2543 E. Park Ln.
TYPE OF PERMIT
Blockwall/ Columns CITY
DATE: 717/2005
JOB ADDRESS: 2543 E PARK LN
LEGAL DESCRIPTION: N TR 5501 LOT 24
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 565
QUARTER SECTION: 121
BUILDING PERMIT NO. BLD20OS-02092
APPLICANT: ALBA BELTRAN
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
MARTIN D CORTEZ
600 S WALNUT ST
ANAHEIM, CA 928020000
JOB DESCRIPTIONlnstaIl113' linear feet of 6' feet high block wall per city stand3rds
VALUATION: 3,500.00 PROCESSED BY: ENO
I 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. 7031.5 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 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 subj&~ts the applicant to a civil penalty of not more than five hundred dollars
ErO).
".,. 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
sale (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 does such work himself or herself or through his or her own €~mployees, 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 cc.ntractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of propertywilo builds or improves thereon, and who contracts for such projects with
[_ ntractor(s) licensed pursuant to the Contractor's License Law).
I e~empt under Sec. _", B & P.C. for this reason:
: - - Owner:
WORKER'S COMPENSATION DECLARATION
i hereby affirm under penalty 01 peljury one of the following declarations:
o J have and will maintain a certificate of consent to se~.insure for worker's compensation,
as provided for by Section 3700 of the labor Code, for the perlormance of the "Nork 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. Myworker's
Compensation insurance carrier and policy are:
Carrier: Policy Number.
Thissl!Ction need not be completed ilthe pennit is for one hundred dollars ($100) or less.
~ertify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the worker's com'pensation laws
of California, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the labor Co shall forthwith co I with those provisions.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Oivsion 3 of the Business and
Professions Code.
8/11/2005
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Date: 8/11/2005 Applicant
WARNING: FAILURE TO SECUR ORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJE T AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED, OUSAND 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 construction lending agency for the
performance of the work for which this permit is issued (Sec. 3097 .Civ .C):
Lender's Information:
Construcion 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 city ordinances and state laws relating to building construction, and
hereby authorize rep ntives of this city to enter u the above mentioned property for
inspecti urpa
Date: 8/11/2005
Fees paid for Permit:
Total:
184.50
i a ure of Applicant or Agent
The p .mit 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.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Uter
SetbacklForms/Trenches (Footings)
Do not install subtloor or pour tloor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane 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-Grout)
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
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 ~bbl~ 4~
After Above Complete)
PARTIAL INSPECTIONS
Building Inspections
Mechanicallnsoections
Plumbing Inspections
Electricallnsoections
..
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TYPE OF PERMIT
Blockwall/Columns CITY
DATE: 7/7/2005
JOB ADDRESS: 2543 E PARK LN
LEGAL DESCRIPTION: N TR 5501 LOT 24
Vj;.~ilhf"?'~
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ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 565
QUARTER SECTION: 121
BUILDING PERMIT NO. BLD2005-02092
APPLICANT: ALBA BELTRAN
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
MARTIN D CORTEZ
600 S WALNUT ST
ANAHEIM, CA 928020000
JOB DESCRIPTIONlnstaIl119' linear feet of 6' feet high block wall per city standards. (Supplemental 8/12105)
VALUATION: 3,500.00 PROCESSED BY: MSM
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 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 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 subjects the applicant to a civil penalty of not more than five hundred dollars
~$ O~)~s 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
th reon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or
off red 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
p....qontractor(s) licensed pursuant to the Contractor's License Law).
U eJdm1pt under Sec. . for thi as
Date: Owner:
WORKER'S COM ENSATION 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 pertormance of the NarK for which
this permit is issued.
D J 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. Myworker's
Compensation insurance carrier and policy are:
Carrier: Policy Nu mbe r:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencin g
with Section 7000) of Dlvsion 3 of the Business and
Professions Code.
8/1212005
Date:
Contractor
NUMBER
EXPIRATION DATE
This 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
e lay any person in any manner so as to become subject to the worker's compensation laws
o alifomia, and agree that if I should become subject to the worker's comperdation
provisions of Section 3700 of the L or 0 all forthwith comp h those provisions.
TYPE
Date: 8/1212005 Applicant:
WARNING: FAILURE TO SECUR ORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJ T AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED OUSAND DOLLARS ($100,000), IN ADDIllON TO THE
COST OF COMPENSATION AMAGES 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 construction lending agency for the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lende~s Information:
Construcion Types:
VN, ,
Fire Sprinklered?
NO
I certify that J have read this application and state that the above information is correct. I
agree to comply with all city ordinances and statf;i laws relating to building COnf".t,:uction. and
hereby authorize representives of this city to r. on the above mentioned property for
il15p ction pur
Date: 8/12/2005
Fees paid for Permit:
Total:
220.26
gna ure of Applicant or Agent
111 permit shall expire by limitation and become null and void if the building or
woik has not passed Ii 001 inspection 365 days Irom the date 01 permit issulllCe. A
new permit is required to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormsrrrenches (Footings) 't.1J.o'T 12. t1...-. If
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 Reinf.)
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/Diaphra9m/Fr~e) I-;:i\~
Masonry (Reinf./Bond Bealjl1'Pre-GrO!/1) ~l.<1\ _I
Rough Plumbing (Top Out) '--- . \-
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Me<:. 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
Engineering/Grading Final 765-5126
Fire Dept. Final 765.4040
Water Engineering 765-5268
Sub List/Business License 765.5194
Zoning 765.5139 I'
Building Final (Last Inspection - Only ~\,A rtI .~^ \ ~II /'" L-
After Above Complete) II'
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections
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PLANNING DEPtlRTMENJ
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