847 N. Zeyn
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CITY(J;fitt'~N~H ElM
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BUILDING DiVISION
200 S. ANAHEIM BLVD,
(714) 765. 5153,
INSPECTION REQUE;ST LINE:
(714) 765 - 4626
CENSUS CODE:, 434
, QUARTER SEOCTION: '11
BUILDING PERMITNO. BLD2004-03026
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TYPE OF PERMIT
Residential Addition
DATE: 11/19/2004"
JOB ADDRESS: 847 N ZEYN ST
, LEGAL DESCRIPTION:
N TR 169 LOT 9
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APPLICANT: GUUERMO PERALTA j
OWNER INFORMATION: CONTRACTOR INFORM'j\TlON: ARCHITECT/ENGINEER INFORMATION:
, Ruben Garcia H. M FARO
847 N Zeyn St ' I 2246 S. STANDARD AVE.
Anaheim, CA 92805 '. , .1., SANTA ANA, CA .92707
JOB DESCRIPTION;Adding garage with laundry, and master becrr.om and b<.::r.. Frame new rc,~f over ex!sting house.
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VALUATION: ,45,900,00i PROCESSED BY: FAN
I ClWNER-BUILDE~DECLARATION
.:1 hereby affirm L!nc;ler pen(3lty of perjury that I am exempt from the C(}ntraciy~'s License Law fer the fol16wing reason (Sec.07031.5 Business t::nd
Professions Code::any city or county which requires a 'permit to construct, 4l!Jer, improve, ~emolisi1 ()r repair any structure, prior,to its issua:nce,::itso
requiies th,e 13ppli,cant for su'ch permit to file a signed state!J1ent that he is iic#nsc;d ,pursuant ,t(,l'theprovisions of the C~ntrgdor's License Law (Chapter
9}(commencing with Section 7000 of DiVision 3 of the Business and Profe~s~')ns Code) or that he is eX,empt therefrom and the bC3sis for the alleged
exeruption.. Any.vioJatfcn of Section'7031.5 by any-applicant 'fer a permit sut'1ects the applb::mt to Cl dvll penaltypf not mere then five hundred dollars
t:$ 0).' , ,I' . ., ,
'I' ,1, as owner_ofp~opertYI or my em~lo. yees with wages as thei,,-so:e c(J!I':~.~n~~tionl will do the work, and th~ structure ~ nc, t,i.ntend~d or offe~ec~.for
. ala(Sec~ 7044 Busrness and ProfeSSions Code: The Contractor's Llce:nSE:~aw does not apply to an owner of property wno bUilds or Improves
thereon, a!1d who'does such work himself or herself or through his or her I)'.~,h empioyees, provided that such improvements are not intended or :
o,ffere~i for sale: If', hcwev~r, the bUil,d,ing 'or improvement is sold with one y~r: ofcompietior.; the .6wner-builder w.ill have the burden Qf proving that he
did not build or improve for the purpose of sale).' , .~'.' . '. . '.',.,,;'
O. I, as the c:wner Of,th.~. p:operty, a~ exdusively contracting wit.h'lid;msedl::ontra~ors t~~ons. truct the prOj€:ct (~3eci.-7044 Busines,sand Pr~f~ssio~s
'Code: The Contractors Lrcense LaN dbes not apply to an owner of propert~, who budds or Improve$ th,ereon, ancwlJo.oo~tracts for such projects with
EJon~radOr(S) licensed pursuant to the Contractor'S,~i~~se Law). . .~: . " ... ' '
I m ~xempt under Sec.. _ _ a & p.C..fq;..ttJls raason: ~~'
Dr:ite I -,,_ Owner: '~~~ -;;~--:--'-~
c: . WORKER'S CO PENSATION DECLARATION~, J
I he~eby affirm;onder pelldlty of perjury one of the follcv.,Iing decfaratiens: 'I' ,
P I have ar..,d w!ll maintain a certificate of consent.to ~e~-insur,;; for'WOrkGI-lcoinpensdior:, I
as provid~.for by Section <3700 of the Labor Cod~, fqrthe performance of F",;; wor\< fc,r.whiC'l1
this permit is issued. " :A I
o " have :3l1d will maintain wark.er'~ compensation 'in. surance,a:s required ~tSection 3700 or' 11;19/2004
the Labor Code, for the performance of the work for ....ttJich this permit is iSSi...''r;d. Myworker's Daie:
Compensation insura'rice carrier and polic.y are: .. . ..~ ., I
~m" . . eo" ,,_C I. I """CO"
ihi section need not be completed if the permit is for one hundred c!oll3i's {~109. ~ :<ss. "TYPE
I. certify.tha. tin !he pert:ormance ofthe work for whi~h t~is perm." ;t ,,' iSSU~p,.':.'.iSI,"i1 not . '.
em !aY'any person In any manner so as tb become sub;ect to the workers cq.opensatron laws
of California, and agree that if I should become subject to the'Worker's comp~I,1sation '
provisions of Section 3700 of the labor Code, I shall forthwith comply with t:;~;se provisions. Iconstiucion Types:
Date: 11/19/2004 APPlicant'X.."'"T_ ~ 'r:;~V .' '~c~~ ~n(;YGroups:
WARNING: FAILURE TOSECU;rE~KER'S COMPENSATION COVEr;~GE IS. R3, 81, , ~
UNLA\iVFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAUTiES AND CIVIL Livino Area:
FINES UPTO ONE HUNDREDTHOUSANb DOLLARS ($100,OOOl, iN ADqiTiON TO THE Garape Area
'COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEC-"!ON)706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.' '" 8
I .'. CONSTRUCTION LENDING AGENCY . . ':--==
I hereby affirm under penalty of perjury that there is a construdio" lending d\:,nCYfor!he. ,
performance ofthe work for whiq, this permit is issued (See. 3097 .Crt.C): ,I;'. .
Le!1d~~~.~nfor~~~r~:__ __~____ ___' ___#_~______. ___._L-___ ,____________~----:-~--:...... -----'--__-------'-___,__
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L1CENS.!:D CONTRACTORS DECLARATION I
I hereby affirm ~,"dar p~nalty of perjury that I"am
lICensed under provislons of chapter 9 (comm6nc!flQ
with Section 700Q)of DlV$1on,3 of i1le BusineSs and
Profesf;.iol'!S Code,
Contract6'r
EX'PIRATION DATE
420
556
I certify that I have-react this application and state that the above information is correct. I
agree to romply with all:City ordinances and state laws relating to bui!drng constn,.;ctioll, and
hereby authoriZe representives of thi~ _city to enter upon the above mentioned property for
~.ns . ecl:ion purpOses. . ~, ',' -,.., -,"
, -r- ~PyUi"~<r Date: 11/1912004
. " ,.. Signature of Applicant 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 required to commence or continue work.
Fees paid for Permit:
Total:
1.512.96
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'INSPECTION RECORD
FINAL INSPECTIONS
Electrical Final
..J;late-" Inspector
INSPECTOR
INl\PECTlON .
DATE
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Plumbing Final .
Mechanical Final
Gas Test .
Engineering/Grading Final 76505126
Fire Dept. Final 765-4040
Water Engineering 765-5268 .
Sub Ust/Business License 765-5
Z"ning 765-5139
Building 'Final fLast Inspection- Only __. >
. Alter Above Complete) I .
PARTIAL INSPECTIONS
BUildina Inspections
3 - ~-~. :R,bt7F flAtfl,tH6 "
Temporary Power Pole
Plumbing (OlllinIWaste Pipe)
Electrical Ground Electrode/lifer. ^ 0 r
Setback/Formsrrrenches (Footings) I~, d'7
Do not ins.tall subfloor or pour floor sl.ab unt I the
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (GroundWork) .
Electrical (Underground Conduit)
Pre-sllib (Compactlon/Membrane.Rei nf.
:' Underpinning (Roor Joist/Girders) .
Do not cover or conceal the work below until the
following applicable items have been signed:
1st .Floor Shear ". .
Firesprinkler (Rough)
.2nd Floor Sh,ar
Roof (SheathinglDlaphragmlFrame)
Masonry (ReinfJBond E!IlamlPre-Grout)
Rough Plumbing (Top Out) .
RoughM,chanical .
Rough aectrlCaI all)
Rough EI'ctrical' .
Framing (Only after Plbg.. Elec.. Meth..' ana Fire)
Insulation (SoundlEnergy) .
Do not tape or plaster until the following applicable
items have been Signed; '. .
Drywall '. .6'b/dr no rl.l. .
Penetrations (Fire Rated) Electrical' . I
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) PI!lmbing
Interior Lath . .
Exterior Lath
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11/fA7
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Mechanical hlspections
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""',AltrlX .Y-/l'1/I
GENERAL ITEMS . .
Extllrlor Plaster (Brown Coal) j(.Jor .vLSI.' ~
T .Bar Electrical , I
T-Bar Mechanical
T-Bar struc.tural. ..
Sewer
Water Engineering Backflow
Water Service
Plumbina Inspections
Electrical Inspections
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S.v. Moreno Inspection Service
8214 California Ave.
WhittierCA 90602 '0
562 882 8589
Re istered Ins ector's Dai!
Type of Inspection:
Project Location:
Contractor
0:51
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Specs: (Y) (N)
Archftect
Subcontractor
Engineer
Material Description:
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Inspector:
Inspection Summary:
tVe:~--n\.S) H 1) =-;/-, (Slc,,'1 '17 Il eY\ 7C~D~iC"'J"'-)
I i\.rt.-;>T~~((Gn e Z- ~r)c'-~<Jl'fo!S .~~ &-..?:-I n (If~ c-~ 1- L-
At.!- If'f)C1f~ f..( !1rf',..J l' P-4't .?f=- ,?r:':..$Z.P-f i!:<'Z" ,
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. Type of Sample ,..... Slump . ...- Quantity'- .,Time.!n '," I, ,Time Out Reg. Hrs. O.T. Hrs. I
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- --. .-_.-. . -- 'A'" -,-,-_. . '-r;r'l~i;:~lrX...._m- --. All .I...~on based ~ a minimum Of,4 hours and over
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I ~o hoursbnimu~. In addition, any inspection
I Weather: Temperature: extending past noon hour 1M1I be an 8 hour minimum.
, , ' II APprove~d A
Certification of Compliance , r:' I, I J/ /," - C;;' /. ~ '
I do certifythal I have observed to the best of my knowledge all of the abblll>le~o~an~6i6di?d,thi ~k to compiyWth
the approved pians, specifications and appiicable section of the governing building law.' Unless other1Mse noted In deficiency report.
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ICC Certification Number 0868219-49
Ag'8~(C~Z-{q _L/~ I Cc..-