1678 W. Palais Rd.
BUiLD!NG PERMIT NO. BLD2004-02254
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CITY' ~lic~~f~H ElM
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BUILDING DI\lJSION
200. s, ANAHEIM, BLVD,
(714) 755 -5153
, INSPECTION -REOUEST LINE:
(714) 755' 4626
CENSUS CODE: ' 434
, ,QUARTER SECTiON: 56
TYPE QF PERIvUT
Residential AdditiclO
DATE: 6/1/2004
JOB ADDRESS: '1578 W PALAiS RD
LEGAL DESCRIPTiON:
N TR 3840 LOT 32 ,
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'APPLICANT: EUSTAQUIO 'AGOR
OWNER iNFORMATION:
. Eustaquio Agar
1 t;i78W Palais Rd
Anaheim, CA 92802 ' ,. ,. , '!" '
JOB DESCRIPTIONi'54 s.f. residential rOQmadd'n. (2 bdrm, l' bath, 1 familY .bpm) H I.H, Program
VALUATION: . 50,744.00 . " .. '-1-.-- _ PROCESSED,BY: CAL '. .
L. .. ,. . ' . , OWNER-BUILD[~Pf"CLAR.i'\TION, " . ' '. ..' . .. ..~
J hereby affirm under penalty of ~rjury that! am exempt from the contraaor}: Lice:lse Law for the folloWiP:J ,eaSOI) (Sec. 7Q31.5,Busiriess and.
Professions 9OOe:_ any dty'or county which r~ujres ~ perrnj~ ,to c,?ns~ruct, a;,: (,. improve, demolish. or repair.any struclllre, pr'ior t6it~.jssua..nce, also" "',
. _reguires the'applicantforsuch;permit to file a signed statement that heisJiC'=J\.:::ed purs;uant to'the plP\!isions of :he:Co.nt;-actor'~~ic.e~,se LawJChapter
g)~cornmencing~ith S~ction 70.0.0 of Divisicf')_ 3 of ~he 8usin~ss3nd?rof!=sS!(~h~ Code) or-tha't he is-,e>~e~pt therefr<?m_an'dthe.ba.~js.for,.th:~-alleg_ed .'. :
~;~~~~iO,~' 'A~~. ViO.l.atiO\l9f S~ctior.. 7031.5 by ~ny dPPfi~~nt f9: aW"Xf'!1i~_sut;:tw,;ts tre ~PPI;,cant to a._ciVil p:~n~._ItY~f'~~~~ rru:'re.t~an. five. hUrl~dr~.~ dQllar~,
,0 I, asowner9f property, or. my employees with wage,s as their s0ieco,~1!Jr:~..':;<::ti:.Jn, ...;;iIl do the work, -ar,d the s~ructure is notiptendoo oroffer(~d for
s,afe'{Se'c. 7Qil4'_BlJs:'nessand Professions Cede: ,The Contraclor'sLice~~f-<.:.~.....-dtjd'S n.)! ap;:;!y to an Owrsr afpraperty who'lJuilds or,ill1praves" ,.-~ ,
thereon, an_d wh'.) d"Jp.s,sllc,h work ~lirns~lfor herself or t!1rough his_or h,er G'..JlemiJ:oyees"prcv!ded th~t StiC~1 ir.'lp[l'Jvementsare not 'intend~.or
offered for.sal~.'lf, ]:cWGver, the build ing 0r implOvement.iS-sold. with ane y!?~r of-. :;o:npletiot.. the- c,^;ner-bu;ld~::- ....illlh~ve the burden of proving' th,a'{ he"
~_qot ~uildoUmp:--9vefor fr!e pUrPc~e of-sale).: _ '~'" . d~ll __ . " _' ' . , ,', _', . '.", .
." . ....1,. a.s. th. e .owr.erOf.tMe property, am exdqsively C~lltracting Withllc~ns.edl~_:..i:':t;a.,;;to.r$'to'.i::~.~~trucnt~e: project {Sec,_7044'Business r.:nd P~OfG56'iC.r,s:
e: The Cor,tr2.ctor's, License ,Law does not apply to an owner of r,ropf-~;tv~f;~:'')bldds c~ !''Dprm!dS thereon, atl~ whO- oontracts fO(Slll.:h projec.ts'with
t1ontractor{.~.)_~iC~nspd_purse~. e~ontractor's Ucen,se laW)..... '::.)('. .', '. , ", -'.
.'- I.am exempt :.ii!dersec.,~:--. S &~'F.G.foithisreason:. __.~.~___.__ ~_
Date: .. " Owner:_ . _. ' . : _c!k:-""- .',. __ .
c::== WORKER'S COMPENSATION DECLARATION 'it ---, .: LICENSED CON..RACTORS DECLARATIONn-_:]
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I hereby affirm-under penaltY of perjury one ofthe followin9 .de~lar'dtiC:1s: '. ,,:i,; . _ " I herebyaffirn-LUnder penalty .of perjury tMa~ I am
. D . 'have and will maintain' a certificate o(oonsenl to 5P.lf~insure for wof~t';d}~j:-::imp~nsation". iIcensed-underproyisiori,s of (;h?lP~er 9 (commencing
as prcivided far by Sect [on 370.0' af the lc:-bor.Code; fot theperform8nce cJ tr1}-WOik.fur' wh!chw!th Sei'::tion 7COP) of- Diwion_~ of the Business and
this permit is issued. ' .' -' !( _ _ Profes~'iOn$COd.e, '.
D I have andyvill maintain worker's compensation insurance, as rGct;ir~~ tJ ~-:~ction 37o'O.of. 6/11200.4'
the labor Cade,Jor the performance of the work for which t~is permit is-.is<::i..l~~. Myworker's ' . Date:
CompenSc:ition irSL!rance carrier and policy-are: ';/' I
Carrier: . . Policy Num~er.. _, NUMBER
. . - . -I.
'his-.section need not be completediff!1e pennit is for one hundred dollars !$1::(~:or.Jess, '":::,,.-:-, TYPE.
ce I 'that in th~ performance ofthe work for which ttlis permit is.!Ss:l:=:9,:,:,shaf[ n:oit~>",--:.
ploy .any. person in 'any manner so as to become subject to the wprker's ci"~np,ensati<?n,la~,s.
of Califomia, and agree that if I should become subject to tlie wo~eJ's, c:arri~~'!\G~tion ,_:,>~;'-:-<
.provisions ofSect[on 370.00ft~e Labor Cope, I shall fC?rthwi,th comply with t:-i\~-3'~.provJ~d~s~'
Date: 611/2004.Applicant:' . . --K-c~----'--., ,:,
WARNING: FAILURE TO SECURE WORKER'S. MPENSATIOr' COVEf)\(j:~l>..:"':":
UNLAWFUL, AND SHALL SUBJECT AN. EMPLOYER TO CRIM.IN ,PENA:,'nES Ai'JDGiVIL
FiNESUPTO ONE HUNDRED THOUSAND DOLLARS ($100,000 .IN A!lL:,"!QN TOTHEO
COST OF COMPENSATION, DAMAG.ES AS ,PROVIDEOFOR INfECTIC!\'J.050FT:"~
LABORCODE,INTERESTANDATTORNEYSFEES. ,'" .. ...'
I .. ,CONSTRUCTION LENDING AGENCY __.'~ --.:--~
.: I hereby'afflrm under p. en..a.lty. of perjury that t.here ;s a constr..uc~.ion !~:m(ji~1f! 1i~n.c;i ror th~->
_nerrNl'r-;;n.:ni='-:'.)r fh("\'\~nrtcfn-rvmich.tt:is..f).f'xmiLL<; ~,o:;Sl.1~...!;s.~,~":>r~';::h'?-,~>:':.... _i;;~ .:;,
lenders !nfcrmation:
CONTRACTOR INFOR!II1A,rION,
ARCHiTECT/ENGINEER INFORMATION:
Contractor.
EXPiRATION DATE'
Construcion Types:
VN" .'
Fire.Sprtnklered?
~JO
I certify th~t I have read this.applicatio:n and state that the above.information is correct.. I
agree to comply-with all city ordinances and state laws relating to building C01struction. and
hereby authorize representive~ of this city to enter upon the above.mention€('j propertY for
inspedionpurposes. ... - . . .
Dat,: 6/112004
Fees paid for Permit:
Total:
585.07
Signature af AppUca or ,Agent
Thepermitshallexpi~e by Iimita Ion and become null and void if the building or
.. work has not passed fimil. inspection 365 days from the date of permit issuance. A
new permit is required to, commence or continuework.
1.':
INSPECTION RECORD.
:::', INSPECTICIN' . . .' ,':DATE' . .INSPECTOR I
Temporary Power Pole'. .' . . .
Plurnbing(DrainlWaste Pipe) . .. . " ,
Electrical Grciund Electrodelurer '. : . ". , .' .
SelbacklFormsfTrenChes (Footings) 11l/U't' 1'(..(.(1( :. .
DO not imtallsubfloor or pour floor slab until the e
follQwing applicable items',.have been signed.:' -.. .
Plumbing (Water Plpe.Sprinkler Valves) '. . . '.
...,echil!lical (Groundwork) " " : " '. .... ','
"
EIec:trical(Underground Conduit) .' "
PIll,slab (Compaction/Membrane.ReinT. '/IW'V "
Underpinning (Floor JoistlGl rdilrs) .' , . '.
.!J'? nbt CovElr br conceal the1iVork below until the .' .
fc>~~g,appJicable items have been Signe~
1 stFloor S.,,,ar. ,. . . , . , I~ .,,:
F1lllsprinkler. (Rough)' . . . .
2nd Flllor Shear: .' .' '. . ~. ", / .
Ri:)ot.IShealhinalDiliDhragnrFrantt) "1'diJ.f1,
_onry (ReinfJBond Bean/Pre,Grout)
ROl1ghPlumblng(Tqp Out) '" . ,. " '. " / '.
Rough Mechanical , "It~64" .SJlI9 .
ROugh t:Iectr'CallUFY ..all) ". " . 'f . ..
Rough Electrical. . . :,. . '., , . '. : . ."".
Framin9fOn1yafterPItg',Elec...MechandFi,ei ~ '~ . .'.
Insulation (SoundlEnergy). .'. '11t1w--r . ". . .
po not tape' orplllster' Until the foll(lwiAg appli,cable .
Itelns have beens.gned: ..,. ""'. .
DrYWall . . .... " .. . -to! 110. t"
, Penetratio/lS (Filll Rated) Electrical' ,'., :
i penetratio/lS (Filll Rated) Medlal)ical : "
Penetrati<ins(FiIllRated) Plul1'lbing .' . .' .' .
. .lnteriorLalh , ," . , -- .' ".
i ElCterl<l.r Lath . . '. W/I/vt".
" '. . '.' , GENERAL ITEMS. . ..'
EJoterlor Piaster (Bl'O\!IInCoaI) 1<>11
. T -Bar Electrical . .' '. . ."
:T-Bar Mechanical " .'.
T-Bar Structural ,
Sewer' , , ,
Water Engineering Backflow . , .' , .'
, Water Service' ..
FINAL INSPECTIONS'
Electrical Final'
PlumbingFinal ' , .
Mec"anical Final
'Gas Test
Engineering/Grading Final 76S-6126
Fir~ Oept. Fina.1 765-4040 .
Water Eiiglneeriri" 765-5268
SuI! 'List/Business License 765-5,19
Zoning 765-5,139
BuildirigFinal (Last InspeCtion- Only ;,; ~)""".
.. .' ,Mer AboV,e Complete). "-V
. '. .. PARTIAlINSP~CTIONS
Buildina InSllections .
Date ' 'Inspector
.' MechanicallnsDections
?Iuinbina Inspections
. . . .
Electricaf Inspections
.