4118 E. Mapletree Dr.
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BUiLDING PERMIT NO.' B'djii.K:.:;..D2SG'i'
TYPE OF PERMIT
Residential Remodel
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.- '~,
. . l:i~t,'":!~~~'~:, '
CITY QJi~~N~HEIM
\~f~,';l~@~ ,:
BU!\tlii'~G D:VISi0N
200 S. ".NAHIi'IM BLVD.
(714) 765 - 5153
INSPECTION REQUEST liNE:
(714) 765-:4626.
CENSUS CODE: 434
QUARTER SECTION: 163
DATE: 6/18/2004
JOB ADDRESS: 4118 E MAPLE TREE DR
LEGAL DESCRIPTION: N TR 4567 LOT 14
APPLICANT: GREGORY WIEDBUSH
OWNER INFORMATION:
Gregory J Wiedbusch
4118 E Maple Tree Dr
Anaheim, CA 92807
JOB DESCB1PTION:Balhroom remodel.
VALUATiON: 3,500.00
I OWNER-BUILDEF:_DECLARATlON
(hereby affirm under penalty of perjury that I am exempt from-the Contract(lt,$ License Law for the follow)ng reaspn (Sec. 7031.5 Business and .
Professions Code: any dty or couhtywhich requires a permit to,construct, alt;H, il11prove; demolish or repair any structure, prior to its issuance; also
requires the applicant for sl!ch- permit to_file a sighed s~fement that he is !!cC".)sed pursuant to. the provisions of the Contractor's License law (Chapter
. 9)(commencing . h Section 7000 of Division ,3 of the Business and Professk,ns Code) or-that.he IS exempt the:-efrom and the basis for the alleged
exel11ption . y'violation of Section 7031.5 _by any applicant for. a permit sub~~cts the applicant toa dvir penalty of not more tha n five hll'1dred dollars
($50 . .'. ... .
I; a3 owner of property" or my employees with wages as their sole corr:;"'~llsation. will do the work, and the structure. is not intended or offered for
sale (Sec~. 7044 Business and Professions Code: The Contractor~s license I.in.." does not apply to an'owner of property wh() buildsor improves
thereon, 'a'1d who does such wo'rk.himself or tie~elfor through his or hero'llf~i-employees, pro'yiJed that $uC;;h improvements are not ',intendedor
offered for ~Ie. If; however. the building or improvement is soltiwith one YE-~!r cf completion, the owner~builder will have th\.1burdenof proving that he
did not buil.d or improve-for the purpose of sale). . ':~, .
. D. I, as the. OWner oOhe property, am exciusively contracting with licensed.:kntractCirs to construct the proje<?t (See. 7044 Business and. Professions .
~Coqe:, The Contractor's. License law does not apply,to an owner of property'.}~;ho builds or improves thereon, and who contracts for such .projectswrth
, '": ontractor(s) licensed pursuant to the Contractor' ice se law). I' . .
e m t under Sec. . & P. is reason: .'f
C ~ OWner:
WORKER'S COMPENSATION LARAT ::::;::;:r
I hereby affirm un.der penalty of perjury one oJ the following declar.ation~:, .' 1
[J. I ha~,and:wjJI~i!1tain ,a. certificate of conse~t to sel(..jnsure.for worke<~ compep.sation,
as provided for,bySectlon 3700, of the labor.Code, for the performance of t1~.'3 work for which
.this Permit is 'issued. '. '~
o I have andwill fTlaintain worker's compensationinsurance~ as requiu~:j b:i: Sec.tiOn 3700 of
the_,=-abor. Code, for the performance of the work for-which this permit is i~l~~~d. My worker's
. Compensation inSurance carrier.and policy are: '
Carrier: .' . Poli~ Number. !:
CONTRACTOR INFORMATiON:
. .
ARCHrrECTIENGINEER INFORMATION:
PROCESSED BY: ODC
'-LICENSE;) CONTRACTORS DE:CLARAT!ON' I
I hereby affirm_ under penalty of perjury that I am
Iicen.sed under provisions of chapter 9:(commencing
with Section 7000) of Divsion 3 of the Businessand
Professions Code.
6/18/2004
Date-: .
Contractor.
NUMBER
EXPIRATION DATE
.This section need no~ be complet~difthepenn!t is foronehundred dollars ($1(1:9 or Ip.ss.
o I certify that in the performanpe of the work .tor whjchthi~ pern1~t is iSSl,;~~d, I shan not
employ any person in any mariner so as to- bee bject to the worker's c:'}mpensation raws
. of CalJfomia, and 'agree' that if! should become su to the Worker's cOrTip'~nsation
provisJons of Se'c.tion37.00 of the lab~e~ I rOI ,.with c ply v.;itl., t.os~provisions.
Dale: 6/.18/2004 Applicant: _-
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVEF'AdEIS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PEN/lj:OIESAND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN iJDOlilON TO THE.
COST QF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTle'" 37069F THE
- LABOR CODE, INTEREST AND ATTORNEY'S FEES. .
I CONSTRUCTION LENDING AGENCY '.' , _
I hereby_ affirm under penalty af perjury that there is 'a con.struction fend fng ;;J~hcyfor tl1e
per/ormanoe of the work forwhlcl1 this permit is Issued (SeCl3097.Civ.C):. . ., .
. , ~r.rl.p.~$Jnf"'":rr"\~ti0-~'
TYPE
Construcion Types:
VN, ,
'nklered? NO
. . , " . .
. I certify that I have read .this application and state that.th.e above information is correct. I
agree to oomply wit,h all city ordinances and state laws relating to building construction, and
hereby authorize ntives of this citY to enter upon the above mentione,1 property for
insp ion pur ses.
Fees paid .for Permit:
Total: 124,85
': 6/18/2004
. ature of lcant 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 continu.e work. .
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'INSPECTlbNRECORD'
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. . . INSPECTION . . . .' ......: DATE. . . INSPECTOR T
TemporaryPower'Pole.' .' .
Plumbing (DrainlWaste Pipe) .' '. .' .' . .
EIe.c:trica' Ground Etectrodeiurer .': .'
. SetbacWForn'lslTrenChes (Footings) . ,'. .
DO not Install subfloor or pour floor slab Until the
following' applicable ite'ms have been signed; '. '.
. Pllllllbing lWater Pipe.Sprinkler Valves) .
Mechanical (Groundwork) :. . : . .
F/ecUK;a!(Undel1lround Conduit)
r Pre-slab (CompactiOll,lMembrane.Reint. '. .
I Underpinning (RoorJoistlGli'llers). '. .'
I'.~onot cover or conceal the work. Qelow until. the ..'
'.following applicable'items have been signed: :
.1sfFloor Shear. . ..... . '. .
,Firesprinkler (Rough)' .
, 2nd Floor Shear' . . ,. '.
.ROof (She;llhing/D1aphragmlFrane) ....
[Masonry (AeitifJ8ond Bean/Pre-G/"OIJt)
Rough.Plumbing (Top Out) . , . .
,RoughMecbanical . , . .'
!<<Iugh l:IectTlcal III' .
Rough Electrical . . . " Il ",
Framing.-' (Only after Pibg., EIeC.: Meeh. 3.'ld Fire~ '11 n-
: Insulallon(SoundlEnergy) . . ., .
1.00 not tape or plasterunWthe following applic;lble .'.
item.s have been'signed:. ,. .,.. '. .'. ,.,.....
DrYwall' . '.- . " ~",~()tt 'f/",rt,,<
Penetralions (FireRaled) ElectriCal . .'.J \
Penlltralions (Fire Rated).Mechanical'. . \ ./
. PenetratiOns (Fire Rated) Plumbing " .
Interidr.Lath ' . .
Exterior I.ath . ".
. . GENERAL ITEMS . -
Exterior Plaster (Brown Coat) . . .
T..J:lar Electrical '.
T-Bar Mechanical.' .' '.' ,.
T -Bar Structural , .
sewer . .
Water Engineering Backflow " . .' ..
Water SerVice . . ,
. . , ", ..
I FINAL INSPECTIONS' Date' . InSpector .
Electrical Fi.nal . . ..' .
Plumbil;g .Final ., ::.';' . .
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Mecha.nlcal Final . ,. . .
'. . .
cSasTest . .
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Engineering/Grading FinaI765.s1~6' < .
Fir~ Dept. Floal 7654040 ' .' .
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Water Engineering 765-5268 '" '.
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Sub List/Business License 765-519 .
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Zoning 765.5139 ' . . . .
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Building Final . ~ast Inspection. Only .
. . fter Above Complete) '.
. PARTIAL INSPECTIONS
Buildiriqlrisoections
. Mechanical insoections '
'. Plurnbitiq Insoections .'
'. Electricallnsoections .
".PERMIT EXPIRED
INSPECTION
NOT COMPLETED
QAT E:ia-\(1410S~ ~..