2120 W. Victoria
TYPE OF PERMIT
Blockwall/ Columns C ITV
DATE: 3/10/2005
JOB ADDRESS: 2120 WVICTORIA AVE
LEGAL DESCRIPTION: N TR 2299 LOT 281
BUILDING DIVISION
200 S. ANAHEIM BLVD. .
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 40
. BUILDING PERMIT NO. BLD2005-00671
APPLICANT: FIDELIA SALAZAR
OWNER INFORMATION:
AQUILINO SALAZAR
2120W Victoria Ave
Anaheim, CA 92804 i
JOB DESCRIPTION: Build 50 lineal feet of 6 foot high block wall per city standords.
VALUATION: 3,000.00 .,.
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that' am exempt from the Contractor':;: Ucense law for-the following reason (Sec. 7931.5 Business and
Professions Code: any city or;countywhich requires a permit to construct, altffr: improv~t_ demolish or tepair any structure; prior to i~- issuance. also
requires the applicant fo(.such permit to file a signed stateme'nt that he is licer::sed pursuant to the provisIons of the Contrad:or's License Law (Chapter
9)(commencingwithSection 7000 of Division 3 of the Business a.nd.prOfesS~,)sCodeJ,?r that he is'exempt therefrom and the basis for the alleged.
exemption. Any violation of Section 7031.5 by any appticanUor. a permIt sutI1cis the applicant toa dvil penalty of nQt more than-five- hundred dollars
($500).. . . ... . . . .
o I, as owner of property, or my_employees with_wages as their sole compeh..<;ation. 'will do the work, and the stnJ,cture is not in~ended or offered for
sale (Sec. 7'044 Business and ProfesSions Code:- The Contractor's License L:lwdoes not apply to an owner of property whq_bu~lds or improves
thereon, and who does sum work hiniself or hersetf or through his or her QI.......r.~~mp!o-Yees,'prb\1ided that such impro"irell1entsare not in.tended or, _ '.
9ffered for:safe. If, however, the building or improvement is sold with oneyeefcf completion, the owner-builder will have the burde.rrof proving that he
~id tbuild or imp!ove for the,purpose of sale). ',' -, t ", '. '.
, . as the oWner of the. property"am exdusiv~1y contracting with licensed (~?ntra~ors to .constr.uct theptoject (See. 7044 BUSiness arid~.Pr~fessiO~g,_
C e: The Contractor's License Law does not apply to an own~r of property\,'1I,~ bUIlds or Improves thereon, and who contr~cts for such,project'S with;
fUrontractor(s) licenSed pursuant to th~Contractor's ~jcense Law); i '
U I'am exempt under Sec. ,P. . t: this r son:
Date: ' Owner:
CONTRACTOR INFORMATION:
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: ENO
I
.~
LICENSED CONTRAC'TORS DECLARATION J
I hereby aff!i:m under'penalty pf perjury that I am
licensedund.er provisions_of chapter 9 (commencing
with SectiOn 7000) of Divsion 3 of the Business and
Professiol1s~ c~..c
3/10/2005 76-
Date: .- Contractor.
WORKER'S COMP SATION DECLARATION
I hereby affir.m, under penalty of perju'ry one of the following decla,rations:
D I have and will maintain'a.certificate of oonsenttc self-insurefarworke,'s;compensestion,'
as provided for by Section 3700 of the labor Code, for the performance .of th~wori~ for which
this permit is issued.
o J have and will maintain worker's compensation insurance. as required b~_Section 3700 of
the Labor Code, for the performance of the work for which this permit is issue:_'. Myworl<er's
Compensation insurance carrier and policy are: .
Carrier: ' . poncy Number.
NUMBER
EXPIRATION DATE
~h' , section need not be completedi,f th_e pennit is for one hundred dollars ($1 00) Qrl~:,~~ . '
I certify that in the performance ofthe workJor which this permit is issu,::c!. Ishaii not
pi y any person in. any manner so as to become subject to t~e warleer's r:om'pert$~.tion laws
0, California, and '~gree,that if I should become subject to the worker's camper.s~ti~n
. provisions of Section 3700 of the Labor Code I shall forthwith p.ly wi h thosa'provisions.
TYPE
Date: 3/10/2005 . Applicant:
WARNING: FAILURE TO SECUREWO KER'S COMPENSATION COVERAGE 1$,",
UNLAWFUL., AND SHALL SUBJECT AN EMPLOYER TO CRIM INAL PENA'-T1E~ AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100.000); IN ADDIlION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 O'FTHE
LABOR CODE. INTEREST AND ATTORNEY'S FEES.
. CONSTRUCTION LENDING AGENCY
ConstrlJcion Types:
VN, ,
, I hereby, affirm under penalty of.perjury that there is a construction lending agl2:1cyfor the
performance of the work for whim this permit is issued (See. 3097 .Civ.C):
Lender's Information:
I certify that 'have read this application and state thatthe above information is correct. J
agree to complywith all city ordinances and state laws relating to building construction, and
hereby authorize representives of this ,city to enter upon the above mentioned property for
. spe I n po s.
r Date: 3/10/2005
ignature of Applicant -or Agent
The perinit shall expire by.limitationand become null and void if the buDding 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.
Fees paid for Permit:
Total:
12S.79
INSPECTION RECORD
. '. INSPECTION .' DATE. INSPECTOR
. .'
T em'porary P.ower Pole .
Plumbing (DrainlWaste Pipe)'
Electrical Ground Electrode/Uter
Se:\backlFormsfl'renches (Footings) "'5flC.(.~ ./
Do not install subftQoror pour floor slab until the .
following applicable items have been signed:
Plumbh:l!l (Water Pipe.Sprinkler Valves) .
Mechanical (Groundwork) . .
ElectricaljUncierground Conduit) .... .
Pre-slab {Compaction/Membrane.Rei nt. .
Underpinning (Floor Joist/Gilders) .
Do notcover:or conceal the worl< below until.the
following apP'li.c~ble items have bee,n"signed:" -. . .
1 st Floor Shear . .
FireSprinkler (Rough) .
2nd Floor Shear. . '. . .
Roof (Sheathing/Diaphragm/Frame) /1 /
Masonry (ReinfJBond ~amlPre-Gl'O\Jt) ~)/~ ~r//~
Rough Plumbing (Top Out) .
Rough Mechanical '. .,
Rough ElectriCal lOry Wall) '. . .
RoughElecirical . . . .
Framing. (OnlyafterPlbg..Elec.. Mech 'an,dFirel
. Insulation (SoundlEnergy) . . '. . .
Do not tape or plaster' until the following' applicable
items havebeefl signed: .' " , .
Drywall . . .
.Penetrations (Fi", Rated) Electrical
Penetrations (Fire Rated) Mechanical .
Penetrations (Fire Rated) Phimbil19 .
Interior Lath : . .
Ederior Lath .
. . GENERAL ITEMS . .
Exterior Plaster (Brown Coat) .
T -Bar Electrical .
,. -Bar Mechanical .
T -SarStructural . " . '. .
Sewer '. .
Water Engineering BackflQw "
Water Service
FINAL INSPECTIONS
Electrical final '.' .
Plumbing Final . ..
Mechanical Final .
Gas Test
Engineering/Grading F.inal 765-5.126
Fire Dep!. Final 765-4040 .
Water E.ngineering 765-5268
Sub List/Business License 765-519
Date Inspector
.
.
..
"
.
. .
.
., .'.
'. .
Zoning 765-5139. .... . .
Building Final (Lostinspection. Only,~ ,,'1 _ ,.~ I,.) n dj,,'~
. . '. Jlfter Above Complete)" -vv ""
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections
.Plumbina Inspections
Electrical InsPections
"