904 N GARDEN STPermit Types
PLMMECELEBLD
X
Permit Number: BLD2011-04190
Issued: 11/03/2011
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
CITY OF ANAHEIM
www.anaheim.net/building
(714)765-4626
Quarter Section: 38
APN: 07247412
Legal Description: N TR 1802 LOT 67
Site Address: 904 N GARDEN ST, ANAHEIM, CA 92801
Project Description: Mechanical for wall heater change out.
Living Area:
Garage Area:
Carport Area:
Balcony / Deck Area:
Number of Stories:Valuation:
Construction Types:
Occupancy Groups:
Fire Sprinklered:
Cool Roof:
0.00
Not Applicable
No
Total Fees paid for Permit: 136.73
People Associated with Project:
1175 N DEL RIO PLACE200204041149384420 ONTARIO, CA 91764Contractor INTER-CITY ENERGY SYSTEMS INC
Permit Applicant CHERYL GAUTHIER
904 N GARDEN ST ANAHEIM, CA 92801Owner VICTOR VALDERRAMA
Type QtyElectrical Fixtures Type QtyPlumbing Fixtures QtyMechanical Fixtures
1Heating Appliances, including vent
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
date of permit issuance. A new permit is required to commence or continue work.
All applicable items below must be signed before utilities will be rel^sed.
FINAL INSPECTIONS INSPECTORDATECityofAnaheim
Building Division
Final Gas Test
Electrical Final
Plumbing Final
Mechanical Final
Cross Connection Control {714)765-»28o
Engineering/Grading Final {7i4)765-si26
Fire Dept.Final (714)765-5041
Fire Sprinkler Final (714)765-5041
Water Engineering (714)765-4591
Do not occupy this building unlil Ihe final inspections have been made .
BUILDING PERMIT DOES NOT AUTHORIZE ELECTRICAL.PLUMBING,OR
MECHANICAL INSTALLATIONS -SEPARATE PERMITS ARE REQUIRED.
Sub List/Business License (714)765-5194
Zoning (714)765-5139
DATE INSPECTOR Building Final (Last Inspection -
Only After Above Complete)
INSPECTION
Do not pour concrete until the following applicable items have been signed:
Plumbing (Ground/Underfioor Drain Waste)FINAL INSPECTION must be approved by the Building Division.
Electrical Ground Electrode/Ufer PARTIAL INSPECTIONS
Setback/Forms/Trenches (Footings)
Do not install subfloor or pour floor slab until the follwing applicable items have
been signed:Building Inspections
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Floor (Joist/Girders)
Underfloor Insulation (Raised Foundation Only)
2nd Floor (Floor Nailing)
Mechanical InspectionsDonotcoverorconcealtheworkbelowuntilthefollowingapplicableitemshave
been signed:
1st Floor Shear
Firesprinkler (Rough)(Fire Dept.)
2nd Floor Shear
.URoof(Sheathing/Diaphragm/Frame)
\\I-jll ')X)\VMasonry(Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Duct (Mechanical)
Plumbing InspectionsRoughMechanical
Rough Electrical
Framing (Only after PIbg.,Ele..Mec.&Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable items have been signed:
Drywall
Drywall Penetrations (Ele.,Mec.&PIbg.)
interior Lath
Exterior Lath
Electrical InspectionsGENERALITEMS
Electrical Service Meter
Exterior Plaster (Brown Coat)
T-Bar (Struct.,Ele.,or Mec.)
Sewer
Water Engineering Backflow (Testable Only)
Water Service
Permit Backs Master-2008.xls
Permit Types
BLD ELE MEC PLM
X
Permit Number:BLD2011>04190
Issued:11/03/2011 CITY OF ANAHEIM
INSPECTION REQUEST LINE:
(714)765-4626
Quarter Section:38
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765-5153
Site Address:904 N GARDEN ST
Legal Description:N TR 1802 LOT 67
OWNER -BUILDER DECLARATION:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License State Law for the following reason(s)indicated below by the
checkmark(s)I have placed next to the applicable item(s)(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 the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors'State License Law Chapter 9 (commencing with Section 7000)of Division 3
of the Business and Professions Code)or that he or she is exempt from licensure and the basis for the alleged exemption.Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I,as owner of property,or my employees with wages as their sole compensafon,will do (.
intended or offered for sale (Sec.7044 Business and Professions Code:The Contractors’State License Law does not apply to an owner of property who,
through employees’or personal efforts,builds or improves the property,provided that the improvements are not intended or offered for sale.If,however,
the building or improvement is sold within one year of completion,the Owner-Builder will have the burden of proving that it was not built or improved for
the purpose of sale).
I,as the owner of the property,am exclusively contracting with licensed Contractors to construct the project (Sec.7044 Business and Professions Code:
The Contractors'State License Law does not apply to an owner of property who builds or improves thereon,and who contracts for the projects with a
licensed Contractor pursuant to the Contractor's State License Law).
I am exempt from licensure under the Contractors'State License Law for the foilowing reason:
j all or C j portions of the work,and the structure is not
By my signature below I ackonowledge that,except for my personal residence in which I must have resided for at least one year prior to completion of the
improvements covered by this permit,I cannot iegally seli a structure that I have built as an owner-builder if it has not been constructed in its entirety by licensed
contractors.I understand that a copy of the applicable law,SecUon 7044 of the Business and Professions Code,is available upon request when this application
is submitted or at the following Web site:httD://www,leqinfo,ca .Qov/calaw.html.
By my signature below,I certify to each of the following:
I am the property owner or authorized to act on the property owner's behalf.
I have read this application and die information I have provided is correct
I agree to compiy with all applicable city and county ordinances and state laws relating to building construction
I authorize representatives of this city or county to enter the above-identif ed property for inspection purposes.
Signature of Property Owner or Authorized Agent Date
WORKER'S COMPENSATION DECLARATION:
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 OR THE LABOR CODE.INTEREST.AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self-insure for workers compensation,issued by the Director of Industrial Relations as provided for by
Section 3700 of the Labor Code,for the performance of die work for which this permit is issued.
I have and will maintain workers compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.My workers Compensation insurance earner and poiicy are:
TWIN CITY FIRE INSURANCE CO.72WEOH1854 7/1/2012Carrier:
Name of Agent:
I 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 thewooerscompensationlawsofCalifornia,and agree that,if i should become subject to the worker's compensation provisions of Section 3700 of theLOTorCode,1 shall forthwith comply with those provisions.
Policy No.:Expiration Date;
Phone No.:
£3/
lignature^Applfcai
Permit Number:BLD2011-04190
DECLARATION REGARDING 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.C):
Lender’s Name:
Lender's Address:
LICENSED CONTRACTORS DECLARATION:
I hereby affirm under the penalty of perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000)of Division 3 of the
Business and Profession^Code,and mylicense is in full force and effect.
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nl^tor Signature Date
NUMBER
587709
EXPIRATION DATE LICENSE TYPE fS>
2/29/2012 B CIO
C20 HTAC C36
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 date of
permit issuance.A new permit is required to commence or continue work.
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