5498 E. Willow Woods Ln.
BUILDING PERMIT NO. BLD2005-02793
TYPE OF PERMIT C
Residential Remodel ITV
DATE: 9/6/2005
JOB ADDRESS: 5498 E WILLOW WOODS LN A
LEGAL DESCRIPTION:
APPLICANT: KENNETH LAMB
OWNER INFORMATION:
JON POLENTZ
5498 E WILLOW WOODS LN #89
ANAHEIM, CA 92807
CONTRACTOR INFORMATION:
KENNETH S LAMB
2169 MINER ST
COSTA MESA, CA 926270000
BUSINESS PHONE: 949631.6739
JOB DESCRIPTION:Construct a new door from the garage to the kitchen.
VALUATION: 900.00
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION:
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: MSM
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Ucense Law for the following reason (Sec. 703 .5 Business and
Professions Code: any city or county which requires a permit to construct, alter. improve, demolish or repair any structure, prior to its issuance, also
requires the applicant for such permit to fjle 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 Professions 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 applicant to a civil penalty of not more than five hundred dollars
($500).
o I, as owner of property, or my employees with wages as their sole compe;,sation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License Lcw 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 smployees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one yeaI' of completion, the owner-builder wUI 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 contractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of property who builds or improves. thereon, and who contracts for such projects with
~ontractor(s) licensed pursuant to the Contractor's License Law).
U I am exempt under Sec. , B & 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 compensation,
as provided for by section 3700 of the Labor Code, for the performance of the work for which
~ permit is issued. ,
I have and will maintain worker's compensation insurance, as required by Section 3700 of
Labor Code, for the performance of the work for which this permit is issued. Myworker's
ompensation insurance carrier and poliGY are:
Carrier: STATE PUND Policy Number. 1263662
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, I shan not
employ any person in any manner so as to become subject to the workets compensation laws
of Califomia, and agree that if 'should become subject to worker's compensation
provisions of Section 3700 of the Labo Co' e, I shall fa w' comply with those provisions.
Date: 9/612005 Applicant:
WARNING: FAILURE TO SECURE
UNLAWFUL, AND SHALL SUBJECT N EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINESUPTO ONE HUNDRED TH 'SAND 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 LENDING AGENCY
I hereby affirm under penalty of perjury that there is a oonstruction lending agency for the
performance of the work for which this permit is issued (See.30g7 .Civ .C}:
Lender's Information:
l.certify that 1.1:t_~ve read this application and state that the-above information is;orrect. ,
agree to oomply with all city ordinances and state laws relating to building construction, and
her y authorize represen' es of this city to enter upon the above mentioned property for
in ion urpose
Date: 9/6/2005
Sig e of Applicant or Agent
The permit shall expire by limitation and becorre null and void if the building or
work has not passed final inspection 365 days from the date of permit issuMce. A
new permit is reqUired to commence or continue work,
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
lh;ensed under proviSIons of ch (commencing
with Section 1000) of Divsion 3 of th Business and
Professio s de.
9/6/2005
Date:
NUMBER
422856
TYPE
EXPIRATION DATE
5/3112006
B
Construcion Types:
VN, ,
Fire Sprinklered?
NO
Fees paid for Permit:
Totat:
113.63
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainJWaste Pipe)
Electrical Ground ElectrodelUfer
SetbackIFormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Relnf.)
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 (ReinfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall) I
Rough Electrical ]; II OwU
,c
Framing (Only after Plbg., Ele., Mec. And Fire) , .1 II fJ~ (A,
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable
items have been signed:1
Drywall iOI!' fiJ~ rrw (;e
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (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
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only 10 1/
After Above Complete)
INSPECTOR
/, &
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections