1904 E. Willow St.
BUILDING PERMIT NO. BLD20M-01205
TYPE OF PERMIT
Residential Addition
DATE; 4/21/2004
JOB ADDRESS; 1904 E WILLOW ST
LEGAL DESCRIPTION; NTR 1565 LOT 112
CITY
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BUILDiNG DIVISiON
200 S. ANAHEIM BLVD.
(714) 765.- 5153
INSPECTION REQUEST LINE;
(714) 765 - 4626
CENSUS CODE; 434
QUARTER SECTION: 103
APPLICANT; JOSE DUBON
OWNER INFORMATION;
..Io'se,F:O"ubon
1904 E Willow St
Anaheim,CA 92805
JOB DESCRIPTIONRoom Addition. Add 37551 bedroom. bathroom and cl05etf.o rear of SFD, (HIH)
VALUATION: 25,23.7.00 -,- '-',:)
I . OWNER-BUIl.DEHDECLARATION
I hereby affirm under penalty of perjury that ,I i?:m exempt from. the- Contracto,\5 License Law for_thE9"foflo.wing reason (Sec. 7031;5 Business and
Prolessioqs C.o~e: any clty or county which requires a permit to'oonstruct,'al~€:r. improve,' demolish.or repair any structure, prior to,its isSuanCe, aisp
requires the appltcantfor such permit to file a signed statement that he is iic<nSed pursuant to the provisions of the Contrador'$ License Law (Chapter. -: .
.-9)(comm~ncing with. Section 7000 of Division 3 of the Business andProfess~ins Code) 9r that he.is e'~empt theret~orn and the, basis tor the alleged
e mnption. Any violation at Section 7031.5 by any applicant for a permit sui:iects the applicant to a dvil penalty of not more than five hundred doltars
500). - '" I 'C:> l../ ,1 . _' ,
fawner f propeny, or my employees with wages as tJ:leir sole comr'!ensation, will do the work, and the structure is not intended or offered for
sae, (Sec. 7044 Business an~ Professions C.ode: 'The Coritractor'sl,.icelnseTaw does not apply to an owner, otproper:ty whobuilds_orimpro\!es'
the,reon, and who does such work himself orKerself or throughWs Or her Ov..-:i empLoyees, provided that such improvements are 'not intended or
uffered for sale. ,If,. howe~r, the building or improvement Is sold yiith one,ye~r uf completion, the owner.,.builder will have the burden-of proving that he
did hot bundor irripro~e forthepurpo~eof sale). " ','"-,. _J:',' . . , " . - . "" '" _.:.' "
[J 'I, a~ the owner of the property" ain 'exdusively contracting with licensec:;contractors'to c,6nstruct the project (See. 7044 Business'and ProfeSsionS
Code: The Contractor's License law does not apply to an owner of pr;JopertY~'flIho'bUildS or improves therp-on, and who oontracts for such projects with
tractor(s) lICensed pursuant to the Contractor's License Law). . .
, m exempt under See: & P.C. for t i reason:.. _. ;J:::;;;:::z::;
Date' Owner: CZ2... U~
WORKER'S CO ENSATION DECLARATlO!::L...:..L - I
I hereby affirm under penalty_of.perjury'one 0: the following declarations: ,/.' _' '
b _ _fliave andwill;matntain a certificate of oonsentto self~insurefQr wOTker~ cdmp-ens~tjon,.
as providecl'for by Section 3700 of the Labor Code, for the performance of Ir.3,workforwhich
this permit i~-.issued.. '. .' . " \" .
o I have a nd will maintain wo~er's c,ompensation insurance, as required tr. Section 3!00 at, .'4/21/2004
the LCjbor Code, for the performal1Ceof the work fpr which this permit isis.'SLC-d. 'My worker's . Date:
Compensation insurance,carrierandpoJir::y are: . 11
'Carrier: .' . Policy,Number: .
'. .' . . ,i '. '.
This section need not be completed ifthe pemiit is for one hundred dollars {$1 Db CT. less,; ,
0,-1 certify.that'.'in the pe1onn~.nce o~ttie"Work for which this permlt'iS iSsv"id.J_shall'~Dt, .
employ any person-in any manner~so as to become subject tothe worker's (.empensation laws
of'Califomia;ancf agree 'that" if I should become slIbject_to .the wo'rker's cOJ'l'l'",,"'nsation' ' ,
provisions ~f Section 3700 of the Lab<rC~.shaU forthwith c~mply with tl.~se provisions.
Date: 4/21/2004 Applicant: ~c;<pt::f?VIrJc/5ce> 0 . .
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVEF.,\GE I
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN!'.,TIES ANP CIVIL
FINES UPTO ONE HUNDRED lHOUSANP DOLLARS ($100,Ooo),INADCITlONTO THE
. COST OF COMPENSATION, pAMAGES ASPROVlPED FOR IN SECTICo!': 3706 OF THE
\.ABORCODE, INTEREST AND ATTORNEY'S FEES. .,
I CONSTRUCTION LENDING AGENCY _
. .I hereby affirm under penalty-of perjury that there is a construction lending a~:encyfor the
performapce of the work, for which this permitis issued (S~e.3097 .eiv.C):
L-::--:;':,,";~3 -~n:~r.:;3~;C1i: . ---,~
CONTR,I\CTOR INFORMA.TION;
. .
ARCHitECT/ENGINEER INFORMATION: .
-<
PROCESSEP BY:. ope
J
LICENSED CONTRACTORS DECLARATION
I hereby'atfirm und,er pemalty at perjufY thatJ am
'icensedund~r provisions of chapter 9 (commencjng .
with Sectio,n7000) ot Divsion 3 afthe Business and'
Profe~s~onS Code.
,Contractor
NUMBER
. EXPIRATION DATE
TYPE
Construcion Tvpes:
VN,. "
Occupancy Groups:
R3; , ~ ,
Fire-Sprinklered,?
DWellinQ Units:
UVlnQ Area:
NO
1
'375
I certify tl)at I have. read, this application .atJd state that the above informatio'n is correc;t. I
agree to oomply -w~11 all city ordinances Clnd ~ate laws relating ,to buil.ding construction, and
hereb authoriZ presentives, of t~jscity to enter upon tha' abov~ mentione':t property for
insp ion ses.
t: ' Co Date: 4/21/2004'
Signature'"of Applicant or gent
The permit shall expire by limitation and become null and void if too 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.
Fees paid for Permit:
Total:.
. 552.52
. INSPECTION RECORD
.' . 'INSPECTlON
DATE
INSPECTOR I
'. '.
..H--....
[-./~-
Tempo....ry Power Pole. .
Plumbing (DraintWaste Pipe) ..
Electrical Grc)und Electrode/Ute. . 5. -)1).
'. SetbacklForrilslT'enches (Footings) ~ ~ }1-61
.Do not install sub floor or pour floor slab imtilthe.
'following'applicable items have been signed:'
Plumbing (Water Pipe.Sprinkler Valves) . .
.
Mechanical (Groundwork)' I '.
Electrical (Underground Conduit). '. .. .
Pre-slab (Compacti.onlMembrane./(einr. . .' ~'"
Unclerpjnning(Floor Joist/Girders)' . ~ .'
Do not cover or conceal.the'wqrk below until the .' . '.
followiogapplicable items have been signed:. . .
1st Floor Shear' . .' . . "
.'.Firesprinkfer (Rough) . '. .
2nd Floor Shear. .. .
Roof (Sl1eathin!l/D1aohragm'l'rame)
Masonry (ReinfJBond BearnlPre-Grout)
Rough Plumbing (Top Out) .
Rough Mechanical . .... .
Roug" Bect.lcal\UIY wall) .
Rough Electrical' ./7 /I .
Framing . (Only after Plbg.. Elee.. Meeh..ahd Fwe) . ,-
Insulation (SOIIndlEnergy) , . ~>V' rT,c,,/L L/, .....
po not tape or pla~teruntH the folloWing applieaDre ,.':
Items ' have been slgn~d:, . ' . '. .
DryWall, . . ..... .... . .' ..., ~ .
Penettations (Fire Rated) Elec.trica' , ' r.
PenetratiOns IF;", Rated) Mechanical ' '.
Penetrations (Fire Rated) Plumbi"9 . .' .'
Interior Lath:' .. ". A./ I . /
'. Exterlor.Lath .... . .. J.~.:U.)d/liA/lU.
. .' . GEt.iERAL IT~' :." . .'
Exterior Plaster (J;lrown Coat) : . . .'
T -Bar Electrical .
T-BarMechanical .' '. . .
T-Bar Structural . . ".
Sewer .'.
Water EnQineerlng J;lackflow
Waler Service
.
'.
'.'
.' "
.
.
.
inspector
FINAL INSPECTIONS
Electrical Final
Plumbing Final.
Mechanical Final
Gas Tesl
Engineering/Grading Final 765-5126 .
Fire Dept. Final 765;4040
Waler Engir'teering 765-5268
Sub List/Business License 765-519
Zoning 765'5139
".";
Buildin'g Final (Last Inspection-Only
. "'. . . After Above Complete).
3~ as-~"
. PARTIALINSP.ECTIONS . '
. BUildi:n~ectio~s. ..... ..,.. .....
. fJ-Y<~' ~~~dl:Jt-.L
~
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. .
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Mechanicallnspecfions
PlumbinQ Inspections
Electrical Inspections
APPLICANT: JOSE DUBON
OWNER INFORMATION:
JO SE F DUBON
1904 E WILLOW ST
ANAHEIM, CA 92805
JOB DESCRIPTION:Construct 255 square feet of patio cover per engineered plans
VALUATION: 3,500.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor'$ Ucense Law iorthe following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct; alter, improve, 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,sed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom 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 01 not more than five hundred dollars
($500).
~ as owner 01 property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
..lare (Sec. 7044 Business and Professions Code: The Contractor's License 18.w does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one yea~ of completion, the owner.builder will have the burden of proving that he
did not buUd or improve for the pUlpose of sale).
o I, as the owner of the property, am exclusively contracting with licensed c:mtractors to construct the project (Sec. 7044 Business and Pro1essions
Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who oontracts for such projects with
~ontractor(s) licensed pursuant to the Contractor's License Law).
U I am exempt u r Sec.~ , B & P .C. for this reason:
Date: ...6 Owner:
WORKER'S COMPE N DECLARATION
I hereby affirm under penalty of pe~ury one of the following declarations:
fl I have and will maintain a certificate of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the pelformance of thework for which
this permit is issued.
o I have and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the pertormance of the work for which this permit is issueo. My worker's
Compensation insurance carrier and policy are:
Carrier: Policy Number.
This section need not be completed if the pennit is for one hundred dollars ($1 00) O( less.
fEJ 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 Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: 7/25/2005 Applicant: r=.-10f71':::::!;X>!~
WARNING: FAILURE TO SECURE WORKER'S COMPENSAT~AGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agencyft)r the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
1...<;:1..::;<3r's In(ormatiolJ:
BUILDING PERMIT NO. BLD2005-02317
TYPE OF PERMIT CITY
Patio Cover
DATE: 7/25/2005
JOB ADDRESS: 1904 E WILLOW ST
LEGAL DESCRIPTION: N TR 1565 LOT 112
CONTRACTOR INFORMATION:
I certify that I 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 mentioned property for
inspecti n pur oses.
Date: 7/25/2005
Signa of Appl" nt or Agent
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 of permit issuance. A
new permit is reauired to commence or continue work.
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 103
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
LICENSED CONTRACTORS DECLARATION
I hereby a irm under penalty of perjury that I am
lIcensed under provisions of chapter 9 (commencing
with Section 7000) of Oivsion 3 of the Business and
Professions Code.
7/25/2005
Date;
Contractor
NUMBER
EXPIRATION DATE
TYPE
Construcion Tvpes:
VN, ,
Fees paid for Permit:
Total:
529.30
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe) ,
Electrical Ground Electrode/uter / I
Setback/Forms/Trenches (Footings) 1",,/ _I... \ A "^(;:)'SlJ.-t
Do not install sublloor or pour II :01 slab until the
following applicable items ha e been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable Items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame) ~ -3_""'5 p. f4,(
Masonry (ReinfJBond Beam/Pre-Grout) /'\
Rough Plumbing (Top Out) (~
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable
items have been signed:
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat) ..
T-Bar Electrical
T-Bar Mechanical .
T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS DATE INSPECTOR
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-5194
Zoning 765.5139
Building Final (Last Inspection' Only 9,~'P ~
Aller Above Complete)
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections