2264 W. Polk Ave.
rYPE OF PERMIT
Residential Addition.
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CITYQ{11~N~HEIM
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BUILD!NG D!ViS~0N'
200 S. ANAHEIM BLVG,
(714) 765.5153
INSPECTION REQUEST LINE:
(714)765. 4626
C!iJ~sus ~ODE: 434
. QUAinE~ Sr=CTION:' 32
BUILDiNG PERMIT NO,
BL02004-02090
DATE:51261~004 .... "', ........ .
JOB ADDRESS: 2264W POLK AVE
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LEGALDESCRIPTiON: N TR 2625 LOT 54
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APPLICANT: TERRY BOOTH j
OWNER INFORMATION: CONTRACTOR INFORM"FiON:
O'ennis E Warner NEWLAND CONSTRUCT ON INC
2264 W Pc!!< Ave , 428 S MONTGOMERY WY .'
Anaheim, CA 92801 "ORANGE; CA 92868401.5 .
. . : 'BUSiNESS. PHONE: 714 6:;'.0300
JOB DESCRIPTIONRoom Addition. New family room, bathroom and extend m.1Ster bedroom. (HIH)
VALUATION: 90,000.00
I OWNER.BUILOER9ECLARATION
I hereby affirm under penalty of perjury that I am eX~mptfrom the Cor:tract..;;r',:'~ License Law.for the "folloWing,reason (See: 7031,.5 Business atld
Pro.fessions Code: a,ny dty or countywl-tich requires a permit to COI},struct, a~:F, jmp~ove, demolish or repair any structure, prior to its issuance', also
requires the_ applicant for suCh p~rmi~ to tHe a signed statemenqh?!he is l:cL....'),sed. pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with.Section 7000 of Division 3 of the Busi_ness and Profess:!<~"s Code) ortllat he IS exempt therefrom and the I?asis for the alleged
exemption. Any violati?n of Section 7031,5 by any ap-pJicantfor a permit Stlbiads the applicant to a d~ij P!'loatfyof nOt"more thal1 five hUl1dred dollars
($500).. .' ....,. . .... .'
o /.. C'ls-owner of property, or my employees with wages as tne.iJ sole cOf'!:;::r-nsation, will do the work, and the structure IS notintend.'ed oroffere.d for
sale.(Ssc. 1044 Business and Professions Code: The Contractor's License- ;'{3W does not apply'to an oWne.r of property who builds or improves .
thereon; and who does such work himself or: herself orthrough his or herov.~, e!Tlployees, provided that such.improvementsare no.(.intended or.'.
, offe!edJorsa.re~ If, however, the building or impro'{ement is 501d with one y!-V of colllpJetion, the owner-bunder will have the bur~n of proving that he
did not buildar improve for the purpose:of safe). .: . . . . '.
0, 1,' as the own~r.ot the property, am exdusively contra ding with !icensed !::C:llractors to constn.ict t/"le l)foject (SGG. 7044 Business arid ProfesSio~$'
Coc{e:: Tf:le Contractor's License Law doeS not ap'lJlyto an owner' ofpropert;\NhobUildS or improves thereon, and who contracts for such projectS with
~ontra~or(s) licensed pursuant totheContra,Ctor's License law). l' .
U ./ am exempt under S;ec. .,"8 & P.C. for this reason:
Date: oWner:
I . WORKER'S 'COMPENSATION DECLARATION ".
1 hereby affirm_under penalty of perjury one of the followin~'declaratio.ns: 1.
o : have'and wiJI maintain a'certificate of c6nsent to self~j.nsLireforworker:Ccompensation,
. 'as pro'lidedfor by Section 3700 of the Labor Code,. for-the performance oft)-';;~ work for which
this permit is.issued. . . . _ ~: .
D' I' have and will maintain wprker's compensation insur.ance. as required, t r- Section '3700 of
the Labor Code. for'the performance of the work for which this permit is iSSII.:~.:t My Vvorker's
Co.mpensation inSurance earlier <;\nd policy are: .
9arrier: SrATEFUND P?lic.y Number: 1713618{
ARCHITECTIENGINEER INFORMATION:
PROCESSED BY: JJJ
512612 0
Datp.:
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Thi~ section need not be completed if the p it.is one hundred dollars ($1U~:. ",r !ess. .
o j certify that'in the performance of e wo'r for which.this r. nit is issur.-:J, I shall not.
employ any person in anY manner so s to. be m subject t worker's c;:mpensation laws
ofCalifomia;and agree that if I sho d beco e s ject to e orl<e~'$ c0mp.:nsation
provisions of Section"3700 o.fthe L bot Co I ~orthw .corTlply with tr:)se provi$lons.
Date: S12612004' . Applican . L
WARNING: FAILURE TO SECU ERKER'S COMPENSATION CQVERt\GE IS
UNLAWFtlL,ANDSHALL SUBJECT AN EMpLOYER TO CRIMINALf'ENAcTiES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLL)l.R.S {$100,OOO),IN'lAbDITION TO THE
COST OF COMPENSATION, DAMAGES.AS PROVIDED FbR IN SEC1'ION 3706 OF THE
.LABOR CODE, INTEREST AND ATTORNEY'S FEES: :',:Z;;~
I CONSTRUCTION LENOING AGENCY!:;;,.
I herebyaffir.m under penalty of perjury that there is a construction ,le@,ing Q;:ency for the
performance ofthework for which .this permit'is issued (Sec.3097,J:;iy~<>):_~
Lender's Information: , .' . -. \ .-.:"':-d~i;/--"':;,:";
-",'~,'!'.-, ' .
NUMBER
451478
TYPE
TYPE
TYPE
EXPIRATION DATE
113112006
.B
C29 MAS.
HIC
Constfucion Tvpes:
VN, ,
Fire Sprinklered?
LivinQ Area:
NO
472
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".--.,.~'..... .
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Dat,,: 5126/2004
Fees paid for Permit: .
Total:
,9.00
Signa ure of Applicant or Agent
The p shall expire by limitation and become nun and void if tho building or
work has not passed finalinspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
INSPECTION RECORD' .'
. .', INSPECTiON . . '.
. . . DATE . iNSPECTOR"
Temporary Power Pole
Plumbing (DrainiWa$te Pipe)'" '.' , . .
EIli.clrical GrOund Electrode/Ufer ,'. .. . .' . .
SeltlacklFormslTrenChes (FootingS) lIJIIIlltJJe ,'IOJJMoI
po not install subfloor or,pour.floor slab until tile , .
fOllowing applicable items .have been signed' . . .
Plumbing (Water Plpe.5prinkler Valves) .
Mechanical (GrOu~k) . .
Elec:tti~ (UndelgroundConduit) .
PnI~lab (CompactlonlMembrane.Reillf.) . .
pndetpinning (F100r.JoistlGlrders) 7/zM XfJ . ~.
.!X'nilt !:Over..or conceal tile \Nor!< bel.ow untIl t.he , '.
lollowlngapphcable.tems.havebeen signed:'. ". . ...
1st Floor Shear .... " aT? I"," ..,... ,u J'
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Firesprinklet (Rough)'. . . " . T \J' .
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2nd Floc)rShear ; ." . " '.
ROof (ShealhinalDiaphrallnVFrane) -ft... I~ . M!4. 1"--' .
Masonry (ReinfJBond 8earn/Pre"GtoUt) )'\'. . \\
Rough Plumbing (TaD Out), ..':' ,
Rough Mechanical '. , '.'
ROugh 6ectricallDFy Wall)
Rough Electrical' . .' ...' m ..' ..
Framing.,. (Only afte~ Plbg.; Elec.. r...iech:, and Fire) -'1l -.I'.Jil/ .
In$Ulalion(SOundlEnergy) . , . . '.
PO 'n.ot tape or. pla~ter' until tile following applicable/ . ~' --
I.tems have been sIgned: . '. . , .' '. ....
DrYwall . .;., ...., .' . 1,//1 :::::rJ =-
Penelralions.(Fire Ral~) Electrical, ' I I .' .
Penetrations (Fire Rated).Mechanical '. ,
Penetrations (Fire Rated) Plumbing . '. '.
'nleriorLath " ". '. ',' . .' I
Exterior, Lath' . " .. II' T-"-'
, " ': GENERAL ITEM~ 'ji .' .
Exterior Plaster (Brown COal) . .. li6
.T -B,ar Electrical . .
T.BarMechanical' .,' .. .' . '.
T.Bar structural ,.
Sewer '. . '. '. . .
Water ErigineeringBackfloiN ,.,
Water Service'
FINAL INSPECTIONS
Electrical Final
Plumbing .Final
Mechanical Final
Gas Test.
E"gineerioglGrading Final 765-6126'.
. Fire Dept. Finaf7654040 .
Water Engineering 765-5268
. Sub List/Business License 765.5.19
Zoning 765.5.139
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Building Final . lust Inspection- Only
. '. "." Afte, Abov,e Complete):
. PARTIAL INSPECTIONS
Buildinallispections
Pw:Ji.J w)e/fW :r;;"Wr., "k 7h~ ~
*~I~n~"'?r(~M:$> <-("xli.~ ..
OfJtJ,bAm /P ftJ~)$fk~. 9(;P'{, ~.'
.' Mechanical.lnspections
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PlumbinQ Inspections
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Electrical Inspections