6196 E. Palo Alto Dr.
TYPE OF PERMIT
Blockwall/Ccilumns CITY
DATE: ,2/8/2005
JOB ADDRESS: 6196 E PALO ALTO DR
LEGAL DESCRIPTION: N TR 5778 LOT 55
,'.
BuiLDING PERMIT NO.BLD2005-'O0359
BUILDING DIVISION'
200 S. ANAHEIM BLVD.,
(714)765 - 5153
INSPECTION REQUEST LINE:
'(714)765- 4626
CENSUS CODE: 565 ~
QUARTER SECTION:' 197 ""';)
APPLICANT: GARY MCKIMMEY
OWNER INFORMATION:.
Gary M Mckimmey
5481 E Santa Ana Canyon Rd
Anaheim, CA 92807 .'
JOB DESCRIPTION: Instail (92') Iinear.!ee! of 3' fee! hi9h retainin9 wail 11
VALUATION: 6,000.00 ' F PROCESSED BY: JNJ
'I OWNER-BUILDERi0~CLARAT!ON --1
. ., hereby affirm under penalty of perjury that I am exempt from the Contra\"1:or'l~ License Law forthe following reaeon (Sec.'7031.5 Business and
Professions Code: any dty or county which reqLiires.a permit to construc~, a119r. .impro....e', demolish or repair any structl,Jre, prlar to Us issuance. also
requires'the applicant for such permit to file a Signed statement that he is !i~~j:ised pursuant to the provisions of the Contmctor's License t~aw (Chap!e'
9)(corrtnencing with Section 7000 of Division3 of the Business and Professii.;-l'::fGcde) or that he is exempt the~trcm and the basis for.the alleged.
exemption. Any viblation of Section 7031;5 by any applicant for a perrnit !3ubiGctst~e' applicant to advllpena!ty of not more than five hun'dred dollars
($500). ',' , ,I " .
o I,as c~ner of property, or my employee5 with wages ,as thei.. SO;€; co;np~~~at;or., will do the wor,k, and the ::!,'ucture is not intended or offered-jor
sale (Sec. 7044 Business a ndPro.fessions'Code: The Contractor's L!cenet:: ),;.~IW does l1.:-,t ~"pry to an owner of property who buitds 0:- improves
thereon..Cjnd who does such work himself or helse\~ ~r thro;.lgn hiS or herm"i!rempioyees, provided tt-,$t sllch imp-rovemer.tz are not intended or
offered for sale. If, however, the building or imprcvement is sole:! w;th one,yo,;;- ofrompletlc.n, thp. owner-builder will r'dve the burden of proving that he
~~t build or improve for the purpose of sale). . on, . . '.
~~: as ihe owner ofthe'property, ar;n exdusively contt2.('ling with !icE::r:sed J..~1r,t(ectors -Co construct the project (SCG. 7044 Business and 'Pr0fess'ians
~, de:, The(;O~,~ractr)r.'s License law d, oes.ryot ;;;PP~I to an, 0, W:1t;~r,of prc.per:.Y~,'!hO bUi,~dS or.im!=,rQ'/ez theroon. ~nd.wh? C9i1trecl.:; far sum projects v(ith
LjQ~tractor.(s) licensed ..pursuant ,~o the Contractor's Lise~se Lav...J. : ~. '. . . .' .
~ e~~t"~rse;wn;.-:- ~ ,~,.c.fOr\h';;;'=~~_~_.____________.. , '
, L..0.,., · ' WORKER'S COMlS"ENSAi1O'.. DECCA... er'~___> ' _ ':-J f UCENSED CONTRACTORS DECLARATI~
!. hereby affirm under .penalty of perjurl ol1&?f tI~efollowjr,g dedarati::ms: '. 'f:,: I. I hereby affirm under p~n3ltycf .perjury that' am
o , I have ~nd .wili maintain"a. certifjcate oJ ~n~-?,n-t,to: ,~It~ins~n<; fc:',j \~O;"!~,c::'4~c9m;;;enSa!jofl, I. ll~en:~d ~ nder ,pr~\iisio!.lS?t cnapter 9 (cO~menCin},
as provided forQY Section 3700 of the LaborCod~,for the ~rfQnr.an~ d.thrw\)...." for whi('.h WITh ::;eC~lon 7COO, of CIVSlOi; 3 oftl1e BUsli1es~ a~...
this oennitis issued,.. . . i ," Professions C..;;de.
D', 'I have and wilLl1}aintain wori.:e~'s.compensatj('.n insurzr.ce, i"15ffiql;in;~.,d; Se.::;tlon 3700 of 2/8/2005
the Labor Ccdl:!, f9"r.the 'p'~"rformance Oftf~'~ WOf~ forwhic.h this penn:t is ;$:.d",t Myworker's Date:
Compensation' ir:~t:$II~, c;8rri~r and policy ~te:
. Carrier: , . ':;':"">'_:.,:.,.':,::;".:.:'.., ..'.:> ,:, ~~ii~,'NumbCr. :'}':_
This S .OH fW,ea ?.@~ba .~;eted if the p.elmit is fur one hundred dojlalS!$'1C(;;:~rles5.
I certjfvtf,~fjr1'ih~<:d~rfQ'n"ance ?fthe,.work for which this pejmit;s ;s~t:<.U;j$hali not.
employ'any per"io'n tn aoy' mennerso :c:lS. t? become ~:~bject.to the worker's t;v-mpEnsat:on laws
of .Califom,ia, and aQree that if I. 'shq~'ld 'beeo.me ~u bje<;t to the worker's con,,:p!,:r.Si:ltfon '
provisions ofSection}J90 of the Labpr Code, I shall fbrthwi~h comply witf; t!~'k~se provisions.
CONTRACTOR INFORMATION:
ARCHITECT/ENGINEER INFORMATION:
Contractor
NUMBER
EXPiRATION DATE
TYPE
Date: 2/812005 Applicant:
WARNING: FAILURE TO SEC.J ORKER'S COMPEN ~'. ';0-:;&
UNLAWFUL,'AND, SHALL SUBJ CT AN EMPLqYER TO CRiMINAL PEN;., TIES ,~NO CIVIL
FINESUPTO OWE HUNDRED1l-10USAND DOLLARS ($100,000). iN ADC,iTI0i< TO THE I
COST OF .COMPENSATION, DAMAGES AS PROVIDED FOR IN SEe; IO~~ 3/06 OF THE '
LABOR cOLiE, INTEREST AND 'ATTORNEY'S FEES. "
-I CONSTRUCTION LENDING AGENCY
I hereby affirm !Jnde,r penalty of~erju'ry t~~t there is a construction ;ef"!d~n~ra~e,j:\.9yfor the
'9~rtorrr:";l:Q.Ge.oft!:le,workjo.r.'whid'lJhls.c~e~m;~ ~is, isslJp.d '(S~r: 3097.,C;'", .!~-:h.. __ ,
Lender's Information:
Construcion T wes:
VN,.
.,....
Signature of Appli
he permit shall expire by limitation 'a and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
309.50
-
. . INSPECTION RECORD FINAL INSPECTIONS . Date Inspector'
INSPECTION . DATE INSPECTOR Electrical Final . . .
. Temporary Power Pole . Plumbing Final . . , .
Plumbing (DrainMlaste Pipe)' . . "
J .' Mechanical Final
EledricalGround Electrode/lifer , lj;asTest ' .
SetbacklFormsfTrenches (Footings) t:, :.-)(-t)7 Ad, . . .
Do not install subfloor or pour floor slab unfit th~ Engineering/Grading Final 765-5126 .
following applicable items. have been signed: .
Plumbing (Water Plpe.Sprinkler Valves) . Fire Dept. Final 765-4040
Mechanical.(Groundwork) . . . . . Water Englneerirg 765-5268'
. .
Eledrical (Ullderground Conduit) . .
Sub List/Business License 765-519' . .
Pre-sJab (CompactionlMembrane.Reinf. . . .
.
Underpinning (Floor Joist/Girders) Zoning 765-5139 . .
Do not cover or conceal the work belOW until tne . BUiiding Final \tastlnspec;tion.Only" I:zz:-:e. /?,;' "//;
following applicable items have been signed: . . fter Above Complete) -. -
1st Floor Shear . . .' , PAR1:IAL INSPE.CTIONS
Fire$prinkler (Roug h)
2nd Floor Shear Buildina Inspections
Roof (SheathingJDiaphragri\lFr . , . '--t::t;t;;- ..' .
Masonry (Reinf./Bond BeamlPre-Growl' .J1: l<U'< . , . .
.
Rough Plumbing (Top Out) /' .(.,,-eifdv'
Rough Mechanical '. . .
Rough ElectrIC all) .' . .
. . .
Rough Electrical , . .
Framing IOn~ after Plbg., Elec., Mech" and Fire) . .
Insulation (SoundlEnergy) .:C- .' .
DO not tape or plaster until the following applicable MechanicallnSDections
items have been signed: ' . . . '. .. '.
Drywall . .
. Penetrations (Fire Rated) Electrical .. . .' '
Penetralions(Flre Rated) Mechanical . . . .
Penetrations (Fire Raled) PJumbi.ng , . ..... .
Interior, Lath. .' . ..
Plb" I . . . .
Exterior Lath . urn me! nSDectlons
. GENERAL ITEMS , . '. . .
Exterior Plaster (Brown Coal) .' '. . . .'
T -Bar Electrical . . ,
"-."-
0' . .,.::.:-:-i":,..:.;.....,, ,.-,_'._
T-Bar Mechanical . . .
".': ~ .. . .."
T .Bar Structural: . .. " . .
Sewer . . . . .
Water Engineering Backflow Electricallnspectiorls . ..
,
Water Service .'
. .
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, ~
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