947 S. Silver Star Way
BUILDING PERMIT NO. BLD2005-02812
TYPE OF PERMIT C
Blockwall / Columns ITV
DATE: 917/2005
JOB ADDRESS: 947 S SILVER STAR WAY
LEGAL DESCRIPTION: N TR 14191 LOT 48
APPLICANT: ANDREA WALTERS
OWNER INFORMATION:
THOMAS JACOBSEN
947 S SILVER STAR WAY
ANAHEIM, CA 92808
CONTRACTOR INFORMATION:
SHORELINE CONSTRUCTION
12116SEVERNWAY
RIVERSIDE, CA 92503 0000
BUSINESS PHONE: 909738.9905
JOB DESCRIPTION:Build 1 1411ne81 feet of 6 foot hi9h block wall per city specifications.
VALUATION: 3,000.00
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 227
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: MSM
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 liceJ'"lsed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division Sof 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 SUbjf:Cts the applicant to a civil penalty of not more than five hundred dollars
($500).
o 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
sale (Sec. 7044 Business and Professions Code: The Contractor's License U.w 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 yea:" of completion, the owner~bu"der will have the burden of proving that he
did not bund or improve for the purpose of sale). I
o I, as the owner of the property, am exclusively contracting with licensed c:mtractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of propertYVl,:ho builds or improves thereon, and who contracts for such projects with
,9..Q"ontractor(s) licensed pursuant to the Contractor's License Law),
U I am exempt under Sec. , B & P.C. for this reason:
Date: OWner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will rnaintelin a certificate of consent to selHnsure for worker's compensation,
as provided for by Section 3700 of the Labor Code. for the performance of the work for which
~hi permit is issued.
I have and will maintain worker's compensa.tion insurance, as required by Section 3700' of
t Labor Code, for the performance of the work for which this permit is issuec. Myworker's
Co pen sat ion insurance carrier and policy are:
Carrier: STATE COMPENSATION FUND Policy Number. 1795957-(5
This section need not be completed il the pennit i.lor one hundred dollars ($100) ," less.
o I 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 worker's compensation laws
of Caltfomia, and agree that if I should b me subj cf 0 the worker's compensation
provisions of Section 3700 of the bo 0 ,I shall 0 h' c with thooe provisions.
Date: 9n /2005 Applicant:
WARNING: FAILURE TO SECUR WORK R'S COMPENSATiON COVERAGE IS
UNLAWFUL, AND SHALL SUBJEdT AN EMPLOYER TO CRIMINAL PENAL-iiES AND CiVIL
FINES U P TO ONE HUNDRED 11;IOUSAND DOLLARS ($100,000), IN ADDll10N TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED 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 .Clv.C):
Lender's Information:
Date: 9m2oo5
Sig atu e of pplic t or Agent
Th ermit 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 reQuired to commence or continue work.
hereby affirm under penalty,
licensed under provi ter
with Section. 00) f
Professi de.
9/7/2005
Date:
NUMBER
742331
TYPE
TYPE
EXPIRATiON DATE
11130/2005
B
C53
,
Construcion Tvpes:
VN, ,
Fire Sprinkfered?
NO
Fees paid for Permit:
Total:
199.30
City of Anaheim
Building Division
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
DATE
INSPECTOR
INSPECTION RECORD
INSPECTION DATE INSPECTOR Engineering/Grading Final 76
Temporary Power Pole Fire Dept. Final 765-4040
Plumbing (DrainlWaste Pipe) Water Engineering 765-5268
Electrical Ground Electrode/Ufer A Sub List/Business License 7
Setback/Forms/Trenches (Footings) qU'lOS i"'"\.&l. Zoning 765-5139
Do not install subfloor or pour floor slab until t e Building Final (Last Inspection
following applicable items have been signed: After Above Co
Plumbing (Water PipefSprinkler Valves)
Mechanical (Groundwork) PARTIAL I
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reint.) Building Inspections
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 (Sheathing/DiaphragmlFrame) ,,/
Masonry (Reint./Bond BeamlPre-GrouA 'TLd [' c_ ~'echanicallnspections
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (SoundlEnergy)
Do not tape or plaster until the following applicable
items have been signed: Plumbing Inspections
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat) Electrical Inspections
T-Bar Electrical
T-Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
5-5126
65-5194
-Only
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NSPECTIONS
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IS OWN RISK.
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ISION OF ANAHEIM
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