3161 W. Polk Ave.
TYPE OF PERMIT
Residential Addition
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CITY GE:f~Ni~HEIM
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BUILDING DIVISION
. 200 S, ANAHEIM BLVD,
(714) 765; 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 8
BUILDING PERMIT NO, BLD2004-D4059
DATE: 11/5/2004
JOB ADDRESS: 3161 W POLK AVE
LEGAL DESCRIPTION: N TR 1820 LOT 46
('APPLICANT: L1ZT GARCIA
'OWNER INFORMATION: CONTRACTOR INFORMATION:
DANIEL ZAVALA
3161 W Polk Ave'
Anaheim, CA 92801
JOB DE~CRIPTIONAdditjon of 138 sqaure feet for 'new bathroom and ,walk-it! dC's~t.
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 12,000,00
L OWNER.BUILD~R!DECLARATION
~ herebY affirm under penalty of perjurf that I am exempt from the COTltrad&i's U:::ens!:: Law for the follo,wing reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a,perJr.itto construct, a!t~,j', improve, demolish or repair ~ny structu're, prior ~0 its issuance, also
requires the applicant for such.permit to.fjle a signed statement thC1t h'::l is-I:c'3r,::,ed pursuant to the provisions of the Contractor's License Law (Chapter
. 9)(commencing with Section 7000 of Division ;3 of tho Business and Profe:::si~j,s Code} o.r that he is exempt therefrom -and tht! basis for th.e alleged
exemption. Any violation of Section 7031.5 by any applicant for a lJermit subi:)cts the applk;ant toa dvil penalty of not more than five hundred dollars
~. . ~ . . . .
o I, as owner of property, or my employees with w::1ges as their $o~e cOJTl~YQgation, wit! do the work, and the structure. is not intel"ded or offered for
sale (Se~. 7044 Business'and Profes.sions Code: fhe Contractor's License ~~~: dqes not a.pplyto an owner of property who bUif,ds or improves
thereon, and who does such work himself or herself or through his or IlerOV\r;\"3mplcyecs, provided, that .such improvements a:-e not intended or
offered for ;5aie. 1f, however, the building or improvement lsso!d with one yeti} of ccmpletion, the owner-builder wil! have the burden of proving that he
IDid l build or improve for the purpose of $<::Ie). . ~, . . ' .
.'. I,a~ the owner ofth-e prop:e:rTy, .~r-l exdusively contrac1ing with iiCe!'1Sp.d-~~ntl'C:lC:tur5 ~o construct the project (See. 7044 3usir:ess and Professions
Co : Thp.. Contractor's License Law does not apply to an owner of propeitY\'1!1v':.uiJds or Improves there-Oj'. and who c.cntrar:ts for such project:; with
Montractor(s) licensed pursuarlt to the Contractor's License L:3w), .:, *_ .
L. iamef.7'PtHnde,s.'ec:'~ .c ,B.& P.C, (orthisreasoc: 1.\ . .
,(D3te:' _I '0__0 'f O,vner: ~L \ '2..1:: ~~."" ~-~b.= . ,..
L..:. WORKER'S COMPENSATION DECLARATION JL____J
1 hereby affirm under penalty of perjury onp, (Jf the following declarations: t\
o . I have and will maintain a certificate of oonsentto self:-lnsure fonvork~d!cornpens~tior"
as provided fO{by Section' 3700 of the Labor Code, f6rtheperfofln:..~()ce ()fth~\':vcrk for which
this permit _:3 issued. . .,k.
D I have 3rd will maintain worker's compensation insurance, a<:s tf;qdre:: bY._~~;"':ctI0:l 3700 of
the labor Code, for the performance of the work for which this pt:rrn:t i5'i~:lJetl. My worker's
Compensation insurance carri.er and policy are: ~
Carrier: Policy Nurnber.~"
This se-::tjon neett" not be.completed if the pennit. is for one' h~r.dred ~!)Il;,:;rs ($109i?r (~S. ,
'f:J/i certify that in the performance of the V'Jor.k for which-this permit is issue'tf;. ~ s!1ail not
~Ioy any person in any manner so Z1S to become subject to the \~::;r~,e(s co;h~~:msatioil laws
of California, and agree that if I should become subject t9 the yvorke(s co.r'rip&.fisation
p~ovisjbns of Section 3700 of the' Labor Code, I shall forthwith comply with t"'::~,se pro',dsions.
Date: 1115/2004 Applicant: _.,}{'J \1... -\- . ~<fC LO"'<' .
WARNING: FAILURE TO SECUREWOOKER'S COMPENSATION COVEf'AGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN'!!.LTiES AND CIVIL
FINES UPTO ONE HUNDRED T1-iOUSAND DOLLARS ($100,000), IN ,ADDI'::Ot: TO THE
COST OF COMPENSATION,.DAMAGES AS PROViDED FOR IN SECTiCI\: ,706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. "
L CONSTRUCTION LENDING AGENCY" H,
I hereby affirm under penalty of perjury that there is a construction _leP,dii',ga~f;:~lcyfor t~e
performance of the work for Which this permil'is is~ued (Sec.309'1 ,qy;;S);';;~:,'__ ),:
.-'-!"!~d~:'~~!"'f'::':";;';'2t:(;:;: . -~/' ..,-~_.'.- '"'---
PROCESSED BY: SAM
LICENSED CONTP.ACTORS DECLARATION J
lhereby affirm LInder P?naity of perjury that I am
Iicens~d under provk:;V?ns c:f chalJter 9 (corlllT1~ncing
with S~ctior"iOOOJ of Divsipn:3 of the Hlis:nessantl
Professions Cod e.
1 i /5/2004
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Co"nstrucion Types:
VN,
Fire Spnnklered?
NO
F
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I certify that I have read this application and state that the above information is correct. I
agree to oomply with all city ordinances and state laws relating to building con8truction, and
hereby authorize representives of this city to enter upon the above mentioned property for
insp dion purpo&es. .
\- C\ or C \.0 Date: 11/5/2004
Signature of Applicant or Agent
T permit shall expire by limitation and become null and void if the building or
work has not passed final inspectioh 365 days from the date of permit issuance, A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
720.04
INSPECTION RECORD
INSPECTION DATE ' INSPECTOR
"temporary Power Pole ~
Plumb; ng (DrainlWaste Pipe) 11-, U, :'-
Electrical Ground Electrode/uter If'19'{)f iL ~
SetbacklFormsfTrenches (Footings) '('J'f.CI'J '1.,:,
DO not install subfloor or pour floor slab until the (j{j ,
following applicable Items have been signed, '
PlulI)blng (Water Plpe.Sprinkler Valves) ,
Mechanical (Groundwork) , ,
Electrical (Underground Conduit) .
Pre'slab (CompactionlMeItlbrane.Rei nt. I/.J9-1)4 'J( I. 1'..
Underpinning (Floor Joist/Girders) III!
DO not cover or conceal the wor!< below until the
following applicabie items have been signed: , I .
1 st Floor Shear , 12./1'/5-
Firesprinkler (Rough) ,
2nd Floor Shear ' , '
Roof (Sheathing/Diaphragm/Frame) '1VT.-o., otrl
Masonry (ReinfJBond BeamlPre-Grout) ,
Rough Plumbing (Top Out) , "
Rough Mechanical
Rougn t:Iectric.. \'" y nail/ ' I "
Rough Electrical , 11 ' .. i \
,
Framing (Only after Plbg., Elec.. Mech.: and Fire) I , " A'
Insulation (SoundlEnergy) ';2,1<llo<j , v M../,6
Do not tape or plaster until the following applicable
items have been signed: ..
,Drywall ' ?v1/-tJ) -r '/F
Penetrations (Fire Rated) Electrical'
Penetratlons,(Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath ,
Exterior Lath ,
, GENERAL ITEMS
Exterior Plaster (Brown Coat) , ,
T .sar Electrical ,
T.Bar Mechanical
T -Bar Structural
Sewer ,
Water Engineering Backflow
Water Service
-
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanica,l Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water EngineerIng 765.5268
Sub ListlBusiness License 765-519 ~~> ' PiA",;!'
Zoning .765-5139
Building Final {Last Inspe,clion. Only
After Above Completel
.l$I..s '
PARTIAL INSPECTIOI\IS
Buildlnalnspections
DM~
, Mechanical Inspections
PlumbinQ Inspections-
Electrical Inspections