610 S. Peregrine St.
BUILDING PERMIT NO.BLD2004-01512 /
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BUILOIN~ DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSLJS CODE:. 434
QUARTER SECTION: .113
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TYPE OF PERMIT
Residential Aadition C ITV
DATE: 5/21/2004
JOB ADDRESS: 610 S PEREGR.lNE ST
LEGAL DESCRIPTION: N TR 1987 LOT 43
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APPLICANT:
. OWNER INFORMATION:
Alexander Desouza
610 3.peregnne 8t
Anaheim, CA 92806
JOB DESCRlPTfON(l.dd 680s,t family roanl, bedro~m ~xtens;o)! and b8ti)r:'::Of,{tHi:;)-
VALUATION: 45,764.00 .... . I .. PROCESSED BY: MJL . .
C . . . .. . OWNER-BUIL!JEi,~)!;:CLARATION..... . . .---1
I hereby affirm under penalty of perjury that I am__e>;emptfrom tlieC6nti-;c~~?;-:i~~riseLawforthe following reason (Sec.- m31..5"j3usiness -and:~: . .
Pro.fessions Code: any dty.or COUlli'lwhiCh r~quires a p&:mit to construe!, .~'Jti~r,.-lrTIpr(>v~, demolish or'lepair c:'lny structure, 'plior to it~ l&3u,mCe, 'also
requir~~ the applicant for such oermitto file'a signe':! stat'9rnent that he is 1icl3"sel;pr..r$UC1f;t to the provis;ons of .the (~ontr;?ctor's Ucense.Law (Chaptet
9){comnencing w~th Section 70UO ofDlvision 3 of the Business andProfes$;l~::;3 G6de) or that he is'exempt th~lBtrolTI and the basis for-the alleged
ex;::ri1pti<,'n. Any vy)!ation' of Section 7031:,5 by rlf.Y applic:,:.nt f~r ap.erml~ :;:~i;:lpctG ti,~e <:!:pplicant to a dVil, pt';ml.lty ("\f njt mare th~0 'fiw>hundred dOllar$
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il i, as owner CT prop<C)rty, cr illY cmployel::s with wages a~ th,3,r 5C,~ C0r,lP~!t'ol'::;C'~Ir;~. w;1l dc) the work, :::tr'Jd tlk'> st,'-,ChJi0 IS rot :/'l!.:mded or offef{~(j fo~
'~ (~$ec.. 70~~ Stlsiness and Prof~sslons Cude' The Gor:l.n::c;!.or'3 Ltc-:,~"',::', ".,\...; d'lc${.ot a (:.ply to ~n cwner tIt property \vno build::: or improves
th<=:reol1. and v~f1.) doe~ sue;;'"I wo.-k hrrns'3lf or lteiSf:lf or tt.rcvgh ilb (,,. ;"ld;' 0~.,t I;..n~;:,:cy~e"'. prc/'r!e~ that ,;;u(,h improve"r1c;-tts C1re net IntenrJed or
ciferedfor saie. if,. however, thG bu'ldulg ,."r improver-lent ic; snid \{,Ith on,: Vli;;~f of comp1ellorl. ~~ ?wrer~bui1der '.VII1.-,z,ve tl1G b::Jrden of p"oving that h~
!'lid not bu~d 0r'il1!Prove fer t~c ~ur,Jost: ".JT f"-Ble), ' . . r. ~""'''''. . . .,. - .
. 0 ",I~. as the oWner of the property" anl ey.dlls~o,(eiy <..ontr3dj!':~ with nC'~~~~E:~J~:ll,"ar.,t-'){s 10 CO:'lstruc,t ~he pr~j0ct {SeG. 7044 E~usine<;sanrJ Professions
. Coce: TI,fe Contmctorc License La....... dOt:':3 net .:ipply to all OW:18t of 9rvpD~~.:~~J~") blJ::ds Ci improve.3 ,thereon, rlr!d ....JhO' :::ont"acts for SlIGh proje(.~tS W~.:-.
,r",-~ont~actcr{s} nc~ritect pursuann,) the C0r,tractor'l, UCC.,se,L~w).'': . - - . .' ' '
.;;-~t,.i am exemplundor sec.';'n.r. . --~\.!;t) ibr ihi"e"so": _ _._j_.. -;;_~... ___,~.,.___~_.-.:..........,._..:...---
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. [_~"-.-:....~. . WORKER'S COM~ENSATION DECLARAT~_J:=--I .! LICENSEDCONT(~A\;TORSDECLARA!IO~CJ'
I hereby affirm under penalty of perjury' one of the ;divwing :Iedara.~k:'n~~: . . j.. ., 'herebyaffi:!Y\ .;!{idt?.'" ~(laJtv, 0; pe:-jury that-! ';;;~J
[J t ha'l~ end w111.maintain a' certiticClte of consentto sAlf-ir.:>lIrG for ;No';"~I':~.':'orr.p;sr,s~tiQ!'"I,. licer,s>Jd undF.:r pfclJisionsufch,?'pter 9 (cor1'lmenciny
ss rr0vide'j for by Section 3700 of the labor Cnc"e, for the pp.rfonn~"a ,t J-<;' ,.,\~ij:~ fOI:...m:ch wiih Section 70(0) of Divsion;3. ()fthe Business :-:l.r-d
(:'i~ p,:,~niit is issued. . :i . I Pr:Jf~ssio!lS r:;0de . , ,
C! I have and -.Nill maintain worker'scompens3tion ;nsur",'i'Ce.,,*~qujrcQ :::_~ St~ct:o.:13700.of. :51'21/2004
the Lab,NCCde. ,forthe performarceofth~ work forwhic:hthis perrnrt:.;g i'~:H}.,}. Myworker'~ I' Date:
Compansation insura,nce ,carrier and ~1icy aie: (. .
Carrier: Policy Number. I f';UM8"R
This'section neect not be completed if the permit i~ for one hundred dOll:MS ~$'i~;:~.,a I~S. I- TYPE
rd:. ! c.eltify that in the perfonnance of the work far whk:t"; t!"tis permit i':i Jssu\..-L:!::,h~n no,;' I
~~Proy 3ny person in any manner so as te become subject to the Vlorker'f..'c:';1lp~'nS:et!O;1i:dws
cf Califomia, a'nd 3gree that if I'should becomesLlbjectto tha worker's ~;j:m9t:n.~a{iOI)~
~rovislons ,of 'Section 3700, ,of the Labor Code; rthwith com,Ply witi'l tr.-:.s:'J .pro(iisions.
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CONTRACTOR !NFORM.'T!ON:
.,
ARCHITECT/ENGINEER INFORM,\TION:
JOHNF SWINT
707 W. NORTH ST.
ANAHE!:':', CA
, Contractor
EXPIRPJilJN DATE
n.te: 5/21/2004 Applicant:
WARNING: FAILURE TO SECURE WORKER'S C MPENSATION c;OYI;',R>.GtilS ..
UNLAWFUL, AND SHAL,- SUBJECT A1\1 EMPLOYER TO CRIMINAL Pl',;.l.":~:ES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,OOOj:IN,.<,dD:~CN TO.THf;
COST OF. COMPENSATION, DAMAGES AS PROVIDED !'OR IN SECTfONJ70e OF THE
LABOR CODE,INTERE.ST AND ATTORNEY'S FEES. ,-.
I CONSTRUCTION LENDING AGENCY
J hereby affirm under penalty of perjury that there is a construction 16nJinq ::;;:.~T\cyfor~h~
performance of the work for which .this permit is l'Ssued. {See,30g, .Civ.C):
i.eildp.(s i~fcrm~t;9.1~: -----------'-
Construcion 1 vpe::>:
VN, '
Occupancy Groups:
R3, ..,' I, .
Fire Sprinklered?
Dwelling Unitl3:
LlvinQ Area:
. 'NG
1
680
I certify that I have read this application and sta~e that the above information i3 correct. I
'agree,to .comply with all city ordinances and state laws relating to building construction,and
hereby authorize representi of t 's city to enter upon the above mentiol')ed, property for
inspection purposes. ' ....'
Fees paid for Permit:
Total:
4.58.
Date: 5/21/2004
Signature of Applicant or Agen
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 continue work.
INSPECTION RECORD
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. INSPECTION , , DATE INSPECTOR
Temporary Power Pole "
Plumbing (DrainlWaste Pipe) 1~.2/.f/ 1/ r1. .IL ,
Electrical Ground Electrode/uter ' , Iv{
SetbacklFormsfTrenches (Footings) II'/~ o()4 J,IW
Do not i1~toor or pour floor slab unti I the
followingap' e items have been signed: ,
Plumbing ater Pipe. . Zol.lolJ4I{Y 11..
Mechanical (Groundwork) , 1.1.1
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane.Reinf. /'//,~;"" I~
Underpinning (Roor Joist/Girders) IL.r- ,//1 ,
Do not cover'or conceal the work below until lOe' 'j.!
following "pplicable ilems hav!> been signed: '
1st Floor Shear ,. ' ' , , "
Firesprinlder (Rough) " "
2nd Floor Shear .. , , '
,RoOf (SheathiriQ/Diaphragrn'Frarne) ,,'
Masonry (ReinfJBond BearnlPr~rout) , ' ,
Rough Plumbing (Top Qilt) , ,
Rough Mechlmical ' , "
I ROugh eectncal (DrY wall) , ,
Rough Electrical ,
Framing (On~ after Plbg.. Elec..,Mech..and Fire) l1lk3&>5 p
Insulation (SoundlEnergy) , ' 1"lV21110.\ I
Do not tape or plaster, Until the foUowin~ applica
items have been signed,: ' ,
Drywall ' " ~/so~, ~"l
Penetrations (Fire Rated) Electrical ' '
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing f
Interior Lath , ' "
Exterior Lath, " ,
0' , ' ' GENERAL ITEMS ,
exterior Plaster (Brown CQal) , '
T -Bar Electrical .""
T-Ba( Mechanical " "
T -Bar Structural ,
Sewer , ,
Water Engineering Backflow , , " ,
Water Service , ,
,
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FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
EngineeririglGrading Final 765-5126
Fire Dept. Final 7654040
Water Engineering 765-5268'
Sub List/Bilsin,ess Lieense 765-519
Zoning 765-5139
Building Final (Lasl Inspection. Only, c..-.'" 7 ,0
" After Above CQmplete) -.:>'"
PARTiAL'INSPECTIONS
Buildina Irlspections . ',' ,,'
t:~~~~ .:1f1!:~~Jfd:
, Date
Inspector
,Mechanical Inspections
Plumbina Inspections'
Electrical Inspections
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Gate
leading to
backyard
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enclosure A
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6 foot high L
Garage
IC DISTRICT REVIEW:
See starn this a e
cte one on above line
lLDING PERMIT FOR
NY CONDITIONS
Front Door
PERMIT FOR NEW METER SPOT AND NEW LOCATION FOR AC UNIT
ALEXANDER and ANNIE DESOUZA
610 S. PEREGRINE STREET
ANAHEIM, CA 92806
TFT. 714177R-(,n?
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