780 S. Stillwater Ln.
TYPE OF PERMIT
Repair
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.- 5153
. INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: .199
BuiLDING PERMIT NO. BLD2005-00943
DATE: 4/7/2005
JOB ADDRESS: 780 S STILLWATER LN
LEGAL DESCRIPTION: N TR 9214 LOT 9
APPLICANT:
OWNER INFORMATION:
Jay H Pickin9
780 S Stillwater. Ln
Anaheim, CA 92807 .
JOB DESCRIPTION:Drywall and frame in ceiling for new iighting fixtures.
VALUATION: 1,000.00
I OWNER-BUILDER DECLARATION
I hereby affirm ul)der PElnalty of perjury that I am exempt from the Contractor's Ucense Law for thefolJowing reason (Sec. 70~1.5,Busjness and
Professions Code: any city or county which requires a permittci 'construct, alter, improve, demolish or repair any structure, prior to itS issuance, also
requires the applicant for such permit to file asigneq 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 Professions Code) or that he is exempt ,therefrom: and the basis for the alleged,
exemption: Any violation of Section 7031.5 by any applicant far a permit subjects the applicant ta a ciVil penalty .of not more than ,five- hundred dollars
($500). '. . '. .
'ill J, as .oWner of property, or h1~ employees with wa!;)es as their sOle campenSation, wHldo the work, and the st!ucture Is nat intended or' afferedfor
~(Sec. 7044 Business and Professians Code: The Contractor's Ucense.La\v does not apply to an -owner of propertY who builds .or improves
thereon" and who does such work himself or herself or through his .or h~r own employees, provided that such improvements are not intended or
offered for sale. If, haweyer, the building .or impravement is sold with .one year of qompletion, the owner~builder wilfhave the burden .of proving that he
did not build .or imp rave _farthepl.HpOSe of sale). _
D I, as the owner .of the praperty, am exclusively cantracting with licensed contractors to canstruct the praject(S~c. 7044 Business and Professians ',-
Code: The Cantractar's License law does not.apply ta an owner of property who bu~ds or improves th,ereon,.and who contracts for such prajects with. .
antractar(s)'licensed pursuant to the Contractar's Licen aw).
I am ex- pt under Sec.' ,B P.C
ate: IJ '1 Di;'.. . Owner:
WORKER' COM NS ION DECLARATI N
'1 hereby affirm under penalty .of erjury one of the follawil:lg declaratians:
0- r have and -will maintain a certificate .of ,consent to self-insure for worker's,compe-nsatian"
as pravided for by Sectior;1 3700 of the Labar Code, far the performance of the work for which
this permit is issued. . .. ' .
o I-have and will maintC!-inworker's compensatian insurance, 'as required by Section 3700 of
the Labor Code, for the performance of the work for which this permit is issued.: Myworker's
Compensation insurance carrier and policy are:
Carrier: ' , Palicy Numb~r.
CONTRACTOR INFORMATioN:
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: ENO
. LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty 9f perjury that I am
licensed under pro'!isions o~ chapter 9 (commencing
. with Section 7(00) of Djvsian 3 of the Business and
Professions Code.
. 4f712005
Date: '
Contractar
NUMBER
EXPiRATION DATE
This s";tion need not be completed If the pennil is for one hundred dollars ($1 0.0) or less.
R I certify' that in the performance of the wor~ for which this permit is issue~d!i. shall not
employ any person in.any manner so as.to become subject ta thewarker's compensation laws
of Calito.mia, and agree that if I should n:'Ie 'subject to the worker's compertsatian '.
provisions of .Section 3700 of the ab . C6de,~all to' pI with thbse provisions.
Date: 417/2005' Applicant: <::::7tl
WARNIN<>: FAILURE TO SECU WO R'S OMPENSATION r::;OV RAGE IS
UNLAWFUL, AND SHALL SUBJ CT AN EMPLOYER TO CRIMINALPE LTIES AND CIVIL'
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($10.0,00.0.), iN ADDITlON'TO THE
COST OF COMPENSATiON, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTER'EST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm- under p'enaltyof perjury that th~reis a construction lending agercy for the
perfac~anCf3 of the work forwhich 'this permit is issued (Sec. 3097 .Civ .C):" .
"Lendef's 'lnlorrnation: :
TYPE
Construcion Types:
VN, ,
Fire Sprinklered?
NO
I certify that I'have r~~d this applic'ation and state that the abave informatian"is carrect. I
agree ta comply withal! city ordin'ances a(1d 'state I,aws relating to building construction, and
ereb~ utnorize representives of this to enter upon the above mentioned praperty far
i e ion,purposes.
Date: 4f712005
Fees paid for Permit:
Total:
10.7,24
Signatu of Applicant or Agent
permit shall expire by limitation and b . orne null and void if the building.or
work has not passed Ii nal j nspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
. INSPECTION RECORD
INSPECTION . .. DATE . INSPECTOR .
... ..
Temporary Power Pole . '. .
Plumbing (DrainiWaste Pipe)
ElectrICal Ground Electrode/uter . ,
SetbaclllFormslTrenches (Footings). .
Do not install subfloor or pour floor slab until the
following applicable items have been signed: .
Plumbing (Water Pipe.Sprinkler Valves) . ..
Mechanlcal:(Grocindwork) . .
Electr.ical (Underground Conduit)
. Pre-slab (CompactlonlMembrane.Reinf. .
Underpinning (Floor Joist/Girders) . .
Do not cover or conceal the work below until the
following applicable items have been. signed:
1 st Floor Shear
Flresprinkler (Rough) .
2nd Floor Shear . . .
Roof (Sheathina/Diaphragm/Frame)
Masanry (ReinfJBond BeamlPre-Grout) I
Rough Plumbing (Top Out) . . ..
Rough Mechanical . . . i
I. KOugn t::IecUlC 'nail) <: 17--0<. ,.
Rough Electrical . -;
Framing . (On~ after Plbg., Elee.. Meeh.. and Fire)' .J'U)I(
Insulatian (SoundlEl1ilrgy) .
Do not tape or plaster until the fOllowing applicable
items have been signedo .. I.
Drywall. ... . <;~<< "h ,/) A. ;..;
Penetratians (FiAl Rated) Electrical . .
Penetratlans (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath... . .
Exterior Lath . '.
GENERAL ITEMS
Exterior Plaster (Brown Coal) .
T.Bar Electrical
T .Bar Mechanical ..
T -Bar Structural " .
Sewer . .
Water Engineering Back1low I
Water Service ..' . . .
FINAL INSPECTIONS
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 765-519.
Zoning 765.5139
Building Final ILast Inspection. Only rt....)o,.-
After Above Complete) 'I V"I )
PARTIAL INSPECTIONS
Buildinalnspections
Date . Inspector
Mechanical Inspections
Plornbina Inspections
Electrical Inspections