2010 W. La Palma
TYPE OF PERMIT
Blockwall/ Columns CITY
DATE: 3/15/2005
JOB ADDRESS: .2010 W LA PALMA AVE
LEGAL DESCRIPTION: N TR 1803 LOT 4
BUiLDING DIvISiON
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTiON: 38
BUILDING PERMIT NO. 8LD200S-00709
APPLICANT: LINDA PATTERSON
. OWNER INFORMATION:
CONTRACTOR INFORMAr:ON:
ARCHITECT/ENGINEER INFORMATION:
. Andrew G Rubalcava
2626 E Hilda PI
Anaheim, CA 92806'
JOB DESCRIPTION:Bulld 6' hi9h block wall a145' long al rear of property.
VALUATION: 6,000.00
i,
'f
PROCESSED BY: ENO
1,
OWNER-BUILDER bECL"'RATION
l here a irm under penao perjury that ,am exempt from the ontractc7$Ucense Law or the allowing reason (ee. 7031. Business and .
Professions Code: any dty or county which requires a permit to construct, 31t~r, improve, demolish or repair any structure, priorto its issuance, also
requires the applicant for such, permit to. file fl signed statement that he is Iic8i\.sed pursuant lathe provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professic'ns:Code) or that he is exempt therefrom and the hasis for the alleged
exemption. Any viblation of Section 7031.5 by any applicsn~ for a permit SIJbj~-;cts t~e a'ppl~c:,i?mt to a civil penattycf not more than-five h~ndred dollars
($500). .: . . ...... . .
00. I, as owner'of property, or my employees with wages as their sole com~nsaIi'?i"J:, Yiill' do the work, arid the structure i~ not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License U~W (foes 'not apply to an owner of property who builds or improves
thereon, and WhO does such work himself or herselfor through his or her ow1 employees, provided that such Improvements are not intended or
offered for sale. If, howev'er.-the bUild,ing or improvement is sold with one yeCrpfcompletion. the owner-builder will have the burden-of proving that he
did not bujld or improve for the purpose 'of sale). . ,j . _ '
[J- I, as the owner o-f the property, all1 exdusively contracting with licensed ecntr"3t.'tors to:constructVle project (Sec. '7044 Business and Professio,r.s
Jade: The Contractor's license La:woes not apply to an owner 'of property ~~_ho builds 6r')~proves thereon, and wt-.o contracts for such projects with
,a.qontractor(s) licensed purSUaA Contractor's Licen aw}.--. ,~ "
LJ I.am exempt under Sec. : _ . or this reason: :i, '
to: zl:i..PY. '.' :'
WOR OMPENSATION DECLARATION
I :, hereby affirm under pen of perjury one.of the following declarations: ~
o I have and will maintain a certificate of consent to self.insure for worker"~comper.satjon,
as'provided for by Section 3700 of the Labor Code, for the performance of the~i.;"ork tcrwhich
'~is~~~~~sU~. _ . ~: t.
o I haye and will maintainyvorker's compensation insurance, as required b)i Section-3700 of
the Labor Code, for the perf9rmance of the work for which this permit is iSSLJi:'~l. Myworker's "
Compensation insuranCe C(8rrier and policy are: . r
Carrier: Policy Number:
i.'
t
LICENSED CONTRACTORS DECLARATION.
ere y a inn u er pen,=, ty 0 perjurY t .at am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Oivsion 3 of the Business ar)d
Professions Code.
3/15/2005
Date:
Contractor
NUMBER
EXPiRATION DATE
. .
This section need not be completed if the pennit is for one hundred dC?lIars ($1 OOlor less.
~ I certify that in the performance of the work for which this permit is iSSUe;~,.1 shall not
employ any person in any manner so as to become subject to the workers compeT'isat\on laws
of California, and agree that if I hould be e subje t he worker's compel1saUon
provisions of Section 3700- of the bar oe, sha ith comply with tt---"Jse provisions,
TYPE
Dale: 3/15/2005 Applicant:
WARNING: FAILURE TO SECURE 0 SCOMPENSATION COVER"GE IS
. UNLAWFUL. AND SHALL SUBJEC AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED USAND DOLLARS ($100,000), IN' ADDnJON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. ' .
CONSTRUCTION LENDING AGENCY
l_i--terebv_'affirm under oenally of perjury that there is C! c.onstructjonle:nd:ng 2(l"3riGyfor the
peiformance of the work for w,hich this permit!s issued (Seo.3097 .eiv ,C):
Lender's Information: .
Construcioll Types:'
VN, ,
Fire Sprinklered?
NO
I certify that I nave react this'appltcation and state that the above info~matlon is correct. I
agree t mply w~h allcity' ordinances and state laws relating to building construction, and
hereb authorize rep~sentlv his city to enter upon the above.mentionee!, property for.
I pion purpo s.
Dale. 3/15/2005
Fees paid for Permit:
. Total:
125.89
gnature of Applicant or Agent
perml hall expire by limitation and become null and void if the building or
k has not passed final inspection 365 days from the date of permit issuance. A
permit is required to commence or continue work.
INSPECTION RECORD
INSPECTION . . DATE' INSPECTOR ..
Temporary Power Pole .
Plumbing (OrainIWaste Pipe) ". . .
Electrical GrOUnd Electrode/uter . . /?/'J.
SetbacklFormsfTrenches (Footings). <~ b?J I ~ A ,
00 not install subflooror pour floor sla unlillhe
following applicable items have been signed:
Plumbing (Water Plpe.Sprinkler Valvlls) .
MllChilnicaJ (Groundworl(j
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane.Rei nt.
Underpinning (Floor Joist/Girders) .
. 00 not cover or conceal the work below until the
.following appli.caQle items have been signed..' .
1 st Floor Shllar .
FireSprinkler (Rough) . .
2nd Fioor Shear . .
Roof (ShllaihinglDiaphragm'Fr..nll) A/J
MaSonry (RelnfJBilIld BearnlPre-GlO\It) .y^~c9J ;r 'C
Rough Plumbing (Top Out) . .
Rough Mechallical .
.1 Rough E1llClriCaI (Dry Wall)
Rough Electrical
Framing lOnlyaherP1bg,: Eli~c.. Meeh and Fire}
Insulation (SoundlEnergy)
po not tape.or pla~ler. untillhe following applicable
Items ha.ve been slgned:-. .
Orywall . . .
Penetrations (Fire Rallld) Electrical . .
I,
f>enetrations (Fire Rated) Mechanical .
Penetrations (Fire Rated) Plumbil1!l
Interior Lath . .
Exterior Lath . . . . . . ..
'. GENERAL ITEMS .
Exterior Plaster (Brown Coal)
T -Bar Electrical
T -Bar Mechan.ical .'.
T -Bar 'Structural .... .
Sewer
Water Engineering Backflow . .
Water Service .
FINAL INSPECTIONS Dale '. Inspeclor
Electrical Final .
Plumbing Final .
.
Mechanical Final .
Gas Test . . . . .
.
Engineering/Grading Final 765-5126 .' .
Fire De!>t. Final 7654040
Water .Engineering 765-5268
Sub List/Business licen.se 765-519
Zoning 765-5139 . . .
Building Final ~asl inspeclion..Only .. ;>-31'(,<t' $~>O
.' C' fter Above Complele)
PARTIAL INSPECTIONS
Buildina .Inspections
Mechanic'allnsDections .
Plumbing Inspections'
Electrical InsDections .
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THE ISSUANCE OF THI PERMIT DOES
~OT APPROVE VIOLATION OF ANy OF
HE BUILDING CODES OF THE CITY
~HE HOLDER OF THIS PERMIT
ROCEEDS AT HI OWN RISK.
FL.OOD ZONE
DISTRICT R VIEW:
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