1211 S. Walnut St.
-~--,,"
BUILDING PERMIT NO. BLD2004"01608
TYPE OF PERMIT
Residential Addition
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CITY ~i~~~HEIM
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6UIt.,D!NG DIVISION
200 S. ANAHEIM Bl.VD.
(7'14} 765 - 5153
. INSPE'CTION REQUEST LINE:
(714) 765." 4626
CENSUS CODE: 434
QUARTER SECTION: 65
DATE: 511.3/2004
JOB ApDRESS: 1211. S WALNUT ST
LEGAL DESCRIPTION: . N TR 1981 WT2
(l
. APPLICANT' SAMUEL 'SaNG.
OWNER INFORMATION:
Samuel' -Song
1211 S Walnut St
Anaheim, CA' 92802 '.
JOB DESCRIPTION:Enlarge!>yo bedrooms and one bath, 180 sq. ft. (HIH)
. VALUATION: 12,100.00 1
C .oWNER-BUILDER bECLARATION
,_I her~by affirm under penalty of perjury that I am. exempt fr()m the Contractor}-l:ic~nse,Law for the'following reason (Sec'_7031,5 Business 81ld.
Professions Code: ?lny dty or county,which requiresa, permit:to construct, ait~~r; i!'Pprove;demOtiS_~:OI:: repair any structl:lre" prior t()' its ,issuance. also "_
requires the applicant for such permi,t to file a s-rgned statement that hB'is tic~;i!sed pUl"suant to the provisions of che-Controctor's LicEm~'€: Law,(Chapter
9){commencing with Se~tiC?n 7000 of Division 3 of.the Busin~ss and Profe::;::~~&s'Code) or that:he is exempt therefrom and the. basis' for the alleged
.ex;smption'" '.Anyviolation of Sec.tion7031.5 'by any applicant fo~ a permit SLlbJlc~ thea~~!)cant:to'~_:dvil-pen;;~ity of liet more,thanfi~e ,hundt~~dollars
~?,)~s owner of prqperty, or my. employees Wit~ w~ge& as their, sole comp;'~'ls~tj,0n. ~ilt do"thewo!"k.and the S.iructu'm'-.is;~6t'inten.ded,6;_~ff~~edf~r
,.'~' (Sec~ 7044 Business and Professions Code:, The Contract~r~s License I.~~W does no~ apply.toan cwr;er of prop~rty '1.ho bIJ.i~(l's 0;:, :mproves ,"
therQon, and Who does such -work himself or herself or through'his (lr t.\:.~ .)w.-'t'hW,loyees, pro'jiqec;i that..wch irriproveiT'ent5',al€'~lcit infendedor
offe'rE~d for sale, .If. however,tl,e_ buildingor improvement is sold Wiltl ci;eYf.:(r of oomplt)tiufl, theowne:r-_build.::r willhaveth_t.:,'bvrdp.n bf. pro"vin'g th~t he
did not build or improve_ forthe'purpos~ of sale),. . . - t+: ,,' ". '" :_' ',' _:' ,- _',:" ' ,,', .
01, as .the owner of .the property, _am exdu~ivcly contra~jng w1th,licel1sed \9;1.traUt;r~:.toc()Jl~truct th~p(oiect (S~c: 7044BI..!$in~;:;S:H"!~: Professior~3_:'
Code:- The.:Contracto~'s License Law does not ~PP!Y t9 an ow,ner of prop~~y t:;.) i;:-li:tJ~ _:.Jr !mproves th~r,?on,-c;::r:d whCl \?Jntrac~s 'for such pil,)ject~wn;l
~: __00. tractor(s) licensed p.ursua._ nt .t,) t~1e .trador's LI _ -e ~e LaVl)~ . fi .
I ampo/lJpt under Sec, -_ :~ P,C., f !r.: rea". . ..;....~~
Date.: .5 ~~/Ol.{awner: . \., . __~.~ _-,
L ' . WORKER'SCOMP - ATION D!;CLARAlION .r:-~ .--1 "..
I hereby affirm under pe:naUyof per;ury one of the folJo'.Ning det:tarat!ons: ':.'. r.
[J I have.and wili maintaina'certificate of CO'1ser.tto se!f-lnsur~for .~,(c;!"I{e'r'J7::omp~i1sat;Qn...
as provr~ed for bySedion '3700 6(the Labor COde., tbr the performance.-Ct._ttI4:wotk for whi-:h
this permit is issued. . . '.n
D I 't-.ave and will.'maintain Worker's cOfTlpensa~ior. insurance, ~$ ~qu:red o;($ectiOn :J~,o of .5/J3/2004 '
the Lab-o~ Cod.~,for the performance-of the'WQl"k for which ttl'IS P<1rmit is ;SS:Jf~~~, rviywo:'"ke-i'.s.. . Date:
Compensation insurance carrier and po'llcy are' .'. ,,1. ~..,
. Cartier: . . Policy Number. . t NUMBER
;.
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CONTRACTOR INFORM.^.riON:
. .
ARCHITECT/ENGINEER INFORMATION:
PRqCE;SSE;D BY: FAN
. L1C!:NSED CONTflAC;ORS DECLARATIOTN
I hereby' afffrrn ,1Jn,d_e~:p6nalty of 'perjt,lry that I am-
licensedulider provi~ionS:ot c;hapt-er 9 (commenci~g
'with. SectiOn ,oooy of.Oh"uion 3 of-the' B,usiness and-
~:~F:"rofe3sjons C~e, -. .
,. Cc~)traCtor
. .
. . .
This s~tion need not be completed if the petn:lit is for aile hundrw dollars {$190;.k:: l~s~
DlcertifX ~~a'~ inthe performance ~fth& work for which this permit is issued; 16hall not..
employ any .person in ,any manner so as to o€'comesubject to' the Worker's cot')pensatiQn~a.w3
. of California, and agree th~Ufl shc' become subje~the wo, er'scOIl}~~~.ljC'ft~.
prov,isions of Sec.tion 37pO of the Labo rthwith Iply. with.~ ,.o-:;.~ pr(~vi'sions,
, . . .
,>
EXPIRATiON DATE.
TYPE
bate: 5/13/2004 : Appllca . _
. WARNING: FAILURE TO SECURE' a ER;S COMPENSATlaN COVERAGE is
UNLAWFUL, AND SHALL SUBJECT AN EMPLaYE;R Ta CRIMINAL PiNAL:fiES AND CIVIl.
FINES UP-Ta .oNE HUNDREP THOUSAND DOLLARS ($100.000), IN ADDn-'aN TO THB.
caST OF COMPENSATJON, DAMAGES AS PRaViDED FOR IN SECTION iJiJo 'OF THE;
LABaR caDE, INTEREST AND ATTORNEY'S FEES. ';; " :t..
I CONSTRUCTION LENDING AGENCY. : ',"
,- - " '" _ , " ',' wl-',
; hereby affirm under penalty'ofperjury that. there is a constructio:"! Ie,nding age!lcy fo-r the.'
pe'ii'c:!"mance of the work for which this permitis issued (Sec. 3097 ,Civ.C): I, .
Lender:s !nformation: _ ' . "
ConstrJcinr! TY!Jes:
VN, ,
LivinQ Arf"<a:
180
'. .f
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:-'h_"_' n_
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. Fees', paid for Permit:
. Total:
1.21
Date: ':i/13/2004
Signature 0 p lcant r Agent.
The perm. shall expire by IimilatiM.and b orne 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 orcontinull work.
, .' INSPECTiON RECORD
. , INSPECTION . .' DATE, . . 'INSPECTOR
.'
Temporary Power Pole . .
Plumbing (DrainlWaste Pipe) . . .
Electrical GrOund Electrode/Uter 17", . ....-
'.
SetbacklFormsfTrenches (Footings) V~ '7'.,
Do. not install subfloor or p'our floor slab until thE! .
following applicab!e ifems' have been signed:
plumbing (Water Plpe.Sprinkler VaIvE!s)
Mechanical (GrOllndwork) '. ....
Electrical (Underground Conduit) .
Pre-slab {CompactionlMembrane,Rei nf. I
Un.pinning (Roor Joist/GirdElrs) . ~I~hu,<" ~.u, A
Do'not'coveror conceal tl)e work below ,until tl)e . '/ '.
"
lollo""ing applicable items have been signed' . . .
'1s.t Floor Shear , ." . ""III
Firespiinkler ,(Rough) , . '
2nd Floor Shear . ' . : . . '. . .
Roof (Sheathing/Diaphragm/Frame) ,JI....
Masonry (ReinfJBond BeamlPr&'Grout) I
Rough Plumbing (Top Out) . , .
Rough Mechanical' : .,.: . " . .
Rougn l:lectrlCai ,Dry wall' . .
Rough Electrical
Framing." (Oh"1y afte'r Plbg.,. Elec:. t,,'1ech.. and Fire) "1\\1101-
Insulation (SoundlEnergy) .- Qll1\v , ' -:\'~
Do not tape or plaster until the following applicable /
items have beensign(!d:. . . . .' . -. . .
Drywall' . . , . "'lvI/at- . --rR1J1 .
Penetrations (Fire Rated) Electrical 1
Penetrations (Fire Rated) Mechanical '. .
Penetrations (Fire R;Iled) Plumbing .
Interior Lath' . ' '.' .
exterior Lath "GENEAALlTEM~ ~.
. ,
Exterior Plaster (Brown Coat) .' . IlIl2zilQ/ L . -
T~Sar Electrical . . . ./
T.BarMechanical . '." ' .... .
T.Bar Structural '. . I " .
"Sewer' .
Water Engineering Backflow . . . .
Water Service .
FINAL INSPECTIONS' .
Electrical Final,
Plumbing'Final
Mechanical Final
Gas,Test . '
Engineering/Grading Final 765-5126
Fire Oept. Final 7654040
Water Engineering 7.65-5268
Sub List/Business License 765-519
ZonJng '765-5139
Building F. i~al (Last lospection; Only .--~. ,_",
. Alter Above Complete) J-r ~
PA~tIAL' INSPECTIONS
.~;nU:;~cti*a,.~UQ~~
. MechanicallnspectiOriS
Plumbina InSDections'
Electrical Inspections