620 S. Westgate Dr.
'-
BUILDING PERfl!l1T 1,10.. BLD2004-03469
-,.'. -'k
. - ~ ..
TYPE OF PERMIT .. . -W '
Patio Cover
'. '. !;~t:;~~rliJo:'~~~~i>\ ....
CITY g\f3'.~"~HEIM
.:(:'1~%1l~~~) . ....
BUILDING DIVISION
200. S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 -.4626
CENSUS CODE: 434
QUARTER SECTION: 134
CONTRACTOR INFORM;\TION:
AMBIANCE ADDITIONS.'-
765 S STATE COLLEGE avo III.
FULLERTON. CA 9283'/OC\lO
BUSINESS PHONE' 7148i}'.4165
JoEi DESCRIPTION;Enclosed patio. ICBO #4590p '.i.
\J
.1',
VALUATION: 10.600.00 '. . . .'Hi:' .' . . PROCESSED BY: FAN
r--. '.' . OWNER-BUILDEfi:OE9.LARATION .'. '.. _____3
I hereby affirm under penalty of perjury 'that I am-exempt from the.c(Jntract<;ia~:J.:jc~n~e Lawf01 theJollowin9 reason (SaG. 7031.5 Busines_s ar.r1
Professions Code: any dty or.countywhich requires iJ permit to construct, 2:'li~:i';'ifr.rrove, derr,olish 'or repair any structure, prior to it:Hssuance, 8.150
requires the appliCant for such p~rmit to file. a signedstatem~nt1hat he is ,!lc~;hied pUi"Soant t6 the provisions of the C<:mtractor's licemetaw {Chapter
9)(commencing with Section 7000 of Division. 3 of the BUSines~and Pr0fes~i~'rrs Code)Dr'that-he is exempt .th~refr6m'and the basis fqr Hie al'.eged " '.
exemption. - Any viQlation of SectIon 7031.5QY an}' applicpnt for aparmit SUV~0'tS the t1ppHc8:T)t to a civil' penalty of not morc than five hundred dOli-<-.c:;~_.
($WO).'. . '. . "U . . . .' '. . ':,
o '." as 61/mero.fPro. pei1y; or my employ~es with wages as, their $ole 6orpf.;irJsatron, Wi.r: do the work, an?'~he str. ucture 'is not inf~~d'ed or ,.6fferedf6r
sale (Sec, 7044~us.iness and Professions Code: The Contractor's uceros/::<,rB\.... doesflot ap~yto an owner-of property who builds or improve.':> _
thereon, and who does such work hrmselfor helSelf or through his or her ()'fi~ ~:11Ployee~;)jcvided that:su.~h improvements are IIO~ int13odej'G'f,,:.-: _,,:
coffered for sa,'e. -l.f,.however. the building O( :l'nprovem.entis SOlrl.With one yt~l.r"Qf CQrDpl,etion. tn. "e.c":Vr.. ,er-b~:.irc:e_r WIll haVe the hu.rd6,O'l)f p. r9V!e!#~lhat_r~
d1dnotbujjdor.i~provefcrthepurposeofsale). ,''<t" , ",' .i . _,'," ,'..,'.:_::"::.:,
U . I, as the Dwo_er: of the' property, am eXdUS;'!/Slv contractmg with lic-sns-adt,,~)ntr8:Ctcr3 to !::qn3t(L;ct the 'prc;.::ct (Sec, : 7044_~1I :;inf'ss andJ'rofession,s_
Code: The Con_tr~3:Ctor's ,License law does 'not app.ly.t? an ownet ,:;,f pr~p.jrt>I}Vho b~;l::fs 9~::!lilpr"vef:dheroe6~~ and ,who .:.ontracts f?fsuc~projects with
~ontra~or(s) Ilcensec:t pursua~t tcthe Contract~i"'~ LIcense ~W). . _l'{ .'." ; . ;" , '
U I am exempt under ~e::;. _ . B & D.C. for this rea.ser.: . __~~ .'....
Date: Owner: ' , -~ .
L . . WORKER'S COMPENSATION DECLARATION . _.J~_._.-. --.-J. r liCENSED CONTR~IORS DECLARATION_J
! hei'~by affirm und~r p~nalty of perjury one of the foll~wjr.~ ijecla~trons: . ,~;. - .,~ ,I., I nereby aff11m u~JCIer TJf:;na.i1y of p~rjw y ~r'at '}m.
o l_havB and-w~lI maintain ,a certificate of consent to,self-insuie for worker*. compensation, !_ 'rcensed U'1cJer prOV,t,:rons of chapter 9 {corr.mencIng
8!'; proyided for.bY ~ction3tOO of the Labor God. e, for the pee rformanre <?f U{,t:.. v.ark for w. hich .'1 with Section 7000) Of Oh'SlOfi ,Ot t: c>. alia
. Professions Cod .
thir-; permit is issued. . "',,' . ...,
,Q(i have and will maintain worker's comp.en.sation insuranc.e. a. requiredJ,.; ~ectlon 3700 of I 9/,4/2004
.Ifhe1-abor Code, for the pefformance of the .work for which this permit Is jssu~:1. My wo~ker'<; Date: Contractor
Coinpensationinsurance {).3rrle~ and policy are: " J." -. '
Carner: STATE FUND ',~olrcy Number; OQOC20t"r/,U03 .'
. This sectio~ need not bo .completed if th~ pennit is fur oiJe..hundroo dOIle.r:i'($1(),~J:l~r lcs':i:
tl I c~rtjfythat in the performanCe of the work for ~hjch this permit los jSStl~4tl-:~h.9ilp01_.., '.
'employ ~ny person in arvy manner $0 as to become sobj.ect to the worke~~:c(:,~_pE.nsatiOh laws
of California, and agree that if I should become subject to the wo ',' )~_I'3at:on- ."
provisipns of Sectio!13700.ot'the Labor Code, Isha' forthwi~h ':0 ply With-~1se pi .; ns.'
Date: 9/14/2004 . Applicant: ,__
WARNING: FAILURE TO SECUREWORKER'S COMPENSATION COVEj~~:GEIS
UNLAWFUL, AND SHALL SUBJECT AN EMPl.OYER TO CRIMINAL PENMtiE;S AND CIViL
. FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN!'i:JCH10N TQ THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR iN SECTION ~706 OFTHE
LABORCODE. INTEREST ANDATTORNE'rS FEES. . ,
! . CONSTRUCTION LENDING AGE~CY' :r-
. I hereby affirm \lnder penalty of perjurY that the~e_is a construct.o~ lending e~:-:"';lc'lf~ the.. ._. f . . .. .
perft"'1rmanc9_.cf fhp- WClrkfor_ whim thi~ l"o.r!TIit." j<:;-,?I'''.'i (S~. ':l.:,_?:.- .':"'.'.:-~'- ~ .:.-- _ - ._~-~---.:.-~--
.. Lender's Informafion: . . .
DATE: 9/1412004.
JOB ADDRESS: 620 SWESTGATE OR
LEGAL DESCRIPTION: N TR 4096 LOT 79
APPLlCANT:AARON O'NEIL
OWNER INFORMATION:
RICHARD GOOWIN
620 S Westgate Or
Anaheim. CA 92806
I certify that i have read 'this application and state that the above information iscQrrect. I
agree to comply with all city ordinances and state laws relating to bunding construction. and
hereby authorize representives of this city.to nee above mentioneo property for
inspection' ,
Date: 9/1412004
Signature of Applicant qr Age!1t
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 dateofperrr.it issuance. A
new permit is required to commence or continue work.
ARCHITECTIENGINEER .INFORMA TION:
NuMBER
541133
,tYPE
'TYPE
EXPIRATION DATE
~/30/2004
B.
.HIC
Construdon Tvpes'
VN. .
Occupancy Groups:
U1. , , .
Patio Area:
256
~ '.
,;: ; .~.
Fees paid for Per~it:
. Total:
667.60
INSPECTION RECORD
.. . INSPECTION .. . DATE. . INSPECTOR .
Temporary Power Pole. .
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/uter ... . ... ..
SelbacklFormsfTrenches (Footings) .. .
Do not Install subfloor or pour flooislab until the .
follQ\oying'-applicable items have been Signed: .
Plumbing (Water Plpe.Sprinkler Valves)
Mechanical (GrOundwork)
Electrical (Uncletground Conduit) I
Pre-$1ab (Cc;>mpactionlMembrane.Reinf. ..
. Underpinning (Floor Joist/Girders)
Do ~o\Cover or conceal the-work below urylil the, ...
followlngapp'li.cableitems have been signed: . .
1 st Floor Shear .
FireSprinkler(Roughl . .
2nd Floor Shear . . .
. . Roof (Sheathing/Diaphragm/Frame) .
Masonry (Reinf./Bond BeamIPre:-GfO\lt) . . .
Rough Plumbing (Top Out) .
Rough Mechal)ical . .. ~
: I KOugh BectriC.a1 (ury Wall) . ~ /
Rough Electrical '. . , /
Framing . {Only after. Plbg., Elec,: r.-1ech and Fire) J.''-'-,,"~
Insulalic;>n (SoundlEner1lY! /3.lIJ.""1
Do nollape or plaster untillhe follOWing applicable I
ilems have. been signed: .. . . .
Drywall . . . . .
Penetrations (Fire Rated) ElectriCal I' . . .
Penetrations IFire Rated) Mechanical
Penelratic;>nS (Fire Rated) P1wnbil19
Interior Lath : . ......~~.
Exterior Lath.
. ... . . GENERAL. ITEMS .. f:
Exterior Plaster (Brown Coat)
T -Bar Electrical
.T -Bar Mechaili.cal . . .
T -BarSlructural ..
Sewer . . . .
Water Engineerlng.Backflow .
Water Service
FINAL INSPECTIONS
Electrical F.inal
Plumbing Final
Mechanical Final
Gas Test
EngineerillQlGrading FlnaI765.s12~
.Fire Dept. Final 765'-4040
Water Engineering 765-5268
Sub UstlBusiness license 765-519
Zoning 765-5139
Building Fonal (laSllnspection. Only . I_I. .f-.6
.. After Above Complete)
PARTIAL INSf>ECTIONS
Buildina Inspections
Oats.. , Inspector'
fNI-
. Mechanicallnsoections
Plumbinalnsoections
Electricallnsoectiohs
,