Loading...
1604 S MEDINA DRPermit Types BLD ELE MEC PLM X Permit Number:BLD2009-02070 Issued:07/02/2009 INSPECTION REQUEST LINE: (714)765 -4626 Quarter Section:50 Site Address:1604 S MEDINA DR Legal Description:N TR 3148 LOT 36 CITY OF ANAHEIM BUILDING DIVISION 200 s.Anaheim BLVD. (714)765-5153 Project Description:Electrical for residential remodel:Change out 100 amp panel completed prior to pulling a permit. Valuation: Construcion Types: Total Fees paid for Permit: N/A,. 273.46 People Associated with Project; Owner SANDRA L SULLIVAN 1604 MEDINA DR ANAHEIM CA 92804-6118 Permit Applicant ROBERT SULLIVAN Electrical FixturesType Qty Type Plumbing Rxtures Qty Type Mechanical Fixtures Qty Meter/Disc Sw -under 600 V,up to 200 amps 1 The permit shall expire by limitation and become nuO and void if the building or work has not passed final inspection 365 days from the date of permitissuance.A new permit is required to commence or continue work.fblcl_permit combo All applicable items below must be signed before utilitiesnwill be relfased. FINAL INSPECTIONS DATE INSPECTOR Final Gas Test Building Division Electrical Final Plumbing Final Mechanical Final Cross Connection Control (7i4)705-428o Engineering/Grading Final (714)765-5125 Fire Dept.Final (714)765-5041 Fire Sprinkler Final (714)765-5041 Water Engineering (714)765-4591 Do not occupy this building until the final inspections have been made Sub ListyBusiness License (714)765-5194BUILDINGPERMITDOESNOTAUTHORIZEELECTRICAL.PLUMBING,OR MECHANICAL INSTALLATIONS -SEPARATE PERMITS ARE REQUIRED.Zoning (714)765-5139 Building Final (Last Inspection - Only After Above Complete) INSPECTION DATE INSPECTOR Do not pour concrete until the following applicable items have been signed: Plumbing (Ground/Underfloor Drain Waste)FINAL INSPECTION must be approved by the Building Division. Electrical Ground Electrode/Ufer PARTIAL INSPECTIONS Setback/Forms/Trenches (Footings) Do not install subfloor or pour floor slab until the follwing applicable items have been signed;Building Inspections Plumbing (Ground/Underfloor Water) Underfloor Rough Gas Mechanical (Groundwork) Electrical (Underground Conduit) Pre-slab (Compaction/Membrane Reinf.) Floor (Joist/Girders) Underfloor Insulation (Raised Foundation Only) 2nd Floor (Floor Nailing) Mechanical InspectionsDonotcoverorconcealtheworkbelowuntilthefollowingapplicableitemshave been signed: 1st Floor Shear Firesprinkler (Rough)(Fire Dept,) 2nd Floor Shear Roof (Sheathing/Diaphragm/Frame) Masonry (Reinf./Bond Beam/Pre-Grout) Rough Plumbing (Top Out) Rough Duct (Mechanical) Plumbing InspectionsRoughMechanical Rough Electrical Framing (Only after Pibg.,Ele.,Mec.S Fire) Insulation (Sound/Energy) Do not tape or plaster until the following applicable items have been signed: Drywall Drywall Penetrations (Ele.,Mec.&PIbg.) Interior Lath Exterior Lath Electrical InspectionsGENERALITEMS Electrical Service Meter Exterior Plaster (Brown Coat) T-Bar (Struct.,Ele.,or Mec.) Sewer -1 \\D\y^T)C7\Water Engineering Backflow (Testable Only) Water Service Permit Backs Master-2008.xls Permit Types BLD ELE MEC PLM X Permit Number:BLD2009-02070 Issued:07/02/2009 CITY OF ANAHEIM INSPECTION REQUEST LINE: (714)765 -4626 Quarter Section:50 BUILDING DIVISION 200 S.ANAHEIM BLVD. (714)765 -5153 Site Address:1604 S MEDINA DR Legal Description:N TR 3148 LOT 36 OWNER -BUILDER DECLARATION: I hereby affirm under penalty of perjury that I am exempt from the Contractor’s License State Law for the following reason(s)indicated below by thecheckmark(s)I have placed next tothe applicable item(s)(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 the perfrut to file a signed statement that he or she islicensedpursuanttotheprovisionsoftheContractors’State License Law Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt from licensure and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for apermitsubjectstheapplicanttoacivilpenaltyofnotmorethanfivehundreddollars(S500). —I,as owner of property,or my employees with wages as their sole compensation,will do ()all or ()portions of the work,and the structure is not intended or offered for sale (Sec.7044 Business and Professions Code:The Contractors’State License Law does not apply to ano^er of property who,through employees’or personal efforts,builds or improves the property,provided that the improvements are not intendedjSfofferedforsale.If,however,the building or improvement is sold within one year of completion,the Owner-Builder will have the burden of/proving that it was not built or improved for the purpose of sale). I,as the owner of the property,am exclusively contracting with licensed Contractors to construct the project (Sec,7044 Business and ProfessionsCode;The Contractors’State License Law does not apply to an owner of property who builds or improves thereon,and who contracts for the projects with a licensed Contractor pursuant to the Contractor's State License Law). .-I am exempt from licensure under the Contractors’State License Law for the following reason: By my signature below I ackonowledge that,except for my personal residence in which I must have resided for at least one year prior to completion oftheimprovementscoveredbythispermit,I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entiretybylicensedcontractors.I understand that a copy of the applicable law,Section 7044 of the Business and Professions Code,is available upon requestwhenthisapplicationissubmittedoratthefollowingWebsite:http://www.leainfo.ca.Qov/calaw.html. By my signature below,i certify to each of the following; I am the properly owner or authorized to act on the property owner's behalf. I have read this application and^lt^e information I have provided is correct.I agree to comph I authorize repr/^enf^tiw itK applicable city and county ordinances and state laws relating to building constructiontf^city or county to enter the above-identified property for inspection purposeI\ /, SignatiJre of^ropWty Owner or Authorized Agent rate WORKER'S COMPENSATION DECLARATION: 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 OR THE LABOR CODE,INTEREST,AND ATTORNEY’S FEES. I hereby affirm under penalty of perjury one of the following declarations: ._I have and will maintain a certificate of consent to self-insure for worker’s compensation,issued by the Director of Industrial Relations as providedforbySection3700oftheLaborCode,for the performance of the work for which this permit is issued. I have and will maintain worker’s compensation insurance,as required by Section 3700 of the Labor Code,lor the performance of the work for which this permit is issued.My worker’s Compensation insurance carrier and policy are: Carrier;Policy No.:Expiration Date: lame of Agent:Phone No.: 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 subjecttotheworker's comp 3700 of the Labor^Co^ sation lawsof California,and agree that,if I should become subject to the worker’s compensation provisions of Sectionall^tbwith comply with those provisions. \ Sigriature of Applicant Dat' Permit Number:BLD2009-02070 DECLARATION REGARDING CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction iending agency for the performance of the work for which this permit is issued(Sec.3097.Civ.C): Lender's Name: Lender's Address: LICENSED CONTRACTORS DECLARATION: i hereby affirm under the penaity of perjury that i am iicensed under provisions of chapter 9 {commencing with Section 7000)of Division 3 of the Business and Professions Code,and my iicense is in fuii force and effect. Contractor Signature Date NUMBER EXPiRATiON DATE LiCENSE TYPE (St 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 conrnence or continue work. fbid permit combo declare CITY OF ANAHEIMINSPECTIONREQUESTLINE: (714)765 -4626 Quarter Section:50 Permit Number:BLD2009-02070 Issued:07/02/2009 BUILDING DIVISION 200 S.ANAHEIM BLVD. (714)765-5153 OWNER-BUILDER ACKNOWLEDGEMENT AND INFORMATION VERIFICATION FORM Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at 1604 S MEDINA DR . We are providing you with an Owner-Builder Acknowledgement and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read,initialed your understanding of each provision,signed,and returned this form to us at our official address indicated.An agent of the owner cannot execute this notice unless you,the property ovmer,obtain the prior approval of the permitting authority. 'pi^Ctions:Read and initial each statement below to signify you understand or verify this information. \1.1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder"buildingpermitthaterroneouslyimpliesthatthepropertyownerisprovidinghisorherownlaborandmaterialpersonally.I,as an Owner-Builder,may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property.My homeowner's insurance may not provide coverage forthose injuries.I am willfully working as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2.1 understand building permits are not required to be signed by property owners unless they are responsible for the^Obstruction and are not hiring a licensed Contractor to assume this responsibility. I understand as an "Owner-Builder"I am the responsible party of record on the permit.I understand that I may protect/L^yself from potential risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4.1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5.1 understand if I employ or otherwise engage any persons,other than Caliifornia licensed Contractors,and the total value of my construction is at least five hundred dollars ($500),including labor and materials,I may be considered an "employer"under state and federal law. 6.1 understand if I am considered an “employer"under state and federal law,I must register with the state and federalgovernment,withhold payroll taxes,provide workers's compensation disability insurance,and contribute to unemployment compensation for each "employee".I also understand my failure to abide by these laws may subject me to serious 'Randal risk. 1 understand under California Contractors'State License Law,an Owner-Builder who builds single-family residentialStructurescannotlegallybuildthemwiththeintenttoofferthemforsale,unless all work is performed by licensedsubcontractorsandthenumberofstructuresdoesnotexceedfourwithinanycalendaryear,or all of the work is performed^nder contract with a licensed general building Contractor, fe.I understand as an Owner-Builder if 1 sell the property for which this permit is issued,I may be held liable for anyfinancialorpersonalinjuriessustainedbyanysubsequentowner(s)that result from any latent construction defects in the workmanship or materials. 9.1 understand I may obtain more information regarding my obligations as an "employer"from the Internal Revenue Service,the United States Small Business Administration,the California Department of Benefit Payments,and the California Division of Industrial Accidents.I also understand I may contact the California Contractors'State License Board (CSLB)at 1-800-321-CSLB (2752)or www.cslb.ca.gov for more information about licensed contractors. Ibid _own er_bui !dcr_inlb_vc li f Permit Number:BLD2009-02070 0.1 am aware of and consent to an Owner-Builder building permit applied for in my name,and understand that I am thekrtylegallyandfinanciallyresponsibleforproposedconstructionactivityatthefollowingaddress:1604 S MEDINA DR . .11.1 agree that,as the party legally and financially responsible for this proposed construction activity,I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 12.1 agree to notify the issuer of this form immediately of any additions,deletions,or changes to any of the information I have provided on this form.Licensed contractors are regulated by laws designed to protect the public.If you contract with someone who does not have a license,the Contractors'State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed Contractors may be in civil court.It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property,you may be held liable for damages.If you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'compensation insurance coverage. Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note;Acopy<^he properly owner's driver’s license,form notarization,or other verification acceptable to the agency is required to ;^esente^/Men the permit is issued to verify the property Property Owjiw'^ig nature Date: fblcl_owm.’r_buildcr_info_verir