2120 E. Viking Ave.
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE: '
(714)765-4626.
CENSUS CODE: 434
9UARTER SECTION: .114
. BUilDING Pf>RMIT NO. c IlLt-2003.Q4312
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TYPE Oi'"PEf.iiCll"r
Residerit!aIAddil~on . C I TV
'DATE: 11/17/2003..
JOB ADORESS: 2120E VIKING AVE
LEGAL DESCRIPTION: N TR 2350 LOT 11
. APPLICANT: PAULINE DODD
OWNER INFORMATION:
PAULI NE DODD
2120 VIKING
Anaheim, CA. 92806
JOBDESCRIPTIONAdd72s1 porch and I~crease existing kitchen 95s1 (190SI:flal)
VALUATION: a,7a7.00 L PROCESSED BY: MJL
I ....... . '.' OWNER-BUllDE~~;pEClARATION" . . .' .
I hereby affirm under penalty o~ perjury that I am exempt fron'l-tile Contractotti License Law for the following reason (Sec. 7031.5 Business and
Professions COde: any dty or county which requires a permit to construct. alt~~t, improve. demolis~ .or repair any structure, prior to .its. issuance. ~Iso
requires the appucant for sUch perT~it to me a sig.n~ statement that he is.IiC~~'$(.>d pursuant to lhe:' pro_visions of the G<:mtract,or's. License~al/l (~hapte'r
9)'(corr:menc_ing with ,Section 7000 of DiVision3 of th~BuslOess and Professions Code) or that he is exempt ttlerefrolT) and the ba~is for the.alleged:, '
exemption:' Any viGiation of S,ec~ion 7031~5 by any applicant for.a pel/nit su~~~rcts the <=.:ppl!co::,nt to_8 .civil Penalty of not more than filv'e huncfrdd d~tla~ .
($500). H. . . . .' . . ."
o '1. as. owner of prop~rty,or my employees with w~ge$.as their sole com~i~'1sation; will do the work,and the structure,_is ~Pt intended'or offered for
sale (Sec~ 7044 Busine.'":s and Professions Code:. The Contractor's Licensebpw does not apply to an owner of property who builds or improves
thereon, and .who does such work himself or helSelfor through his Of_ her ow4.:cimplo)'ees" provided that such ,improvements are notinte!'1ded or
o~ered f6~'SaI..~~'_I~., how.ever. the. ~ilding o.r im.p:,o.vement is sold withorie Ye:~~r of comPletion., 'the~n'er~bu~der will pave .t.h7 burden of prOVing. that he
dId no.t buDd O(lmptove for the purpose of sale), .' . .'. . . - .
15t1. ~, as tpeowner of ttfe, property, am eXdusiV.'elv contracting- with licenc;;ec ;~n~ctors'to const.:''Jct tht. project (S.- ec. 7041:1- Business '300 ,prOf...eSSjalts
~de: The.Contractor's Li~se Law dees not apply to an owner of- propert:.-3- ho9UUdsor improves thereon,.and Who contracts for such projec~~with
f1J!ontra:.~or(s)Hce~~Rursuantto'the Contractor's LioenseLaW).i.1 < '. . ". . . .
U, al11exelilpt uriQc3r $e;c. " B & P. ,fo~ this reaso ':t
Date: < Owner:
IF -'--'-' I
. .' WORKER'S COMPENSATION DECLARATION 1___--1 LICENSED CONTRACTORS DECLARATION
I herebyaffirml,!'nder penalty of perjUrY,one of the following declarations:" ~ .' ' .1 hereby affirm underp€:nalty of perjury that I am
o ',have ancfwiU. rna,inti.=un a'cert;flCate of consent'to self-insure for wOi~.el~~:,~;::;;,:)€:('ls~tioh,' licensed urider provisions_~f chapt~~ 9 (commencing
as provided_for by_SectiOn 3'tOG of the labor Code, for the performance ofu-!";wor:k for which wHh S~c.tion 70qO) of Divslon 3 of the Business and
'thispermitis"jssued, ,;" ,- - F:. . ,PrcfessionsCode.
o I have andW..iH fn.aintainWOri<er's compensation iosuratlc.., as required v1 ',uClio". 3700cf!. ,~1/17:20CT~.
the labor COQe, forthe performance of the work for whic'1 ,this permit is iss:.:l. ;viyworker's '-Date: -.
CompensatiOn insurance earrier and poliq are,: . '. ;j
Carrier: . . . Policy Number: ..~. f\~t.:MaER
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This sec;tion ~~ net be cOmpleted if the permit is- for one hundred dvllnrs ($10l:l.!.'~ l~~.
~ J certify that in t~e performance 6f t~e work for which this permit is iseU.~~~'1 shaH not."
~)Ioy any person,in any' manner so as to become subjectto the worket-$-c~~.~pensation'laws
of Califomial and agree. that if t should become $Llbjed to the worker's qom;i:;/"1s3~lon
provisions of Section 3700 ofthe labor de, I S!'aH forth~ith co~pl with tft;lI:.e p ~isions,
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CONTRACTOR INFORWTION:
, .
ARCHITECT/ENGINEER INFORMATION:
SCOTT BELAIR
505 S OHIO ST
i\NAHEIM, CA 92805
I
Contractor
EXPIRATiON DATE
TYPE
. Date: 11/1712003 . . Applicant:
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVEP~,GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAi':-j=:S AND CIVIL
FINES liP TO ONE HUNDRED 11iOUSAND DOLLARS ($1QO,000), IN ADQ!l10N TO THE
COST OF COMPENSATJON, DAMAGES AS.PROVIDED FOR IN SECTI0~j~196 ()F THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. ~ ,---
I . CONSTRUCTION LENDING AGENCY '.
I hereby affirm underpenalty of.perjury that the~e is 8 construt;tion lenqing ?;:::~'cyfor the
t!erfon'na~ce.oft~ework: for which this permit-is issued (Sec,2097.eiv.C): OJ L
-'--~'):"!1~:''Z''''~::':-::''.::':>:;-R:' ,----, -, - - -..-- ~~..
Construcion Types:
VN, ,
Occupancy Groups:
R3" ..
Fire Sprin~lered?
DwellinQ Uni~:
LivihQ Area:
Pa.fio Area:
. NO.
1
95
72
'41 ~_:
_.,._';'-~-;''':
. '1 certify that.1 have r~fuis application arid state thatthe'above information !;3 correct. I
agree to comply with.all city ordinanc'es and state laws relating to building conlitruction. and
hereby authorize. represeritives of this city to ante u n the above mentiqned property (or
inspe 10 purpose
Date: 1111712003
Fe~s paid for Permit:
Total:
.355.13
Signature of Applicant or Agent .
The permit shall expire by limitation and become null andvoid if the building or
work has not passed final inspectiOn 365 days from the date of perm't issuance. A
heW permit is required to commence or contlJ1ue Work.
INSPECTION RECORD
.INSPECTION
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DATE
. . INSPECTOR
Temporal)' Power Pole
Plumbing (Dl3inlWaste Pipe)
Electrical GrounctElectrodelUfer
SelbacklFornis(Trenches (Fpotings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
. Plumbing (Water Pipe.5prinkler Valves)
Mechanical (Groundwork)
Electrical (UndergroUnd Conduit)
Pm-slan. (CompactjonlMembrane.K~nf.i
Underpinnlng(Floor Joist/Girders) .
Do not cover or conceal the work belcwunt" the .
fOllowing applicable items have been signe(j:
1st Floor Shear .'. L. :..(~G{
Fimsprinkler (Rough) f
2nd Flopr Shear .' . , A
Roof ($heathing/D1aphraQm'Fram",1 .., ~Z.ijL'" b P'.
Masonry (ReinfJBond BeamIPre-Grout)
Rough Plumbing (Top Out) .
Rough Mllchanical
, Rough l:Iectrical (ury Wail)
Rough ElllClrlcal .
Framing . (On~afi.rPlbg.,EI.C,.r-.'.ech.,andFir . -r;..p4< P
Insulation (SeundlEflllrgy) _<~I t?
po not. tape or plaster until the folio,," 109 applicable .
.tems haye.been,slgned: .
Dcywall q.;. ? / -"if
PllIlelratlons (File,Ratfild) Electrical . I
PllIlelrations(File Rated) Mechanical ,.
. PllIlelratlons (File Rated) Plumbing
Interior Lath . . .
Extllrior Lath . Jj~
GENERAlITEMS I r
Exterior Plaster (Bl'OVin Coat) b. ,.lf~"'1f
T -Bar Electrical . . ,-. v. .
T -Bar Mechanical . .
T -Bar .Structural
SeWer .
Water Engineering Backflow
Water Servicll
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FINAL INSPECTIONS
Electrical Filial
. Plumbing. Final
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Mechanical Final
Gas Test ..
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Engineerin9/Grading Final 76S..s126
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Fire Dept. Final 16S-4040 .
Water e:ngineering765~5268
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Sub ListlBusiness License 165.-519
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ZC)ning 165-5139
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Building Final ([astlnspection. Only " /,,1. _:/Xl^ J l~1l '.
After Above C"mplete} rlZSI (Jc" (I.
. '.. PA~TIAL INSPECflONS '. OV '
BUdding Ins~ctlons . . . j ..
. .z. ~7-L?i-:- J1J'TZIff!!H A7-l ~ . f,/f... ...,. '.
J. J 1-0V(;JO~LA 0-1;::'<, .~);u. \ .,~ ./
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Mechanical Inspections
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Plumbinct Inspections
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Electrical Inspections
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