2120 S. Waverly Dr.
APPLICANT: CHAM NGUYEN
OWNER INFORMATION:
Khuong 0 Pham
2120 S~aveiryDr.
Anaheim, CA 92802 "
. JOB DES.CRIPTIONRoorriA~ditjon 887 sq.ft.. New kit9hen,'-dining, e~erci;se roc~m, bathroom and open pati~. (HIH)
VALUATION: '62,000.00 PROCESSED BY:CAL ,
I . OWNER.SUILDEROECLAAATION
I hereby affirm under penalty of perjury that.\ am exempt from the Contractqrl'i License law for the folloWing reason (Sec. 7031.5 Business and .,
,Professions CoJe; any'dty or county which requires a permit to con'struct. a4t'1i. improv~, demolish or repair ~nY$tructure; prior to its i~uancei also:
requires the app.licant for such, permit to' file a signed statement that he is Iice;:\,lsed pursuant to the plOvisionsofthe Contrador'~ License Law (C~apter'
9)(commencin9_with Sl?ction 7000 of Division 3 of-the Business and Profess.~jf\S Co~e}"6r that he is, exe!TIpt t.herefrom and the basis for th_e a"e~ed
exemption~~ Anyviolation of Section 7031.5 by any.applicant fora permit slJb~?cts theappUcant to a dvjl penaityof not m9re-than five hundred dollars
($500), '. . . . . ..:;. .';,. .' .... . .'
o I, as ~oer 'of propertY, or my employeeS with wages as their sole comr)'~n,sati.ori;wili .do the work, a.ndthestructure is not. intended or offered for
. sale (Sec. 7S144,~siness and Professions Code: ,The Contractor's:_Ucense 1.1,iw'does'not apply,toan-owner of property~ho ,builds or improves
thereon, and who does :such .Wprk 'himself or herself 'or through his or her ow!';'employe.es, provided that such improvements,a re: not i!ltended_ or .
. offered for sale. If"howi3ve,r;:the building or,improvement is sold with oneye{r of .completion, the owner-builder will have 'the burden of proving tt=!at he
did riot b ild or 'imprdve,for the purpose or-sale). " , {" _ '''....' ::_ . ..' :<
, as the owner of the property, :a/Tl exClusively cont ra cting with UceM'ed,~ntractors- to consfru~t the proj~ct {See. 7044 'Business ,and ProfeSSions
e: The Contractor's Licen~ Le'!w does not apply-te,an owner of pr'opertY)Jho buUds'or:improves thereon,- and who. contracts forsljch -projects with
n.tract?r(s)licensedpunwa~t.totheContrel?t?r'sLicense Law),. ,:{1,. ;. ... ,.,. -....'.',.: - .
I am exempt under Sec; ~ & P.C. for his reason: .
Date: , Owner: : 1
WORKER'S..
I hereby ?ffirin under- penalty of perjury one.of the following declarations: J
o 1_ ~av~ and win maintain a certificate_ of oonsent 'to- ~If-insure for Wo(ker'~COO""lpensa.tion>
as p,rovided for QySectioii 3700 of the Labor Code, for the,performance QfthlWOrk forwhich
this permit is iss~ed... " "
DI,'have'al)d will maintaihworker's compen.sation insurance, as requiredr;~ Sec,tion3700 of
th~ Labor Code, for the perfo.rmance of the work for Which tl,is permit is iSSU",\J.. My worJ<er's
CompensatiOn insurance carrier and policy are:' .
. Carrier:' Policy NUrT!ber. _.
'.\ 'I
This section need not be completed if the.pennit is for one_ hundrec ~ars {$1 0(.; "1' Jess. ' ,
~ certi'ry the t in theperf()TTrl~nce of the work for which thi~ -b:::f~il~i$ 'i_~ye~'.', J. ~hall nbt .
er~ any person in any manner so' as to. be.oome sUbjectt~~'\\1P(:Ke~S'ev~ation -laWs
of Cal}fomia, and agr~e_ that if I-should become subject'to,th~~1<er's.comp:~'!').Sati6ri':,:- ',-.,:_'
provisions 01' Section3700 afthe Labor Code,: I shall forthwitt-tii~IY\.Vitt'! tr.'?$~ proviSions..
~;~N~~~~~~;LOREr~~~~U~~RK~i~~~'E~~~~R\~~IS' ..'. ....
. UNLAWFUL, AND SHALLSUBJECT AN.'EMPLOYER TO CRIMINAL PENA!.TIESANDCIVIL
FINES UP TOONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADO:T10N TOrME
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIOi':3706.0FTHE
LABOR CODE, INTEREST AND .ATTORNEY'S' FEES, ,'.
I CONSTRUCTION LENDING AGENCY _
. t hereby affirm under penalty of perjury 'that there is_a .construction lending ~:.;?ncyfo~ the
performance of the work.for which this permit i.s issued (SSC.3097 .Civ .C):' J ~f '. :,,-:-,
-1.enuefs'TriTolination;-'-.._-~'---"-' -----,. - ------ ~.-- ,- --,'~--..- - -. ..(.>'-~,-~
BUILDING PERMIT NO. BLDZ004-01181
1YPE.OFPE.RMIT '.C.tTY.
Residential Addition .'
DATE:.4/15/2004 '.'
.JOB ADDRESS: 2120 S WAVERLY DR
LEGAL DESCRIPTION: N TR 11482 LOT 1
'\\
<-
BUILDING DIVISION
200 S. ANAHEIM BLVD:
(714)765 - 5.153,'
. INSPECTION REQUEST LINE:
(714).765 - 4626
CENSUS CODE: .434
QUARTER SECTION; 59
ARCHITECT/ENGINEER INFORMATION:
CONTRACTOR INFORMA"ION:~
LICENSED CONTRACTORS DECLARATION .,
the.reby affirm under penalty' of perjury that I am
'licensed under provisions of chapter' 9 (co.mmencing
with Seotion 7000) of Divsion 3 of the Business. acid.
Professions Code. .
4115/2004
nate:
NUMBER
TYPE
: Construcioh Types:
VN,' i
.'Fire SPrtnklered?
UvinQ Area:
Patio Area:
. , - .
I ,certifY thC!lt I have read this application and state that th e. above information is correct. I
agre,e to CX?inply with all city ordinances and state laws rel.ating to huilding cCflstruction, ar.ld'
l:1ereby.authorizerepresentivesofthis city t.o.enter upon the above mentioned property for
inspection pu~ .. De.te.4115/2004
-' \( '. ,.' Signature 01 Applicant.or Agent
. ThE. p~mit 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 cont.inue work.
Contractor'
EXPIRATION DATE
NO
. BB7
255
~
. '"
Fees paidfof Permit:
. Total:
6,.20
INSPECTION ~ECORD
, ' ' "
, INSPECTION ' , ' , " JNSPECTQR "
: DATE
TeinporaryPower Pole
, Plumbiilg (Drail}/Waste Pipe) ,
Electrical Groom:! Electrode/Uter ,
SetbacklFormsfTrenches (Footings) '1'/0810 ' tPL.-M
, Do not install subfloor or pour floor slab UIltil the ,
fOllowing applicable items have been signed: ,,_ '
Plumbing (Water P1pe.Sprinkler ValveS)
Mee'hanlcal (Grour\dwork) , ,
Electrical (Underground Condu it) " "
Pre.-:slab (CompactionlMembrane.Rilinf. ,
Underpinning (FI(lO( Joist/Girders) : , "
Do not cover or conceal the wo,rk below Urltll the
lollowingapplicable items have been signed:
1st Floor Shear , ' , ,
Firesprinkler(Rough) " "
2nd Floor Shear " " " , " 171 " ,
Roof (Sheathin!ilDiaphl3gmlFrane)7\ - ID-oY" ,,'
Masonry (RilinfJBond BeanlPrlH3rput) , . , ,
Rough Plumbing (T QP Out) , ' ,
Rough Mechanical ", , '
Rough B8Ctrical (Dry wall) ,', , ", '
Rough Ele-ctrical ,'. , , " , J , ,
Framing, - (bnlyafter Plbg.. Elec.; Mech., oa-nd Fire). /()-Ic.. '"
Insulation (~ndlEnergy) , ' , "
Do not tape or plasteruntinhe following applicable .1.
items,hav", beerl'signed: " ,",'
" , . .,' ' , It.(( "4"
DryWall' ,
PenetratJons(FireRated)Electrical ' 7
Penetrat)ons (I'lre Rated) Mechanical ,
Penetrations (Fire Rated) Plumbing 'I
InteriQr Lath .. ' , .' ",
Exterior Lath, 1
. , - GENERAL ITEMS
Exleri,or Plaster (Brown Coat) " ' . ,
T.Bar Electrical ' ' , '
T-BarMechanlcal ., ,
T.Bar'Structural' ' , -
Sewer . ,
Water Engineering BackflQw ' , . ,,' ,
Water Service ' '
FINAL JNSPECTIONS '
EJectricalFinal
Plumbing Final
Mec;h"nical Final
Gas Test
Engineering/Grading Fi(lal 7.6(j-5126
,Fire Dept. Fin", 765-4040
Water Engineering.765-5268 '
Sub List/Business License 765-51'
,
>
Zoning 765~5139
BulldingFimil (Lastlnspeetion- Only .
, ,After Above Complete) (JI
i>ARTIAL INSPECTIONS'
BuildinQ Inspections
c,..-/I:,-t>'fr; cyt ~ &
lIIIechanicalll'lspections '
Plumbing Inspections
Electrical Inspections '