3151 W. Polk Ave.
APPLICANT: MARIA ROBLES
OWNER INFORMATION:
MARIA G ROBLES
3151 W POLK AVE
ANAHEIM, CA 92801
JOB DESCRIPTION:lnstalJ 150' linear feet of 6' feet high blockwalJ per city standards
VALUATION: 8,500.00
I OWNER-BUILDER DECLARATION
I hereby affirm under pena~y 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 requimsa 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
($500).
a I, as owner of property, or my employees with wages as their sole compe,.1sation, 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 employees, 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 bu ild or improve for the pu rpose 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 exem t und r Sec. . ~ ,B ~.Crdor this.reas9'1LJ ". ,
Date' OJ{ 0 () Owner:C:::> M 2i~~}~
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
JA~ave and will maintain a certificate of consent to self-insure for worker's compensation,
~rovided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
o 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.
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
W, certify 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 workers compensation laws
of Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I s 11 forthwith compl with e provisions.
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BUILDING PERMIT NO. BLD2005-02468
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TYPE OF PERMIT C
Blockwall/ Columns ITY
DATE: 8/8/2005
JOB ADDRESS: 3151 W POLK AVE
LEGAL DESCRIPTION: N TR 1820 LOT 48
CONTRACTOR INFORMATION:
Date: 818/2005 Applicant:
WARNING: FAILURE TO SECU EWORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED lHOUSAND DOLLARS ($100,000), IN ADDITlON 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 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:
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 representives of this city to n r upon the above mentioned property for
inspection~oses.
CC" <
Date: 8/8/2005
Signature of Applicant or Agent
e 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 issuance. A
new permit is required to commence or continue work.
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 565
QUARTER SECTION: B
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
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.
8/8/2005
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Construcion Types:
VN, ,
Fees paid for Permit:
Total:
184.85
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground ElectrodeJUfer
SetbacklFormsfTrenches (Footings) WilDS- l"q /-)ti 1-',:>
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 (SheathinglDiaphragmlFrame)
Masonry (Reinf ./Bond Beam/Pre-Grout) '1-1 C1f" /l. f'w" P. fj
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 ListlBusiness License 765-5194
Zoning 765.5139 /
Building Final (last Inspection - Only r1~i)
After Above Complete) JA-J..Io(.)S(t..\
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PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbina Inspections
Electrical InsDections
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Fcnclne, approv-::d ,:;ubjeG't to CODE: SECTION
18.46.110.110 rr''1uirinj\. all fences/ b!v~k wal!4 and trash
etlr.lo5ures c~~;a;nint !;olid ~urfaGes which are visible to any
public rit,ht-of-way to be planted with either c;lintine.
vine& or fa.st e.,rowint shrubbery ",.'hich will Goreen
the fence or wall surface 1";.0 as to eliminate a,raffiti
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