272 N. Paseo De Juan
BUILDING PERMIT NO. BLD2003-00954
ElM
. BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
II\ISPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 196
. TYPE OF PERMIT
Residential Addition C I TV
DATE: 1.1/512004
JOB ADDRESS: 272 N PASEO DE .JUAN
LEGAL DESCRIPTION: N TR8081 LOT32
APPLICANT: TED LARSEN
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECTiENGINEER INFORMATION:
Theodore Larsen JERRY TUCKER
272 N Paseo De Juan 350 E 17TH STREET
ANAHEIM, CA 928070000 COSTA MESA, CA92627 0000
JOB DESCRIPTION Room Addition. 2 bedrooms and 2 bathrooms to 2nd floor and remodel 1st floor kitchen" (stairway-and kitchen expansidn at existing
VALUATION: bed6'5~Blfo.\loermit renewedtil5/5/05) PROCESSED BY: MSM
I . OWNER,BUILDER;DECLARATION .
I hereby: affirm under penalty of perju'ry that I am exempt from the Contractoris License Law for the following reason"(Sec. 7031.5 Business and .
Professions Code: any dtyor county which requires a ,permit to construct, aller, improve, demolish or repair anystru.cture, prior to its issuance, also
requires the applicantfor such permit tOfiJe a signed statement that he is licE\nsed pursuant -to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of-Division 3 of the Business and Profess,:6ns 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 su!~~ects the applicant to a dvil penalty of not more than five hundred dollars
I~~ ...... .
, I, as ,owner of property ,-or my employees w. ith wages as their sole coml,~~"'nsation; will do the work, and the. structure is not intended ~r OffE? red for
a e (Sec. ,7044 Busin~s and Professions Code:' The Contractor's License ;aw does not apply to an owner of property who buildsor improves .
thereoni and who does su.ch work himself or herself or through his or her owrl employees., provided that such improvements are not intended or .
offered, for Sale. If, however, the building or improvement is sold with one ye:3r of oonipletion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale).' . _
D I, as the owner of the 'property, am exdusi'O'ely contracting with licenser(contradors to construct the project (See. 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 oontracts for sum projects with
~ontractor(s) licensed pursuant to th Contract's License. Law).
U I am exe pt under Sec.' , & .C. r this reason:
Date -"'0 Owner:'
WORKER'S COMPENSATION LARA ION
I hereby affirm under penalty of perjury one of the fallowing declarations:
o 'I have and will maintain a certificate of mnsent to. self-insure for worker'3 compensation,
'as provided for by Section 3700 of the Labor Code, for the performance of the work for whidl
. this permit is issued. .
D I have and will maintain worker's-compensation insurance, as required b! Section 3700 of
the Labor Code, for the perform,ance of the work for whichthis permit is issutd. Myworker's .
Compensation Insurance carrier and polioy are:
Carrier:' Polioy Number.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under: penalty of perjury that I am
licenSed under provision-s of chapter 9 (commencing
with'Section 7000) of Divsion 3 of the Business .and .
Professions Code.
11/5/2004
Date:
Contractor
NUMBER
EXPIRATION DATE
. .
jrhi secti~n ,need not be. completed if the pen:nit-is for one,hundr~ dollars ($10(:1 or less.
I certify thatin the performance of the work for which this permit is issue:::!, I shall not .
employ any person in any manner so as to become subject to the worker's t:ompensation laws'
of California, and agree that if I shou Id beco 50 bject to the worker's compeQsatian .
provisions of Section 3.700 of the L Co e, hall forthwith comply with th6~e provisions.
Date: 11/5/2004 Applicant:
WARNING: FAILURE TO SECU' EWER'S PENSA TION COVER.~GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYE TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADD:TJON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 bF THE
. LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending a!;encyfor the
performance of the'work for whim this permit is issued (Sec.3097 .Civ .C):
_L_ender's Information:
TYPE
Construcion Types:
VN, ,
Occupancy Groups:
R3, U1, , ,
Fire Sprinklered? .
LivinQ Area:
NO.
897
I certify that I have read this application and state,thatthe above information is correct. I
agree to. oomply' with all cJty ordinances and state laws-relating to building construction, and
. here thOriz resentives of this city to enter upon the above mentioned property for
sp p se.
Date: 11/5/2004
Fees paid for Permit:
. Total:
1.988.47
. of Applicant or Agent
The permit shall exp 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 continue work. .
INSPECTION RECORD
, INSPECTION DATE INSPECTOR
Temporary Power Pole , ,
Plumbing (DrainlWaste Pipe) , ,
Electrical Ground Electrode/uter ' '
SetbacklFormsfTrenches (Footings)
Do not install subfloor or pour floor slab until the
followingapplicalJle items have been signed:
Plumbl ng (Water Pi pe,Sprinkler Valves) , ,
Mechanical (GroUndwork) , '
Electrical (Underground Condu~) " "
Pre-slab (Compaction/Membrane.Rei nf" ,
Underpinning (Floor Joist/Girders)
Do,not ,cover or conceal the, wol'l< below until the
following applicable ilems have been signed:
1 st Floor Shear , ,
Firesprinkler (Rough) , ,
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (ReinfJBond BeamlPre-GrOut) ,
Rough Plumbing (Top Out)
Rough Mechanical ,
,Rough l:IectrlCaI (llI'Y Wall)
Rough Electrical
Framing ,(Only after Plbg" Elec.. Mech.. and Fire) ,
Insulation (SoundlEnergy) , , ' '
,
po not tape orpla~ter until the following applicable
-Items have been slgne.d: '.
Drywall
Penetrations (Fire Rated) Electrical
,Penetrations (Fire Rate!!) Mechanical . "
'Penetrations (Fire Rated) Plumbing
Interior !-ath \.. , , , ,
Exterior Lath
, ,GENERAL ITEMS
Exterior Plaster, (Brown Coat), '
T .Bar Electrical
T .Bar Mechanical, , , ,
T 'Bar Structural "
Sewer ,
Water Engineering Backflow' , '
Water Service ,
-,
FINAL INSPECTIONS ' ' Date ,Inspector, '
Electrical Final V , ' "
Plumbing Final ", V ' ,
Mechanical Final ' , V/
' , ,
Gas T!>st " " v "
Engineering/Grading FinaI765-5126
Fir!> Dept, Final 765-4040 . ,
Water Engineering 765-5268
Sub List/Business License 765'519 ,
Zoning -765.5139 , "
Building Final l}astlnspection.Only vJialo' /~I
fler Above Complete}' 111( '/, '
, PARTIAL INSPECTIONS ',J"I v~ ().; "
Build/no Inspections
Mechanical Inspections
Plumbino Inspections
, Electrical Inspections