910 S. Sylvan St.
TYPE.OFPERMIT CIT. Y
Reroof
i
J
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153.
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE:- 555
QUARTER SECTION: 21
BUILDING PERMIT NO. BLD2004-03.834
DATE: 10/15/2604
JOB ADDRESS: 910 S SYLVAN ST
LEGAL.DESCRIPTION: N TR 1951 LOT 69
APPLICANT: L!JIS CHACON
OWNER INFORMATION:
LUI S A CHACON
910 S Sylvan St
Anaheim, CA 92804 . I ..
JOB DESCRIPTION:Tear off existing roofand replace with 13 squares of COnlJO'sitionshingles.
I
,
CONTRACTOR INFORMi'lTION:
. ARCHITECT/ENGINEER INFORMATION:-
VALUATION: 2,000.00
I OWNER-BU!LOER'DECLARATION
I hereby affirm under penalty of perjury that I am exempt fronJ the Contracto{"s license Law for the following rea~on (Sec. 70"31.5 Business and
Professions Code: any dty or countywhich"requires '8 permit to construct, alie"r,_im'prove, den\Olish or repair any structure, prior to its ,issuance, -also
requires the applicant fo~such permitto fi,lea,signed statement that he i'5 fb,.h';:;8d pursuant to the g^rovisions of the Contractor's License Law (Chapter
9)(commen,cilJ9 with Section 7000 of Division 3 of the BUSiness and Prbfe-ss~(lnS Code) or that he :3 exempt therefrom and the basis.for thea~~pged
exemption. Any violation of Section 7031.5 by.any applicanttor a permit sr~t'h:cts_lhe appiicant lo a dvil penalty of not mor& than five hundred dollars
~~)~s owner of property., or my employees with wages aR.' thei;- ~ole e. omi.~nsaii~n; will do the work, and the struetu. re is not intended or Off._,~.red for
~e (Sec. 7044 Business and Professions Code: The Contrsr;tor's License t~a,w does :1ot apply to an owner of property who builds or improves
thereon, and who does such wo~k himself or herself or through his 0;' her o"';:~:l:?mployees, provided that such improvements are not lntend~:-()'r.
offered for sale. If, however, the building or improvement is :.,;old with one Y0.~rof completion, the owner-builder w111 have the-burden of proviTl9 that he
did not build.or impro~e for the pUrpose of sale). .' .j, _ . . '. ' '.~.~..
D. I, as the owner of the property, am exdusively cor;tracting with licensed1:ontractors to CC:1st!uct the project (See. 7044 Business and Pr()fessions
Code:, The Contractor's Licsflse Law does not _apply to an O'Nnei of properl.Ytwho bunds or improves thereon, and who contracts for'such' prol~sts with
FtJ(on~ractor(s) licen.sed purs,ua':1t to the Contra~tor's Lice~SE!\~:~W)...: l ~. .' .'" . ," .~X" ' .'
LJ. I am exempt under- Sec. , , B ,& P.C. for IS re"j~.,on. . '~..' , -_ ,
Dat -IS_Co OWner: . .. .
PROCESSED BY: MSM'
WORKER'SC PENSATION DECLARATION t
..f
I hereby affinn under penaltY of perjury one 'of the following declarations: .(
o I have,;and will maintain a certificate 'of oonsentto self-insure for worker-\ compensation,
as provided for by Section 3700 of the Labor Code"for the performance ofth);! work -rOi which
this_ permit is issued.. .' _' -'f
o I have and will maintain worker's.comp'ensation insurj3nce.:::s required b~' Section 3700 of
the Labor Code. for the_performa'nce of the work for which thin permit is j~Gh-:..My worker's
Compensation insurance carrier and'policy are:. ". :
Carrier: Policy Numb~r. ;,
. . . . .1;. .
~. hi_ section need not be completed if ,the pennit is foro~e hundreP dollars ($1 o.~J '~dess. '
1 certify that in the performance of the work for Which this permit is i515t'~d;~s~haH not
e ploy any person in any manner'soas tp.become subje~tto the worker's ~'~'Ti:pensation laws
of.Califomia, arid agree that if I should become subject to the worl<er's_comp'~~nsation
provisions of Section 3"700 6fthe Labor Code, I shall forthwith comply w!th tf~.ie))rovisjons.
ex <;:/
I
LICENSED CONTRACTORS DECLARATION I'
I hereby affirr:1 under penalty of perjury, that I am
licensed under p(oViSiOns of chapter 9 (Gomni~ncing
w:th Seetio'n 7000) of Divsion 3 of the Bu.siness, and
Professions Code;
10/15/2004
Date:
Con'tract9r
NUMBER
EXPIRATION DATE
TYPE
Date: 10/15/2004 Applicant:
WARN ING: FAILURE TO SECUR ".
UNLAWFUL, AND SHALL SUBJEC' AN EMPLOYER TO CRIMINAL PENAI,TIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDmON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIOl'i3/06 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 aGemcy for the
perf()(~a9ce _ofthf';! wo~~_!9_~__~b!ch__t.h!!3P€lrmit is issuect (Se(:.~097.Ciy.Ct _ . L
. Lerlder's inforriiation:
Construcion Types:
VN, ,
Fire Sprinklered?
NO
I certify that. I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state I~ws relating to building c~:)Jlstructioh. and
htveby authorize representives of this city to enter upon the above mentioned property for
ins' ection purpOses. .
e-. -c.. Date: 10/15/2004
Signature of Applicant or Agent
The permit shall expire by limitation and becoll)9 nllll 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 tp commence or continue work.
Fees paid for Permit:
Total:
160.61
INSPECTION RECORD
, ", , , , DATE ,
, ' , INSPECTION " 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 hav,e been signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork) , ' , "
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane.Rei nt. ,
Underpinning ,(Floor Joist/Girders)
Do not cover or conceal the work below ul)tilthe
following applicable items ~avebee'n,signed:'
1st Floor Shear ' ,
Firesprinkler (Rough) " " '" "
2nd FI ' ' ,
~~hin . hragnv'Frame) , Of,PflUO \"t.V1
Mas (ReinfJBond BeamlPre-Gl'O\It) I
Rough Plumbing (Top Out) , , ,
Rough Mechal)ical ,
tlOugn ElectriCal ( ury Wall) , ,
Rough Electrical
Framing (Only "after Plbg.. EJec...Mech and Fire) ,
Insulation (Sound/Enef!IY) , , '
Do not tape: .or plaster until the following applicab~e "
items have been signed:. .' ,
Drywall ,
,Penetrations (Fire Rated) Electrical ,
Penetrations (Fire Rated) Mechanical , "
Penetrations (Fire Rated) Plumbil1!l
Interior Lath , , " ,
Ellterior Lath
, GENERAL ITEMS ,
Exterior Plaster (BroWn Coat) "
T -Bar Electrical ,
T -Bar Mechanical ,
T-BarStructural , ,
Sewer' , ,
Water Engineering Backflow , "
Water Service " " ,
FINAL IN~PECTIONS Date Inspector
Electri,cal F.inal ' , "
Pluinbll,g Final ' , ,
" '
Mechanical Final
Gas test ,
Engineering/Grading Final 7j;S-5126 , " '
!',ire Depl. Final 7654040 ,
Water E,ngineering 765-5268 , ,
Sub L.ist/Business License 765-519 ,
Zoning 765-51,39 , ...# -
Building Final, !l:astlnspection. Only, \~Io) A'
, fter Above Complete) "..-
PARTIAL INSPECTIONS
BuildinQ InSDections
MechanicallnSDections
,PlumbinQ Ins~e'ctions
ElectricallnsDections
TYPE OF PERMiT
Residential Addition , CITY
DATE: 611712004
JOB ADDRESS: 910 S SYLVAN ST
LEGAL DESCRIPTION: N TR 1951 LOT,59
~"":' _' ;i ;! _ :'
4'';';' 't-, : ,j;~~~~I(.~~
t ; ,r~(!:i(;';'x ' '
(, J~iHEIM
~\ "H#i"j;.!,ji'"
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~,~~ ~~~:~~<;: f; ~ _~-;~
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 515a
INSPECTIO~! REQUEST LINE:
(714) 765 - 4626
'CENSUS CODE: 434
QUARTER SECTION: 21,
BUILDING PERMIT NO. BLD2004-01478
. APPlICANT:.FRED AMBATALI !
,
'OWNER INFORMATION: CONTRACTOR INFORr,I,',irlON:
LUIS A CHACON ARCIVEL CONSTRUc.;TICN INC
910 S Sylvan 5t 3120 W ROME AVE ;'
Anaheim, CA 92804 ' ANAHEIM, CII 92804 0000:
" " ,BUSINESS PHONE: 714' 52 !-5222 ' ,
JOB DESCRlpTIONAddWon 01968 $q It 2 bedrooms, bathroom, with dining rC)'fll snd Iivin9 room extension,{hih)
VALUATION; . 65,100,00' i , PROCESSED BY: MJF
I, ','" , ' OWNER-BUIlDER'oEClARAT10N: ,
I hereby affirm ur)Qer penalty of perjury that) am exempt from the ContractoO. License .Law for the followj~g reason (Sec. 7031.5 Business 'and
Prof~$siOn$'Code: any dty'or county which,requires a., permit to.construc~, ,z::,~rl improve, demolish or repair any structure, prior to its issuance;.also
requires. the applicant for such permit to file a signe({statement that he is lfof>/;-sed pursua[lt, tot~e p./Ovfsions of the Contra.dor's .L1c'ens.e Law (Chapter
9)(commencing,with Se;ction 7000 of Division 3 of the Business andProfecsidr'1s Code) or thathe is'exempt therefrom and the basis foethe aUege:d
exemption. Any violation'of Section.1031.5 by any applicant for a,permit sub1'f;.,cts the applicant to a dvil penalty of not more than ,five hundr€>ddollars
($SOO) , , ',.' ' , . ,."" .', .',' , .,'
0, .!;, as owner of property,or.myemployeeswith wage~ as th~ir sole comJ:,in~ation, will do the,work, and.thestruc.ture is not lntendeCf or offered for
sale.' (Sec', 7044 Busin.ess and .Professions Code: ,The Contractor's License! '::w does not apply to an oWrJer of pro perty who !)ufldsor improves
thereon,_ ai1dwhodoes suCh work himself or herself or through'his or h'erowJ~mployees., provided that such improvements, ~re noi.int,e"ndedor
,offeredfo"r.'Sale.. ,If, however, the build,ing _or imprdvementis' sold 'with one yef..'f)( completion, the.ow~er.builder wjll have the~bu.rdEmofproving that he.'
'didnot-bu.Udorimproveforthe'purposebfsaler .' ., ,l ',....-- " " . ,'_ _., .'._ .'_ "., '
o 1;.i3,'t.the. owner of the property,' am exdusively contracting with licensed t.~ntractors to construct the project (Se6. 7.044 Business and ProfessiOns
CCd<J: '1h_e Contra?tor's.UcenseLaw does 'not apply to an owner of property t~ho-buildsorjmproves the(eohj' and who rontracfsfor such -proJects with
~o~~r;)~or(s) licensed pursuant totheC?ntractor's License Lciw}: ' !. ."
U 'am exempt under Sec. . " B & P,C. for this reason: .
Oate:__._ Owner: :=..~.
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under,penalty of perjurxol')~. of ,the following, declarations: . - j : .
01 have and.:will maintain a certificate of consent to Self-insure forworRer':,:t;:::mp:Jnsation,
as providecHor.by Sect:ion3700 of the labor CQde, for the performc::nCEl' of t:l,~'"\;"Crk for which
this..'permit is issued: .. . . { . .
D.f have a_nd wHl m?intai"~ ,<<orkef's .compensation insurance, as fe."ql,lired b'f. Scct!on.3700 of 6/17/.2004
the.Lal:)Qr Code,for-the.performance of the work for which this permit is jS<::lJf_~}. t'liyworker's
Compensation insur nee carrier and po~Of are: .' , i
Carrier: . Policy Number. EXEMPTr
, - . ,. . .<;, ',< ,,- ' , !
This s on need not be completed if the permit is for one hundred'dollars ($10.0;: or less.
I certify 'that in -the perfOrrTl_ance of the work for which this pehriit is i~ti:~i1. I shaU' ~t
emploY,any person in ~ny manl1s,r so as to be~ome subject tt) the workers'cc!opensation'laws
. of California, and agree that if 1_ should become subject-to the 'worker's cOmPE'A,satlon.
provisions of Sec~ion 3700 of the La bor_ Cod e., I shall wi Iy With th-..'1o:;e ~~visions.
Date: 6/1712004 APPIi';"nt:'~ '
WARNING: FAILURE T EWORKER' N COVEj,,'.GE is
U'NLAWFUL, AND SH L SUBJECT AN EMF' , 0 CRIMI. ALPENA!:nESAND CIVIL
, FINESUPTO ONE HUNDREDD DOLLA(lS ($'100,00 ), IN ADD!JION TO THE
COST OF COMPENSATION, DAMAGES AS PROViDED FORJN ECTIO~: 3706 OF .THE
LABOR CODE, INT!:REST AND ATTORNEY'S FEES..,
I 'CONSTRUCTION lENDING AGENCY ~:'
! her~byaffirn:' uf1~er penalty of perjury that there is a constructio~ le"dip'g ~:~~~!?yfor ~~e
i:..:.r:.....~-.;;.;"",C<;..v;.,~..;; ~~v,i, i'vl" ""IlUllili.sj.)eTilllll.::nSsueo t:::ec.;-'lk;( .~fv.(;}: ~ ~ -
Lender's Information:
ARCHITECT/ENGINEER INFORMAtiON:
G,F, MONTEMAYOR
1'617 WAVERLY GLEN WAY
HACIENDA HEIGHTS, CA 91745
I
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty 01 perjury that I am,
licensed-under provisions of chapter.g (commencing
. with Section7000) of DivSi9n 3 oftheBusiness and
p.rofessions' Cod e.
e:
. \""-,
~
NUMBER
822686
TYPE,'
'TYPE
B
Hie
EXPiRATION DA' E
8131/2005
Constru~ion Types:
Fire Sprinklered?
Living Area: .
-NO
968
., "
I certify that I have'.re9d this.application and ~tate ~hat the above information is correct. I
agree to: comply' all city ordil)ances ands.tate laws' relating t9 building .;;orstruction, and
. hereby author.' representives of thi. upon the above mentioned property for
inspe if) ., rposes. --- -. .
Date: 611712004
,,'-":<- .. Signature ~f ,'_ _ '. ' .
'The-p.llW)it l;hall expire , n.. become, null and void if the building or
work has not passe mal inspection 36 days from the date of perm;t issuance. A
new permit is required to, commence' or ontinue work.
Fef;lospaid for Permit:
Total:
1,136.51,'
INSPECTION RECORD
. .INSPEC'T1oN' .
Temporary Power Pole.
PlUmbing (DrainJWaste Pipe)
ElectriCal GrounQ ElectrodllllJrer
S6tbacklFormsITrenChes Footings)
DQrlOtinslaJrsubfloor or pour'floorslab u Iii he
fOllowing applicable "ems .have'been signed' .
Plumbing (Water Pipe.Sprinkler Valves)
MeJchank:a1 (Groondwofk) .
"lec;tt~ (U rgr(lUnd Conduit).
b ( ompaclion' embrane. einf.
. Underpinning (Roar JoistlGirderS)
nOI. cover Or conceal I work below until Ihe
'.16Uowingapplicable items have been signed:.
1st Floor Shear ~.
FireSpril,k1er (Rough)
2nd Floor Shear'
RO athi Di hra . Frame) .
. Masonry inf./Elond BeamlPre,Grout)
. Rough Phimbin (Top Out)
Rough Mechanical. .
ugl1 ectrk:a1(. al
Reiu h Electrical
Fraining- (Only ?!otter Plt,g., Elec.. r-:iech.. and Fi~e)
InSl.llatip"n (SOundIEnergy)
po not tape "rpla\'.ter' until the f"IIowh'g ilP Iic;lble
,tern,s bave' b.een sIgned: ", . -, ,. "
Drywall
Penetrations (Fire Rated) Electrical
PenetratiOllS(Flre Rated).Mechanical . .
Penetrations (Fire Rated) Plumbing
Interior Lath
. Exterior I.;ath '.
.O...TE . . INSPECTOR .
GENERAL ITEMS'
Exterior Plaswr(Bl'OlNn.CoaI) .
T -Bar Electrical
T-B"r Mechanical.
. .T-8ar Structural
Sewer
Water Engineering Backflow
Water Service'
FINALINSPEcnONS ..'
"Electrical Finaf
plumbing .Final.
MechaniealFinal
Gas Test .
Erigineeringf(,;rading (,i08I16505126'
Date. Inspector
,- ;. .' . . . '.- " ,.-'
Fire Dept. Final 7654040
Water Eiigin&eri,ig 765-5268
Sub List/Business Lic&l)se 765;5.19
ZOl)ing 765-5139
Building .Flnal (Last Inspectio'n. Only,. 1-0
. '. Mer Abov.e CompleteL
. PARTIAlINSPE.CTlbNS.
Buildinalnspections
. .-. ., .
.... .,.... . .' . -'. .
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CJt.. 7l>lll1511t.f:ttNI.-Y ~m~
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.. Mechanical Inspections . '.'. .....,..' , ". . 'f
Plumbincr Inspections
ElectricallnslJ6ctions
,
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