1812 W CHANTICLEER RD (6)Permit Types
BLD ELE MEC PLM
X
Permit Number:BLD2009-0V548
Issued:,05/15/2009
INSPECTION REQUEST LINE;
(714}765 -4626
Quarter Section:49
CITY OF ANAHEIM
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765 -5153
Site Address:1812 W CHANTICLEER RD
Legal Description:N TR 3256 LOT 32
Project Description:Replace water main 80 ft.
Valuation:
Construcion Types:
Total Fees paid for Permit:
VB,
136.73
People Associated with Project:
Owner ROBERT H MARTIN TR 1812 CHANTICLEER RD ANAHEIM CA 92804-5519
Permit Applicant EVAN GAUTIER
Electrical FixturesType Qty Type Plumbing Fixtures Qty Type Mechanical Fixtures Qty
Water Main per 100 ft.1
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.!)●mill combo
All applicable items below must be signed before utilities will be released.
inspections'DATE INSPECTORCityofAnaheim
Building Division
Final Gas Test
Electrical Final
Plumbing Final
Mechanical Final
Cross Connection Control (7i4)76s.42eo
Engineering/Grading Final (714)765-5126
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.
BUILDING PERMIT DOES NOT AUTHORIZE ELECTRICAL,PLUMBING,OR
MECHANICAL INSTALLATIONS -SEPARATE PERMITS ARE REQUIRED.
Sub List/Business License (714)765-5194
Zoning (714)765-5139
INSPECTION DATE INSPECTOR Building Final (Last Inspection ●
Only After Above Complete)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 INSPECTIONSSetback/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 alter PIbg.,Ele.,Mec.&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
GENERAL ITEMS Electrical Inspections
Electrical Service Meter
Exterior Plaster (Brown Coat)
T-Bar (Struct.,Ele.,or Mec.)
Sewer
Water Engineering Backflow (Testable Only)
Water Service
Permit Backs Masfer-2008
Permit Types
-●..D -ELE MEC PLM
X ¥
Permit Number:BLD2009-01548
Issued;05/15/2009
INSPECTION REQUEST LINE:
(714)765 -4626
Quarter Section:49
CITY OF ANAHEIM
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765-5153
Site Address:1812 W CHANTICLEER RD
Legal Description:N TR 3256 LOT 32
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 the
checkmark(s)I have placed next to the 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 permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors'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 a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500).
I.as owner of property,or my employees with wages as their sole compensation,will do (
intended or offered for sale (Sec.7044 Business and Professions Code:The Contractors'State License Law does not apply to an owner of property who,through employees'or personal efforts,builds or improves the property,provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Qwner-Builder will have the burden of proving that it was not built or improved forthepurposeofsale),
I,as the owner of the property,am exclusively contracting with licensed Contractors to construct the project (Sec.7044 Business and Professions Code:
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:
)all or ()portions of the work,and the structure is not
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 of the
improvements covered by this permit,I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entirety by licensed
contractors.I understand that a copy of the applicable law,Section 7044 of the Business and Professions Code,is available upon request when this applicationissubmittedoratthefollowingWebsite:httD://www.leainfo.ca .Qov/calaw.html.
By my signatire below,I certify to each of the following:
I am the property owner or authorized to act on the property owner's behalf.
I have read this application aiqd ftiie informalion I have provided is correct.I agree to comply with all ^pliMbte city afid county ordinances and state laws relating to building constructionIauttjorizerepresefitat|ves oft lis (ity ot couiw fo enter the above-identified propertWor inspection purposes,V 1^1 Signature of F^perty Owner or Authorized Agent
a
Date
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 provided for bySection3700oftheLaborCode,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,for 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:
Name of Agent:
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 subject to the
worker's compensation laws of California,and agree that,if I should become subject to the worker's compensation provisions of Section 3700 of the
Labor Code,I shall forthwith comply with those provisions.
Phone No,:
Signature of Applicant Date
i^ermit Types
ELE MEC PLM
X
^ermit Number:BLD2009-01548
Issued:05/15/2009
INSPECTION REQUEST LINE:
(714)765-4626
Quarter Section:49
CITY OF ANAHEIM
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765 -5153
Site Address:1812 W CHANTICLEER RD
Legal Description:N TR 3256 LOT 32
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 the
checkmark(s)I have placed next to the 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 permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors'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 a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500).
I.as owner of property,or my employees with wages as their sole compensation,will do (
intended or offered for sale (Sec,7044 Business and Professions Code:The Contractors'State License Law does not apply to an owner of property who
through employees'or personal efforts,builds or improves the property,provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Qwner-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 Professions Code:
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:
-)all or (,)portions of the work,and the structure is not
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 of the
improvements covered by this permit,I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entirety by licensed
contractors.I understand that a copy of the applicable law.Section 7044 of the Business and Professions Code,is available upon request when this application
is submitted or at the following Web site:httD://www.leainfo.ca .Qov/calaw.html.
By my signatire below,I certify to each of the following:
I am the property owner or authorized to act on the property owner's behalf.
I have read this application and the information I have provided is correct.
I agree to comply with all applicable city and county ordinances and state laws relating to building construction
I authorize representatives of this city or county to enter the above-identified property for inspection purposes.
DateSignatureofPropertyOwnerorAuthorizedAgent
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 provided for by
Section 3700 of the Labor Code,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,for the performance of the work for which this
permit is issued.My worker's Compensation insurance carrier and policy are:
Carrier:
Name of Agent:
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 subject to the
worker's compensation laws of California,and agree that,if I should become subject to the worker's compensation provisions of Section 3700 of the
Labor Code,I shall forthwith comply with those provisions.
Policy No.:Expiration Date;
Phone No.:
Signature of Applicant Date
CITY OF ANAHEIMINSPECTIONREQUESTLINE;
(714)765 -4626
Quarter Section:49
Permit Number:BLD2009-01548
Issued:05/15/2009
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 1812 W CHANTICLEER RD .
We are providing you with an Owner-Builder Acknowledgement and Information Verification Form to make you aware of yourresponsibilitiesandpossibleriskyoumayincurbyhavingthispermitissuedinyournameastheOwner-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 owner,
obtain the prior approval of the permitting authority.
Dli^ctions:Read and initial each statement below to signify you understand or verify this information.
1.I 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 for those
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.I understand building permits are not required to be signed by property owners unless they are responsible for theConstructionandarenothiringalicensedContractortoassumethisresponsibility.
3.I understand as an "Owner-Builder"I am the responsible party of record on the permit.I understand that I may protect^^yseif from potential risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own.4.I understand Contractors are required by law to be licensed and bonded in Californiaand 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
I of my construction is at least five hundred dollars ($500),including labor and materials,I may be considered an "employer"^.-^nder state and federal law.
I understand if I am considered an "employer"under state and federal law,I must register with the state and federal/government,withhold payroll taxes,provide workers's compensation disability insurance,and contribute to unemploymentIcompensationforeach"employee".I also understand my failure to abide by these laws may subject me to serious financialy^^isk.
7.1 understand under California Contractors'State License Law,an Owner-Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale,unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year,or all of the work is performedjOWndercontractwithalicensedgeneralbuildingContractor.
8.1 understand as an Owner-Builder if I sell the property for which this permit is issued,I may be held liable for any financial
■cf personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the^workmanship or materials.
9.I 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
n -800-321 -CSLB (2752)or www.cslb.ca.gov for more information about licensed contractors.
10.lam aware of and consent to an Owner-Builder building permit applied for in my name,and understand that 1 am the
party legally and financially responsible for proposed construction activity at the following address:1812 W CHANTICLEER
RD .
lbld_owner_buiIder_inro_verif
—11.1^agree that,as the party legally and financially responsible for this proposed construction activity,I will abide by allc'^v'caBTe laws and requirements that govern Owner-Builders as well as employe ’
—12.I agree to notify the issuer of this form immediately of any additions,deletions,or changes to any of the information Ihaveprovidedonthisform.Licensed contractors are regulated by laws designed to protect the public.If you contract withsomeonewhodoesnothavealicense,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:A copy of the property ow^'s driver's license,form notarization,or other verification acceptable to the agency is requiredtobepresentedwhentl^perrryf i^issued to verify the property owner's signature.
rs.
<:l^op^y pwner'^Signature Date:
n‘)ld_owncr_buiklcr_inro_vcnr