826 S. Maywood St.
BUILDING PERMIT NO. BLD2005-03572
TYPE OF PERMIT
Blockwall / Columns CITY
DATE: 11/9/2005
JOB ADDRESS: 826 S MAYWOOD ST
LEGAL DESCRIPTION: N TR 3371 LOT 10
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 104
APPLICANT: LUZ HEREDIA
OWNER INFORMATION: CONTRACTOR INFORMATION:
LUZ HER EDIA
826 S MAYWOOD ST
ANAHEIM, CA 92805
JOB DESCRIPTION:Build 39 lineal feet of 6 foot high block wall per city specifications.
VALUATION: 1,000.00 PROCESSED BY: MSM
I OWNER-BUILDER [)ECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's.:Ucense Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, 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 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 subjepts the applicant to a civil penalty of not more than five hundred dollars
~O). ,
I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
sa Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves
there n, and who does such work himself or herself or through his or her own I3mployees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner~builder will have the burden of proving that he
did not build or improve for the purpose of sale).
D 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
,a..Qontractor(s) licensed pursuant to the Contractor's License Law).
U I , exempt under Sec. ,B ..,p.C. f his r ason:
Date:" r- Owner:
WORKER'S CO ENSA ION DECLARATION
I hereby affirm und~r 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
this permit is issued.
D I have and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the performance of the work for which this permit is issued. My worker's
Compensation insurance carrier and policy are:
Carrier: Policy Number:
io section need not be completed if the pennit is for one hundred dollars ($100) or less.
I certify that in the perfonnance of the work for which this permit is issued, I shall not
loy any person in any manner so as to become subject to the worker's compensation laws
of California, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Lair Code, I shall forthwith comply wit~ those provisions.
Date: 11/9/2005 Applicant:
WARNING: FAILURE TO SECUR RKER'~OMPENSATION COVERAGE is
UNLAWFUL, AND SHALLSUBJE T'AN EMPLOYER TO CRiMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDIllON TO THE
COST OF COMPENSATION, DAMAGES AS PROVI DED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under pena~y 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:
I certify that I have read this application and state that the above information is correct. I
;e to com~ly with all_clty..d?-b9.!Q~~a~d sta!~_!~W~ relating to buildi~g consJruction, and
h r by authorIZe representlves--oT-thi~to enter upon the above mentioned property for
. ect~oses.)
~- ~ 4- .=,(L" ~...;. Date: 11/9/2005
o Signatur~ ~r Applicant 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 date of permit issuance. A
new permit is required to commence or continue work.
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code.
11/9/2005
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Construcion Types:
V N, ,
Fire Sprinklered?
NO
\':;,"!'.:'
. """...
.:~~.;~
Fees paid for Permit:
Total:
133.28
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer t;'~
SetbacklFormslTrenches (Footings) I '16.~
Do not install subfloor or pour floor slab until the C
following applicable items have been signed:
Plumbina/Water Pipe/Sprinkler Valvesl
Mechanical (Groundworkl
Electrical/Underaround Conduitl
Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame) ~ .
Masonry (Reinf./Bond Beam/Pre-Groutl 'fI-(8-q;, IY./P<-,/
Rough Plumbing (Top Out) / ')
Rough Mechanical <---
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable
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 (Brown Coat)
T -Bar Electrical
T-Bar Mechanical --' "'..,."
T-Bar Structural -~-~~. .-
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS DATE INSPECTOR
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Cross Connection Control (714)765-4280
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 I{)(~ V~
After Above Complete)
PARTIAL INSPECTIONS
Buildina Insoections
Mechanicallnsoections
Plumbina Insoections
Electricallnsoections
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