7940 E. Woodsboro Ave.
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;:i~e~~:;~~;~n CITY
DATE: 7/19/2004
JOB ADDR'.:SS: 7940 E WOODSBORO AVE
LEGAL OESCRIPTION: N TR 7417 LOT 71
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BUILC::NG DIVISION
200 S. ANAHEIM BLVD.
(714} 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 200
BUILDING PERMIT NO. BLD2004-02580
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APPLICANT: DELORIS JOHNSON
OWNER INFORMATION:
Jack C Joh nson
7940 E Woodsboro Ave
Anaheim. CA 92807
JOB DESCRIPTioN;Add entertainment room bedroom and bath.
CONTRACTOR INFORMA'!ON:
ARCHITECT/ENGINEER INFORMATION:
TERRY V PICKENS
9351 PROTSMOUTH DR
HUNTI NGmN BEACH. CA 92646
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VALUATION: 45.158.00 j:
c: ' OWNER-BUILDElf,tECLARATION
I hereby affirm under penalty of perjury that.1 am exempt from the Contracto!'t,License Law for the fol'owillg reason (Sec. 7041.5 ,Business ar.d
Professions Cl'x:fe: any city or county which requires a permit to-constntct. ,eUJ.,t, irT'!prove, demolish or repair any structure, prior. to'its issuance, also
requires the'applicant for such permit to file a signed statement that heis j!c.e'~~d ~ursuant to the provislonsof the Contractor's License Law {Chapter'
9)(commencirjg with Section leon of Division 3 of the Business and Professk,!~"s Code) or that he is exempt therefrom and the basis for the alleged
1-. .'. _ ." .-' . ,
exemptio'l. Any violation of Section 7001.5 by anY3pPlica11t for a permit S~lbJ,::c;ts the apJjHcant to a' civil ~enaltyof not ~ore~hanfive hundred dollars
($500). '. ." ,.r:" '
o I, as owner of property, or my employees with wages as their sole c()mp~i;'isatjon, WIll do the work..and the Gtn.:cture is not intended or offered for
sale (Sec, 7044 Business anti ProfessiiSns C;;ode: . The Contractor's Uce;'1$e Lf.'1I-! do~s not f)~ply to an owner of property whCl builds or im.proves
thereon, andwho.dqes such work himself or herself or through his orher ow.~;€,mploY'3es, provIded that sl!ch improvemen~sare not tntend,ed or
offered for sale. If, however,Jhe building or improvement is sold with ene ye::;:.:")f comp:etion, the owner-tluildoi will have the burden of proving that he
did not bu lId or il'T\prove for the pu rpose of sale). . \ ., . . .
[j" 'J; as the oWI-:;;;r of the property, am exclusively contlacting with Ik:P.ll.9f-'J. tmtractors to cop.struct the project (See. .7044 Busine.~s and Profes'3ions
Code: TheContra"tor's License Law doe.s not. apply to an owner of properly {o;ho builds,or improves ther~on, and ~ho contracts forsudl pro.iects with
Montractor(s), licensed ,pursuant to the ,C?cntractor's License I (l . j~. '.
~l am'exe pt under Sec.. _' ' . & P. 5 r 0: \ ___.~
Date: Owner: ~-,
E- WOR ER'SC PENSATIO' ECLA~TION __..:Jt::_ -_~._J
I hereby affirm under p_enaity of perjur)1 or.e of the following declarations:
D I have arid.will maintain a certificate of oo~S'3nt to self-insure for worker'~:~;~OlTijJensation,
as !,'fovided fot by Section 3700 of the Labor Code, for the performance of !h'\vorj{ for which
this permit is issue.ct'., . . , .
[J I have and vli'li' mai.ntain worker's compensation insurance, as reqUired h:-);ect:an:.3706 of
t,""e La::Jor Code, fo!" the performance of the work for which this j:'erm~ is iS5U;~;~- MYVvvrkGi'S
Compensation insurance ca.rrier and po'ficy are: "-
Carrier: 'Policy Number:
PROCESSED BY: FAN
I
LICENSED CONTRACTORS DECLARATION J
.1 hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (.oommencing
With Section 7000) of Divsion 3 oUhe Business and
P.rofessions Code. . '
7/19/2004
D~te:
Contractor
,"
NUMBER
EXPIRATION DATE
This section need not be completed if the pennit is for one hundred dollars ($1:}:};,(,,,: iesS.
O' I certify that in the, perfonnal1ce of the w~rk for whieh this permit is issLJOIJ: I sha:1 not
employ any person in any manner so as to become sUbj,ect to the workers cOJ:1pensation laws
of Califomia, and ?gree that if' should become subject to t 0 sr's comp6r~atjon
provisions of Section 3700 of the Labor s all fo w. ply with tl,,,l.::.e prOVIsions.
Date: 7/19/2004 Applica t. ~ 'i,
WARNING: FAILURE TO SECUR ORKER'S MPENSATION COVERAGE IS
UNLAWFUL. AND SHALL SUBJECT AN EMPL ER TO CRIMINAL PENA',~IES AND CIVIL
FINES UP TO ONE HUNDRED.THOUSAND DOLLARS ($100,000), IN ".DDI,nON TO THE
COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION ..1706 OF THE
LABOR CODE. INTEREST AND ATTORNEY'S FEES. ,',
I ' " CONSTRUCTION LENDING AGENCY , 1 '
I hereby affirm under p~nalty of perjury -that there is a c 'nstruction lending C::!g:::'loyfor the
performance of the work for which this permltis issued See. 3C97 .Civ .C): l
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TYPE
Construcion Types:
VN, .
LivinQ Area:
671
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I cert.ify that I have read this ap'plipation and 'state that the above information i.s correct. J
agree to rom with aI/city ordinances. and state laws relating to building constructi'on, and
hereby a o. e representives-- h' city to enter upon the above mentioned property for
inliPe on rpo ~.~,
t'." ( Date: 7/1912004
Signat of Applicant or Agent
The permit shall e Ire by limitation and become null and void if the building or
work has riot passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
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Fees paid for Permit:
Total:
1.706.42
, INSPECTION RECORD
FINAL INSPECTIONS
Date
Inspector
, " INSPECTION , Electrical Final , 7/irfpr j)~
DATE INSPECTOR
,
Temporary Power Pole 1HF- Plumbing Final , l/S-!or auih
Plumbing (DrainlWaiste Pipe) Mechanical Final 7/'1/1i> ~'
Electrical Ground Electrode/uter ' ' I I '
SetbacklFo..rnslTrenches (Footings) ". - !H H L-- Gas Test ,
Do not install sub floor or pour floor slab unt; I the I' Engineering/Grading Final 765-5126
following applicable items have been signed:
Plumbing (Water PlPIl.Sprinkler Valves) , I Fire Dept. Final 765-4040 ,
Mechanical,,(Groundwork) I Water Engineering 765-5268 , ,
,
Electrical (Underground Condu~) , , I sub List/Business License 765-519 Ch-/1;; [.[crt1!!;
Pre-slab(CompactionlMembrane.Reinf. 1 ..-.
Underpinning (Floor JoistIGirders) , 1 Zoning 765-51,39 , "
Do not cover or conceal the work beloW until the I Building Final~astlnspection: Only rJ? /a~ ~~t6'
following applicable items have been signed: .. 1 fter Above Complete) .
1 st Floor Shear I . .
. PARTIAL INSPECTION'S
Firespririkler (Rough) , I
2nd Fioor Sh.ear ' ' " :,~ Buildina Inspections
Roof Diaphragm/Frame) 1'2l1M~ ' ~~ l~ttD~~~eW1ir1~
Masonry (ReinfJBolld BeamlPre-Grout) m
Rough Plumbing (Top Out) :8'~ ~~
Rough Mechanical , ,.(,::"7'.. ho --- , "
, Rough Electrical (Dry Wall) . 7.,..r ' '
Rough, Electrical ' ~ ~ \1..1 .,
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Framing iOnly afterPlbg.. clee.. Meeh, and Fire).~ ' :
Insulation (SoundlEnergy)' , V " ' , '
Do not tape or plaster until the following licable I" , ~ions gA-'4V$, ,
items have been signed: . . . .. , ' ,~~ "-
Drywall " ' , , , 'fll"l\o'" I~~.,'
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Penetrations (Fire Rated) Electrical ! ,
Penetrations (FIll! Rated) Mechanical ' I
Penetrations (Fire Rated) Plumbing ,I , , ,
Interior Lath' , " , , '
, , " I
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Exterior Lath ' ' ~ ':[B. 'J', Plumbina Inspections
, . ' GENERAL ,ITEMS ,I
Exterior Plaster (BroWn Coat) <lltIOl[ :'\1)(' 010.'
T -Bar Electrical , I "
T-Bar Mechanical - j ,
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T-Bar Structural , !
Sewer ' , ' " I , , "
Water Engineering Backflow I , ElectricallnSDections
Water Service , ! ,
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