8805 E. Wiley Wy.
TYPE OF PERMIT
Blockwall/ Columns
DATE: 3/1 0/2005
JOB ADDRESS: 8805 E WILEYWY
LEGAL DESCRIPTION:
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BUILDING DIVISION
200 S. ANAHEIM BLVD
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 565
QUARTER SECTION: -:to s
BUILDING PERMIT NO. BLD2005-00670
APPLICANT: BRAD BENSON
OWNER INFORMATION:
BRAD BENSON
8805 E Wiley Way
Anaheim, CA 92808
JOB DESCRIPTION: Install 41' linear feet of 6' feet high blockwall per city stan~ards and (1) 6' feet high pilater per city standards
VALUATION: 2,000.00 . ( PROCESSED BY: JNJ
I OWNER-BUILDER tiEClARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's,lic~nse Law for the following reason ($ec. 7031.5 Business and
Professions Code: any city or countywhichrequ.ires a permit to construct, afte,#, -improve demolish or repair any structure, prior to its issuapC6: also
requires the applicant for such pe'rmit to file a signed statement thathe.is Iicel'i.3ed pursuant to the provisions of the Contractor's License Law.(Chapter
9)(commencing with Section 7000 of Division 30hhe Business Clnd Professio~\s Code) or that he is exempt therefrom. and the basis for: the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subj~cts the applicant to a dvil penalty of not more than five hundred dollars
!f$?)~s owner of property, or my emPlOyees, w,' ith wages.as their sole coml"',':"salicn, wili do the. .work, -and the structure is not int~nded o~ offered fer
$, (Sec. 7044 Business and Professions Code: The Contractor's License I..~.,v does not appiyto an owner of property who builds or improves
th reon, and who does sud1 work himself or herself or through his or her own~mployees., provided that such improvements are not intended or
offered for Sale. I~, however, the building Oi improvement is sold with.one yea~{of ro~pletion, .the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale). "r
D !, as the oWner of the property, am exdusively contracting with licen3ed otntra~ol::' to construct the ~,roject (Sec. i044 6usiness and ProfeSsions
Codl3: The Contractor's License law.does. not app' an ow I" of propelty\,)ho buijd~ or improves thereon. ar:d who .contrac~s for such projects with
~Oritfaclor(s) licensed pursuant to the ContI" . 1'" lcen....' \f). ,.\..' .
LJ . j am exempt un.der Sec. ,.- 1"" i '1.-
Date: Owner: .
WORKER'S MPENSATIONDEC RATION ._:L ..i"'~
! hereby affirm under penalty of perjury one of the following declarztions: \(~.
[] I have arid will maintain a certificate of oonsent to self~in5L!re for worker's;;orr:pellsation,.
as proVided for by Se~ion. 3700 of the Labor Code, for the performa:1ce ofthe'f.vorl< forwhich
this permit is issued. . r..
[] I have and will maintain worker's compensaticn iAsurance, as required bit;ection3700 of
the Labor Code, for the performance of the. work fOol" which this penn it is issue(~Y' Mywork9('s.
Compensation insurance carrier and policy are:. 'I~
Carrier: . Polley Nu mber:
~'S :;ection need not be completed If the pennit is for one hund~ed dollars ($1 CO) ~; i"es"s. ..
I certify that in the pertOnnance of the work for which this permit is issued"1 shaJlllOt
m l y any person in a ny manner so as to become sub' ect to the ~orker's cort~peilsaticn laws
California, and agree that if I should.become ect the' ..er's com r;sa on "
provisions of Section 370Q'ofthe LaborCo '. Is orthw' c ply.' l~ provisions.
CONTRACTOR INFORMATION:
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATIQNl
I hereby affir011Jnder penalty of perjury that I ar:1
ilcensed under provisions of chapter 9 (commencing
with Section 7000) of Dil/sion3 of the BIJsiness and.
Professicns Code.
, ~/1 0/2005
Date:
Contractor
NUMBER
EXPIRATlor. DATE
TYPE
Dat"e: 3/10/2005 Applicant:.
WARNING: FAILURE TO SECURE 0 K OMPEN ATION COVERAGE IS .
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL'i'rES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOlLARS ($100,000), IN ADDiTfON 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
t hereby affirm under penalty of perjury that there is a construction lending ag~:1cy for the
performance of the work for whid1 this permit is iSSUl'~d (Sec.30A] .eiv.C)' . ...._.'
LenC1er's Information: .-
Construcior. Types:
V N, ,
I certify that I have read this application and state that the above information is correct. I
agree to comply with all ci dinances and state laws relating to building construction, and
hereby authorize re ntive his city to nter: the above mentioned property for
inspection pur
Date: 3/10/2005
Fees paid for Permi~:
Total:
164.94
ature of pplicantor Agent
The permit shall expire by limitation and become null and void if the J:.uilding 0<
work has not passed final 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 Power Pole .
Plumbing (DrainlWaste Pipe) .
'Electrical Ground Ele'ctiodelUfer d /
. SetbacklFormsfTrenches (Footings I. 5- V t-(/r:' Lt,
Do not install subfloor or pour floor slab until the
.following applicable-items have beeD signed:
Plumbing (Water Plpe.Sprinkler Valves)
Mechanical (Grouixlwork) : . I
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane.Reinf.
Underpinning (FlOOr Joist/Girders) .
Do not cover or conceal the work below ul)lll tne .
.following appli.cable items have been signed: .
1 st Floor'Shear . .
Flresprinkler (Rough)
2nd Floor Shear . . . .
RQof (Sheathing/Diaphragrn'Fr-A\ .
Masonry (ReinfJBond Belm/~e-Gl'O\It) ./
Rough Plumbing (Top Out) .' . I
Rough Mechanical . . .
Rough Electrical (ury wall) ./1
Rough Electrical ./
Framing (Only after PJbg.. Elec__ t...lech" and Fire}
Insulation (SQUndlEnergy)
po not tape or pla~ter until the fol.lowing appli.cable .'. j
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 (arown Coat) . .
T .aar Electrical
T -Bar' Mechanical.
T -Bar Structural .
Sewer . .'
Water Engineering Backflow .
Water Service '.
fiNAL .INSPECTIONS Date InSPector
Electrical F.inal . . .
~rumbing Final .
, .
Mechanical Final
Gas Test . .
,
Engineering/Grading Final 765-5126 . . .
I .".
~ire Depl. Final 7654040 '1
Water Engineering 765-5268
I . ',' .
Sub L.ist/Business License 765-519 .
,
'toning 765-5139 . .n
Building Final ~asllnspection- onl~i/ ~.$l{A 1--.4. '//,,1
I fter Above Complete
I PARTIAL INSPECTIONS
B.U. i1dina In. ~tions. '. J
s--,g.or. . eu::t-
I .
MechanicallnsDections
1 . .
Piumbina InsDections
I .
ElectricallnSDections