Waste Pipe) (,y.l-tl~ f/Z
Electrical Ground Electrode/Ufer I
,
SelbacklFormsfTrenches(Footings )
Do not install subfloor or pour floor slab until the .
following applicable items have. been signed:
Plumbing (Water Pipe.Sprillkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit) .
Pre-slab (CompactionlMembrane.Reinf.
Underpinning (ROOr Joist/Girders)
Do not cover or conceal thewor1< below. until the . ..
following applicable items have been signed: .
1st Floor Shear . . .
Firesprinkler(RolJgh)
2nd Floor Shear ..
. Roof (Sheathing/Diaphragm/Frame)
Masonry (ReinfJBond BeamlPre-Grout) . f , I
Rough Plumbing (Top Out) , I LlIS II. .~
Rough Mechanical . ,
Rough aectrlCal (Dry walll
Rough Electrical . .4
Framing (Only afterPtbg., Elec.. Mech.. and Fire} j.tJ;'-
Insulation (SoundiEnergy)
Do not tape or plaster until the follOWing applicable
items have been signed: ,
Drywall ., L/ ,~ ~ ./
PenetratiollS (Fire Rated) Electrical. . .
Penetrations (Fire Rated) Mechanical
Penetrations (Fire, Rated) Plumbing " .
Interior Lath .vII - ' ,
Exterior Lath
GENERAL ITEMS.
Exterkir Plaster (BlOWn Coat)
T.Bar Electrical .
T -Bar Mechanical
T -Bar Structural
Sewer
Water Engineering Backflow
Water Service . .
FINAL INSPECTIONS
Electrical Final
Date
. Inspector
Plumbing Final
'Mechanical Final
Gas Test
ErigineeringlGradi'!9 Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-51
Zoning 765-5139
Building Final iLastlnspection. Only . _ _/0
After Above Complete) v
PARTIAL INSPECTIONS'
Buildina Inspections
Mechanical Inspections
PlumbinQ Inspections.
Electrical Inspections