3181 W. Polk Ave.
TYPE OF PERMIT C
Blockwall/Columns ITY
DATE: 6/9/2005
JOB ADDRESS: 3181 W POLK AVE
LEGAL DESCRIPTION: N TR 1820 LOT 41
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 8
BUILDING PERMIT NO. BLD2005-01764
APPLICANT: FRANSISCO GUZMAN
OWNER INFORMATION: CONTRACTOR INFORMATIONI ARCHITECT/ENGINEER INFORMATION:
Vicente Pineda
3181 W Polk Ave
Anaheim, CA 92801
JOB DESCRIPTION:Build 6' high 65' long block wall per city specifications.
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 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 Professiors 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
~OO).
-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
sal (Sec. 7044 Business and Professions Code: The Contractor's Ucense law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or helSelf 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 build or improve for the pUlpose 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 Ucense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractor's Ucense Law).
D I am e e pt )jllder Sec. . . forthis soo:
"6) . ~~
WO 'S COMP NSATION CLARATION
I hereby affirm under penalty of perjury one of the following declarations:
D 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. Myworker'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.
a I certify that in the performance of the work for which this permit is issued. I shall not
enipIoy any person in any manner so as to become subject to the worker's 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 forthwith c ply with t e provisions.
r
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.
6/9/2005
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Date: 6/9/2005 Applican .
WARNING: FAILURE TO SEC E~OR "'S COMP ATION COVERAGE IS
UNLAWFUL, AND SHALL S JECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUN ED THOUSAND DOLLARS ($100,000), IN ADDlllON TO THE
COST OF COMPENSA ION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OFTHE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
1 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:
VN, ,
Fire Sprinklered?
NO
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 enter upon the above mentioned property for
in e iorf pur
Date: 6/9/2005
Fees paid for Permit:
Total:
125.79
Signature of Applicant or A
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 reCluired to commence or continue work.
City of Anaheim
Building Division
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INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
Setback/Forms/Trenches (Footings)
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 (CompactioniMembrane Reinf.)
Underpinning (Floor Jolsl/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 (Sheathlng/Diaphragm/Frame)
Masonry (RelnfJBond Beam/Pre-Grout) ..IA
Rough Plumbing (Top Out) "
Rough Mechanical
Rough Electrical (Dry Wall)
'Rough Electrical
,Framing (Only after Plbg., EIe., Mec:. And Fire)
!Insulation (Sound/Energy)
! Do not tape or plaster until the following applicable
i items have been signed:
Drywall
!Penetrations (Fire Rated) Electrical
i Penetrations (Fire Rated) Mechanical
! Penetrations (Fire Rated) Plumbing
I Interior Lath
I Exterior Lath
I GENERAL ITEMS
Exterior Plaster (Brown Coat)
T -Bar Electrical
T -Bar Mechanical
T-Bar Structural
Sewer
Waler Engineering Backflow
Waler 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 Lisl/Business License 765-5194
Zoning 765-5139 /
Building Final (Last Inspection - Only l~i5 4AlJoWS/L.. ,
After Above Complete)
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PARTIAL INSPECTIONS
B";ldln~~ ~
~a ,~k ~)?4-r
Mechanical Inspections
Plumbina Inspections
Electrical Inspections
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~ JJHEj ANCE OF THIS PERMIT! DOES
~OT P OVE VIOLATION OF ANY OF
'l<HE\ I DING CODES OF THE! CITY.
~HS H L.,Oe:;R of THIS PERMIT
~ROCE D3 AT HIS OWN .RISK.
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