126 N. Wade Cir.
TYPE OF PERMIT
Residential Remodel C I TV
DATE: 9/8/2005
JOB ADDRESS: 126 N WADE CIR
LEGAL DESCRIPTION: N TA 6717 LOT 11
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 179
BUILDING PERMIT NO. BLD2005-02824
APPLICANT: BRIAN POLIVKA
OWNER INFORMATION:
JOHN R TOWNSWICK
126 N WADE CIR
ANAHEIM. CA 92807
CONTRACTOR INFORMATION:
ELEGANCE ENTRIES INC
1130 N KRAEMER BLVD #H
ANAHEIM, CA 928060000
BUSINESS PHONE: 714632.3667
i
ARCHITECT/ENGINEER INFORMATION:
JOB DESCAIPTION:Change Window into door.
VALUATION: 2,700.00
PROCESSED BY: MSM
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor'sUcense Law for the fol owing reason (Sec. 7031,5 Business and
Professions Code: any city or county which requires a permit to construct, alte1, 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 of the Business and Profession"s 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 subje~ts the applicant to a civil penatty of not more than five hundred dollars
($500).
o I, as owner of property, or my employees with wages as their solecompeflsation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's Ucense Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale). .;
o I, as the owner of the property, am exclusively contracting with licensed cqntractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's Ucense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with
$iQontractor(s) licensed pursuant to the Contractor's License Law). ~;
U I am exempt under Sec. , 8 & P .C, for this reason: ,\
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to self-insure for worker's j':ompensation,
as provided for by Section 3700 of the Labor Code, for the pefformance of the'work for which
~i permit is issued.
I have and will maintain worker's compensation insurance, as required by Section 3700 of
t e Labor Code, for the performance of the work for which this permit is issued: Myworker's
C mpensation insurance carrier and policy are: :
Carrier: STATE FUND Policy Number. CA006001~61
This section need not be completed If the pennit is for one hundred dollars ($100) Or less.
o I certify that in the performance of the work for which this permit is issued~l shall not
employ any person in any manner so as to become subject to the worker's compensation laws
of Califomia, and agree that if I should become subject to the arker's compensation
provisions of Section 3700 of the Labor C de, I shall forthw' co Iv. ith those provisions.
. '
Date: 9/8/2005 Applicant:
WARNING: FAILURE TO SECURE
UNLAWFUL, AND SHALL SUBJEC AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED TH USAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMl'GES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, I NTEREST AND A"l TORNEY'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.C):
Lender's Information:
LICENSED CONTRACTORS DECLARATION
I ereby affirm under penalty of perjury that I am
licensed under provisions of chap 9 (commencing
with Section 7000) of Divsion f e usiness and
Professions
9/8/2005
Date:
Contractor
NUMBER
745285
TYPE
EXPIRATION DATE
7/31/2006
B
Construcion Types:
VN, ,
I certify- that i haw read this appiication and slate that the above jniorrnation isBorrect. I
agree to comply with 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
insp ion Rur ooos.... ~ Lf1 ""4
~ Date: 9/8/2005
Signature of Applicant or Agent
The p mit 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 issuau:e. A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
113.63
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainJWaste Pipe)
Electrical Ground Electrode/Ufer
Setback/FormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkier Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane Rein/.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (ReintJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable
Items have been signed:
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T.Bar Eleclrical
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
Waler Engineering 765-5268 I
Sub List/Business License 765.5194 :
Zoning 765-5139 :
Building Final (Laallnspecllon - Only /,))(/['5" 1.~~
After Abova Complele)
PARTIAL INSPECTIONS
Building Inspections
MechanicallnSDections
Plumbing Inspections
Electrical Inspections
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BREA/ORANGE COUNTY PLUMBING, HEATING,
AND AIR CONDITIONING
420 WEST LAMBERT ROAD
SUITE A
BREA, CA 92821
PHONE:714-529-1034
FAX:714-529-0467
FACSIMILE TRANSMITTAL SHEET
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SENDER'S REfERENCE NUMBER:
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YOUR REFERENCE NUMBER:
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