1260 N. Potomac Cir.
TYPE OF PERMIT
Repair
CITY
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626 .
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BUILDING PERMIT NO. BLD2004-02664
DATE: 7/2/2004
JOB ADDRESS: 1260 N POTOMAC CiR
LEGAL DESCRIPTION: TR 7422 LOT 67 POR OF LOT
CENSUS CODE: 434
'QUARTER SECTION: 194
CONTRACTOR INFORMf\lnON: ARCHITECT/ENGINEER INFORMATION:
CALIFORNIA CONSTRUciTION & FIRE RES'I'TTANEH ARGANEH
,
410 E MERCED AVE #C i .
WEST COVINA; CA 91790 pOOO
BUSINESS PHONE. 626 9"'-535J
JOB DESqRIPTION;Fire repair. .Rebuild garage w/storage above and partial r{!of replacement.
VALUATION: 40,000.00 . ' .. ..
I OWNER-BUILDER'SE:GLARATION
I hereby affirm under penalty of perjury that 1 am exempt frolT" the ContractGlt..'U':::flns'e Law for the following .reason (Sec. 7031.5 Business and .
Profe'Ssions. Code: any city or"coi.mtywhich requires a permit to construct, ai~~''', !rnprove, demolish or repairany structure, pr!cr.toits issuanc.e, also
requires the appJicantfor such permft"to file a signed statement that he-is licer,wd pUi3udnl to the provisions of the Contractor's License Law'(Chapter
9)(commencing with Section 7000 of Division 3 Of the Busines~ and Profes::>~f1s Cod~!.x that he is eXl?n:tpt there-frotrtand,the basis for the allegec
exemption. Any violation of Section 703'1.5 by any applicant for a_permit sUi::j:~CTS the applicant to Cl civO penalty of no't more tha n five- hundred dollars
($500). ... T .. .. . . .
o I, as owner of property, or my employees with wages as the:; sOJ~G~rf'lP"f11salioh.; wW dc the work, and the structure is not inten.ded oroffered for.
sale (Sec. 7044 Business and Professions Code: The Contmctor's LidanseL:':twdce,s not apply to an owner of propE'rty who builds or improv'e~
thereon, -and who does such work himself or herself or through his or her owr,:i,enlpIOyeeS, provided that such imp'rovements-are not Intended,or ., .
offered for sale. If, however, the' building -or improvement is.. sold wi~h ql1p..y!(~,;r of c~"-h\~leti'Jn, the owner~builderwill have thl1 burden of proving that fi~
did not build or ifl1prove for the purpose ofsale);'p _:_~..,-: _ , ' "" .'_,J;;
o -.1,: as the owner of th'e property, an) exdusively contracting with lic~m::ea ::hnfraao~:s:to r.ons.truct theT~roiect (See. 7014 BI.1SlneSs'and Prote$S'ion~_ ~
.God~:The COfltractor's license Law does not apply to an owner aT pryperty ~;Jho bU~lds' 0r ilTiproves the"'eon, anti who rontr?cts Tor S.Udl pr.ojeclS ~ith
?<.Qof\trado~(s) licensed, Pursuant to 'the Contra~tor's License La~}, ':' :'L .. _. '.'
U I am e),.ernpt under Sec. _ ~ B & P.C. for fhls reason: _~_'j-.;..... ' '.
Date: Owner:
L WORKER'S COMPENSATION DECLARATION .__L
I hereby affirm under penalty of perjury one of the following declarations: ' i
o I have~nd will_ma intain'3 certificate cf oonsent to self-insure. for worr,e!";fc,1mpensation,
as provided for by Section 3700 of the Labor Code, forthe performal1ce or tr...~'..Vork fo'rwhich
~ permit is issued. . . '. ;: '
}$J I'have and will maintain worker's compensationinsurCtnce, as reqUire.j ;'J~ $-ectlOn-S7COof
the Labor Co~e, for the performance of the work for which this permit is i~'3\..'F_;: My Wi)rker's
Compensation insurance carner and policy, are: . .! _ .
Carrier: STATE FUND . Policy Number. 0008d11_~'::C~ .
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This section need not be completed if the pennit IS for one hundred dolla~s (S100},Or.:J.ess.
o I certify that i.n the perforrn~nce'ofthe work-for which this permit is"issue\~:'i~h.:::~~~_~f, .'
employ any person in a ny manner so as to become subject to the worker's 'cor~'?6nsatior. laws.
of California, and agree that jf I should become subject to the'worker's compe;.hsation ~,
provisions of Section 3700 ofthe Labor Code, J shall forthwith,comp!y.whh thq':i~,'provjsions,
Date: 7/2/2004 Applicant: v- ~-I;' h.. ~'<<- Ixii'..,
WARNING: FAILURE TO SEcu~6MPENSATlON COVE~J~EIS': .
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER. TO CRIMINAL PENAL:jM AI\ID CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ,oDDt"iGN TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION, }'O\l OFTHE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. . . " '",.) ...
I . . CONSTRUCTION LENDING AGENCY' -',:.{'
I hereby affirm under penalty of perJury that there is.a constru9tion !endinc,J :?~~;f,~;Vdorihe
., ~.':";'i.;;;;::::-.jC'vf1~i$"'10;-'7fc;r;:~T.;:ht:i::::pCrrljitf.::r!:;s<;0~ ~3'e-.:.:)C::'i.-Ci--...-.--C;: -.,--.~""-- - ---- ---.--'. -",--'--'- ---.-
. Lender's Information:
APPLICANT: FERNANDO MEZA
OWNER INFORMATION:
Richard 0 Pederson
1260 N Potomac Cir
Anaheim, CA 92807
PROCESSED BY: FAN
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LICENSED CONTRACTORS DECLARATION Y"
I hereby affirm under penalty of perjury that J_ am .
licensed lfnder prov;sior;s of cli<::lpter 9 (commencfng
with Section 7000) of O;vsion 3 of~he Business and
Professions ~~ 1 ^"
7/2/2004. Q-' I p,.,..., _
Date: Contracto~
NUMBER
800231
TYPE
B
EXPiRATION DATE
1013112005
Construcion Tvpe.!:>:
VN, ,
I certify thi3t I have read this application and state that the above information j~~ correct. J
agree to cOmply with all city ordinances and State laws relating' to building COf:Btruction, and
hereby authorize represeritives of this city to enter upon the above m~ntioned property for
insped~poses. .
V ~.WL }J.,e<-- Dale' 7/2/2004
Signature of Applicant or Agent.
The permit shall expire by limitation and become null andvoici if the building or
.work has not passed finallnsp-ection 365 days from the date of permit issuance. A
new permit is required to commenJ:e or continue work.
Fees paid for Permit:
Total:
937.49
INSPECTION RECORD
INSPECTION . DATE IN.SPECTOR
Temporary Power Pole
Plumb; ng (DrainlWaste Pipe) ~
Electrical Ground ElectrOde/lifer I
SetbacklFormslTrenches (Footings)
Donot install subfloor or pour floor slab until,the
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves) . .
Mechanical (Groundwork)
Electrical (Underground Conduit) , .
Pre-slab (Compaction/Membrane.Reinf.
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below unt,lthe
, following applicable ilems have been signed:
1 st Floor Shear
Firesprinkler (Rough) ,
2nd. Floor Shear
'Roof (SlleathingfOiaphragrnlFrame) , .
Masonry (ReinfJBond BeamlPre-Grout)'
Rough Plumbing (TopOutJ .
Rough Mechanical
Rough Electrical/Dry wall)
Rough EleCtrical . .
Framing ianlyafter Plbg., Eleo, Mech, and Fire) -lor '-
Insulation (SoundlEnergy) IIIJ .
Do not tape or plaster until the following applicable
items have been signed: -
Drywall
Penetrations (Fire Rated) Electrical
penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing . .,
Interior "ath . , -:-
Exterior Lath.
GENERAL ITEMS 'II l-
Exterior Plaster (Brown Coat) , /()
T -Bar Electrical
T -Bar Mechanical . .
T -Bar Structural
Sewer
Water Engineering Backflow
Water Service
-
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-519
Zoning 765-5139
Building Final CLast Inspection. Only I
' ,After Above Complele)
PARTIAL INSPECTIONS' ,
Buildina Inspections
Mechanical Inspections "
PlumbinQ Inspections
Electricallns{)ections
CALifORNIA
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CONSTRUCTION
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& Fire 'Restoration Inc.
August 26, 2004
Re: Repairs done at: 1260 N. Potomac Circle
Anaheim, CA 92807
To Whom It May Concern:
Please be advised that California Construction has performed an electrical
inspection at the above referenced property and we have found that.all
existing electrical wires to remain at the property are in good working
condition and safe to re-use. .
Should you have any additional questions, please contact our office at 626.
966-9255.
Respectfully,
Californi onstruction
State Lic.#800231 . PriorLic.#532783
Office: (626) 966-9255 . (800) 963-6657 . Fax: (626) 966-9252 . Web: www.caconstructionco.com
3104 E. Garvey Ave. South, Ste. 5 . West Covina, California 91791
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