1212 S. Western Ave. (2)
TYPE OF PERMIT
Residential Addition
CITY
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 7135- 5153
INSPECTION REOUEST LINE:
(714) 765-46213
CENSUS CODE: 434
QUARTER SECTION: 11
BUILDiNG PERMIT NO.
BLPZOO1;;Q1998
.... ,.,.
'?"
DATE: 7/2/2004
JOB ADDRESS: 1212 S WESTERN AVE
LEGAL DESCRIPTION: SEC 23 T 4 R 11 S 93 FT N 2134 FT W
APPLICANT: BRIAN YAREMA
OWNER INFORMATION:
Ma rgaret T Yarema
1212 S Western Ave
ANAHEIM, CA 928040000
JOB DESCRIPTION: Reissuance of expired permit # 58431 for 540 sq It Familjroom addition. .Renew permit to 1/2105
VALUATION: 33,650.00 PROCESSED BY: MJF
I OWNER-BUILDER .OECLARATiON
I hereby affirm under penalty of perjury that lam exempt from' the Contractor.~; License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any oty or county which requires a permit to construct, alt~ir, improve, .den101ish or repair any structure, prior to its issuance, also
requires the 'applicant for such permit to file a signed statement that he is licebsed I?ursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business a nd P.rofess:,:~ris Codp.) or that he is exempt theref:-om and the basis for the alleged
: exemption. Any violation of Section 7031.5 by any applicant fora permit sUl'y:,,,cts the applicant to 8...:.-civD penalty of not more thanfive hundred dollars
($500). '.' ",., ; '. . . .
01, as owner of property, or my employees with wages as their sole comp~nsation, will do the wOrk, and the strl,lctute is not intended or offered-for
sale ($ec. -7044 Business.and Professions Code: The Contractor's Licen~~ tjsw does not applyto'an owner of property who builds or improves .
thereon, and who does such work himself or tl,erself or through his or her QWi. employees, provfded that such in1provament-s are not intended or
offered for,sale. If, howev~r, the building or improvement!S sold with one'f6-1r of rompletion. the owner-builr1crwill have,!rle burdel1 of-provifl9 that he
did not build or improve for the purpos.e of sale). . ~'. . .
D I, as the,'owner-offhe property, am exdusively contl'acting w!th ficensecf:~'mtractors to'constructthe project (See. 7044 'BuSiness and Professions
Co"de: The Contrac.:tor's LicenS;e Law <loes no p Iy to an owner, of property ~ho builds or improves thereo;1, and who rontracts for such projects with.
tjontractor(s) licensed pursuant to the Contr t s License ,w. .! .
J_,~amxemtuderSec. . '," P.fthisf
~te. . ",Owner.
WORKER'S COMPEN ATION DECL T!ON
I her~_b,y,a~rm' under pen~lIty of perjury one of the following de a: nons: r
. D-:!'J1a"ve_and,'wm maintain a certificate' of ronsentto seJf-insureforworker'~compensat;on.
as provided for by Section 3700. of the Labor Code, for theperformance oftt;~:: work for which
this-permit is issued. I
[j' . i .have and will rnClintain worker"s compensation insurance, as required t,~{ Section 3700 of
the Labor Code, for tlle performance of the work for which this permit is !sslJ(:d. Myworker's
Compensation insurdnce carrier and policy are: '
Carrier: Policy Number.
i'
This section need not be completed if the pennit is for one hundred dollars ($1 O!,;~ or less.
o I certify that in the performance of the work for which this permit is isSliJ\i. I shali not
employ any person in any ma'nner so as to become su.bject to the worKer's d:.impensation laws
of California, and agree V1at if J'shbuld beco e., bje'q to the worker's comp~n...ation
provisions of Section 3700 of the Labor Co hall,forthwi amply with tl.::"se provisions.
'&J.2.. . .
TION COVEF:AGE IS
IMINAL P~NAtTIES AND CIVIL
FINES UP TO ONE HUNDRED.l1-IOUSAND DOLLARS 100,000), IN ADDITIPN TO THE
. COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI0113106 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.. ki' .
I CONSTRUCTION LENDING AGENCY
I hereby affirm Und~r penalty of-perjury that there is a qonstruction lend(!)g a~~e.:icyfor the
p_erformanceofthe work for which this permit is issued (Seo.3097 .Civ.C}: -
Lende(s ,nJormation: . _'_ _ -: .__._-".-".__ ___._
--:'-~-7
CONTRACTOR INFORM".T10N:
ARCHITECT/ENGINEER INFORMATION:
F;ICENSED CONTRACTORS DECLARATiON"!
J hereby affirm under penalty of perjury that I am
. HC€ilSed under provisiorfs of-Chapter 9 (commencing
with.8ection 7000) of Dlvsion 3-0f the Business and
Professions Code. .
7/2/2004
Date:
Contractor
NUMBER
EXPIHATION DATE
TYPE
Construcion Types:
VN" .
Fire Sprinklered?
NO
;'J
I certify tha
agree to
hereby a t
~.
Fees paid for Permit:
Total:
529.15
Date: 7/2/2004
INSPECTION RECORD
INSPECTION . INSPECTOR
. DATE
Temporary Power Pole . '.
Plumbing (DrainlWaste Pipe) ...
Electrical Ground Electrode/Ufer
S!!tback/FormsfTrenches (Footings)
Do not install subfloor or pour floor slab until the ,
following: applicable items have been signed:
Plumbing (Water Pipe.Sprinkler ValVes)
!IIechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane.Reinf.
Underpinning (Floor Joist/Girders) . ,
,Do not cover or conceal the work below until the
fo!lowing appliCable items have been signed:
1 st Floor Shear
, Firesprinlder (Rough) ,.
2nd Floor Shear .
Roof (Sheathing/Diaphragm/Frame) . ,
Masonry (ReinfJBond BeamlPre,Grout)
Rough Plumbing (TopOut) . .
Rough Mechariical. . . , .
RougnElectrical (Dry Wall)
Rough Electrical .
Framing -,_ (Only after.PJbg., Elec., Mech,. amj Fire)
Insulation (SoundlEnergy)'
Do not tape or plaster until the following applicable
ite"1s,havebeen signed:. - :
Drywall -,-
Penetrations (Fire Rated) Electrical
, Penetrations (Fire Rated) Mechanical
Penetrations (Fire Raled) Plumbing
Interior Lath .
Exterior Lath
GENERAL ,ITEMS
Exterior Plaster (Bre....,," Coal)
T -Bar Electrical, ..
T -Bar Mechanical .
T-Bar Structural
Sewer .
Water Engineering Backflow
Water Service .
FINAL INSPECTIONS , Date Inspector
Electrical Final, .
Plumbing Final ' .
Mechanical Final . ..
.
Gas Test
Engineering/Grading Final 765-5126'
Fire Dept. Final 765-4040 ..
Water E'iigineering 765.5268 '
Sub List/Business License 765-519
Zoning 765-5139 , . . .
Buil'ding Final ~ast Inspeclion. Only ,
fter Above Complete)
PARTIAL INSPECTIONS
BuildinQ Inspections
,Mechanical Inspections ,
, PlumbinQlrispections
Electrical Inspections
~ER;yiiT C:~<?IRt~
INSPECTION
NOT C MPLETED
OA T ~~JL
PERMIT NUMBER
'nfi,4;?J1
TYPE OP'PEi'lMIT
llU 1 UH NLl f'LU,.n'l
DATE
"1 '.,.;'./ ~)~~./'-1'/
PLAN TRACK #
JOB ADDRESS
L..:; ,12b ~~!t;. 8T LnN ~V,<'
LEGAL DESCRIPTION
GL:C:.:;:,;:. T {} n 11 L, fl::'
2b'l FT \<l 170 I'f H\'Ii/.'1
W'l;l /4 I'll".! /.1
OCCUPANCY
HS
TYPE CONST.
V N
# OF STORIES
DWELLING UNIT(S)
GARAGE AREA
SQ.FT
CENSUS CODE
ZONE
HI"'....,
OWNER
'i'Plf~:[;;J"h:~ ~
,)"..'
t:f? f(11\1 ~J l;.JHN
ADDRESS
'<1:/:l tf) 15ii:L.b"Hl.>. ,.',,"
, ,lll~'.{:,';".~' ,,"""',\ ", ~~].
f;~~\HCli'1 :; OJ';'STA~l;:
PHONE .;;' .
( 'l1/t ) ~):}5.- '/c..'-!,~ '".\'
'-.,
..
(:-\;'<;'
, ZIP CODE
APPLICANT
CONTRACTOR' .
ADDRESS
CITY
STATE ..'
.. .ZIP CODE
::. ~,'
PHONE
CITY LICENSE #
ARCHITECT/ENGINEER " I
ADDRESS
CITy
STATE ZIP CODE
PHONE CALIF. REG. #
JOB DESCRIPTION
'P,OD '5.4~) f3l- FIi!'11 L Y r;:OOt'il/O(H~'it:. F:(JU\"_1
VALUATION PRIOR BLDG. USE
3~:,., .t,j~50
ITEM
lSSU{;NCE 'LL D i
~~HCh;(]F iLN rq:iC (t~HC.t:-f) t.tO
I!UILDi.NG 1"SmUl FEE E'i
HASH.: PU)l\! CHCC1< F'c,:C i:'>
'.:)'1',;',12 'Hi>: CI~I (,8UHf II! lJ'/
r I lLU 24 PUIN ClILe).; U~.
QUANTITY
1
2
I
1
l'
... ':0
J
TOTAL FEES
J ~..::-
BUILDING DIVISION
200 S. !\NAH('IM BLVD.
{ ~~ .~ " i:,.:. r"'::J J. ~:,\
INSPECTION REQUEST LINE
( iI- .~}) L~,'-;":L, 1.:::;1
CITY OF I6.NAHEIM
"
QS
II
NL.t:.l U "
FEE
,~..>~. .,'~)U
;2;;.(h"j
'';..1.0.. e:~l.)
:::::Ol~t:.:k:;
:.;;...40
"l6. ;~;t-J
t ':;u '} ~ :~, 1.
j
To obtain this permit. the undersigned hereby files this application and agrees, certifies
and declares: ,That rlotk:ehas:.been-givenme that.this permi.t may be used only in
compliance wi1h 1heAnaheim Municip_al Code,and all other applicable ordinances and laws.
That this permit does ,not ,-allow' occupancy, and .that no .occupancy is permitted, of
the construction for which' this permit is issued until it has been approved in -writing by
this office for occupancy_~fter final inspection. '0,: :',. ,'.
That this permit doesn6t(l.\\O-W, and separate permits are required for, any plumbing,
electrical, heating and air conditioning work.
That a double fee will be paid for any permit issued after any work thereby allowed
has been commenced.
t agree that the City may enter upon the job premises at' any reasonable, time to inspect
any work installed under this permit, and to otherwise act as and when required, by the
Anaheim Municipal Code.
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License
Law for the following reason (Sec.7031.5 Business and Professions Code: any city or
county which requires a permit to construct, alter, improve, demolish or repair' any
structure, prior to its issuance, also requires the applicant for such permit to file a'signed
statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9) (commencing with Section 7000 of Division'3 ofthe Business and Professions
Code) or that he is exempt therefrom and the basis for the ,alleged exemption. Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to,8 civil penalty
of not more than five hundred dollars ($600). , ',. ",,' ;
o I, as owner of property, or my employees withwages.as theirsofe compensation, will
do; the work, and the structure is not intended or:offeredfor sale (Sec. 7044 Business.
. and Professions Code:. The Contractor's License law does not apply to an owner of
property.who builds or improve~ th13reon, and who does such)^/orkhimself or herself or
thrOUgh his or her own employe.$~;' provided that such imprpvementsare not intended or
offered for sale. If, however, the_,building or improvement i~:Soldwithin one year of
completion" the owner-builder will have the burden of, proving; that he_ did_ not build or
improve forthe purpose of sale).' " ",,' , ;, ",,_," ,,'.~
o I, as the owner.of ;the property, am eXClusivelY contracting with.lic~nsed contractors
to construct. the project (Sec.:7044 Business and ProfessionsCQde: ""The Contractor's
License Law do~s not apply to an owner of property who builds or improves thereon; and
who contracts for'such projects with a contractor(s) licensed-pursuant to the Contractor's
License Law). . . ,
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Bllsiness- and Professions Code,
and my license is in full force and effect.
License Class Lic.'Number Exp. 'Date
Contractor
WORKERS' COMPENSATION DECLARATIQN
I hereby affirm under penalty of perjury one:of the following declarations: I
o I have and wi!lmaintain.,a,' 'certificate''9f consent. to' selHnsure for worker's
,.compensation, as provided for by Section 3700,:.ofthe Lab.or Code, for the performance
of the work for' which this permit is issued. .... " '.' ,
n I have and will maintain worker's compensation insuran~_e, as required by Section 3700
or the Labor Code, for the performance of the work for which this permit is issued. My
workers' compensation insurance carrier ~nd poticy num.ber are: '
Carrier
Policy Number
(This section need not be completed it 1hepermit is for one hundred dollars ($100) or
less). , ' . . . . . .' .__'
.1 certify that in the ,performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if ,I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with
those provisions.
I hereby agree to indemnify and hOld harmless the City of Anaheim, it's officers and
employees from any liability for damages incurred by any person, of persons, resulting irom
work or activities undertaken pursuant to this permit.
WARNING: FAilURE: TO SECURE WORKERS' COMPENSATION COVERAGE IS
,UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION
TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706
OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097.Civ.G):
lender's Name
Lender's Address
'-certi'fYlha'd have read tnlS awliCafiorl-Snd state th<if the above InformatiOn IS Correct.
I agree to comply with all City ordinances and state laws relating to building construction,
and hereby authorize representatives of this city to enter upon the above mentioned
property for inspection purposes.
THE PERMIT SHALL EXPIRE BY LIMITATION AND BECOME NULL AND VOID
I?,,:THIS WORK IS NOT COMMENCED OR SUSPENDED AFTER A PERIOD OF
.-~~~DAYS. NEW PERMIT IS REQUIRED TO COMMENCE WORK.
DATE
CASHIER VALIDATION ONLY
.;;:.- ,~ ~
PARTIAL INSPECTIONS
BuildinQ Inspections
Mechanical Inspections
PJUlnbi~Q Inspections
Electrical Inspections
'" .,,':"....'.;,
INSPECTION RECORD
Type of Inspection
Date
Inspector
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
Setback/Forms/Trenches (Footings) i:? -
Plumbing (Water Pipe/Sprinkler Valves) r
Mechanical (Groundwork)
Pre-slab (Compaction/~embrane/Reinf.)
Unde,rpinning (Floor Joist/Girders) .
1 st F!oor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof ;(Sheathing/Diaphragm/Frame)
Masonry.(Reinf./Bond Beam/Pre-Grout)
Rougr Plumbing (Top Out)
Rough Mech.
Rough Elect. Walls
Roug~ Electrical
Framing (Only after Plbg., Elec., Mech., and Fire)
Insulation (Sound/Energy)
Drywall
Interior Lath
Exte~jor Lath
GENERAL ITEMS
Ext. ~Iaster (Brown Coat)
Perm~nent Electrical Pole
Construction Pole Service
T -Bar Electrical
T -Ba( Mechanical
T -Bat Structural
Sewer
Water Service
Electrical Final
Plumbing Final
Mechanical Finat
Gas Test
Engineering/Grading Final 765-5125
Fire Dept. Final 765-4040
WatetEngineering 765-5266
Sub List/Business License 765-5194
Zoning 765-5139
Building Final (Last Inspection)
..
CITY OF ANAHEIM, CALIFORNIA
Planning Depa.rtment
Building Division
December 7, 2000
f
Margaret Yarema
1212 S. Western Ave.
Anaheim, CA 92804
Subject: Extension on Building Permit #82842
Dear Mrs. Yarema:
We have received your written request to extend the above mentioned permit for your project
located 1212 S. Western Avenue.
Please be advised that the Building Official has the discretion to extend permits. After reviewing
your request, we have extended your permit for six months. Therefore, your permit will expire
April 19, 2001. Due to the fact that the City has adopted the 1998 California Building Code
effective July 1,1999, we will not be able to extend this permit after April 19, 2001. At that time
it would be necessary to renew your permit by paying a new fee. In addition, your project may be
subject to a plan check review.
We look forward to serving you in the "Anaheim Way". Please do not hesitate to call me if you
have any questions.
Sincerely,
~wq.~
Julie A. Seay, C.B.O.
Building Official
JS:lh
xtens;onlEXl-1212Western2
(
P.O. Box 3222, Anaheim, California 92803 . (714) 765.5153 . FAX (714) 765-4607 . www.anaheim.net
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