421 S. Westridge Cir.
BUILDING'PERMIT No. BLD2004-02198.
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BUILDING DIVISION
200 S. ANAIiEIM BLVD. .
(714) 765 - 5153 .
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434 .
QUARTER SECTION: .180
TYPE OF PERMITC ITY.
Patio Cover' '.
DATE: 5/28/2004
JOB ADDRESS: 421 S WESTRIDGE CIR
LEGAL DESCRIPTION: N TR 7569 LOT 13
APPLICANT:
OWNER INFORMATION:
Betty L Buchel
421.8 Westrldge Clr
Anaheim; CA 92807 . .
. JOB DESCRIPTION;2 Latlicepatlo covers built without permit. 405 5.1.' '.'~
VALUATION: 6,075.00 . PROCESSED BY: FAN .
I .' '. . . OWNER--BUILDER .JECLARATION. . .
I hereby affirm under penalty of perj\jry that I am exempt from the Contractor':; license Law for the"fdllowing reason (Sec. 7031.5 Business and
Professions Code: any city or county which' requires a permit toconstruct,'aJt~~r, impfOve, :ctemolish or repair any structure, prior to its issuance. also
. requires the ,appl.icant for such permittofile a signed statement that he lslicenseci pursuant to the provisions of the Contr'actor;slicense Law.(Chapter
.9)(commericing with Sectian 7000 .of Divisian 3 _.of the Business-and Professio:1s Code) or.that hoe is exempt therefrori1 an.d the basis forthe,alre.ged
exempt.ion, Any vialation .of Sectian 7031,5 by ar)Y applicant for.a. pennit subl ~cts-.the appl.icant t.o a dv~ penalty of !"lot more tba n five- hundred dollars
($500). . . . . .
~' I,as .own'er of property. army ,el}lplayee,s withw<:3ges as their sOle com~!isation, will do the work, and the structure is not. intended or. offered for
s.ale(Sec. 7044 Business aridFrafessions Code: The Contractar's License Law daes nat applyta an. .owner of praperty who builds or improves
therean, and'wha does such work himself .or herself a-r through his .or her own-'emplayees. 'provided that such improvements are not'intended .or
.offered for sale;, If, however,', the bUilding .or impravement Is salq with .one ye::"~ .of ('A) mpJetian_. the owner;'buUder will have the b~rc;ten .of proving that he
did not'build or improve for the purpose of sale). '
.0 I,as the owner oqhe property, am exdusively_ cantracting with licensed (ontractors.ta construct the project (See. 7044 Business and Professions
Ca_de: .Th~'Cantractor'sLicense Law daes not apply taan .owner of prbperty~~nc builds .or impraves !herecin, and who oontracts for such projects with
~ontractor(s) Ilcensed pursuant ta the Contractar's License Law);' .
U I am exempt under Sec, . .. . B ,C, f r this ran:
Date: ' Own,er:, '
r WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of, the following .declarations:
o I have and.will maIntain a certificate of consent to self-insure fcr\,vorker's :;ompensation,
as.provided for bY SectiOn 3700 of the La.barCode, .far the performance 'o"fthf." work far which
'this perm ins. issued. .
o ,I have'and wiU maintain worker's compe_rlsation insurance, as, required by Section 3700 .of 5/28/2004
the Labor Cade; far 'the perfarmance of tlie wark'for which this permit is,'issue::;,. M"Y'worker's "{)ate:
, Gompensation insurance carrier, and policy are: '
Carrier:. Policy NumbC?r:
CONTRACTOR INFORMATION:
ARCHITECT/ENGINEER INFORMATION:
J
"-
l:.ICENSED CONTRACTORS DECLARATION
I hereby.affirm under penalty,of perjl,Jry that I am
licensed under provisiOns of ctlapter 9 (commencing
.with Section 7000)of Divsion 36fthe Business and
Professians Code. .
Con~ractar
NUMBER
EXPIRATION DATE
This section r)eed not ~.conipletedifthe p'ennit is for.one hundred dollars' ($100) )"19$S:
3' I,c'ertifythat in the perfo-nn_ance .of the, ~ork for whiyh this permit is issuec, \' shaD not
-employ any person in any manner sa as to ~ecame subject to the worker's cO~lpensation laws
of Califomia, and agree that if I,shauld become subject to the warker.'s compe:r:sation
provisions of Section 3100 oftheLaborCo~1 shall forthWi~h comply wit those provisions.
Date' 5/28/2004 Applicant: -K. . .. .
WARfIING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND. SHALt. SUBJECT-AN EMPLOYER TO CRIMINAl. PENALTIES AND CIVIL
FINESUPTO ONE HUNDRED lHOUSAND DOLLARS {$100,OOO),IN ADDr:ION TO THE
COST OF COMF:ENSATION, DAMAGES ASPROVIDED FOR IN SECTION :J7060F THE
LABOR CODE, iNTEREST-AND ATtORNEY'S FEES.
I 'CONSTRUCTION LENDING AGENCY .
I hereby affirm under penalty of- perjury that there is a construction lending 3ge-ncy for the
performance of the wark forwtiich' this permit is issued (-See.3097:Civ,C):
I.p.nrf,=r'~ I.,f"r",~fjl"ln: ' .
TYPE
Canstrucion Tvpes:
'{N;.. ,
Patio Area: 405 .
,'certify that ,I have read this application and state that the abo,ve information is correct. I
agree-to comply with all city .ordinances and state laws relating to building constructian, and
hereby authoriZe representives of thiscity ta enter upon the abave menti'oned property for
Inspection purr::.M- ~'~.. Date: 5/28/2004
Signature pf Applicant ar,Agent .
The permit shill! expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to 'CQmmence or continue work.
Fees paid for Permit:
Tolal: 0.61
"INSPECTION RECORD
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. .' . . INSPECTION .,ilATE . INSPECTOR
Temporary Po~r Pole' '. : . .
. Plllmbing(DrainlWaste Pipe) . .
Eleeir.ical.Grciund ElectroclefUfer . . ."
. Setbackll'orrn!SITrendles (Footil\gS) '.
Do not install sUbfloor or poor floor slab until the
.' following applicable items. have been signed! .
f>1u!1lbing (Water Pipe.Sprinkler Valves)
. Mec;hanical(GrOundYiorkl . .'. '. .' : . .'
Electrical (Underground Conduit) . . .
. preoSlab. (Compaction/Menibrane.Reinf. . '.
. Underpinning (ROorJOi$t1Girders) . . '. .
Do not cover or con<:eal the work below until the
'fcil!owingappficable items have been-signed:. .
1st Floor St)ear . . '.
.' Flresprinkler (~gh) '. . . . .. . . . '.
'. 2nd Floor Shear: '. .
ROof (Sheathing/DiaphraarnlFrame) . . . . . .
Masanry (RliinfJBond Beam/Pre-Grout' .-,
RQughPlumbing' (Top Out) ..
ROllghMechanical ., . .'
1<<)1191\ l:IectrlC I, '.
Rough Electrical . ". . . .'
Framing (OnlY 'after P\bg.,Elec.: r...lech.. and Fire)
In.saiJation'(~ncllEnergy) . '-.
po'nottape or pla~teruntilthe followillg applicable "
. Item.s have been signed: " ',- . '. . ,. ..
Drywall " '.' .
Penetrations (Fi~ Rated) .Electrical . .
penetrations (Fire Rated) Mechanical .
. Penetrations (Fire Rat!!d) p'lumbing . . . -c--
'nteriorLath. .... ,
Exterior, Lath .' ., .' l.
. . GENERAL ITEMS, '. '. . .
Exterior Plaster (Brown Coal) .' .
T -Bar Electrical . '. . . . .' .
T 'Bar Mechanical [ . .'
. T -Bar Structural " .' .
Sewer. . ". . .
..' Water Engineeriilg,Backflow
Water Service
: . .' . . .'
FINAL INSPECTIONS' .,,' . D'ate. ..' Inspector
Electrical Final." '.' -
'['
plumbing .Final .... '. . .-:: .
. .
Mechanical Fina.1 . . '. , .. .,'
. .
Gas Tellt '. . I .
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Engi neering/Grading Final 765-6126' . .... .' . .' .
Fire Dept. FiOlil 7654040 . . .-
. .'
Water Engineering 765'5268 ,.. ... " .
. ..
SlIbListLBulIiness License 765.51'9
Zoning 765-5139 ~ . ......
.'
Building Fin,,1 \t'st inspection- Only ~~1Ios'" -t':"'AtL.;dl
fter Abb.~e Campletel.'
.
, ,PARTIAL INSPECTIONS
Buildina Iiispections ". . .
. Mechanical Inspections
Plumbh1Q Inspections · .
Electrical Inspections
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-r;t'iE IBGUII.r4CE or if'iIS PERMIT OOES\G / ?- ~ ( f',F.r1l!'1 I ./
NOT APPROVE VIOLATION OF ANY. OFv - ')'" ~-
THE BUILDING CODES OF THE CITY /', JY" -7 fc:J.~(
THE HOLDER OF THIS PERMIT " ,#,Y,I)f12S ;;;
PROCEEDS AT HIS OWN RISK, 'III Ii I ~c..._,
MAY Z 8 2004
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BUILDING DIVISION OF AN HEIJ0J''''
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BUILDING PERMIT FOR
CONDiTiONS
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PROJECT ADDRESS:
DESCRffiE WORK TO BE DONE:
VALVA TION OF PROJECT: $
BUILDING PERMIT ApPLICATION
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R~ K 73F-77Y (3Ur1"!~,~!tOPERTY OWNER:
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CONTRACTORlARCHITECTIEN(;INEE~:!/[j'?rrC::::)'~'::W(jRi&iPstd1\f"Pli~SA TION CERTIFICATE:
Co. Name: \\ \ ~~~<({~S~C'~:~?:k~'^':';~'i ~%;:;;;~,;(1~1n~S~~n~i On l1i1e with the City
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,\. . \ \ :")' : ;oc:f",.,\:: ,!jPl['Orhil1ial'qit!ificate Provided
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pA7'ltJ ,('tlVCY-tJ' - /3:t/~r wi/) /ltft2Mlrs.
Name:
I am the:
1i- Property Owner
a Contractor
Employee of the:
a Owner a
*Verification 0
'7 ~,pd7
Address:
City:
Phone Number:
City License #
State License or Registration #
Existing Roof Material is:
Is existing roofing being removed?
Amount of squares:
If roofing OVer existing: layers existing.
Proposed Roofing Material:
If 6 lbs. or over per sq, ft, provide structural analysis
by a licensed architect/engineer,
ICBO# of roofing.
New roof sheathing:
_ Skylight(s) to be installed: _ x_
Make and Model:
Lineal feet of _" x _' Garden wall
Lineal feet of _" x _' Garden wall
Square feet retaining wall
Pilasters: _" x_" x~' _' high
Standard detail plans are available at the Building Division
counter for 6'-0' hi~h masonrY ~arden walls. vilasters. and
retainiM walls to 8' hif!h, Any design other than City plans
require wet stamp and signature of liceltsedengineer/architect.
Please fill in the following boxes based on the activities that will be performed on site during the term of the building permit for
which you are applying,
There will be no:
a Soil Movement (i,e, earthwork, excavation, etc,),
a Uncovered materials (dirt, sand, fertilizer, etc,) that could be carried offsire by wind or rain,
a Exterior mixing of cementaceous products onsite (concrete, mortar, stucco, etc,).
If all three boxes are checked, the applicant is exempt from NPDES related storm water inspection requirements,
PLAN CHECK SUBMITTAL
DATE:
PROJECT ADDRESS:
DESCRffiE WORK TO BE DONE:
VALUATION OF PROJECT: $
OWNERfI'ENANT:
ARCHITECTIENGINEER OR RECORD:
Name:
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Address:
Phone Number:
APPLICANT:
Phone Number:
Current Use:
Current Occupancy:
Current Square Footage:
Type of Construction:
Fire Sprinklers?
Current Codes in Effect:
2001 California Building Code
2001 California Plumbing Code
2001 California Mechanical Code
1999 National Electrical Code
City of Anaheim Ordinances
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