1703 William Miller
BUILDING PERMIT NO. BLD20.05-00858
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765" 4628
CENSUS CODE: 565
QUARTER SECTION: 43 ./1
TYPE OF PERMIT C
BJockwall1 Columns . I TY
DATE: 3/31/2005
JOB ADDRESS: 1703 S WILLIAM MILLER DR
. LEGAL DESCRIPTION: N TR 1808 LOT 34
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APPLICANT: KHAliL SHAABAN .
OWNER INFORMATION:
Khalil Shaaban
.,i03 S William Miller Dr
Anaheim, CA 92804 .
JOB DESCRIPTION: Install 69' linear feet of.6' feet high block wall per city slaniards
VALUATION: 1,000.00. I . PROCESSED BY: JNJ
I.. .. .' OWNER-BUILDER It~LARATION . . . '. . .
I hereby affirm under penalty of perjury that J am exempt from the Contractor'~ License Law for the fotlowing reason -(Sec. 7031.5 Business and
'Professions Code: ahy oty or county which "requires 8: permit to construct, alt~:., tmpiOve, demolish or repair any structure,-prior to its issuance, also
requires the applicant for such permit"to file a signed statement that he is lice.\ked:pursuant to the provi"sions of the" Contractar's license Law (Chapter..
9)(commencing with Section 7.000 af Division 3 of the Business a nd PrafessiflnsCode) ar that he is_ ,exempt therefram and the. b(:jsis .far the alleged
exemptian._ Any violatian of Sectiori7031.5 by any applicant for a permit sUbj.;2cts the applica!1t to a dvll penalty of nat more than;five hundred dollars
($500). .' . '.,'., '.
~as awne.rpf. property, or., my emplo.yees with wages as tll.,eir sole ~amp~:{ls<~tio.n, Will. do t1~ewo.rk, <:I.nct th.e.structure is nat in. t.li!'nded ar o.ffered for
lale (Sec. 7044 Business and Professions Code:- The Contractar's Lic~nse_ Lrh"does net apply to. an owner of pro.perty who. .builds o.r improves
therenn, .and, who. daes such work himself o.r halSel! o.r through his ar her owd ~mplo.yees, pro.vided that 'such impiovements a re nat intended o.r. .
affered far sale. If,_hawever, the building o.r impravement is sold ~itli uneyea~af c:ompletion, th~ o.wner-builder will h~ve the-burden of proving that he
did not-build or improve far the purpo.se af sale)... :." .., .
o I, as'.the owner af the prop~rty, ~m exdusively contracting with licel's.ed ;:.?!~t:ractors to. canstruct the'oroject (See. 7044 Business and Professio.r,s.
Code: The Contractor's License Law does nat apply to an owner of praperty ;.NHO builds ar improves thereon, and who. contracts for sudl prajects with.
Fl..qantractar(s{ licensed pursuant to. the Contractor's""l.{cense Law). , _ ,'. (
U I am'exem tunder. Sec.' ,e & P.C. fO/thiS ~e7s~' __~;..-'
Date: M - ---: Owner:. ~ A/k~..,,;> ~ -f---:!---
WORKER'S COMPENSATION DECLARATION i
I hereby affirm under penalty of perjury one of the following declarations: t .
~I.have and will.maintain a c~rtifjCat.e of oonsent toself-irisure for worker'~~ compensation,
provided far by Sect.ion 37.00 of the-Labor Code, ,for theperformance afth:'..Y,ark far which I
his permit is issued. . ': . .
o . I have and will maintain worker's campensation insurance, as required by SectiOn 3700 of
the Labor Cade, for the performance.of the work tor which this permit is 'issued. Myworker'!'l
Campensation insurance carrier and policy ~re: i
Carrier: Policy Number:
Thi~ section need not pe completed if the pennit is for ane hundred dollars ($10C) lejr less.
~ertify,that in the perfarmance otttie wark for which this permit is issuEd.: shaH not
ploy any person in.any marmer so as to become subject to the warker's cnri":pensation laws
f Califomia, and agree that if I should become' su bject to the worker's Gampensation
provisians of Section 3700 of the Labor Code, I s all farthwith camply with thote provisions.
CONTRACTOR INFORMA~'ION:
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION
I hereby a irm under penalty of perjury that I am
lICensed under provisions of chapter g. (commenting
with Section 7000) of Divsion 3 of the Business -and
Professions Code. "
3/31/2005
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Date: 3/31/2005 Applicant:
WARNING:' FAILURE TO SECURE WORKER'S COMPENSATION COVEFiAGE IS
UNLAWFUL, AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENAtTiES AND CIVIL
FiNES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000),!N ADDiTiON TO THE
COST;OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION'LENDING AGENCY _
Iherehy affirm under penalty of perjury that there is a can~ructian lending ag'~ncyfor the
pp"rfarl'T'lClnce' afthe.work for which this permit is issued (Sec.3097.Civ.C):
Lender's'lnfarmation: .
Construcion Types;
VN, ,
I certify that I have read this application and state that the above info.rmation I~; correct. I
. agree to comply with ,all city ordinanc~es and ,state laws relating to. building constructian, and
hereby autho.rize representives of this city to. enter upon the above mentio.ned property for
i spection pur ses. .:.,...J.. J,J..J-...d _ t-- .
""'- ;l.kL f ~ t:.. Date: :1I31/2005
Signature af Appli.cant or Agent
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 dale of permit issuance; A
new permit is. required to commence or continue work. .
Fees paid for Permit:
Total:
125.79
INSPECTION RECORD
(,"
INSPECTION DATE. . INSPECTOR
Temporary Power Pole. .
Plumbing (DlainlWaste Pipe)
Electrical Ground Electrode/lifer /1 / I:
SelbacklFormsrrrenches((FOotinbs.i> Vt.>>/", - (I.
Do not install subfloor or pour lIoor slab until the
following applicable Itemshave.been Signed:
Plumbing (WaterPipll.Spriilkler Valves)
Mechanical (Groundwork) .
Electrical (Underground Conduit) . . ..
pre-slab (Compaction/Membrane.Rei nt. . .
Undet:'pinning (Floor Joist/Gilders)
Do not coveror conceal the work below until the
follOWing applicable .tems have been Signed:
1 st Floor Shear . .
Firesprinkler (Rough) .
2nd Floor Shear . . A. I
Ro~~DiaphragmlFrame)
Maso InfJBond BeamlPre-Grout) "h)"'; 1J<ft. I, rl
Rough Plumbing (Top Out) . .
Rough Mechanical .
Rough ElectrIC . ....II) ..
Rough Electrical --
Framing (Only after Plbg.. Elec.. Mech.. and F;re)
Insulation (SoundlEnergy)
Do not tape or plaster until the fOllowing applicable
items have been signed: ' .
Drywall . . .
.Penlllratlons (Fire Rated) Electrical
Penlllratlons (Fiie Rated) Mechanical
Penlllrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath ..
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T -Bar Electrical
T-Bar Mechanical
T -Bar Structural .
Sewer
Water Engineering Backflow .
Water Service .
:'
, .
FINAL INSPECTIONS Date Inspector.. ..
Elllctrlcal Final . . .
Plumbing Final
Mechanical Final .
Gas Test .
.
Engineering/Grading Final 765-5126 . .
Fire Dep!' Final 765-4040 ...
Water Engineering 765-5268 ..
Sub List/Business License 765-519
Zoning 765;5139 .
Building Final ~astlnspection- Only (jrJ~S
fler Above Complete) ,.,r.
PARTIAL INSPECTIOfllS
Buildina Inspections
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Mechanicallri.spections
Plumbinalnspections
.Electricallnspections
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