1855 S. West St.
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BUILDING PERMIT NO. BLD2004"03805
TYPE OF PERMIT
Residential.Addition
DATE: 10/14/2004 .
JOB ADDRESS: 1855 S WEST ST
LEGAL DESCRIPTION: N TR 3204 LOT 1
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CITY ~1'~irg~H ElM
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BUILDING DIVISION
200 $. ANAHEIM BLVD.
(714) 765: 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 67
APPLICANT: RICK PETERSON'
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
. RICK PETERSON DONALD J INMAN
1855 S. WEST 5131 FOX HILLS AVE.
ANAHEIM. CA BUENA PARK, CA 90621 .
JOB DESCRIPTION First & second story addition, total 2,104 sq. ft. addition, 5',6 sq.ft. deck and 300 sq. ft garage. Supplement permit # BLD2004-02018
VALUATION: 150,000.00 PROCESSED BY: SAM
I _ OWNER-BUILfJEP,,'1ECLARATION
I hereby affirm under penalty of perjury that lam exempt from the Contractor':. License Law fer the following reason (Sec. 7031.5 Business and
Professions Code: any dty or county which requires a permit to constnJct,~~,!(r, imp~ove, demolish.or repair any structure, prior to its issuance, 'also
requires the applicant for such permit to file a signed statement that he is licer,lsed pursuant to the provisions of the ContrAlctor's License Law (Chapter
, 9)(commencing with Section 7000 of Division 3 of the Business and Prefes$Jc,:,":s Code) or that he is exempt therefrom and the basis for the alleged
7;~)~i~n. Any vioiation of Sect~on 7031.5 by any: aP.~~icant for a permit ~~bj~~cts the apptic~nt to a evil penalty of not more than five hundred dollars
ci)-~~, as owner of piOperty, or my employees with wages as their sole c;0mp~rns?tion, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Businp.$S and Professtons Code: The Contractor's Lic~n~eJ.,:;w does not apply to an owner of property who bu.ilds or: improves
thereon, and who does such work himself or herself or through hifi or her owr; empioyees, provided that.such improvements are not intended or
offered for sale. If, hawever, the building or imprQy_ement 13 sold ':\lith or.e '1d;"-:of CXJlllpleti'on,' the owner-builder will have the burden of proving that he
, 'did not bu'i1d or improve for the purpose of sale)." :;;~: . .
. Oi, i:IS the owner of the property, am exdusive1y" Gontrac-!ing with licensee (.~ntradt)rs to construct the project (See. 7044 Business and Prof~ssior!s
Code: The Contractor's License Law does not apply to an owner or pr..}pe.ity \~/ho builds or improves thereon, and who contracts'for suCh projects with
Ljontractor(3) licensed pursuant to the Contractor'$ License Law\'"
tamexernPtunders~c..., . . ,B&,p.C,for~;_,~~.:.
h!1a\e:~ -r4-{)<-r Owner: ~--L:. . __ _~, _
c= WORKER'S COMPENSATION DECLARll.TION ~___-=:J
I hereby affiml under- penalty of perjury one of the foJ1o\rving dec!a;qtior:s: .: _ .
[J I rlave and wit! maintaJn a certificate of ronsent to self-irlsure for wor:\e"'~-comp:::nsatiQn,
as prbvidt;>c:l"for by Section 3700 of the LaborCorje. tor the perfonn::jnce of ti":~'NclrX for which
1his permtt is issued. , '
D I have a!"!d wi!! maintain worker's compensation lnsur:mce. as required bySectfan 3700 of
the L9bor Code, for the performance of the work for which this permit ~'> !ssuc). Myv,'orker's
Compensation insurance carrier and policy are: . '
Carrier' . ' Polic.y Numb~r: '
Th!~tion need not' be completed if the pennit is fo~ one hund~ed dollars {$1Cri~: Pf iess.
, ~_I c:ertify that in the perfo.rmance' of the wo~k for which this .permit is issu~<I~ I shall not
employ any person in any manner so as to become subject to the 'Norker's-compr.-nsation Jaws
of Califomia, and agree that if ,I should become subject to the worker's COf!1jJ€:;lsation
provisions of Section 3700-ofthe labo'r Code, I shall forthwith comply with th(,se provisions.
Dat';l: 10/14/2004 A~Plicant:j. .~ .~ P~r -::--.t
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERPGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIM!NA._ PENALTIES AND CIVIL
FINESUPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDrnON TO THE
COST OF COMPENSATION; DAMAGES AS PROVIDED' FOR IN SECTiON ,\106 OF THE
. LABOR CODE, INTEREST AND ATTORNEY'S FEES. . .
I CONSTRUCTION LENDING AGENCY _.
! hereby affirm under penalty of perjury that there is 3 construction lene ing a~~')cy fer the
. ~(lrferm~_r1ce_qfthe_~.ork for_!",~~_~his permit-!s issueJ (Sec.3097.Civ.C): ,-~.____..
LenGeo(::;: lnrorniation:
LICENSED CONTRACTORS DECLARATION .1
I hereby affirm under penalty. of perjury {hat I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code.
10/14/2004
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Construcion Types:
VN, ,
rire Sprinklered?
NO
I certify that I have read this application and state that the above information is correct. I
agree to oomply with all city ordinances and state laws relating to building construction, and
hereby authorize representives of this city to enter upon the above mentioned property for
inspection purposes/' ~d - . "'_
-j--- ft ~ P"'/~.:;;-"- - ~ Date: ~0/14/2004
. 'Signature of Applicant or Agent ,
The permifshall 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.
Fees paid for Permit:
Total:
5,072.61
INSPECTION RECORD
. . '
,,' ,INSPECTION DATE, INSPECTOR ,
Temporary Power Pole ' , ,
Plumbi ng (DrainlWaste Pipe)
Electrical Ground Electrode/Uter
SetbacklFormslTrenches (Footings) , ,
Do not install subflooror pour floor slab until the ,
following applicable items have been signed: ,
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork), ' , ,
Electrical (Undergrounel Conduit)
Pre-slab (Compaction/Membrane.Rei nt.
Underpinning (Floor Joist/Girders) "
" Do not cover or conceal the woll< below until the
, following app'li.cable- items have been signed:"'
1 st Floor Shear ' ,
FireSp;;nkler (Rough) ,
2nd Floor Shear
, Roof (Sheathing/Diaphragm/Frame) ,
, ' Masonry (ReinfJBond BeamlPre-GRl\It)
Rough Plumbing (Top Out)
Rough Mechanical, ,
ROugh ElectriCal (Dry Wall)
Rough Electrical , ,
Framing (Only after Plbg.. Elec.. r..lech and Fire) ,
Insulation (SoundlEnergy) ,
00' not t;;ipe or plaster until 'the following applicable
, items have been signed: " . , . , , ,
Drywall , , ,
,
, Penetrations (Fire Rateel) Electrical ,
Penetrations (Fire Rateel) Mechanical. , ,
Penetrations (Fire Rateel) Plumbil19
Interior Lath , ,,' ,
Exterior Lath ,
" , GENERAL ITEMS
, Exterior Plaster (Brown Coat) ,
T -Bar Electrical I
T -Bar Mechanical
T -Bar'StJ'Uctural ': , /l "
" Sewer/ ::i" i V" /H?'\, I "H.O - /~, ,
Water Ehgineering Backfl6w .;.
Water Service , ,
PERMIT' EXPIRED
INSPECTION
NOT COMPLETED
DATE: \ 0 -\9; '06
Date
FINAL INSPECTIONS
Electrical F,inal
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Cept. Final 7654040
Water E,ngineering 765-5268,
Sub List/Business License 71;5-51,9
Zoning 765-5139
Building Final (Last Inspection. Only ,
After Above Complete)
PARTIAL INSPECTIONS
BuildinQ Inspections
Inspector
Mechanical Inspections
PlumbinQ Inspections
Electrical Inspections
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BUiLDING DIViglON
2~0 S.AN.AHEIM )'lLVD.
(714) 765 - 51!i3
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 67
BUILDING PERMIT NO. BLD2004-02018
TYPE OF PERMIT
Residential Addition
DATE: 5/25/2004
JOB ADDRESS: 1855 S WESTST
l.EGAL DESCRIPTIQN: N TR 3204 LOT 1
CONTRACTOR INFORMATION:
L RCONSTRUCTION
948 DENVER DR
COSTA MESA, CA 92626 ::'000
BUSINESS PHONE: 71455,_7939
JOB DESCRIPTION:New 1 story 1.024 sq It addition.
VALUATION: 68,915.00
I . OWNER-BUILDEI1DECLARATION
I hereby affirm under penalty of perjury that I am exemptfrom the Contrat:f:ol:"s license ,Law -for the following reason (Sec; '7031.5_ BU,Si-eess, and ' '
Professions, Code: any,dty orcountywhich requires a permit to construct, a~:er. improve, demolish or repair any str.\J_c,ture, prior to its !ssuance~'aki.6
requires the applicant for such permit to file 'a 'signed statell1ent that he is Iic~~nsed pursuantto the provisions ~f the\Contradqr's License Law'(C~apter
9)(comm'encing with Section 7000 of Division 3 of the Business,and Profes~i~ns Code) or that he is exempt. therefrom andlhe basis forthe alleged '
exemption.- Any violation of Section7031.5 by any applicant for a permit sut):ect.sthe applicant to a dYH~naltY~f !:lot marl;! than five, hundre,d dollars ,"
($500). . , " . . ,. IL' " .,... . ..
'0 .I"as owner of property, or ~yemployees with woges as their ,sole cOI(l~,ens~tion, will,do the ''l!fJr~{~~nd the structure is not intended or,offered fur:
sale (Sec. 7044 Busiliess and Professions,Code: The Con!ractor's License i,.av.: dees not'apply,to"an ?W~r of propertY w.ho:~uildsor,jmproves
thereon, and who does such work ,hin1S:elf_or herself or through his or .her o"1,'~,employees., provided th9t sUC::h,imp,lOvemerits ar,e n.ot intended or .
offered for sale. If, however, the building or improvement i::; sold with one, Y~~H of oompletion, the owner-bu~aer will have the ~urden of prov!ng thathe
did not'bulldorimproveforthte pu~osed salp.), ... '. . ' ' .'t' " rV~, :"'. ,: '_, _'
o I, as the cwnercf -rh<;! property" a~ ~xdlJ~ivE:l!Y (;l)nt:-ac.:tfng wi!h ncensed j.::ontraclors to construcHhe, project (Sec. 7044 Business' an~ Professions
Code: The Contractor's Liceros,e Lowdot?~; ilO~ apc-!y to an OWI)(;r 0t' propertyJ-,:Vho buiLds or improves thereon, afld who c6ntractsfor such projects wrth
~ontractor(s) !!ce"'~se{! ~..I;s~<mtto theContrr:-ctc,'r. Li~er.~;<:: ~.Q\'\I}. :,' "/ ' '
U lamexeioiptup.dl?rSec. ".-....,'. .' ,,8&P.C.foi'thisreason: \'
Date:. Owner: .
r-- WORKER'S COMPENSATION DECLARATION
1 here,byaffirrn- und.er penalty ,?f perjury one of the followin~ dl?clarations:, _ \ ,',
D I have and will ma intain a, ce~ificate of oonsent to self-insure for workel'~ comPl?nsa.tion',
as 'provid8(j forby'Sedion.3700 of the: Labor Code. for the performance offr~::::,:wo:1< for.whidl
this permit is issued" ' , .'::"
o -i.have and will 'rna,intain wol1<er's compensation insurance, as required t:-! Section 3700 of
the, Labor Code, for ths"performance of the work for which this permit is i-S3lnd. Myworker's
Compensation insuranCe Carrier and policy are: "
Carrier:' NO'EMPLOYEES Policy Number. EXEMP':
. 'section need not't}e, complete,d if the pennit is for, one hundred dollm;s' ($1ri,~) ~_~:I~,S;
certify that in the perfonnance of the work for w.l1ich this.permit-is issu<!d. i shall, not
ploy any perso.n in !3ny manner so as to becom.e subject to th _ \oVorkers,c')mpq,Osation lawS-
o C~1ifomia,~ancl agree that if I should become. bject t e w rker's corr:?,n~ation".
. pr'ov'isions of S~ction 37~O of the Labor. Code, han fo it,h 'ply with ~~.:.se provjsions.
APPLICANT; L1VIU RATIU
OWNER INFORMATION:
Jayendra A Shah
4601 E Ocean Blvd
Long Beach, cA 90803
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: CAL
LICENSED CONTRACTORS DECLARATION
COritractor
NUMBER
778387
TYPE
B
EXPIRATION DATE
5l31/2004
Dale: 5/25/2004 AppliCant:'
. WARNING: FAILURE TO SECU
IJNLAWFUL, AND SHALL SUBJ CT MPLOYER TO CRIMINAL PENi\~ TIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,OOO),.IN AD~TTlON TO THE,
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTiO~.3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. '
I CONSTRUCTION LENDING AGENCY
! hereby affirm under penalty cf perjury that-th~rl9 is a constnlcti0n lenrlins-;.a:;':";.:1('"v f'.'ll:!TIA
performance of the work fOJ which'this permit'is bsued (Sec.'3097 .Civ.C):
.Lender'~ Information: .
Construcion Types: '
VI\J,. ,
.:
L'
an,d state that the above information iscorreet .1
Date: 5/2512004.
Fees paid for Perinit:
Total;'
1,106:89
,Signature of Applicant or'Agent
The er it shall expire by limitation and become nu.1I 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 ~ontinue work.
. . .' '. , " '.'
.,
'.' . INSPECTION RECORD' . ." - ,
. FINAL INSPECTIONS . . Date InspectQr
. INSf'ECTlON . . . . ,. .\-- I&" .INSf'ECTQR Eleetnc..' Final . '. . . ", . - .' . .
. , '. '" ~ ..DATE .., .... . '.
. . .
Tempor..ry Power Pole ,; Plumbil)gFinal' . c.
Plllmbing(OrainlWaste Pipe) . . ~:30.,; ~7/f=. . ..' . . '. ' I
Mech..n'''''1 Fin..'.'
ElectriCal GrOund ElectiodefUfer . . . I.
Sl!tb;ock/FormsfTrenChes. (Footings) ')d '~ G..s Test '. '. . ".'
.' . ..,
DO oot install subfloor or pour floor sl..b until the Ellliineering/Grading Final 765-51.26, ....: . .
fO~owing applicable .items have beensig'ned.:. . '. 0.'. .' .'
Plumbing (Water Plpe.Sprinkler Valves) . Fife Oept.FinaI765-4040.. ".
. . . ,. .
Mecl1anical (GrOundwork) . '" . '. Water Engineering. 765-5268 .', . ..
Electrical (Undergr.ound Conduit) . '. . .
I'. . Sub LIst/Business License 765-5.19 '.' -c-
Pre-slab (l;ompactionlMembrane.Reinf. . r.. . .'
. Underpinning (RoorJoist/Girders) . . . . Zoning 765-51.39 .' . I;'"
'. . . .
po'not cover or C>>nceal.the wor1<below until the Building Final '~astlnsp~ctic:in. Only '.~
'followingapplicable ilems have.been signed: '. '.' . . . ." fterAbov.e Complete) "c." . ......
.1 stFI!lor Shear . .. . . . .PARTJALINSPECTIONS
Rresprinlder(RoUgh) '. . . . . . .'.
2nd Fioor Shear' ..' . . . ..' . '. Buildinalnsoections '. ,.,
. '. f
ROof (Sheathing/Diaphragm'Fram,) " . .
"'f. . . . . .
Masonry (Ri!infJBondBeam/Pre,Grout) . . ". . . .. .
.. '.
Rough Plumbing (Top Out) , . . f. .' . . . .'. .
Rough MeChanical, . '. . . . . . .' .
.'
lUIugh ~ectrlCal al.) .' . '. .' .' .
. . .'.
Rough Electrical '. .'.
Framing .(9n1y after Plbg., Elec.: r"".ech and'Fire).' '. . '. .. . .' .
Insulatlon(SoundlEnergy) . . .... '. '. '.
Do not tap." or plaster' unlU the following applic..ble .' Mechanicallnsoections '.;
items h..ve been ,;ignlld: . .' . . . . .' '. '.' " .' . '.' ,
'Drywall . . . . . .. .;' ~
.. '. . .
Penetrations (Fire Rated) Electlical . . .
. . . . '.
Penetrations (Fire Rate!l)M8ch;onical . , . . '. . . .
. PenetratiOns (Fire Rated) Plumbing '. .... ,...
Interior.LiIth '., . .' . . .
f
Plumbinti Insoectionsc-.. .
Exterior L..th .... '. .
GENERALlTEMS . . . . . .
Exterior Plaster (Brown Coal). . , . .. ..
,T -Bar Electrical '. '. o' . . '. .
T -Bar Mechanic...1 ' .' . . .. . . ,.'.
..' .
. . T -Bar Structur..' ',. . .' ^
. . .' ...... ':,' ~.
Sewer ~.., ., 'f' l"ffi .., . , ''j.B..<r ID.c.d.' ,
Water .Engin'eering Backflow '. / . . Electricallnsoections . . .
. . .
-.Water Service .'. .
EX?i RED'
~NSPFCTION
NO TCOMPLETE D
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DATE:
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