431 S MOUNTAIN GLEN RD (3)Permit Types
BLD ELE MEC PLM
X
Permit Number:BLD2009-01566
Issued:05/18/2009
INSPECTION REQUEST LINE:
(714)765-4626
Quarter Section:163
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765-5153
Site Address:431 S MOUNTAIN GLEN RD
Legal Description;N TR 9792 LOT 13
Project Description:Replace heating and air conditioning system.
Valuation:
Construcion Types:
Total Fees paid for Permit;
N/A,,
68.40
People Associated with Project:
Owner LAURENCEW DOTSON
ANDREW D COOPER COMPANY
THOMAS MARKOS
431 S MOUNTAIN GLEN RD ANAHEIM CA 92807-3502
543 E CENTRAL PARK AVE ANAHEIM CA 92802 0000Contractor
Permit Applicant
Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Type Mechanical Fixtures Qty
Heating Appliances,including vent
Compressor/Boiler -up to 15 hp
Heating/Cooling Coil
1
1
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 ofpermitissuance.A new permit is required to commence or continue work.Ibid pc‘nr'--
f
All applicable items below must be signed before utilities will be released
FINAL INSPECTIONS INSPECTORDATE
Final Gas Test
Building Division Electrical Final
Plumbing Final
Mechanical Final
Cross Connection Control (7i4)76s-428o
Engineering/Grading Final (714)765-512S
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 mado Sub ListySusiness License (714)765-5194BUILDINGPERMITDOESNOTAUTHORIZEELECTRICALPLUMBING.OR
MECHANICAL INSTALLATIONS -SEPARATE PERMITS ARE REQUIRED.Zoning (714)765-5139
Building Final (Last Inspection -
Only After Above Complete)
INSPECTORDATEINSPECTION
Do not pouf concrete until the following applicable items have been signed
FINAL INSPECTION must be approved by the Building Division.Plumbing (Ground/Underfloor Drain Waste)
Electrical Ground Electrode/Ufer PARTIAL INSPECTIONS
Setback/Forms/Trenches (Footings)
Do not install subfioor or pour floor slab until the foliwing 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 Plbg.,Ele .Mec &Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable items have been signed:
Dry wall
Drywall Penetrations (Ele.,Mec.&Plbg.)
Interior Lath
Exterior Lath
Electrical InspectionsGENERALITEMS
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.xls
r Permit Types
BLD 1 ELE MEC PLM
X
Permit Number;BLD2009-01566
Issued:05/18/2009
INSPECTION REQUEST LINE:
(714)765 -4626
Quarter Section:163
CITY OF ANAHEIM
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765-5153
Site Address:431 S MOUNTAIN GLEN RD
Legal Description:N TR 9792 LOT 13
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 to the applicable item(s)(Sec.7031.5 Business and Professions Code:any city or county which requires a permit toconstruct,alter,improve,demolish or repair any structure,prior to its issuance,also requires the applicant for the permit to file a signed statementthatheorsheislicensedpursuanttotheprovisionsoftheContractors'State License Law Chapter 9 (commencing with Section 7000)of Division 3oftheBusinessandProfessionsCode)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 Owner-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 alicensedContractorpursuanttotheContractor'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 ackonowiedge that,except for my personal residence in which I must have resided for at least one year prior to completion of theimprovementscoveredbythispermit,I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entirety by licensedcontractors.I understand that a copy of the applicable law,Section 7044 of the Business and Professions Code,is available upon request when this applicationissubmittedoratthefollowingWebsite:http://www.leQinfo.ca ,Qov/calaw.htm!.
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.
Signature of Property Owner or Authorized Agent 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:
STATE FUND WEN0023993-02 7/1/2009Carrier:Policy No.:Expiration Date:
Name 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 subject to the
worker's compensation laws of Cajitorfii
Labor Code,I shall forthwith
d agree that,if I should become subject to the worker's compensation provisions of Section 3700 of the
ply with tjabse provisions.
Si«nature"o^pplicanl Date
riCLA .ATION REGARDING CONSTRUCTION LENDING AGENCY:
I nerebv affirm under penalty of perjury that there is a construction lending 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 penalty of per]Business and Professions Code^ndifluiry^hat-ham licensed under provisions of chapter 9 (commencing with Section 7000)of Division 3 of thelylicensesinfullforceandeffect.
VComractoTSignalure
NUMBER EXPIRATION DATE LICENSE TYPE (SI
C20 HTAC2205513/31/2011 C36
B
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 ofpermitissuance.A new permit is required to commence or continue work.
Ibid permit combo declare