2668 W. Shadow Ln.
APPLICANT: ANDRES MORAN
OWNER INFORMATION:
AOdres Moran
2668 W Shadow Ln
ANAHEIM. CA 928010000
JOe DESCRIPTION:Add man door at garage.
VALUATION: 300.00 \.
I . OWNER-BUlLOEi(OECLARATION
! hereby affirm underpenalty ofperj~ry thaU am exempt from. the Contractc(~ Ucens~ Law for the following reason (Sec. 7031..5 Busines~ and
Professions Code: any city or county which requires a permitt9,const_;'u.(..:t..a:~~r. improve, demolish or repair ;3ny structure, _priOr to lis issuance, _also
requires the applicant for such permit to file a signed statement th~t he is!k:l'1!':P.d pursuant to the provisions cf the Cont~ctor's License Law (Chapter
9){commencing wl.thSectlon ,7000 of Division 3 of the Business aJ1<.fJ)r~fes:i.::ris Code) or that he is exempt therefrom and the basis forthe alleged
"exemJ)tioh. Any violation of Section 7031.51Jy aryy apptic;:mt for B:permif Stlb:ects the applicant -to a civil penalty of not more.than five hundred dollars
$500): .. . ..Y . . .. .
r s_ow'ner cf property, or my employees'with wages as th...~ir $Ol~'C',or-'.!~~j\~ation: Will do the-work, and the stluctwe is !lot inte-ndedor offered for
e Sec. 7044 !3usiness and Professions Cod.e: The Contractor's Lir.:;:..:msoJ";J:~ dop.$ not aoply to an owner cf property who bui!os Ot improves
fhcreon;-and who. does sum work himself or' herself or through his or her Oi.:~,-enjp!cy,?es; provided that such improvements afe not intended or
. offered for sale, If, however, the build!ng or Irnprovemer.t is sold with Cine Y~2~ of compietion, the owner-builderwHthavE'!_the bur~en of -proving that he
di.:,jrotbuild'orimprovefortheplJrposeofsale). . -- . " .
0'1, :;:IS the owner of the property, am eXdusiveiJ' c')ntract:ng with licefl;:~~d!(~J:1tii''!ctors In con.'5tructthe projecl (See. 7044 8usines.s 8.nd Professions
Code: -The' Contractor's License law does nofapp-Iy to an o\,me!' of"prop-e~l.~;N b~iid13 or improves thfjreOrl, ar0- whu contn:l~;ts fOr such projects with
Montractor(s) lican;;:ed- pursuant to the Contractor's Ucenoo law).-' .
1:.-1 Jam t::xempt under Sec. ____ ,88. P.C. .for this rEiC;:lson: ~._~~~~__
Date:,,-,-:3-.71-o5" Owner: ~". . . __. t.,_.
U. - WORKER'S-' PENSATiONJ)ECLARATIQ.iL....::.\.~..-J
I hereby affirm under penalty 6fperjury one ofth,e follewing declarations:, _ .
. rq:;; nave.' and-'wiIl maintain a certjfica~e of Consent to. S;;1f-il1sur.~ for worke1-s.~ornpe. nsatfon,
~.provided for by Section 3700 of the Labor Code, for the pe!formant;;e of';:!-!ework ro,.vl1ieh
this per.mit is issued. . . -::: ;
o I have I'lndwllI maintain worker's COIT'!pensat!C<r"I insurance, asreql.lired i:.'} .Section 3700 of
the Labor Code, for the. performanqe of th!';:l work fcrwhicn1his permit Is iss,;t~-.i" Myworker's
Compensation insurance cartier and policy. are: . ,.
Carrier: Polic..y Number:
BUILDING PERMIT NO. BL02003-04375
TYPE OF PERMIT
Miscellaneous' CITY,
DATE: 3/28/2005
J6B ADDRESS: 2668 W SHADOW LN
LEGAL DESCRIPTION: N TR 2332L01 119
CONTRACTOR INFORiv'.~TION:
BUILDiN(3 DIVISION
200 S. ANAHtiM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765- 4626
CENSUS CODE: . 434
QUARTER SECTION: 18
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: SAM.
----~--~-
lICENSE~.:cONTRACTORS OECLARATi~N 1
I hereby ?ffirm under pena.lty of perjury that I am
licensed under 'pravi~ion~ of chapter 9 (commencing
with Section 7"000) cf Oivsk?n 3 ofthe BlJs:ness and
Professions Code.
3/28/2005
Date:,
. NUMBER
~:rhiS section need .not be completed if the pemlit is fo:- one hundred doH~~s ($1 oi.1 ::)(Jess.
certify that in the perfolT11ance or the work far which this pertlJU:_~ !ssu~ri~ I shall not
. ploy any person in any manner so as to become subject to the ~brker's CC1.T,'pensation raws
oT California. ahd agree that if I should become subject to the work~r,'s c6mj)l~;~3ation
provisions?f Section.3700 of the labor Code, , sh~ll forthwith complywlth tho"lse preVisions.
TYPE
Contractpl
EXPIRATION D~ TE
Coristrucion Types:
V N. . .
Fire Sonnklered? . NO
Date: 3/28/2005 Applicant:
WARNING: FAILURE TO SECU
UNLAWFUL. AND SHALL SUB CT.AN EMPLOYER T0 CRIMINALifENAtTiESAND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100.000)/jj~. ADD,TjDNTO THE
COST OF COMPENSATION. DAMAGES ASPROVIDED FOR.IN SEt'nON 3706 OF THE
LABOR CODE, INTEREST.AND ATTORNEY'S FEES.
r CONSTRUCTION LENDING AGENCY
I hereby afftrm under penalty of perjUry that there is n construction ler.ding a.!Je;'cyfor the
(I€:rformance of the work fot which fh:s,oercrnf i'i isc:.ued (Se':.3(~LG:'J eL') ~ ._
~'t:ntf~rs._~j:(I!ln3Iior.: . -
I certify,that'l have read. this application,aOO.state that the above information is correct. I
agree to comply with aU'city ordinances and state _laws relating to building COl1struction, and
hereby authorize representives of this city to eriterupon the'above mentioned property for
ins ectjon purposes. .. .
"
. Date: 3/28/2005
Signature of Applicant or Agent
The permit shall expire.by limitation and become null and void if the building or
work has not passed finalinspection 365 days from the date of permit issuance. A
new permit is required to commence. or continue work.
Fees paid for Permit:
Total: 111.82
INSPECTION RECORD
INSPECTioN . DATE INSPECTOR
Temporary PowerPole
Plumbing (DrainlWaste Pipe)
Eledric;al Ground Elec;trodelUfer
SelbacklFormslTren<:hes (Footings) ..
Do not install subtloor or pour tloor slab until the
following applicable items have be.en signed: .
Plumbing (Water Pipe.Sprinkler Valves) .. .
Mechanical (Groundwork) .
J::ledrical (Underground COndu it)
Pie-slab (Compaction/Membrane.Reinr.) ..
Underpinnlng(Floor Joist/Girders) . .
Do not cover or conceal the war!< below unlflthe
following applicable items have been signed:
1 st Floor Shear .. .,
Aresprinkler (Rough)
2nd Floor Shear . ...
Roof (SheathinalDiaphragmlFrame)
Masonry (ReinfJBond BeamlPre-Grout)
Rougl\ Plumbing (Top Out) .
Rough Mechanical
IlUlugn t:IectrlCallury waU) 3
Rough Electrical
Framing '(Only after Plbg.., Elec.. r...lech.. and Fire)
Insulation (SoundlEnergy) .
Do not tape or plaster until the fQllowing applicable ..
items have-been signed:' , .
Drywall .. . ,
Penetrations (Fire Rated) Electrical . -.
P8I'lelra\Ions (Fire Rated) Me<:hanical .
Penetrations (Fire Rated) Plumbing ,
Interior lath .
Exterior lath . .. .
. . GENERAL ITEMS
Exterior Plaster (l!rown Coat) ,
T .Bar Electrical
T.Bar'Mechanlcal . . .
T.Bar Structural
Sewer
Water EngIneering Backflow
Water Servic:e
FINAL INSPECTIONS Date . lri~ector .
Electrical Final . ; (. .~
Plumbing Final .
Mechanical Final . . .'
Gas Test.
Engineering/GradillgFinal 765-6126 .
c . ' ' .
Rre Dept, FI.nal 765-4040
Water Engineering ,765'5268
Sub List/Business License 765'519
Zoni!lg765-5139 .
Building Final Ikast Inspection- Only Jf J ..J~' .r.~ .
. fter'Abov~ Complete) ---V' ..
PARTiAl INSPECTIONS . 'Ie..
. Buildinalnspections
~I-J
Mechaniclilllnspections
, PlumbinQ'lnspections
ElectricallnSDections .
-$-H-A~ C) W
L 4tJ'ir;.
s~
PLANNING DEPARTMENT
AP RO;VFn
DATE (t I D O~
'^
..?f'
~
,...j
r
~
. G AC iON
BY
FLOOD ZONE
(Initia.lo;:.)
r....o"'-!- Doo
~
HISTORIC DISTRICT REVIEW.
,~ See stamp Jrlis paRe'
~ one on above line
SEE BUILDING PERMIT FOR
ANY CONDITIONS
~~ rTOV ~
lJ'"~
6'1-/":/1- HOU'5G
.)
.
/
Ai7P RE-6>sfl 2- (p(p8 . w- Sh::iJO&0 LY)
AV'?thG'fM, ~'12801