514 W. Water St.
TYPE OF PERMIT
Blockwall/Columns CITY
DATE: 411112005
JOB ADDRESS: 514 W WATER ST
LEGAL DESCRIPTION: N TR 1453 LOT 85
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD:
(714)765 - 5153
INSPECTION REQUESTlINE:
(714)765 - 4626
CENSUS CODE: 565
QUARTER SECTION: 73.
BUILDING PERMIT NO. BLD2005-00998
APPLICANT:
OWNER INFORMATION: CONTRACTOR INFORMATION:
Gray S Kilmer
617 S Harbor Blvd
Anaheim, CA 92805
JOB DESCRIPTION: In$laIl107' linear teet ot 6' feet high block per city standards
VALUATION: 3,000.00'
ARCHITECTIENGINEER INFORMATION:
PROCESSED BY: JNJ
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from .the Contractor's ~jcense Law for the following reason (Sec. 7031.5 Business-and .
Professions Code: any city or county which requires a. perm it to con.struct, atter,: 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 licens~d pursuant to the provisions of the Contractor's-License Law'(Chapter.
9)(commencing with Section 7000.of Division 3 o{the Business and professiori'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 subjects the appHcant to a civil penaltyof not more than five hundred dollars.
($500).. ...'., . . ~ I ..' '.
~ owner of property, or my employees with wages as their sole compe~~ation, will d9 the work, and the structure is not intended or offered for
~e-(Sec. 7044 Business and Professions Code: The Contractor's Ucense latH does not apply to an owner of property who builds or improves "'
thereon,' and who does such 'work himself or hers.elf or through ,his or her own employees, provided that such improvements are not in~ended or
offered far sale. If, however, the' building or improvement is sold,~ith one year ,)f completion, the owner-builder will have the burdenof proving that he~
did not build or improve for the purpose of sale).. , , '
o I, as the owner of the property, arfl e,xclusively contracting with licensed ccntractors to construct the project (Sec. 7044 Business and Professions-",
Code: The Contractor's Ucense-Law does not apply to an own~r of propertyw;-,6 builds or improves the~e,on, and who contracts far such projects with
.p...Qontractor(s) licensed pursuant to the Co~tf'actor's Lice ~w}.
U lam empt- nde,Sec.' ,8 .C. rt. r n
De Own. - f
WORK NSATION D ARA
!~~~ affirm under' of perjurY one of the following d lar . s: ::"
~ave aJ)d,wiU maintain a certificate of Consent to Self~insure for worker's c~mpensatjon,
as pravidecffor by Section 3700 of the Labor Code, for the pertormance of the,l_vor\<; for which
this permit is issued. ., . . :
Ol..have. and wil.l maintain worker'scompensation insurance, as requrred by Section 3700 of
the Labor Code, for the performance of the work for which this permit is i~ued. Mywor~r's
Compensation insurance carrier and policy are:
Carrier: Policy' Number.'
LICENSED CONTRACTORS DECLARATION
I hereby a~irm under penalty 0 perjury that I am
"liCensed under provisions of chapter 9_(commencirig .
with Section 7.000) of Divsion 3 of the Business and
Professions Code.
411112005
Date: Contractor
NUMBER
EXPIRATION pATE
T is section need not be.~pleted if the pennit is for one hundred dollars($100) Of less.
rtify that in the performance of the work for which this permit is i~!Jed.1 shall not
ploy any person in any manner so as.to become subject to the workers compensation laws
ofCalifomia, and agree that if I should become subject to the worker' compensation
provisiO':ls of Section3700 of the or Co e, I shall forthwith m w' e f!'ovisions.
Date: 4111/2005 Applic
WARNING: FAILURE TO CUR RK R'S COMPENSATIO
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINA TIES N VIL
FINES UP TO ONE HUNDRED lHOUSAND DOLLARS ($100,000), iN .ADDI1lON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE.
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRU.CTION 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 (8ec.3097 .Civ,C):, _.-
Lender's Information: . '
TYPE
Construcion Tvpes:
VN, ,
I'certifythat I haVe read this application and state that the above information is correct. I
agree to comply with all city ordinances and lelaws relating to bUilding,construction, and
hereb authorize representives of .this i er ,upon the above mentioned property for
lnsp .ion purposes. )
~
Date: 4/1112005
Fees paid for Permit:
Total:
.184.50
Sign ure of Appli
The permit shall expire by (imita . b and void if the building or
work has not passed final inspection 365 days rom the date of permit issuance. A
new permitis required to commenceor'continue work. .
. INSPECTION RECORD
.. INSPECTION DATE .,NSPECTOR.
Temporary Power Pole .
PIUII1blng (Dl3inlWaste Pipe)
Electrical Ground E/ectroclelUfer ""'
SelbacklFormsrrrenches (Footings) s- 1/.
Do not install subfloor or pour floor slab until the /'
folloWing .applicable items have beer1 sigr1ed: .
Plumbing (Water pjP8.Sprinkler Valves) .
Mechanical (Groundwork)
Electrical (Underground Conduit).
Pte-slab (Compaction/Membrane.Reinf.
underpinning (Floor Joist/Girders) .. .
. ..00 not cover or concealthe work below unt/'tne
following applicable items have been si9r1ed:
1st Floor Shear
Firesprinkler (Rough) .
2nd Floor Shear ..
Roof ISheathilllllDiaphl3gmlFramel. . . .-:-... .
Masonry (ReinfJaond BeamlPre-Grout)
. Rough Plumbing /Top Out) /'
Rough Mechanical .
lUlugh ElectrICal all) .
RC!ugh Electrical
Framing (OnlY after Plbg.. Elec.. Mech.. and Fire)
Insulation (SoundlE...rgy) . . "
ponot tape or pla~ler until the following applicable
Items have been signed:
. Drywall
Penetfatians (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
. Penetralions (Fire Rated) Plumbing
Interior Lath
Exterior Lath . . .
GENERAL ITEMS .
Exterior Plaster (BlOWn Coat) .
T -Bar Electrical
T -Bar Mechanical
T -Bar Structural
Sewer .
Water En\lineerin\l Backflow
Water Service .
.
FINAL INSPECTIONS Date Inspector,
Electrical Final .
Plumbing Final ..
Mechanical Final . . .. . .
Gas Test ..
Engineering/Grading Final 165:S126 .
.. .
Fire Dept. Final 765-4040 . . .
Water Engineering 765-5268 .
Sub List/Bulllnes5 License 765.519
Zoning 765-5139 .-:.
Building Final ~.st Inspection-only I(hj~:~ ,c,./ I /'"
fter Above Complete)
. ,
PARTiAl INSPECTIONS J)L/~
Buildina Inspections
Mechanical Inspections .
PlumbinQ Inspections
Electrical Inspections
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PLANNING DEPf,RTMENT
APPROVED
DATE -'t /11 tOE;.
q. Z""i~<"ON J ,\
BY ~,,..~ ~ ( K~
CinltLalti:)
FLOOD ZONE )(
HI S~C S~:~S ~~.:_:-22~J~.i~; ~~ ~:;
Circle Cr\(~ \,n c.bQVB lille
SEE BUILDII% PERMIT FOR
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ADDRESS:. 5392 t1/. DOVE ST.
LOT.c;; TRA CT ,,;t /3697
BUILDING PERMIT Nq. BLD200S-00998
ElM
BUILDING DIVISION
200S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: ' 565
QUA8TERSECTION: 73
,TYPE OF PERMIT
Blockwali/Columns CITY
DATE: 4/11/2005
JOB ADDRESS: 514WWATERST
LEGAL DESCRIPTION: N TR1453 LOT-85
APPLICANT: VIDAL RODRIGUEZ
OWNER INFORMATION:
VIDAL RODRIGUEZ'
514 WATER ST.
Anaheim. CA '92805
JOB DESCRIPTION: Install 107' linear feet of 6' feet high block per city standa~s. (Supplemental 4/12/05 addition of 15 lineal feet of 6 foof high block wall)
VALUATION: 3,000,00 . PROCESSED BY: MSM
IOWNER-BUlLDER DECLARATION
-I hereby affirm under penalty.of perjury that I am exempt from the Contractor'~ Ucense.Law for the fQllQwing reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, alter, improve, demolish or repair ~ny structure, prior to its issuance, also
requires the applicant for such: permit to file a signed .statement that he is liCe~sed purs'-tlant to "the provisions of the Contractor's License Law'(Chapter
9)(comme'ncing with Section 7000 of Division 301 the Business and ProfessiOns Code) otthat he ,is' exempt therefrom and the,basis for the alleged
exemption.. Any yiolation of ~;"ectibn 7031.5 by any applic~nt for a permit subjrcts the a~PJicantto a civlJ pen~ltyof not more th~n five hundred doll~rs
"?\s owner of property, or my employees with wages as their sole compe,:"nSation,' will do the 'work, and the structure is hot intended 9r ,offered for
~e (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who-builds OJ improves
thereon, -and 'who does such wqrk himself or herself or through his or her oWr/;employees, provided that such imp lOve ments are not i~tended or
offered for sale. ,If, however, the building.or improvement is sold with one yea( of completion, the owne.r~builder,wilf have the burden of proving that he
'did not build orimprove for the purpose of safe)..{ , .' ", '_" '
D I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and ProfeSs,ions
Code: The Contractor's License Law does not apply to an Qwner of'property J,hb builds or improVes thereon, and who' contracts for .such projects with'
'~ontract9r(s) licensed pursuant e Cgntractor's License Law). ' '1'
U ) a xe t. der Sec. P or this reason:
Date: Own :
WORKER'S C M NSATIOND LARATION
I hereby affirm'under penalty of perjurY:one of the following declarations: 'i
o . I have and will maintain a cert.ificate of consent to self-insure for worker's:compensation,'
as provided fcsr by Section 3700 of the Labor Code, 'for the pe'~ormanCe of the:wOJkfor which
this permit is issued. ,- j
o J have'and will maintain w, orker'$ compensation insur,a~c,e, as required by[sectio,n 3700 of 4/12/2005
the Labor Code, for the performance of the work for which this.permit is issued. Myworker's Date:
Compensation insu' Fancecarrier and POIi,CY are: . '. _. !'
Carner: - " . .. Policy Number."
, ,
isectiOl1 need not be completed if the pennit is for ~ne hundred dollars ($100) pr less. ,
, 'I certify that in the performanc'e ofthe'work for which this permit is issued, I shall not
e ploy any person in any manner"so as to become subject to the worker's compensation laws
of Califomia, arid agree. that if I shQuld become subject to the worker's c.ompeMsation .
. provisions of Section 3700 of the l,.8bor Code, I shall forthwith comply wi~h th~e provisions.
. {
CONTRACTOR INFORMATION:
ARCHITECT/ENGINEER INFORMATION:
I
LICENSED CONTRACTOItS DECLARATION
I hereby affirm under penalty of perjury tha~ lam
licensed unt;:fer provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the BUsiness and
,Professions. Code. .
Contractor
NUMBER
EXPIRATION DATE
TYPE
Date: 4/12/2005 Applicant:
WARNING: FAILURE TO SECUR PENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJE, AN EMPLOYER TO C;RIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LE/liDING AGEN,CY
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.: .
Construc:ion Tvpes:
VN, ,
.Fire Sprinklered?
NO
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby authoriZe rep ntives of this city to enter upon the above mentioned property for
i action purpo
Date: 4/12/2005
. Fees paid for Permit:
Total:
220.26
Signatur~ of Ap cant or Agent.
e perm shall expire by, mitation and become null and void if the building or
work has not passed fi na inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue'work.
, ,
INSPECTION RECORD .
INSPECTION . . DATE INSPECTOR
Temporary P!>wer Pole
.Plumbing (Drain/Waste Pipe) .
Electrical Gr!>und Electrode/Vier
SelbacklFormsITrenches (Footings)
Do. not il1Stall subfloor or.pour floor slab until the .
following applicable items have been signed:
Plumbing (Water l'lpe.sprinkler Valves) .
Mechanical (GroundYrork)
Electrical (Underground Conduit) .
Pre,slab (Compaction/Membrane.Reint.
Underpinning (Floor Joist/Girders)
Do not covet or conceal.the woll< below Imtil the .
following applicableilems have been signed: .
1st Floor Shear .
Firesprinkler (Rough) . .
2nd Floor Shear
Roof (SheathiJl!llDiaphragmlFramll) .
Masonry (ReinfJBond BeamlPre-Grout)
Rough Plumbing (Top Out) .
Rough Mechanical . .'
. : KOugn l:Iectncal (Dry wall) . .. .'
Rough Elecirlcal . . .
Framing (OnlyaherPlbg., EJec.'. Mecl'1.. and Fire) .
Insulation (SoundlEnergy)
Do not tape 'or plaster. until the following applicable . .
items have been si.gned: . " .
Drywall . . . .
Penetrations (Fire Rated) Electrical . .
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing .'
Interior Lath -
Exterior Lath .
GENERAL ITEMS
Exterior Plaster (Brown Coal)
T .Bar Efectrlcal .'
T .Bar Mechanical .
'T.Bar Structural .
'Sewer
Water. Engineering Backflow '. .
Water Service . .
FINAL INSPECTIONS . . Date . Inspector .
Electrical Final , . .
Plumbing'''i"al . "
'.
Mechanical Final '. -.
. .
Gas Test. I
. .
Engineering/Grading Final 765-5126 .
Fire Dept Final 765-4040
Water Engh,!eering 765.5268 -
Sub List/Business License 765-519
;Z:oning 765-5139. -
Building Final *ost Inspection. Only d-;jy -'7 7'
fter Above Complete) .
PARTIAL INSPECTIONS .j) J ,;07 ..
Buildina Inspections
MechanicallnSDections
Plumbina InsDections
ElectricallnsDections
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FLOOD 20'1'1 ~ "nit'.I")
I TORle DISTRIC REVIEW,
NIA S~!a.n:.p_.0.!j_ga~
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SEE BUILDING PERMIT FOR
ANY CONDITIONS
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"'FlOC ~'oDSER OF THIS PERMIT
AT HIS OWN RISK.
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APfT ~ti005
aUILOING DIVISION OF ANAHEIM
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