230 S. Willowcreek Ln.
BUILDING PERMIT NO. BLD2004-02847
TYPE OF PERMIT
Residential Addition C I TV
DATE: 8/1612004
JOB ADDRESS: 230 S WILLOWCREEK LN
LEGAL DESCRIPTI.ON: N TR 13716 LOT 8
i(~0;S"~:"-:'\{lit\
f' 0; ,. \$"<;;~
t!).i - '" ';.'';fJ'''' <\
.'d~., ElM
,>o.~""
.-~<" 'gJ~.'i '
~ ,*"1';%Ji,, /1
".YJtX/
-':.. ,~y
.-..-
, - 8UILQING DIVISION
200 S. ANAHEIM BLVD.
(714)~65- 51,~
INSPECTION REQUEST LINE:
(714)765- 4626
CENSUS CODE: 434
QUARTER SECTION: 196
.
APPLICANT: EDWARD HOFFMAN
OWNER INFORMATION:
Edward K Hoffman
. 230 S WiII9wcreek Lo
. Anaheim, CA 92808
JOB DESCRIPTION;Add Media. room.
VALUATION: . 30,600.00
I OWNER-BUILDEil DECLARATION
I hereby affirm under penalty of perju'ry that I am.exempt from the Conti:c~ctO{.s License Law for the-following reason (Sec.. 7031".5 Business and
Professions Code: any dty or county which requires a permit to construct, a{~r. -improve, deMolish or repair any'structure, pnorto its issuance, also
requires the applicant for such permit to file a signed statement that he is lic:;'.1sed pursuant-to the provisio~softhe.Contr8ctor's' License Law (Chapter
9)(commencing with Section loaD of Division 3 of the. Business and Profes~l')ns Code) or that he .is eX19mpt therefrom and the' ba::,is tmihe allegp.d
exemption. Any violatlorr of Section 7031,0 by any appJjc8nt fer a p$i',l1it si'[:~ects the ap;:>lJcant to a dvll pen~ltyof notmore than five'h~ndr~d ddlars
($~OO).. . ..' .
o I, as owner of property, or my employees yvith wages as ~heir .sole corn[.":'>l1sation, wWdo the vyork, and the structure is not Intended or offered for.
sale (Sec, 7044 Business and Prof~ssions Code: 'The COlitrflctor's Uc.=,r'sri ::,:'~\"/ does POt'3~.p!y to ~~('l ()vmer ofp'np"!rfy Wh0 L~u'ilds cr ;:n~mvfs
t!I\.;r~Oi"";, and Vl'110 GJc,s S~c11 workhimsc;;f or herself or thrQugh his ":r l1e::.:' .ii O:ilp\0j(::;t..S. prov:d8d tn-,,!,t such in't)fO\'S-, ,;,;:_(::~ ~;~8 ,,;c.t ht~r;;,:~.x! ur
cf."ered for &ile. If, however, the' buHding or imprcvement is solc.:'wifh iH'I!3 ,,.::,,j" of conip!"':!tion, 'the owner.bu;j(;er wilJ'have the- ~)yrden of proving th3t r,6
aid not.build or improve for the purpo'se of sale), '.. ~ '. . , '. .
[' I ~'" -t"O C"II'er of the orope-y am' excILI"';/~'" c,.,.........., ~I;,...,... ..:", ':,~~.". --.... ': -, .,~ '~'G-'" '" ,..:~.,... ~r'I^' t~. '"' '~rok'ct (~""G- ""'(',1;1 ;')I,d,.,-",,,, ..'1...... d .P.,.,~f.O.^".. ;.'.".'._
~:-J .:.~ ":',' "I'"' 1(" ,_,>-;,.'1 ~"..,.l'~""::.o',"l';:"";'_":",~';""",o..J:.':"":','-"':'~"'~',''''r''''; \'-J,....('-'-.'.>-':'~._,.<:::-~_:_ ... ~
I,J::~_!..:;, I nt~ t./)i'undor' s License 'L8';'i ':lCE:S nol,-,:)~);y ;'.; ,:,[) ,-,,"v'ne.. (., ;' f':; :, !)!.;I':>, ;rrT.::.)ve:" ,he"""..,,,'.. T".! '"hI. r,:-':+;";;~-:; hl . ,,", ;,,:';2~:ts t'.'l~'
:L:,>~'r';r.::cto:'{s'!:'~>::.':";>'d pursuant [I) the CG.'I!r,,::~c:'.- ~"', ,..~,.. ~'~~'.'I'"
, ~~te:.:i:eXl~~der s.e~wner;" 7:r~~ ':: ~:...Y'ii3 i:paSl)!~' ~. .:.------.---.-----.-,..----- --:_-...,.~--_._- ._"__u-,_,__._
. L WORKER'S COMPENSATION DECLARATiON'-=~e-- . -__::5-- LI~~ti;ONTRACTORS DECLARATlON-T
I hereby affirm under penalty of perju!)' one oftne following declarafions. r . herehy affirm undp.rpenalty of perjury that h3:m
o '1 have and Will ma intain a certificate of 'consent to seft-insure for 'f.il,j;ker'~ compe~satjon, Ucer.sed under provisions of chapter- 9 (cotnmencing
as p'rovided for by Section 370a of the Labor Code, tor the performance oftt-.b woik fbi vVhich with Section 7000) I)f Divsion3 of the Bu.sfrleS!; and
'this permit is i$sued. . .'.: . ProfeSSIOns C0de,
o I have and will maintainworker's compensation insurance, as requ!reJ::'1 Section 3700.')f 8/16/2004
the lai::lor Code, for the performance vf the work for which this_permit " k:,=~>j, Myworker's - Date: . Contractor
. Compensation insurance carrier and Polley 'are'
. Carrier: PolicY Number. NUMBER EXPIRATiON DATE
CONTRACTOR INFORMdION:
ARCHITECT/ENGINEER INFORMATION:
RUDY L RODRIGUEZ '
14172 BOWEN ST.
. GARDEN GROVE, CA 92643
PROCESSED BY: KBT
"I
This section need not be completed if the penni~ is for~ne hundred dollars ($-j{ii;- vr_:ess.
o I. certify that in the performance of the work forwhich'this permit is iSSf.l&1,1 shalt not
'employ any person in al!Y manner so'asto become subject to the worker's c.:rnpensation laws
of California, and agree that if I should become subject to the worker's cornp'~-nsation .
pro"lJisions of Section 3700 of the Labor Code, I.shall.fo hvl ..omply ~ith_ [1";:1se provisi~ns.
Date: 8/1612004 . Applicant: . . . r ~ '-"'" _.~
WARNING: FAILURE TO SECUREW RKER'S CO PENSATION COVF.<",GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEP.:.TIES AND CJVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADIJ"TlON TO Tf1E
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIOi_ 3706 QF THE
LABOR COD E. INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION' LENDING AGENCY .
I hereby affirm .under penalty of perjury that there is a construction le~ding a;,~!1cyfor tne
performance of the work for which this Pl3rmit is issued (Sec,3097 ,Civ.C):
_I,':>~r:!~r'<; !(Ikn''1~~i('ln~._. . -_- "",>_'
TYPE
Cons'trucion Types:
VN,. .
Occupancy Groups:
R3, '; "
Li"in~ Area:
455
~Ii"
-I certify that J have read this application and state that the above information is correct. I
agree to comply with all city ordinances and' state laws relating. to building construction, and
hereby authorize representives of this city to enter upon the above mentibne'i property 'for
i'}6Pection pur~. ~s~/.
:J- /""='/~ . Dale 8/16/2004
Signature of Applicant or Agent
The permitshaJl 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.
F&&s paid for Permit:
Total:
781.8~ .
-'
INSPEC'r10N RECORD
, ,
INSPECTION " ,
. Temporary Power ,Pole '
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/uter
SetbacklFormsfTrenches (FootingsHlt:"
Do not install subfloor or pour floor slab until the
follciwing applicable items have been signed: .
Plumbing (Water Pipe.Sprinkler V"lves)
Mechanical (GrOundwork)
,
,Electrical (Underground Conduit),
P,e.slab (CompactionlMembralle.Reinf.,
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed: .
fstFloor Shear I~rq.oc
FireSprinkler (Rough) , " '
2nd Floor~ear ' ,
~~healh!oilDiaphragm'Fraine) , J,N-'<J~
Masoory (RiinfJBond EleamlPre-Grout)
Rough Plumbing (Top Out) Aliff
Rough Mechanical. 1-'21.0' J<
Rough l:IectrlCaI (ory Walll L, '
Rough electrical -/'f'O r-O:.+, \.b"''-
Framing (Onlyafter'plbg..Elec"Mech and Fire! I-U.()~ ~ .L
Insulation(SoundlE~rgy) ,'1-7."7-<> J
00 not tape or plaster until the following applicable /' .
. items have been's;gn~d:" " " ~ - . ", . .
Drywall ' ' ' ~/'fJU1 -r..(M/,
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath ' " '~' ./'
Exterior Lath ' ' ' , 7./11., '
, , GENERAL ITE 5 ;;,' ,
Exterior Plaster (Brown Coat) , 1'/</,"'"1 ~ ,<..-
T -Bar Electrical ' ' /'
T -Bar Mechanical '
T -Bar Structural '
Sewer,' "
Water Engineering Backflow
Water Service ' ,
, "DATE'
,
INSPECTOR
,
" '
, '
'~
'""r' /, L.h
""
{
, t
FINAL INSPECTIONS' " "
Electrical Final (O V~l,
,
Date" Inspector,
7ff(a: 'L
Plumbing Final
,
Mechanical ,Final
Gas Test
~r f.. fridrMl',
NI
,
Engineering/Grading Final 765-5126'
Fi,eDept. Final 765-4040
Water Engineering .165-5268 ,
Sub, List/Business License 765-519
Zoning 765-513,9 ,
I " Building Final' ILast Inspection. Only"
Mer Above Complete)
,
,
,
,
Vt{1I1~~ ~'," ','
, "
qj(jo( f': MM
PARTIAL INSPECTIONS
Buildina Inspections
4- JtJ:"'7_~^'r f'A:1It'*-' ...2-~r:Ullhl' fZMJ.
... ". ,"""",1/ 9>1L,1...~ "
!rf-/{'o\, ;Oe.Jd ,,.~..t ~,~
~ ,( '/.:'J I.l...' 1'4( ',.";...;...L ~'" ~
, v I
"
-mechanical ,Inspections
"
,
,
,
',' "
'Plumbing Inspections
, ,
, '