2375 W. Mystic Ln.
~-
TYPE OF PERMIT
Residential'Addition
a~p2004,Q117.0 ' , ,l:!~~~~."':~g;:~'~\ . ' '
CITY g~'tN~HEIM
, \:~~~ifi~~j: ,i
BUILDING DIVISION
200 S: ANAHEIM BLVD,
(714)765- 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
,CE'NSUS CODE:' 434
QUARTER SECTION: 34
BUILDiNG PERMIT NO.
DATE: 5/25/2004
JOB ADDRESS: ,2375 W MYSTIC LN
,
LEGAL DESCRIPTION: N TR 2563 LOT 47
APPLICANT: TODD CAMPBELL
OWNER INFORMATION:
Todd Campbell .
2375 W Mystic Ln .
Anaheim, CA 92804 .
JOB DESCRIPTIO'N:Add bathroom, family room, laundry room.. 563 sQ. ft. H!~;
VALUATION: .37.900.00 ,.' , . PROCESSED BY: HRO
I .'. .' ___:"'__~.' OWNER-BU1LDEB~ECi.ARATION " .' ,~
I hereby affirm under pAnalty ofperlwy that i am exempt. from ..he COIllruct~'I} Ucense Law fo~ the folfo~ing reason (Sec. 7031.5 Bu~iness ahd
Profeseions Code: any CIty or courtty which.requires.a -permit to construct, ..=.!t;~;, improve, demolish or repairan,y.strlJcturG, orior to its issuance,. also
require,:> theappU _ t for such permit to tHe a signed statement that he'js !:~'r+~ed pursuant to the prpvisiori,~ of the_ Contractor's L.j~ense Law(Chapter-
9)(.commenc. with Sectioll lOaOof Division 3 of the Business and Profe~'siJ:f. Code) or that he is exempt therefrom and the basis for the aileged
exerncti ". AflY violation bf Section 7031.5 by any applic21nt for a perm!t3ur:'.i;';,':ts the applicant to advll' penalty of not more than five hundred' dollars
$50', ' ," ,,}, ' , ' "
,- I, as, owt1~rof property, or my,empJo)'Ges with wages as their sele cm~~~/iisatjon,\~lill do .the work; and the structure is' t10Un tend '=Kl or afte/s-d fo;
sale (Sec.. 7044 Busli1ess-and Profes~;;jc~s Code: The Contractor'3 LicenseLkw does not appiyto,an' owner ofpro!)edy who buifdsor improve's
thereon" and who does'suchwork hirns€!tf or helBelf or through his or h€:lr O\....;~ employees, provided that sUt~h,im~roveinent$ are not i~'ter:de..:l OJ
offered for sale. ,!f, howe'ler, ,the' building or improvement is sold '.vith Of)~ 'yf.(,\r of Compietion, the owner-builder will h:3'1e t110 ~urdAn of proving that he
.didnot ~uird or inlProye for tile purpose of'sale). ':.-~ ,-
o --l, a3 the owner'oftheproperty, arTl exdu~ively controcting with Jieer:sE'::t-t;:v;ltf;.:'Ctors to construct the projeC",t.{:;:'ec, ,044 8u.siness and PrufessioAs
. C'.:-de: The Contracto,'s License law does not ap!)IY to ail O'Nner of fJr0p~rj.y~~ho bl;i:ds or irripi'o'ves'ther~on" andv;ho oontj'ac.ts f(;r suCh 'project.c: wif:.h
:i.Qontraclo',(s)lice'nsed pursuant to!h, Co t r.tor's icense Law), ),
~mexeinPtundersec" ' . . ,C'.1 I, a n' ---J--, ,__~_.,____
~: 'j7-hl"'~~OR~;;~ COMPENSATI~N D~ ;l'RAT;ON~l=-_' =-. j. 'i~~~~-;;N~~"CTORSDECLARATION~
1_~erebY a~rm unde~ penalty of perjury one of the following ct claraticns: ' ;' .'~ ~ her.eby Clfi"lrr,n .UI.1.jer p;malty of p_e~jury that _I. am
o I' have_and will ,maintain a certificate of con-senUo setf-Insure fO.r-v,.,-:-,rl<6, '1 compensatio;l, .rlcensedUJ1(]..~rpr~W1SI0ns (IT chc:pter 9 (commencing
as provided'for by Se,dion 3700 _of the Labor Code, for the performarlC':'. oJ tt<~ wor':'.: fer which wit~ $ection 7000). cf Divsiun 3 of thE -Business and
tr-ia permit is 'jssued.. '. _ ' .i ' proress:ons Cod-\?'
O! ha'{e and will maintain worker's eompc!1s~r;:ioLl-insL:ranc~, C\:> reqtJired r.J'St:lc;tion 3700 of 5/25/2004
. the LaborCode, for the performance: of the work.for which this permIt is iSSll~~. My worker's . Date:
CompensaUon,insurance carrier and poiicy are:
Carrier:
. CONTRACTOR INFOR~-1."'r:ON:
ARCHITECT/ENGINEER INFORMATION:
CdntraGtor
f
This section need not be .completed if the pennitls for one hundred dOllars is''!')') or le-ss.
D. I certify_th~t in the performance oftbe \'Jork for which this per-mitis i'SSl~\ I shi=lllnct.
'. employ any person. in any manner so as to become subject to the,wo~kers {:(mp~p.satiop laws
of Califomia, and agree that if I sr,OUld becorn,e su bj~ct to the w.6iker'~,Go~?s~_li,on
. provisions, of'Section 3700 of the Labor. od H II rt. ith c" ,~ith_f.:~~)Sf\ptov,i,si~ns. .
Date: 5/25/2004' Applicant:. ". "~_
WARNING: FAILURE TO SECURE WORK.EFl"S COMPEN TION COVERY3EIS
UNLAWFUL. AND. :,\HALL SUBJECT AN EMPLOYER TO C IM1~ PEi"If.~TlESAND CIVIL
FINES UP TO. o.NE HUNDRED THo.USAND Do.LLARS ($100;0001.' IN pm:.,r'ON,TO THE,
COST OF COMPENSATION. .DAMAGES AS PROVIDED FQR IN SECTlot 1i:>706,OF THE
LABOR CODE. INTEREST AND. ATTORNEY'S FEES, ' "
I CONSTRUCTION LENDING AGENCY __",
I hereby affirm, under pen. alty 0f perj':lr,Y that. th~ere. a,constructi,on lend.in.Q/ll'.',il.CY f..o. r the
pe~qrrr~fnce oft~e work for whjdl ~his permit i . ~su.ed (S~~:~~,9~,:~i~.C):":, ,.~, '.' .
!.:--~~...~ ,I,..~,:,;"-?:":~~~?."':-~_,,,_ ___,' __,.,e__=__',_~~ _._._ __, ,." ~:,',,_ _.<' '-' _,_:" .,.- ._____ ,~-, ,.,J_.
Policy Nl,lmber.
NUMBER
eXPIRATION,DATE
TYPE
ConstrlJcion Types:
V N. .
LivinQ Area:
563'
I certify that I have read thisaWlication and stc;lte that the above information is correct. I
, agree to com'ply with all city ordinances and state laws relating to building cO:lStruction, 'and
hereby t '. e r ntives of this 'city to enter upon the a bove mentioned property for
ins ec!:i '
Dak 5/25/2004
Fees paid for Permit:
Total:
3.79
f Iiean r Agent
The permit shall expire Iimitatiol) and become null and void if the building or
,work has not passed final insp'ection 365 days from the date of permit jssuance. A
,!'!ew permit is required to commence or co~inue work.
'", ' ,
INSPECTION RECORD' FINAL INSPECTIONS '. .... . Date .., Inspecter
.... . : INSPECTOR Electrical Final . . . .
.... INSPECTION . . .. DATE .
.' TempararyPower Pale: . '. . .. . Piumbing .Final . .' .-
. . . '. . .. .. .
Plumbing (DrainlWaste Pipe) .' . .~ 1/// . Ml!.Chanical Final .
Elllctric:a1 GrciundElectlodelUfer . X'"" ..,D<; {// . . '. . . . . '.
. .' .
SetbacklFortnslTfe.l1Ches (Footings) . '\C . -:- Gas Test . : .. ; i'. .'.
;-~~ 6 'I' . .' . .... . .
. 00 net instal.1 subtroor .or pOI.Ir flecr slab untiJthe/ . Eng,neeril1jllGradingFinal 7!i5.-612~'. .Y
following applicable items have been. signed: .' .' . . .'. . '.. .
. . . '. . :'. . .' . . . .
Plumbing (Water Pipe.Sprinkler Valves) . . Fire Dept. Final 7654040 . .' .
Mechanical (Gr()llndWQrk) ". . .: . Water Eiigineering765-~268
.' '.. I .....:
;:~o;:tric:al (Underground Ccnduit) . c
pre-s~b (l,;ornpactiOlVMembrane,Reinf. . . . .' Sub List/Businells License 765.519 . . . I . ':
.
Underpinning (AciorJOistJGlrders) . qltl~tf \ AI '"~ Zaning 765:5139 . . .-
. . .
.00tlDt cover .or col)ceal the work. below IIntil the . ~. Building Fin;!1 ~ast Inspection-Only
'fdllowlngappliGable items' have been signed:' . . Iter Abov,e Complete).
1siFloor Shear . , ; . F'ARTIAL INSPECTIONS
Firespiinkler(Rough) . . ~~~k9ff..ft.
. 2nd FlaarSheat: ..'; .
ROof (She.hin9/DiaphraamrFram!l) .. .
MaScmrY (ReinfJBc:i1ld Beam/Pre-Giout) ..' .
R!lugh.Plumbil)g(Top Out). . .' .' . '. .
.' RaughMeChanical .....:. . > '.. '.... .:
KOugh .l:lectrlCaI (Dr-y Wall) ,;-z.l-o\ .',. .' . -
Rough Electrical ..' . . ..' . ....:
. Framing" (Cnly afterPlbg.. Elee.. Meeh. and_Fire) . . ....
lI: InllUlalian(SoundlEnergy) . '. .' - .' '.. . .' .. .-
. . . Mechan'ical Inspections
00 nat tape .or plaster until ttle fallawingapplicable. .
. i.tems have .been signed:'. " ,-'--'- . . . .' '. . '.
.
DrYwall; .. .' . . , .- .-' '. , .
. Penetrations (Fire Rated) Electrical .
. '.' '. "
Penetrations (Fire Rated} Mechanical I
PenetratiOns. (Are Raled) Plumbing . . .' . ., . '.
"ntenar Lath " . . . .' '. , ...... .,,:-
Exteriar Lath . '.. . . Plumbincilnspections
." .... . GENERAL ITEMS . , ~
exteriOr Plaster (Bl"OV(n Goat) . . c .. . '. .
T .Bar Electrical. . .. . ....
T.Bar. Mechanical. .- . '. ." . '. .. .
.. '.
T.Bar Structural . . . .. . ' . . .. .'. ' ,
S(twer ....
Water Engineering Backfiow .. . . Electrical Inspections .'.
Water Service .. . . . ..~.'
--
~ ~":>GOltkf.
ff>>. ~<-,,<,oe<<..P~
. .
'..PERMIT EXPIRED'
..tNSPEGTION"
NOT 'CO'MPLETED
\/:5/ (xfJ'
. ./ ./."
'DATE: