2620 E. Lizbeth St.
.0,
TYPE OF PERMIT
( Residential Remodel"..
CITY
ElM
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765- 5153
INSPECTION REQUEST LINE: '
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 124
BUILDING PERMIT NO. BLD2003-Q4865
DATE: 12124/20'J3 ,,' '
JOB ADDRESS:~:21120:~t~BETH AVE
tL2'~~~~i,v;,~""'" , ,
LEGAL DESCRIPTION: N TR 3825 LOT 10
APPLICANT: WiLLIAM VAN SON
OWNER ,INFORMATION: CONTRACTOR INFORMATION; ARCHITECT/ENGINEER INFORMATION:
Son W Van
2620 E Lisbeth Ave
. Anaheim, CA 92806
'JOB DESCRIPTION:Remodel kitchen, remove non-beaong wall. I
VALUATION: 1,200.00 ~:-:, PROCESSED BY: FAN'.
I. . ,'. '.,' .... .OWNER-BUllDE~DECLARATION ......, l
I.hereby affirm under penalty of perju,ry that I am e~empt from the. Contrll.gQPs Lic.ense law for the following reason (Sec. 7031.5 Business and "
Pro'f~sions Code: any dty'mcountywhich requires a permit to construct;a~~i,.'improve, demo'lish or repair any structure" prior to its i,ssuance,also
requir.es the a'pplicant for such permit to file a signed statement that he is Hc~nsed pursuant to the'provisionsoftheContra(ior's.License Law (Chapter.
9)(comlT)encing with Section 7000 of Division 3.of the Business and Profess??ns Code) or that he is exempt .therefrom and the.basis for-the alleged
~ti,on. Any violation of Section 7031.5 by any applicant for a permit sulj.~ts the applicant to a civil penalty of not more-than fiye hundred dollars
, -?),~s owner of pro~a'rty, o~ my e.m~I~yees with.~ageS as thei; sole cO~f:U~atibn, Wil~ d~ th:e work, 'and'the structure is not inte~~~-6r offer~d for
sae (Sec. 7044 Business and Professions Code: The Contractor's lic~nsel~w'does not apply to ,an owner of property who builds or improves .
thereon, and who does suq-, work hi~elf or herself or through his or hero~\i employees', provided that such improvemfmts are'notiDtended or
offered.for sale.- If,'howeve-r, the- bUilding or improvement is sold with one y~~a'r-of oompletion; the owner-builder will have the burden of proving,'that he
did nf?t build or improve for the purpose of ~Ie). _ '. . "~\ ,'. " . "', ,. . , . -
0- I,as the-owner of the .property, am exdusively contracting with licenseQi~-ontracto!s to construct the, project"{Sec. ,7044 s,usin~s and ProfessiOns
Code: The Contractor'sUcense law does not apply,to an .C'~....ner of projJert~~who bli.lds or:irT1pr.:lVeS there'cn, and who oontracts for such. projects with
ontrador(s>, license~:f pursuant to the Contractor's license . CAW). (;
exemp.t under Sec. .C' or .1f)is' ason: ----:;!.
-z ~p. .Owner: , ~ '.:
WORKER'S COMPENSATION DECLARATION' \
I hereb'y affirm under penaltY. of perjurY one of the following declarations: ;i',
o I have .and will maintain a certificate. of oorisent to Self-insure for worr~ei;;;compensation,
as provided for by Section 3700 of the Labor Code, for the petformance of th,~; work. for which,
this permit is issued. . -
o I have and will. maintain worker's compensati~n insurance; as required t:~, Section 3700'of
the labor Code, for the p.erformance of the work for which this permit Is iS5U~~d; Myworker's
-'Compensation insurance carrier and policy are: r
Carrier: Policy Number. .f
. This section need not be completed if the pennit is for one 'hundred dollars '($1 O(~ or-less.
o "c~rtify that in 'the performance ofthe work for which this permit~",jSS~~~,t shallnqt
emploY'.any person in any m~nnerso as to become subject to the worker's .ccmpensation laws
of Califomia, and'agree thatif I should. become subject to thewor:ker'~com~~;1s'atiori>
provisiOns of ' Sect. ion 3700 of the laborG I shall fo hvvfth comply.with ~""~se.provisions.
. <" -"( :.,c, '.
I
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that., am
licensed un,der provisions of chapter 9 (c~mmencjrig
with Section 7000) of Di'JSlon 3 of the Business and
Professions Code.'
12/24/2003
Date: ,Contractor
NUMBER
EXPIRATION DATE
TYPE
Date: 12124/2003 Applicant: .' .>' ,
WARN ING: FAILURE TO SECURE. ORKER'S COMPENSATION COVER;;GE IS
UNLAWFUL, AND SHALt SUBJECT AN EMPLOYER TO CRIMINAL PEN6:.TIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), !N.AODIT10NTO THE
CO.ST.oF COMPENSATioN, DAMAGES AS PROVIDED FOR INSECTld!-I3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'.S FEES. '
I 'CONSTRUCTION LENDING AGENCY : [.
I hereby affirm underpenalty of perjury that there is a construction lend ing (~-::~"l.cY for the
'performance of the work for which th~~ permit is issued (Sec.a.O,!l?'~9iv.C): t!f-: <-:._~
- i:..enaer'S' inrern latlon:-
Construcion Types:
VN, ,
'~-!;:-~~<..
~-_:.-
-,-co
I certify that I ~ave read this application and state that the above.information is correct. I
agree to romply with all city ordinances and state 'laws relating to building construction; and
h_~.. - authorize presentives of ,this city to enter upon the abovementioned property for
j,'{\EK:tiOnpur. s. " -,
. Dale: 12/24/2003
Signature of Applicant or Agent ,
. The permit shall expire by limitation alll! become null and void if the building or
work has not passed final inspection 365 days froni the date of permit issUance. A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
79.87
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test.
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water EriginQering 765:5268
Sub List/Businessi3cens& 765-519
Zoning 765-.5139
Building Final (LasUnspection. Only' 1/ ~'"
. . After Above Complete) I~ .......
PARTIAL INSPECTIONS
BUildil'lalnspections
INSPECTION RECORD
, . :
. 'INSPECTION DATE . INSPECTOR' "
.
TQmporary Power PolQ . . "
Plumbing (DralnlWaste Pipe) .
Eledrical Ground ElecinxlelUfer . . . '.'
SetbacklFormsrrtencheS (Footings)
Do not install subfloor or pour floor slab until. the
following applicable items have been signed: ....
Plumbing (Water Pi pe.Sprinkler Valves) .
Mechanicai (Groulldwork) . .
Eledrical (Underground.Conduit)
Pre-slab (Compacti9fllMembrane.Rei 01. '.
Underpinning (Floor Joist/Girders) , . .' ,
Do not Cover or conceal the work below until the .'
fOllowing applicable items have been srgned: ..
1 st Floor Shear . '.'
.
Firesprinkler (Roljgh) . . .
2nd Floor Shear . . '. .'
Roof (Sheathing/Diaphragm' Frame) . . . , .
Masonry (Reint./Bond BeanlPr~rout)
Rough Plumbing (TopOut) .
RO'ugh MQchanical . .
Rough ~ectrlCal (ury wall)
Rough EIQdrical . . /7
Framing, ,Only after Plbg.. Elec.. Mech.. and ~t. r ./
Insulation (SoundlEnergy)' .
Do not tape or plaster until the following applicable ,
items have been signed: . ,.I .
'.
Drywall 'r.,. 'I HJ- VI,
Penetrations (Fire Rated) Electrical I .
Penetrations (Fire Rated).MeChanical . .
Penetrations (Fire Rated) Plumbing . ,
.
Interior Lath . .. . . .'
Exterior Lath . . .
. GENERAL ITEMS . . .
ExtQrior PlastQr (Brown Coal) .
T -Bar Electrical
T -Bar MQchanical
T-Bar Structural .
SQwQr . ..
WatQrEnglnQQring Backflow . .
WatQr SQrvicQ .
.
\
Date
Inspector
Mechanicallnsliections
Pli.tmbina Inspections
Electrical Inspections
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