731 N. Modena St.
APPLICANT: AURORA OLlMON
OWNER INFORMATION:
CESAR C OUMON
731 N Modena 8t
Anaheim, CA 92801 0000
JOB DESCRIPTION:Add bedroom & bath (340 s.f.), extend front porch (72 s.t.).
VALUATION: 24,200.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Business and
Professions Code: ahy city or county which requires a permit to construct, altel improve, demolish or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that he is licenHed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjeGts the applicant to a civil penalty of not more than five hundred dollars
i$ 00). .
I, as owner of property, or my employees with wages as their sole compersation, will do the work, and the structure is not intended or offered for
ale (Sec. 7044 Business and Professions Code: The Contractor's License laN does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own omployees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale).
o I, as the owner of the property, am exclusively contmcting with licensed cX,ntractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with
~ontractor(s) licensed pursuant to the Contractor's License Law) .
U let der Sec. P.C. for this n:
Date: ~ Owner:
WORKER'S C MPENSATION DECLARATION
I hereby affirm under penalty of perju one of the following declarations:
o I have and will maintain a certificate of consent to self.insure for worker's (:ompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the '/Vork for which
this permit is issued.
o I have and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the periormance of the work for which this permit is issued Myworker's
Compensation insurance carrier and policy are:
Carrier: Policy Number:
BUILDING PERMIT NO. BLD2005-01901
TYPE OF PERMIT
Residential Addition C I TV
DATE: 6/29/2005
JOB ADDRESS: 731 N MODENA ST
LEGAL DESCRIPTION: N TR 2296 LOT 60
CONTRACTOR INFORMATION:
~
ihi section need not be completed if the pennit is for one hundred dollars ($100) or less.
I certify that in the perfonnance of the work for which this permit is issued, I shall not
ploy any person in any manner so as to become subject to the worker's corr:pensation laws
of Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Lab Code shall forthwith co it,p.-th~e provisions.
Date: 6/29/2005 Applicant
WARNING: FAILURE TO SECU EWORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDIT10N TO THE
COST OF COMPENSATION, DAMAGES AS PROVI DED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the
periormance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
I certify that I have read thiS application andstate that the above information is correct. I
agre~ t~ comp!y with al! d.Jty o~dlnancs~ z.r:d s!:ate laws reklting to bui~dir.g c,:;,;-~~,uction, and
hereby authorize representives 0 i ity to enter upon the above mentioned property for
i rposes.
Date: 6/29/2005
Signature of pplicant or Agent
The permit shall expire by limitation and becorre null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new DerlTit is reauired to commence or continue work.
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 25
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: FAN
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code.
6/29/2005
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Construcion Types:
VN, ,
Occupancy Groups:
R2.3, , , ,
LivinQ Area:
Patio Area:
340
72
Fees paid for Permit:
Total:
1.788.21
City of Anaheim
Building Division
FINAL INSPECTIONS DATE INSPECTOR
Electrical Final o't"o} C_~(.....,
Plumbing Final olu.lor C'~1f"""'1
Mechanical Final t- ZS.o .~.
Gas Test I
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765.5268
Sub List/Business License 765-5194 tP:z.<(,O\ IUKO
Zoning 765-5139
Building Final (Last Inspection - Only ,olu (0 ~ ~~
J"""-/
After Above Complete)
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
SetbacklForms/Trenches (Footings)
Do not install subfloor or pour floor slab unlilthe
following applicable items have been signed:
Plumbing (Water Pi e/Sprinkler Valves)
Mechanical (Groundwork)
Electrical Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear "I 1
Flresprinkler (Rough)
2nd Floor Shear
Roof Sheath in Diaphragm/Frame)
Masonry (ReinfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (Sound/Energy)
Do not tape or plaster unlilthe following applicable
items have been signed:
1) ,y
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
o
GENERAL ITEMS
Exterior Plaster (Brown Coat) , 7-
T -Bar Electrical
T -Bar Mechanical
T -Bar Structural
Sewer
Water Engineering Backflow
Water Service
c..1""L-
'.
t,""''"'''Ie-
PARTIAL INSPECTIONS l.A"'i I~
Buildina Insoections
Mechanicallnsoections
Plumbina Insoections
Electricallnsoections