1206 N. Siesta St.
TYPE OF PERMIT
Blockwall/ Columns CITY
DATE: 4/4/2005
JOB ADDRESS; 1206 N SIESTA ST
LEGAL DESCRIPTION: N TR 2201 LOT 69
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765-5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTJ;R SECTION: 30
BUILDING PERMIT NO. BLD2005-00899
APPLICANT: ROBERT KOON
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
RoberfE Koon
1206 N Siesta St
Anaheim, CA "92801 ,
JOB DESCRIPTION:Build 80 lineal feet of 6 foot high block wall per city specifications.
VALUATION: 4,800.00 PROCESSEDBY: MSM
t OWNER-BUILDER DECLARATION
I hereby affirm under pena.1ty of perjury that ll3m exempt from the Contractor's License Law for the following reason (Sec; 7031.5 Business and
Professions Code: any city. or"coLintywhich requires a permit tei construct. aHer, improve, demo~sh or repair any structure;. prior to its issuance, aiso
requires the applicant for such permit to-file a signed stat"ement 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 t!1e basis' for the alleged
exemption. Any yiolation of Section 703_1.5 by any applicant for a .permit sutjects the applicant to a civil penalty of not more than five hundred dollars
~O~)~s ow~er of property, or my employees with wages ~s their so. Ie comf'ensation, will do the work, and the structure is no\ intended' or olfered for
~e (Sec. 7044 Business and Professions Code:' The Contractor's License Law d,oe,s not apply to an owner of property who builds or improves
, thereon, and who does suct;l Work himself or herself or through'his.or her OYFl employees. prOVided that sUCh ir:nprovements are not 'intended. or ,
offered for sale, If. however,-the b~ilding _or improvement is soldwith one ye-3r of oompletion, the owner-bu ilder will have the'burdenofproving'that he
did not build or improve forthe purpose of sale), , :. _
o .I. as ihe owner of the property, am exdusively contracting with licensed contractors to construct the project (See. 7044 Business ~nd Professions
Code: The Contractor's License Law, does not apply to an owner of propertyWho builds or improves thereon; arid who rontracts forsuch projects with
~ontractor(s) Iicen.sed pur~u~nt to the Contractor's Lice~se Law).
U 1 exempt.under Sec. . ,p. "for thiS reas :
Date: -. Owner:
WORKER'S CO PENSATION DECLARATION
I hereby affirm under penalty of perjury one,of the following declarations:
01 have'andwill maintain -a certificate of con-sent to Self-insure fo'r worker'S compensation,
as provided'for by Section 3700 of the-Labor Code, for the performance Of.th:3 work for which
. this permit is issued.
o i have and will maintain worker's compensation insurance, as required b; Section 3700 of
the Labor Code. for the' performance of the Y,lork for which this permit is issu<-d. My worker's
. Compensatio_n insurance carrier and policy are: .
Carrier: . Policy Number.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty 9f perjury that I am
licensed under provision's of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code. . .
4/4/2005 .
Date:.
Contractor
NUMBER
EXPIRATION DATE
i' 's section need not be completed if the pe~it is for one hundred dollars ($~OG: or les~.
I certify-that in the ~rfonnance of the work for whic'h this permit is issu~d, I shall not
e, ploy any person i'n any manner. so as to become subjeCt to the worker's ccmpensation laws
, of Califomia; and agree that if I should'become subject to the worker's compt.nsation
provisions of Sec\ibn 3700 of the ;z,~shall forthwith compl .with trose provisions.
D~te: 4/412005. Applicant:. ~ _
WARNING: FAiLURE TO SECU E,WORKER'S COMPENSATION COVER"
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER:rO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION 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 penafty of perjury that there is.a construction lendin.g af:encyfor the
performance of the work for which thi,s permit is issued (See. 3097 .Civ .C):
Lender's, Information: .
TYPE
Construcion rypes:
VN, ,
Fire Sprinklered? '
NO
I certify that I have read this application a~ state that the above information is correct. 'I
agree to rom ply with all city ordinances and state laws relating to building construction, and
hereby authorize representives of this cityto ~nter upon the above mentioned property for
~1\eEzsk~ Dat.:4/4/2oo5
. r _ - Signature of Applicant or Agent~.
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 required to commen.ce or continue work.
Fees paid for Permit:
Total:
125.79
INSPECTION RECORD
,
INSPECTION , DATE INSPECTOR
Temporary Power Pole, ,
Plumbing (DralnlWaste Pipe) , , ' ,
Electrical Ground Electl'OdelUfer, ' ' , 0
SelbacklFormslTre,nches (Footin~) ~'
Do not install subfloor or pour floor slab until the
, following applicaole items 'have been signed: ,
Plumbing (Water Plpe.Sprinkler Valves) ,
Mechanical (Groundwork) . " ,
Electrical (Undel'!lround Conduit) , ,
PI'e-slab(Compaction/Membfane.Reinf.
, Underpinning (Floor .,JoiSt/Girders)
Do not cover or conceal the work below untnthe ,
" following applicable items have been signed: '
ls,t Floor Shear ,
Flresprinkler (Rough)
2nd Floor Shear .
Roof (SheathinQ/DiaphragmlFnme)
Masonry (ReinfJBond Belll1llPre-Grout)
, Rough Plumbing (Top Out) , ,
Rough Mechanical
Rough Electrical all)
'Rough Electncal
Framing (Only after:Plbg., Elec.. t....lech. and Fire)
Insulation '(SoundlEnergy) ','
po not tape or plaster until the following appHcable
'Items have been SIgned: ' ' ,
Drywall , , '
PllIletfallons (Fire Rated) Electrical ,
Penetratioml (Fire Rated) Mechanical "
Penetrations (Fire, Rated) Plumbing ,
Interior Lath , ,
Extenor Lath ,
GENERAL tTEMS
exterior Plaster (Brown Coat) ,
T .Bar Electrical ,
T .Bar Mechanical
T.Bar Structural " , ' '
Sewer " ,
Water Englneenng Backflow ,
Water Service "
FINAL INSPECTIONS Date' Inspector
Electrical Finat ' '
Plumbing Final ' "
Mechanical Final ,
Gas Test' ,
Engineerin91Grading Final 765-5126
Fire,Depl. Final 765-4040
WaierEngineering 765-5268
Sub List/Business License 765-519 ,
Zoning 765-5139 ,
"
Building Final ~ast Inspection. Only tI~' .,>
' ,Iter Above Complete) ~.
PARTIAL INSi>ECTIONS
Buildina Insoections
Mechanicallnsoections
Plumbin!:! Insoections
ElectricallnsDections
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. THE rSSUAN'CE OF THIS PERMIT' DOts
NOT APPROVE VI.OL.ATION OF ANY OF
THE .BUIL.DIN'G 'QODES..OF.:tHE,OI1!Y.
THE :HO'LDER 'OF THIS :PERMIT
.:Pi'l-O.C.E~qB. ...t., H:IS 1=''''':I'l. RIS!<..
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+SUIWDJNG DIVISION OF ANAHEIM
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