1619 W. Lorane Way
"
TYPE OF PERMIT
Residential Remodel , '.... ","
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CITY:" \5i~~tl~H ElM
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BUilDING DIV:SION
200 S. ANAHEIM BLVD,
(714)765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - ,'326
CENSUS CODE: 434
QUARTER SECTION: 59
. BUILDiNG f'ERMrr NO. BLD2003-03958
DATE: 10/612003
JOB ADDRESS: 1619 W LORANE WAY
LEGAL DESCRIPTION: P BK 11 PG 18 PAR 2
APPLICANT: LUCILLE KRING
OWNER INFORMATION:
Ronald G Kring
. 1619 W Lorane Way
Anaheim. CA 92802
JOB DESGRIPTJONAlteration to add a vault.ed ceiling.
,
VALUATION: 5,000.00 J
I OWNER-BUILDE;IC';:CLARATION
_I hereby affirm under jJenalty or perjury that. I am exempt frorn th,e ,Ccntrackl,s Lict?i:se LawJor tt)e follo\:~ing reason (Sec. ~031.5-Business and
Professions Code: .-any city or county which reqii:res-<" peimit ~c cor.struct, ,I.;~r. improve,d-embhsh or repair any structure, prior to its issuance, also
-requires the ;:l_ppl!cant for such permit to file a signed st3tement that he iSn(;~)lSP.d pursuant to'the proVisions of the Centracter's License Law (Chapter
9)(commencing with Section 7000 of Oi,vise., 3 of the 8~~ine~,s 3nd Profes~:;br"ls Code) e'r that he is exempt therefrom and the basis for the alleged
exemption. Any violation ofSectio.n 7031.5b~' any applicant fer a permit s'::~:~cts tM~ a~)plic?:1t :te a evil penalt-yefnot more thar\five hundred dollars
($5,)0)... ". . . .; . . ..
D I.. as owner of pro.perty, o.r my el11ployees with wages as their'sole C0f110~m:atipn,wm do the work. and the structure is ~ot infpnded or-offerecUor'
sale (Sec. 7044 Business and Professions Cade: The Car1tractor'~ licemj&J~z:w daes,not apply to. an owner I)f pro.perty who. builds or improves .
thereo.n; and who. doessud1 work himself er herselfor through his '.:>r.her 0.\,':;) empleyees, provided tl1at such improvements arenot i1itenaed ar'
ifffer . fer sale. if.' hO.'.Never, the bUild. iri.a o.r ..impravcment is solO with 0. nSY../',r 0t comPletien., thco.wner-b. uHderwill have the., bu rd en b. f }::ravirg tha t I)e
'd o.tbuildarimprovefarthepurposeofsale). . ' " ';f , " .
I, 'as the awner of the pro.perty,am exdusively cor:tracting with license~-:,L:'r:tt'actors to. censtruct the project (SZc. 7044 Business and Pro~essions
.de:, The Contractar's License Law daes nat apply to. an awner o.t prop_ i~!,~::":,e bL!jrd~ or impraVes therean, i;lnd '.vho contracts for such pro.jects 'with
~antractor{s) licens~pursuanttQ the C(,~i1tractc:r's License Law). . ~. ~ . ,-, ,
U l:am ~lI.f;lmpt under Sec.. . ' .B P.C. for this ree- n: '- :i,~
Date: Owile'r: .. J.l
. WORKER'S C r ~
I hereby affrrm under penalty of pe~ury ,ane- af the following declarations: ~~::-~.
. .. II; .
o 1.~Fl"e an~ will maintain a certificate of con$6ntto self-insure far\..'od~:"1f? cot!'1pen'5afic,n,
as provided for by Section 3700 of the labor Code, for the performance Uil'() wo!k fOiwhich I
this permit is issued.' , :ifi' I
o '1l1ave and will maintain werker's compensatian insurance, as required 'l~ S..x..~;Vn ~700 v~! 10/6/2003
~~~~r.F~~~~~~:''':n"c:~~~~:;~~:':~ ;o;k fO~::~:hN::::rn;t ~ i~.":I>J.'. M. ,.I!,W.U. r.k e,'s U:~:BER
This section need notbe completed if the pelTt1it is for cine:hun::lred 'dollars ($~(!.; or'less. _ TYPE
D .1 certifythatin theperfarmance of the work forwhich,this permit is is.~'.'' d; I ~'1all.n61 '
employ. any person in any manner sa as to. became subject to the workcIJ!;.~;~~01pe1;1sation laws
of Califernia, and agree that if 1- shauld became su bject to the wark..r's con'j~Yri5'at!on-:-:~
previsions,af Section 3700 ofth,e labor Code, I shall ferthwith camply-wlt~ t'li.I~l?: provisions.
. _... ,1..:-.;
CONTRACTOR INFORr":\TION:
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: AEM
~l
LICENSED CONTRACTORS DECLARATION I
I hereby affirm under penalty of perjury that I am
licensed uflder pre\.i~ionsQf chapter 9 (c\:lmmencing
with Sect' ) ofDivsion3 ('fthe .su!=;if1ess and
Professiens . .
.Contractc.r
EXPIRATION DA;E
Date: 10/6/2003 . Applicant: . ,-".
WARNING: FAILURE TO SECU~E VORKER'SCOMPENSATION. (J !:;"J\GEIS ~:. .
UNLAWFUL, AND SHALL SUBJE AN J:MPLOYER TO CRIMINAL EW,..TIES AND CIVIL'
FINES UPTO ONE HUNDRED ,OUSAND DOLLARS ($100.000), IN'{<~,;!TION.TO THE.
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIO~:3iOa Of,THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.. , 't .c-
-.":-
I CONSTRUCTION LENDING AGENCY ,., '''.~c..
I hereby. affirm under.penalty ,of perjury that there.i~ aconstructian len~l~g a'/~ncyfor the
per:term_~~~:'o.f,~~.~:^,ork:or which this permit is issued (8.e. c.3097 .CiV._~}:;'; t _._ .'._,
Lender!s,ncrma,lon. . ' .' ..,_ . ___ _c,.....', -'---~_o
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Construcion Types:
VN, , .
Fire Sprin.klered?
NO
. Ln.
- . . -
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I cer!Ifv,Jh?-t 1:O-Q\I~ read this api'lication ands~te that the ~baveinfor~tic.n IS corr~t. I'
agree to comply with all city ordinances and state raws relating to 'bu Uding construction, and
hereby atithadze..representives af this city'to enterupoti the abave mentianed property far
'ins ectib"n purposes: '
, :1
. Dale: 10/612003
Fees paid for Permit:'
Total:
215.66
Signature at plica'nt ar Agent
The permit shall expire' Imitation and become null and void If the building or
work has not passedfin;ll inspection 365 days from the date of perm'j issuance. A
new permit is required to commence or continue work.
" INSPECTION RECORD
FINAlINSP,ECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas,Test
0"_'"
Date
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, INSPECTION , DATE INSPECTOR .
Temporary Power Pole' -
,
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/uter
Set!>acklFormslTrenches (Footings)
Do not ,install subfloor,or pour floor slab unlilthe
following applicable i,tems have, been signed: , , "
Plumbing, (Water Plpe.Sprinkler Valves)
~hanical (Groundwork) "
Electrical (Underground Conduit) , , . ,
Pre-slab (CompactionlM"",brane.Rei nt. -
Underpinning (Floor Joist/Girders) ,
Do not cover or conceal the work belOW unt.1 the
following applicable items have been signed:
1 st Floor Shear, , ,', ,
Fiiesprinkler (Rough) B
2nd Floor Shear , " ,
Roof (Sheathing/Diaphragm/Frame) I 1
Masonry (ReinfJBond BeamlPre-Grout)
Rough Plumbil\g (Top Out) ~
Rough Mechanical
I KOugh!:l'!Ctrlcal (Dry Wall) , ' ,
Rough Electrical , , . \ ' , "
Framing 19n1yafterPlbg., Elet.. r.:1ech...and Fire) \ I-.lJ i'\ tlI'~ ,,.
Insulation (SoundlEnergy) . ;~ ~!':>.)l V .~ WI ,M
00 not tape or plaster until the following applicable , I
items have beer:J ~igi1ed: . .- , . . . J ,
Drywall ' , " e.-tZ -(:I ~H
Penetrations (Fire Raled) Electrical ' ,
Penetrations (Fire Rated) Mechanical f
P~etrations (Fire Rated) Plumbing , , ,
Interior Lath , , IV,/",,,,,,k. ,
Exterior Lath '1-""/"'" I\,.xl........ P
GENERAL ITE ~S ' ,v '
Exterior Plaster (Brown Coat) ,
T -Bar Electrical ' , , I
T 'Bar Mechanical ' ,
T -Bar Structural " ,
Sewer ,
Waler Engineering Backflow E
Water Service'
Engineering/Grading Final 765-512~
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License,765-519
Zoning 765-5139
Building Final (Last Inspection- Only
Mer Above Complete)
echanicallnspections
/
lumbiriQ Inspections
lectricallnspections '
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