1782 Siva Ave.
TYPE OF PERMIT
Blockwall/ Columns C ITV
DATE: 6/1/2005
JOB ADDRESS: 1782 W SALLIE LN
LEGAL DESCRIPTION: N TR 2722 LOT 9
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 50
BUILDING PERMIT NO. BLD2005-01513
APPLICANT: FRANCES HISER
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
Frances T Hiser
1782 W Sallie Ln
Anaheim, CA 92804
JOB DESCRIPTION:lnvestigation for 47 lineal feet of 6 foot high block wall buill without permits.
VALUATION: 5,000.00 PROCESSED BY: MSM
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt rom the Contractor's License Law for the folowing reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, alhH, 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 Professicns 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
~$ 0).
, I, as owner of property, or my employees with wages as their sole comp~msation, will do the work, and the structure is not intended or offered for
ae (Sec. 7044 Business and Professions Code: The Contractor's License L'1w does not apply to an owner of property who builds or improves
thereon, and who does such work himse~ or herself 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 purpose of sale).
o 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 License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with
~ontracl:or(s) licensed pursuant to the Contractor's License Law).
U I exempt under Sec. , B & P.C. for thi reason:
Date: r Owner:
WORKER'S CO PENSATION DECLARATION
I hereby affirm under penalty of pe~ury one of the following declarations:
o I have and will maintain a certificate of consent to selHnsure for worker'scompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
o I have and will maintain worker's compensation insurance, as required bySect!on 3700 of
the Labor Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carlier and policy are:
Carrier: Policy Number:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code.
61112005
Date:
Contractor
NUMBER
EXPIRATION DATE
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
~ I certify that in the petiorrnance of the work for which this permit is issued, I shall not
loy any person in any manner so as to become subject to the worker's compensation laws
f Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I shall forthwith compJy with those provisions.
TYPE
Date: 6/1/2005 Applicant:
WARNING: FAILURE TO SECUR WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJ T AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 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.Civ.C):
Le6dets 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
her by authorize representives is city to enter upon the above mentioned property for
i action rposes.
Dafe: 6/1/2005
Fees paid for Permit:
Total: 213.48
Signature of pplicant or Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed Ii nal inspection 365 days Irom the date 01 permit issuance. A
new permit is required to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DralnlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormslTrenches (Footings) (,-,)4'-1) \"'/Y J'1A J,
Do not Install subfJoor or pour floor slab until the
following applicable items have been signed:
Plumbinq (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underqround Conduit)
Pre-slab (Compaction/Membrane Rein!.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Firesprlnkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame) " ,
Masonry (ReintJBond Beam/Pre-Grout) it;,}/;-P ) yrL'lA . /l
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fir">
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable
items have been signed:
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) MeChanical
Penetrations (Fire Rated) Plumbing
interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T -Bar Electrical
T -Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
Water 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 List/Business License 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only 1?)dJ( ~ ---/
After Above Complete)
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections
Plumbina Inspections
Electrical Inspections
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