4830 E. Santa Ana Canyon Rd.
LEGAL DESCRIPTION: TR 1005 LOTH POR AS DESC IN DD
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REOUESTLlNE:
(714) 765.-4626
CENSUS CODE: . 434
QUARTER SECTION: 167
BUILDING PERMIT NO, . BLD200S-00154
TYPE OF PERMIT
Blockwall/ Columns. C I TV
DATE: 1/19/2005
JOB'ADDRESS; 4830 E SANTA ANA CANYON RD
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CONTRACTOR INFOR~Li.JbN:
iJ ,V.1
Benjamin V Rodriguez .... .:<,'-:)1.. '. .
4830 "E Santa Ana Canyon Rd. . . .;:l, .:il' .
Anaheim. CA 92807"" '. . . .'l~ ',!i: "-
JOB DESCRIPTION:Build 1351inearfeet 0(6 foot hi9h block wall at rear oi:~.ro~..rty al1d(3; 6' feet hi9h pi/asie's to city stal)dards.
!\+ .
4,000.00 . . ,.'. Q,J.:lxl:.L_ PROCESSED BY: JNJ.
OWNER-BUILllEr~@'ECLARATIO .
I ereby.a irm under pena 0 perjury that I am exempt from the, on1raC;tc:'sp...icense La.w or the .allowing reason ( ec.-70 1.5 Business and
P"rofess;ons Code: any city or county which requires a permit to construct,'-h.:~~:l,mprbvc, demolish or f'epair any structUre. prior"to its issuance, .also'
'reQUires.the sppfic:ant for suCh permit to file a signed stateme. ~It thatfle is. ,.;!..~.:'.~We~_p.I~.'!'S:lant to the provisions of ttle ' Contractor's LicenseL.aw (Chapter
9)(commencing with Section 7000 of Division 3,of the Businessand PrQfl:i~..~,)l;.:-Coe,;e)orthat heis exempt therefrom and the basis for the alleged '
e xemPt.ion. AnY. Viola~ion. of Se~tio 0703 '1.5 by any apPliC. ant. for a pe...m...i..t:.._....'.~_..:._."..~.:~.I...~...'~..~'.1~~......I_.,S...',..'...(.;I_e. 2'.P. P licant to:a.dV i.1 pe. n. a.ft Y Of.not more than five.h undie. d.. d~II..a.'s
,~~~,~s Qwne.r of property, or m'y em!?,cyees With wages a~ t~eirsde:;.~~W!;;:~;Ji~'1, .will do the work, and the stru~ture:~ not intendedor-offered for
~~e'(Sec. 7044 Business and Professions Cocie: The Contractor's Licen..<::~;~;"}:.!(,les not app:yto an owner of property who builds or,improves, .'
thereOll; and who does such' work himself or herself or ,through his ,?r her.~~IJ;'~' ~?\pfrl'y'ees, pr?Vided t~at'sucl1 in:p~vements are not intendedpf' ~"
offered for sale. If, 'however, the build~ng or imprcvemcntis sold with on~:,~f,i\?8.fcorr:Pletion, the Qwne r-bu Rde'r will have the borden .of proillhglha.t he
did not build or improve for the pUlpose of sale).,' ", :J:>~1_<:---- . _ . '. .' '. . _', . '""
o . I. as the o""<<)~,r of the :property, ani exd!-,sively_contrading witli lic~ns~p,~~r,;_!;'adDrs"to.constriJct tne project (See.. 7044 Bosines.s and ~rofessions
Code: TneCcntractor's License' L.:lw dO,es nc5r'a]5ply to an owner of pr~p'3rtv'_~i~'y.~ui1d!'; or improves thereon, and who ,contracts for such prajects ,^,~h
UOO t~acta. r{'s) licenSjed purs.. IJa.nt to. the Cont.a"!',,'. License ~ 5.": Y.:,.J-::::.i:'", '.". . ,'. ' .' .
-' Lsmex n ~derSec. "''';'' . ,B ,C.f~ thl r.o-_!_~t..:1+~_~ " '..' . "..,'.
Date:. : J5 Owner:, . - '. :;...i..-~,_ - ,
C ..' WORKER'S COMPENSATION O:;CLARATI()N..2~T . _' -::J i . LICENSED CONTRACTORS DECLARATION J
I hereby affirm under penalty of perjuryane'ot the: fcl!o\l'.~ng ,jeC:ar~tiooo~ _: i~::~;t._ . " ., r ." I ,hereby affirm under penalty of perjury ih~t 1 rim .
o I have af.1d will maintain a'certiftcate of cO!iS6r}t to ::;air-insure ,ter. wurK~;r;i->."-;_9!!iP~.... ;1saticii;.' . !i~~.,sed ~nder pr~Visio.~~?f chaP1.er 9 (cO~mencing
a$ provided forbv Section 3700 af the- Lebar Code, fer the perrOrm31lct;of:~}-;;i:. "~t);'k ,!.;.r-wh;d1 With SectIOn 700.0, of DIVSlCn 3 0, the BUSiness and
this permit is issued.' . - ,{ ;:':'>:,"-" . r Professions Code. ' ,
~haveand.Will maintain ,warKe~ls compensatioh if1&uranc.e;_A:l5 re8u!i\3:,t! b}.S~~~k~n 3700 of I"~ 2f8i2005 ___
~eL~~or C.()d~1 for the perfo~manc~ pf ~he, work for which this pp-rnlit is i~'5u,~;.<r./.Y~'JQrker:s . Date: Contractor
Campe~lsatlO~ InSUral"lce carner ana ,polley are: . ' . -~ :'-.<~i"
Carne~. . . Palicy Number. ,,;;;.,. . . NUMBER ,'EXPlRATION DA1E
. ." . ..;.;, . . ~
. This s~o~ ne~ not be COJ1.1pleted if the penn!t is for one hundr~. ~OIl&"S ($#::~92rfess. ' . TYPE
~. : . '. ify that in the perfo~ance ~fthework for which t~is permIt i~ 4st.t;?'t[dsha1: not .
, lay any, person in any manner SO::lS to become subject to.the worker'$~C(~[:t>c/"!sa~jan laws
of, California, and agree that if I should become su.bj to the worker's ccrr:;P~:'C'lsaticm" ,
:::~i:::~o:eCiion 370:p::i::tLabOr Code. I sh fo hwith 00 Ip 1iJJ~e provi.ions.
WARNING: FAILURE TO SECURE W 'RKER'S COMPENSATiON COVE'PAGE /S '.
UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIM INAL PEN"'j,TIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100.000). IN A.ri.S~ nON.' TO THE
COST OECOMPENSATION,DAMAGES AS PROVIDED FOR IN $EGTIO;; 3706 OF THE
LABOR.GODE, INTEREST AND ATTORNEY'S FEES. . 'i,
L CONSTRUCTION LENDING AGENCY _,i_
I hf.lreby affirm under penalty .of perjury that there IS a canstructlon lp-ndJn-::; ,.,;en:;y tor the
iJCI ;;Jr(r-lC:IiH~,j( lil(j\,,{OIK".~'i')t:..vinLcnmfs ~rmi'is !ss~<f\Strc:3097'.-CiV)':;i:' .,
Lender's Information: .
APPLlCANT:EILEEN MILLER
OWNER INFORMATION:
ARCHITECT/ENGINEER INFORMATION:
VALUATION:
Constrlicion Tvpes:
VN, ,
Fire Sorinklered?
NO
~:-_.
, 1" .'.
I certify that I have read _this application and'statethat the.above information is correct. I
agree to romply with all. city ordinances and .state Jaws relating to building constructian, and
hereby authorize ,'rep ntives afthis city to e . er upon the above mentioned property for.
inspection p~rpO . s. .
Fees paid f<?r Permit:
Total:
247,50
Date: 2/812005
Signatur Applicant or Agent .
T permitShaJl expire by limitation and become null'andvoid if thehuilding or
work has not passedfirial inspection 365 days from the'dateofpermil issuance. A
new permit is required to c:ommence or continue work;
, ' -,
INSPECTION I'DATE " INSPECTOR
T e!'1porary Power Pole, , , "
, Plumbing (DrainiWaste Pipe)
Electrical Ground Electrode! I
SelbacklFormsrrrenches tl=ootings)) IIUlo!:)(" '1, ,
Do, not install sUb,f1oor or poOl'lfoorslab until the I
following applicable items have ,been signed: ' ,
PIu!'1bing (Water Plpe.Sprinkler Valves), - ,
Mechanical (Groundwork) , ,
E,lectrical (Underground Conduit) ','
Pill-slab (COIl1pactionlMembrane.Reinf.: ' '
Underpinning (Floor Joist/Girders) , 1
Do, not cover or conceal the Woll< below until the
following applicable items have been signed: ,
1st Floor Shear ' " -
" Firesprinkler, (Rough) , :,
,2nd Floor Shear, ' , ,
Roof (She;tl:hinglDiaphragm'Frarne) ~
Masonry (ReinfJBond BearnlPre-Grout) ',210.."
Rough Plumbing (TopOut) " ,
Rough Mechanical
Rougn l:lectrical (DrY wall) , , ,
'Rough Electrical
Framing (Only after Plbg., EJec.; Mech.. an(j Fire) ,
Insulation (SoundlEnergy) ,
Do not tape or plaster until the following applicable
items have been signed: , ' " '
DryWall ' , ,
I
Penetrations (Fire Rated) Electrical ' .
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing " ,
Interior Lath '
Exterior t.ath " ' " I P
GENERAL ITEMS .
exterior Plaster (Brown Coat).
T .Bar Electrical, " , . "
T -Bar Mechanical ,
.T.BarStructural ", ,
Silwer
Waler Engineering BackfJow E
Water Service ,
INSPECTION RECORD
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mllchanical Final
Gas Test
Engineering/Grading Final 765.0126
Fire Dept. Finai765-4040
Watllr Enginllliring 765-5268
Sub List/Business License 765-519
Zoning 765-5139
Building Final (Last Inspection- Only
, 'After Above Complete)
PARTIAL INSPECTIONS
Buildina Inspections
Dale
Inspector
'~
Mechanicallnspecti'ons
lumbina Inspections
lectricallnspections '
~ THIS Pe:RMll" DOES
"'f~~E ISS VIOLATION OF ANY of
..., PR.OVE S OF THE CITY.
THe: BUILDING Cg~ETHIS PERMI
THE HOL_DE:R.,. HI SK.
PROCE:EDS A
JAN 1 ~ 2005
BUILDING DIVISION OF ANAHEIM
APPROVE
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