117 E. Simmons Ave.
TYPE OF PERMIT
Blockwall/ Columns
CITY
t~~"~~~~~~\. .
~..~'~E1~J.\N.iH ElM
\ .,0!l..j,.,"2<....,_;._~-;:&"'-_.J ,j
-,-~ .~.~,.;,:>.-;,--til 'j
. \~?~PJti~>/
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE:
(714) 765 -4626
CENSUS CODE: 565
QUARTER SECTION: 99
BUILDING PERMIT NO. BLD2q04-03433
DATE: 9/9/2004
JOB ADDRESS: 117 E SIMMONS AVE
LEGAL DESCRIPTION: ORANGEWOOD TR LOT 9 PbR OF LOT
APPLICANT:
OWNER INFORMATION:
PHUC HUYNH
117 E Simmons Ave
Anaheim, CA 92802
JOB DESCRIPTION Install 90 lineal feet of 6 feet high block wall fence
VALUATION: 3,500.00
I OWNER-BUILDEr: DECLARAT!ON
I hereby affirm under penalty of perjury that I am exempt from the.Contractcl:'s License Law for the following reason (Sec. 7031.5 Business ?lnd
Professions Code: any city or county which requires a permit to construct, a'iier, improve';demolish or repair any structure; prior to lts issuance, also
requires the applicant for such permit to file a signed statement that he is lic?nsed pursuant to the provisions of the Contractor's Licellse Law (Chapter
"9)(commencing with Section 7000 of Division 30t the Business and Professbns 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 su~iects the applicant to a dviJ penalty of not'more than five hundred dollars
_~ . 1 . .
D I~. as. owner of property, or my employees with wages as their sole comRensation, wilt do the work, and the structure is not intended or offer~d tor
sale (Sec. 7044" Business and Professions Code: The Contractor's Ucef'~e i_oW does not apply to an owner of property who builds or)mpro....es
thereon, and who does such work himself or herself or through hjS: or her o.th employees, provided that such ill1prov~mcnts are not intended or
offered'fot sale. If; however, the building or improvement is sold wi~h.one yEar of completion, the owner-bljjlder wm have the burden of proving that he
did not build or improve.for the purpose of sale). "; . .'
o I, as the owner of the property, am exdusively contracting with licensed;' ccnt~adors to construct the prcject (Sec. 7044 Business and Profession.:;
Code: The Contractor's License Law does nol apply to an owner of prop~rtywho builds or improves thereon, and who cOntracts for such projects with
fLqontractor(sJ licensed pursuant the Contract9r's License .Law). ',~
U I am.exempt under Sec. i B & P.C. for this reason: ,1
Date: ~ Owner: -J~-
r IWORKER'S CO PENSATION DECLARATION ;
I hereby affirm unde~ penalty of perjury one of the following declarations: . ~l
o J have and will maintain a certificate of oonsent to self-insure for workel'c; compens8tion, '
ZlS provided for' by Section 3700 of the Labor Code, for the performance ~f !I{.:~ 'Nork for which
this'permit is issued.
'0 'I have and will maintain worker's compensation insurance, as required i:~' SecTion 3700 of
the Labor Code, for thE!: performa!1ce of the work for which this permit is i~u~d. Myworker's
CompenSation insurance carrier and policy are: .
Carrier: Policy Number.
CONTRACTOR INFOR~.!ATION:
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: DOR
::J
L!CENSED CONTRACTORS DECLARATION
I hereby affirm under pe;'1alty cf perjury thi?t ! am
lic.ensed under plovisions of chapter 9 (commenc:ng
with Section lOOO) of Divsion 3 oUhe Business and
Protessiol13 Cod e.
9/9/2004
'Oat€f
Contractor
NUMBER
EXP!RATION DATE
This section need not be completed if the permit fs for one hundred dollars ($1G~) or less.
o I. ce'rtify that in'1~e performance of the work for which this' permit is i$'5ued, I s~al! n~t
employ any person in any manner so as to become sl,tbject to the workers c.."lmpensation laws
of Califomia, and agree that if I should become subject to the worker's,comp::1(lsaHon
provisions of Seetion 3700 of the labor Code, I shall fort.hwith co ~y with tho isions.
Date; 9/9/2004 Applicant:
WARNING: FAILURE TO SEe R .
UNLAWFUL, AND SHALL SUBJECT PLOYER TO CRIMINAL PE:NALT1ES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,009), IN ADDt':ioN TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR 1",.SECTlON 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY. _
J hereby affirm under penalty of perjury that there is a construction lending aqs!,!cy for the
performance of the work for Which this permit is issued (Sec. 30!17 .Civ.C); .
Lepd,er's !nform,aUon:
TYPE
Construcion Types:
VN, ,
Fire .~pr!nkle{ed? NO
I certify that I have read this application and state that the ab,ove 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 enteru'pon the abOve mentioned property for
in ec:tion 'p, poses.
fees paid for Permit:
Total: 125.04
Date: 9/9/2004
'f pplicant or
The p.er explr y . Imitation and become null and void if the building or
worl< has nOt assed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
INSPECTION RECORD.
. INSPECTION . .. DATE. INSPECTOR
Teml'orarypower Pole .
Plumbing (OraintWaste Pipe)
ElectricalGround ElectrodelUfer . . I . . .~.
Setback/FormsfTrenches (Footings). "1Lll'''''''S~ ~
00 not install sUbfloor or pour floor slab until the
,following applicable .items have been. siglJed: '
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork) ...
Electrical (Underground Conduit) . . .
Pre-s/ab (CompactionlMembrane.Reinf.
Underpinning (Floor Joist/Girders)
Oo.not cover or conceal the work below until the
following applicable .items have been signed: .. . .
1st Floor Shear . .
Firesprinkler (Rough) . .'
2nd Floor Shear. . . . .
ROOf (ShealhinalDiaphragm'Frane) . .
Masonry (ReinfJaond BeanlPre-GlO\Itl fLIP -Iu .'-/' \ I
Rough Plumbing (Top Out) .
Rough Mechal)ical - .
Rough BectriCal (Dry Wall) .
Rough Electrical
Framing {Only after PIl:lg.. EJec.. r..1ech and Fire}
Insulalion {SOU ndlEnergy) ..
Do not tape or plaster until the following applicable .
items have been signed: .
Drywall . ..
f>enetrations (Fire Rated) Electrical ..
PenetratiOns (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbil19
Interior Lath
Exterior Lath
. GENERAL ITEMS .
Exterior Plaster (BraNn Coal)
T -Bar Electrical .
T -Bar Mechanical... .
T -Bar Structural .
Sewer ..
Water Engineering Backflow
Water Service
FINAL INSPECTIONS Date. Inspector .
Electrical F.inal . . , . . .
Plumbing Final . . .
. .
Mechanical Final .
G.as Test .
Engineering/Grading Final 765i5126 . :
Fire Depl Final 765-4040
Water Engineering 765-5268.
Sub list/Business License 765-519
Zoning 765-5139 . .
Building Ffnal ~ast Inspection. Only ~'J{1J( /~ <L-
fter AlloveComplete)
PARTIAL INSPECTIONS
Buildina InsDections
Mechanical hlsDections
Plumbinq InsDections
Electrical InsDections
qO
~
N~1tl
~ f~DfD5~D
GfHlbJ~ ~\fiJU.V
qr/
fi"l?TIj{~
'Kt71D~~
%
""
\si
~
HISTORIC DIST ICT REVIEW.
See st to this P3e e .
ircle one on bove line .
ERrIl/T FOR
ANY CONDITIONS
1/7 c- SI/"11101Y5 AVM1/E ~ v\&tk- LA.Ja1I
M:> -S~J
rl-lUC #clY /VII