639 N PINE WAY (3)Permit Types
BLD ELE MEC PLM
X
PemfirNuniBer:BLD2009-020
Issued:07/01/2009
INSPECTION REQUEST LINE:
(714)765 -4626
Quarter Section:71
Site Address:639 N PINE WAY
Ugal Dj^cription:N TR2237 LOT 38
CITY OF ANAHEIM
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765-5153
Project Description:Plumbing for residential remodel:Copper re-pipe and change out main line from house to meter.
Valuation:
Construcion Types:
Total Fees paid for Permit:
N/A,.
136.73
People Associated with Project:
Owner
Contractor
Permit Applicant
RALPH H OSTERGREN TR
MASTERSERV INC
JIM JOHNSON
639 N PINE WAY ANAHEIM CA 92805-2506
560 LIBRARY ST SAN FERNANDO CA 91340-2524
Electrical Fixtures Qty Type Plumbing FixturesType Qty Type Mechanical Fixtures Qty
Water Distribution (modify existing)
Water Main per 100 ft.
1
1
The permit shall expire by limitation and become n ull and void if the building or work has not passed fhal bispect'nn 365 days from the date of permit
issuance.A new permit is required to commence or continue work.fbid permit combo
All applicable items below must be signed before utilities will be released.
FINAL INSPECTIONS INSPECTORDATE
Final Gas Test
Building Division Electrical Final
Plumbing Final
Mechanical Final
Cross Connection Control (7i4)76s-428o
Engineering/Grading Final (7u)765.5126
Fire Dept.Final (714)765-5041
Fire Sprinkler Final (714)765-5041
Water Engineering (714)765-4591
Do not occupy this building until the 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
Building Final (Last Inspection -
Only After Above Complete)
INSPECTION DATE INSPECTOR
Do not pour concrete until the following applicable items have been signed:
Plumbing (Ground/Underfloor 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 foilwing 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
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Duct (Mechanical)
Plumbing InspectionsRoughMechanical
Rough Electrical
Framing (Only after PIbg.,Eie..Mec.&Fire)
\qIInsulation(Sound/Energy)
Do not tape or plaster until the following applicable items have been signed:
Drywall
Drywail 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
Pemrril Number:BLD2009-02088
Issued:07/01/2009
INSPECTION REQUEST LINE:
(714)765 ●4626
Quarter Section:71
CITY OF ANAHEIM
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765-5153
Site Address:639 N PINE WAY
Legal Description:N TR 2237 LOT 38
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 thecheckmark(s)I have placed next tothe 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 islicensedpursuanttotheprovisionsoftheContractors’State License Law Chapter 9 (commencing with Section 7000)of Division 3 of the Business andProfessionsCode)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 apermitsubjectstheapplicanttoacivilpenaKyofnotmorethanfivehundreddollars(S500).
I,as owner of property,or my employees with wages as their sole compensation,will do (
structure is not intended or offered for sale (Sec.7044 Business and Professions Code:The Contractors'State License Law does not apply toownerofpropertywho,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 ProfessionsCode: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 following reason:
)all or {)portions of the work,and the
an
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 oftheimprovementscovetedbythispermit,I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entiretybylicensedcontractors.I understand that a copy of the applicable law.Section 7044 of the Business and Professions Code,is available upon requestwhenthisapplicationissubmittedoratthefollowingWebsite:httD://www.leainfo.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 the information I have provided is correct.
I agree to comply 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-identified 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 ATTORN EY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
I h and will maintain a certificate of consent to self-insure for worker's compensation,issued by the Director of Industrial Relations as provided
r by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
\/I have and will maintain worker's compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the work for
which this permit is issued.My worker's Compensation insurance carrier and policy are:
Carrier:DELOS INSURANCE CO.Policy n8.1DKRM12002879 Expiration
Name of Agent:Phone No.:
_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 the worker's a
370Q.«Kthe Lgbo
pensation laws of California,and agree that,if I should become subject to the worker's compensation provisions of Sectionk52ie.I shall forthwith comply with those provisions.
'Date
/C
Signatureyof Applicant
Permit Number:BLD2009-02088
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:
UCENSED CONTRACTORS DECLARATION:
I hereby affirmBusinessand^rofe^ions Code,ISY the pena of perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000)of Division 3 of the
ara my license is in full force and effect.
/'c
^clor Sign^ure Dat
NUMBER
580017
EXPIRATION DATE LICENSE TYPE fSf
10/31/2009 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 newpernit is required to commence or continue work.
fbtd permit combo declare