865 S. Swallow Way
. -
..,'-
TYPE Of PERMIT
Residential Addition, CITY
DATE: 7/2112004
JOB ADDRESS: 865 S SWALLOW WAY
LEGAL DESCRIPTION: N TR 9465 LOT 32
ElM
BUILDING DIViSioN
200 S. ANAHEIM BLVD.
(714) 765,5153
INSPECTION REQUE'STlINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 210
BUILDING PERMIT NO, BLD2004-02849
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APPLICANT: ORA DEMARIA. .'
OWNER INFORMATION: CONTRACTOR INFORMATION:
~~D~ \
865 S Swallow Way I
ANAHEIM, CA 928070000 I,
JOB DESCRIPTION:Add 1/2 path Path ir'side patio. Work done with Deck BI,tz004-00161
.i,
VALUATION: . 4,800.00 f
I OWNER.BUlLDER(DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the COf'ltractQlfsLicense Law for the, fOllowing reason (Sec. 7031.5 Business and.
Profes~ionsCode: anY'd.ty or county which requires a permit to..golls~ruct, 2rt~r, improve, demolish or repair any structure, prior to its issuance, als,?
requires th~:l"lpplical1t for such ,p~rmit to file ,1 ::ljgil~d ~tatpment that hej~,lic~'~,sed pursuant to the piovisions'ofthe Qontractor'sLicense'Law (Ch,apter
9}(cor;'I:ner:clng with 8€ct~:m".70CO of Olvi'Sion 3 of \hl':l Business and prof~ss' '!?s Code) or that he is e"empt therefrom and the basis for the alleged
ex~:.r""pt!cn', :Any vrO!03tior. ~f Sect!o~ 7031.5 by _~i1Y applicant forA. ~e((rlit sulj~;~t~ 'the applicant to a civil penalty o"f not more than five hundred dollars
~ . .~. ,
L~l .;..... ~~: ~'::ne...ot p:o.i??';!y. or.rrlY 2m~lo~ees '~i;:~ :'oge::; ,~s tr'el':':o~0 ,,~,::-~tnsaLion, will do .the work, and the structure is 'not i_ntend~ Or offered for
~~:~l0 i.v~~G., (~_t:4 BUSm~S?,,3r.~ :~r?fe.s5ions COG~!:, fl:e (:Vr,\.r'3(:.~'~'$ L\~)~;,.>e "'r~Yldoesnot'app\~toan ownen:~f prop?rty who bwlds ~r Imf?rov.es -'
-:fl':r:,~o,;"" ,-:nU'_,"tJhtJ dOS.:r'{;,jJch1l'.'O,r~:_himse!f or he_lSe!t nr_!hrOl;ch hl~ or:.;,,!_f-{r CY'T,employees, provided that such Improvements are not,U1tended or
'iCf~ ~';':;,,;~,!'~ =,~,":_;~~m!f~, :~:'~,'~~~~:~~~:~,~fO, ~~~ro""m~ ,'n; i$ ;c,k1 With9,n (''.Ye.(~:",,:, ','f completion, the owner-bu Oder w III have the bu r~e n ofP,r,O~_ing, that he
~ .~, .:-:s (i~jl~'(;"'i;~r oqr.e piOperty; zm-e?<q!lJ.:;:lh/eJy conhar.l:;ng with !i:::erl~'<.:ld~ '.,l1tractor:3-'to construct the proJect (See: 7044 Business and'Profe.ssions
C ,I(~!:':, :n-,~.:.\)ntl"ar,tot.s License law does not apply to an owner of ~(operty he builds or improves thereon, and who 'contracts for such projects wtttl
,~o, n'i.n3~c.r(s) .1~Ce'1S~' pursuant to the ~ ractor's ~icense w).' ;k : ,"' ., .' ~" , .'
Ulam.exemptuiI<ierSec. _ ; ,,~.&P.C.othiS a n: .~_~'!:_ ' ", .
Date: Owner: .l-.'
, " WORKER'S COMPENSATION DECLARATION . li . , -I
I hereby affirm u!1der pera1ty af perjury oneu)f the fcllowing declarations: i;:.',
o I h,ave ~nd will maihtaln a certificate Qf'oonsentta self-irniUreforwafker,'~,compensation,
as provided:.for by Se~ion3700 of the. Labor Code, for the performar.'ce of tf:l)f'wo:rk for which .
, this permit is issued. . . : ~. . .
o I have and will maintain worker's compensation insu'rance,as required ,h'.('Section 3700 of
the-Labqf Cod~,f9r the performance of the work f6r which this permit is lssUtrJ. Myworl<er's
Compensation 'insurance carrier and policy are: l'
Carrier:- - . Policy Number. ~I
. I) .
a:hi section need not be completed if the pennitis for one hundred dollars ($1C~i or less, .
I certify that In the perti, onnance of the, ,work for which this p~rnl!t, t!? iSSC,.r,p,:'1 sh~11 not .
.t1 'oy any person in any manner so a :0 become subject to the worker's'~'1mP8nsation laws
of Calffomia, and agree_ ~hat if I $hou 9ecome subje to thew .'e(s corf1~lli_~ation. .
~ .provlSions of Sectiori37bO "fthe L r Code, I sha~,rt~~ PIYWit~.t:r~e provisions. .
Date: 7/21/2004 Applicant:. I..... <..... ,~~. ,'i
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVEi{.',GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN'ii/TIES AND CIVIL
FINES UPTO ONE HUNDRED 1H OU SAND DOLLARS ($100,0001, IN ADL1!'nON TO THE'
COST OF COMPENSATION. DAMAGES AS PROVIDED FOR .IN SECTIQliii3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. . \
'1 CONSTRUCTION LENDING AGENCY . r
I hereby affirm under penalty of perjury that there is a construction lendin$ ?~f.:ncy forJhe .
: 'performance of the work for which this permit is issued (Seo.3097 .Civ;C):]. > !' . -
lender's Information: '
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: FAN
. LICENSED c.:ONTRACTORS DECLARA!ION,' ,.1
I hereby'affirm under penalty of perjury t'lat lam
licensed under provisions of chapter 9 (commencing
with ,Section 7000) of Divsion 3 of the Businoos and
Professions Code,
7/21/2004
Date:
Contracto~
NUMBER
EXPIRATION DATE
TYPE
Construcion Types:
VN. ,
Livina Area:
,
72
'(I
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J~ crti at I have read this application and state that the above information ~s correct. I.
agr ,to;,CO mply with "city'9 . ano' 'afld state laws relating to buDding construction,' and
he y 'uthorize re resentives 0 IS city to enter upon the above mentioned property for
in ,purpo s.; . '_ . .' .
, ~,' ~ . .' Date: 7/21/2004
Signature af plicant_orAgent
The permitshaJl expire by Iimit<ltion <100 become null and void if the building or
work has not passed final inspection 365 days from the date Of permit issuance;' A'
new perr:nit is required to commence or continue work.
Fees paid for Permit:
Total:
227;96
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, INSPECTION RECORD ' " FINAL INSPECTIONS ' Date Inspector
, INSPECTION , DATE II~SPECTOR Ete,ctrical Final WiD "" "/"111/
Temporary Power Pale , Plumbing Final [';/~ "'7
Plumbing (DrainlWaste Pipe) Mechanical, Final' dl,/iJ'f V
Electrical Ground Electrode/uter ,',' " ,
SetbacklForrnslTrenches (Footings) ,~T7 ,Gas Test , ,
00 not install subfloor or pour floor slab until the Y Engineering/l>radingFinaI765-5126 ,
fOllowing applicable items have been signed: ' '
Plumbing (Water Pipe.SprinklerValves) , Fire Dept. Final 765-4040 , ' "
Ml!(:lianiCal' (l>rou ndwork) . Water Engineering 765-5268
,
Electrical (Underground Conduit) , ' //1
Pre.slab (CompactionlMembrane.Reinf. "7-7("'- ~-- Sub List/Business license 765-519 ~./;-iJt; '~
, ,
Underpinning (Floor JoisllGirders) , " y , Zoning 765-5139 , , .
00 not cover or conceal the work below until the Building Final '\}astlnSpgction- onl~ic '.60( /4,
following appJiq'ble items have been signed: ' : , . fler Above Complete) _.
1st FlOOr Shear " , , , PARTIAL INSPECTI.oNS '"
Firesprinkler (Rough) , , ,
2nd Floor Shear , , , BuildinQ Inspections W#q; ~.
Roof (Sheathing/Diaphragm/Frame) , Y:~ $""'.....",...4/
Masonry (ReinfJBond BeamlPre-Grout) ,
Rough Plumbing (Top Out) , , ,
Rough Mechanical' , ,
Rough 8ectrical (Dry Wall) .' , , , ,
, ,
Rough Electrical "~ ,
Framing' (Only after Plbg.. Elec/.MJ ,Fire) er~ , ,
Ins~"ation (SoundlEnergy) " ' , 9.~ -- Mechanical Inspections
Donat tape or plaster until the following applicable/,
items have been signed: .' . ,
Drywall " , " ~~;tOU ~ ,
Penetrations (Fire Rated) Electrical' ,
',.
Penetrations (Fire Rated) ,Mechanical , , , " , , ' ' ,
Penetrations (Fire Rated) Plumbing , , , "
Interior Lath ' ' _~1'
Exterior Lath " ff-Z1"C4 ~ Plumbina Inspections
" GENERAL ITEMS , ,
Exterior Plaster (Brown Coat) //J ~7..o --
T -Bar Electrical , , ,
T -Bar Mechanical ,
T -Bar Structural ' , , ,
Sewer ,
Water Engineering Backflow , Electrical Inspections -
WaterSilrvice ,
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APpLICANT: JOE VERTREES
OWNER INFORMATION:
Maria 0 De
. 865 S Swallow Way
ANAHEIM,CA928070oo0 . . . , .
JOB DESCRIPTIONResidential Remodel. New 282sf deck and exterior stairs.;R~model eave and re-stucco.
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VALUATION: 25,000.00 Ii, PROCESSED BY, JJJ
I 'OWNER-BUILDE~ liECLARATION
I herebyaffirrn under penalty of perjury that I am exempt from-the_Contract9.fs Lie.anse Law for the following, reason (Sec; 7031.5 Business and,
. Prof~sions Code: any cityor countywhichrequiresa permit to cQnstruct, a~er. improve,-demolish or r.epair any structure, prior. to its issua~ce. also
requires the applicant for such permit to file a signed S4'1tement that he is 1!c:1nred pursu~_nno the provisions of the Cpntrador's Lie_ense law (Chapter
9)(commencing with Section ,7000 of Division 3 of the .8usinessand Profes#-ns Code) o'r,that.~e.is exempt the~f~m and the basiS for the alfeg~d ,
~~~~~ion.. Any Yiola~ion Of. Section 7031.5 by any ap~l~cant for a permit s~~fects~he applica.ntto a civil. ~naltyof not ~?re tha~.~v~ hundreddoJiars.
o .I._as. owner Of. p.r operty. or my .empl. o. yees with wa.ges as. their sole com.~,.r'~re~tjon, w m do the work, ~~d.the$tructu.. re.. is,nP. t. intendedo..rOffar..e.. d.fO r
. sale (S.ec. 7044' Business and Professions Code: The Contractor's License'! aw does l:1ot apply to an owrter of propertyw~-buiId3or.improves .
thereon, and who d6~s such work himself or herselfor through his or.h~r 0'_ , employees, provided that such.imp"rovements'are not inter1cled or.'
'. 9ffered for Sale.. If; however, the building or improvement is sold with and y';pr of~completion, the owner-bu.ilder~ill have: the burden of proving that he'
~'dnotbuildo.rimproveforthep~rposeofsal,e). _. _ .-,j} .' . . _ '.' ' . .
.. ,.as the. owner of the property. am exd,usively contr'c:l.ct. ing with .Iice. nse:i:J.jeolltractors to GO. nstruct the.project (Sec. 7044_ Bus~.~.es~ a!XI profeSSion.".'
e: The Contractor:'slicense Law do ,t apply to an owner of ropett~twho ouUds or improves thereon, and who.-cqntracts for su'd"\ projects With.
. FU{on~a.~or($)ncei1Sed.pursuanttothe . ac~o.r'3 .._ ice~~'. . ".''!.' . .
U I a!11 exempt under Sec. . . & P. . f ,I a '1: -,1 ~''''''l
Date: Owner: ,..... ~
I WORKER'S COMP'[NSATION DECLARATION
I herebx affirm ~nder penalty' of penury o.ne 'of the- followi~g declarations: \1 ' .
Q I have andwill maintain a certificate 'of consent to self-insure for worke!',- compensation,
_a~ proVid~ f~r by Secti?" 3700 of the labOr Code, for the performance of Ule wo~ ~or whidl
thiS permit IS Issued. _ _.. " - _ 'J' .'
,0 I haV_eand wiJImairitain worker's compensation insurance; as re,q,Jir:ed-t.t'-Section 37.0.0 of 2/10/?004
the La.borCode,.for the performance of the work for which this permit is iSSlif<t My worker's. Dato:
. Compensation insurance Garner and' pOlicy are: . '_ . ~
Carrier; . . P.ollcy Number. ;L
This section need not be completed if the pennit i!:i for o_ne hundred dollars {$1.~~1; ~ -less. TYPE
~ertify that in the perfonnance,ofthe work for which this' permit is issuf"t.:::Jshan not .
.~Ioy any person in any ma'nner so as to become subject to the workefscy,:;}p_ensation laws
ot' California, ar1cl agree thilt if I should bee. e subject to the workel"s C R-Hlsation
, .. ,". ""or-
proviSions of Seyt\on 3700' of the Labor e I shaD fo ith comPli-vri !i1~e:provis!ons.
Date: 2/.10/2004 Applicant: L't6<:..- .~
., . -'. . .'., ~., -.-.. . .
WARNING: FAILURE TO SECURE ORKER'S COMPENS . ION CQVER',IGE IS". . '.
UNLAWf'UL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN.~.~'i1ES)J.NDCIVIL
FINES UP TO ONE HUNDRED "THOUSAND DOLLARS ($100,000), INADI:>1"noNTO THE
. COST.OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEC;TICNp7060F THE.
LABORCOOE. INTEREST AND ATTORNEY'S FEES. . ' ",;..:>'"
.1 CONSTRUCTION LENDING AGENCY "h"
. I hereby affirm under penattybf perjury that there is a construction lending ~~J:{f)9Yfor the
perf~r~_n~'?ft.tJe wo~k for I/{hict1_ this permit is issued. (~ec._~~.97_~~i\j~~: \.ll_;-:.);e>,~;;:.._._.~~ _..I,_'~'__"
L.i:;IIU~1 ;j'llll(lfIT1attvn; -'--. ".'
BUILDING PERMIT NO. BLD2004..Q0161
TYPE OF PERMIT
Residential Remodel CITY
DATE:. 2/1 0/2004 .
JOB ADDRESS: 865. S SWALLOW WAY'
LEGAL DESCRIPTiON: N TR 9465 LOT 32
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CONTRACTOR INFORMi,WION:
i
BUILDING DIVISION
200 S. ANAHEIM BL VD./
(714)765.5153 .. "-,
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE:' . 434
QUARTER SECTION: 210
ARCHITECT/ENGINEER INFORMATION:
I
LICENSED CONTRACTORS DECLARATION I
I her~by affirm. under pen~Jty Of perjury ~at I am
."Ucensed,lJhc1er provisions .of chapter 9 (commencing
with Section)OOO) of Dilision 3'ofthe Business and
. Professions Code.
NUMBER
Contractor
EXPIRATION DATE
Construcion Types:
VN" .
Fire Sprinklered?
?<....../
Date 2/10/2004
, ignature of Applicant or Agent. .
The permitshaJlexpire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date ofpllrmit Issuance, A
new permit is required to commence or continue work.
NO
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_.:.._-~..~~..~~,-----.:.....:;,,-,---,-,-,-,".:..:...-.,'"
Fe:es paid for Permit: .
Total:
704.60
INSPECTION RECORD
:;., . ,
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INSPECTION . DATE INSPECTOR
TemporaryPower PQ'e . . . .
Plumbi ng (DrainlWaste Pipe) . .'
Electrical Ground Electrode/Uter " ' , . " ,',
SelbacklFormslTrenches (FoOtings) , ,
Do not install subflooror, pour floor slab until the'
following ,~pplicable items have been signed:,
Plumbing (Water Plpe.Sprinkler Valves) ,"
Mechanical (Groundwork) "
Electrical (Underground Conduit) " . ,
Pre-slab (Compactlon/Membrane.Reinf. .' , ,
Underpinning(FJilor JOis,t1Girders) ,
Do not cover or conceal the work below. until the
following applicable items ha~e been signed: ",
1st Floor ,Shear " , ' ,',
Firesprinkler (RpUgh) , .' ,
2nd Floor Shear . , , ' ,
Roof (Sheathing/DiaphraginlFrame)
Masonty (Reinf./Bond BeamlPr&-Grout) , " , I
Rough Plumbing (Top Out) . . , . '
, Rough Mechanical , ' , . ;"
Rough ElectrICal (Dry ,Wall) , ., , "
Rough Electrical , , .'. , I
Framing . {Only,after Plbg" Elec.. Mech,: and Fire)
Insulation (SoundlEnerav)
po not tape or pla~tilr until the following applicable
Items have been SIgned: .' " ,
DryWall' .' , ,'. , " ,
Penetrations (Fire Rated) Electrical '
Penetrations (Fire Rated) Mechanical , ,
Penetrations (Fire Rated) Plumbing . "
IntericirLath ' , " ., '~
Exterior Lath ' 1'-2/-04- 'JI.:,L
, , GENERAL ITEMS' '~ '
Exterior Plaster (Brown Coat) /J( ?
T-Bar Electrical' . , ,
T -Bar Mechanical I
T.Bar Structural ,.
Sewer:
Water Engineering Backflow
Water Service . ,.
FINAL INSPECTIONS
Electrical Final,
Plumbing Final
Mechanical Final
Gas Test
Engii1eeringiGrading Final 76S-5126
,F,ire Dept. Final 765-4040 '
Water Ellgineering 765.5268
Sub List/Business License 765.519
Zoning 765.5139 '
Buildin.g Final (Last Inspectiqn. Only
After Above Cqmplete)
PARTIAL INSPECTIONS
Buildinq Inspections
ffrr~~- ~.?.5 ~4-~CA.e:;.:;v ~,
" P'~---
Date
Inspector
Mechanical Inspections
Plumbi"!:! Inspections
Electric:allnspections
TYPE OF PERMIT
Blockwall / Columns
/~~;i\k1:::~~~i~~~',\. . ' :'
<<511}, .... '. ."", .
/;;..QiKr ,~ :'::,; \}:I}'t.,'~.,\
CITY Q) "~:::NI\iHEIM
\~~"~.~.I~~J~/'
BUILDING -DIVISION
200 S. ANAHEIM'BLVD.
(714) 765.5153'
INSPECTION REQUEST LINE:
(714) 765, 4626
CENSUS CODE: 55.5.
QUARTER SECTION: 210
BUILDING PERMIT NO. BLD2005.00124
DATE: 1114/2005
JOB ADPRESS: 865 S SWALLOW WAY
LEGAL PESCRIPTION: N TR 9465 LOT 32
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APPLICANT: DOMINIC DE MARIA
OWNERfNFORMATION: CONTRACTOR INFORMATiON:'
DOMINIC DE MARIA . . I
865 S Swallo," Way )
Anaheim, CA 92807. . . . . I..' '. _ . .
JOB DESCRIPTION:Build 6 lineal feet of 5 foot high bkJck ,"all, 3 pilasters, 16j'!n<O! feet of wrC\lght iron leryce & 3 ,"roughtiron gate.
VALUATION:. 1,500.00 l' PROCESSED BY: MSM.
I OWNER;BUILCE~;;~RJ\T:ON
I hereby affirm under penalty of perjury that I am exempt from the Contractolj',s,~iC?f75e Law for the ~r:Mo~jng reason (Sec. 7031 ;5..Business and
f:'rofessions Code: any city or county which requires a permit to cons,truct, A:;;~r.~.-)rnprove.; demolish ouepair any structure, prior to its iSSUBnce, also .
ret:uire$ theapplicarit for such permit to file a signed statement that he is-'iC~F,~E:d:'Pursuan.t to'thE: provisions of the Contractor's license la"V (Chapter
:,9){commencing with Section 7000 of, Division 3 of the, Business and Profes::;f~:~:.::,;DCde) or t~at ht1 is exempt therefrom and the basis forthe,alleged
7$f;:r~)~i~n. ~y Vioiat~o~ of Section 7031.5\by any applicant for a pe~mit .slJt1:?~~$,~he applicant to a civil, ~nal~Y of ('~t.more tha~.,five hu~d.red ~ollars
I. t,..a. sown er.Of prop. erty, army employees w. ith wages as their sole c(lm:i4;',!~.3tio .n. ~~i!I do the work, and the structure. is not lrltend.ed or off,ered for'
S . e (Sec. 7044Business and 'professions Code: The Contractor's Ucen-:;:; ;{~'{'Jdoes notappsyto ar. owner of property who builds or improves ._'
! feon,: and'Who does such work himself or herself or through his or.her o\'J~:p..mpioyees, provided that sucf"l im;~'lovements are not intended or '
pfh:i:r€:d fo~ sale. .If; however, t.he huilding or improvement is sold with one Y9.',k fJfoomplet!.cn, the owner.build~r will have trle tuF.ien of proving- the-t he
did not.build or improve for the purpo.se of sale)" ... _~ " .
-'0 !. 8.$ the o~:nel"-ofthe property, am exclusively contracting with licel'tszjJ'~r:tr;.K;tc.rs t.;.i ~onstNct the p!,oject (0e(~ 7044' Business and. ProfeSsions
Code: The Contractor's License Law does not apply to an owner of prorelt\ly,r,o buRds Qr improves there0n. z:nd wh,~ cx:mtmr:m fer S(l{'h prcj~c~s with
t::::5oiltractor(s) licensed pursuant to the Contractor's L!(;e~M Law). 'y:, '
'\'fn ~'7''!lo/yn.,.Sec, ~, B ~P.C.d1"i.this reason: _-.1.._-' '--_ _
)J.te~4L Owr>er' "If. ~ ~ 1__ L. '
i WORKER'S COMPENSATION DECLARATION if." i liCENSED CONTRACTORS OECLARATION
I hereby affirm'und~r pel_laity ofperjuty,?n~ .ofthefo!!owing de~lar2tions. .'.-IS~--:- !her,eby.affir!n under pei16lty of ~il~ry Ulat I am
o I have and wi!1 maintain a certificate of consent to self~insure for ~/t)~keft::C~HniK;ns~tjl)n, licensed Ui'l<..ier provl~io:ls of chapter S {cOmmencing
,as .Drovided for!>y Sedion 3700 of the Labor Code, tor the penorm8r.(';e ct ~hi~~wor;~ for,I."-'hld"I,' wt.tn Section 1000) of Oivsiol13 of the &tsinE'..ss al1d
this permit is.issued. . .}. .. . Professions Code~
[J.) have and ~.yili maintain worker's compensation insurance, as required .t?ti_~;-::ct~':n 3700 of t 1/14/2005
. the Labor Code, for the performance of the work for whIch this permit is i~3:J;t.-!. MY'"v'\Iorxer's Date:
C"..ompensation insurance carrier and poliOf are: t'
'Carrier: Policy Number: ~
. . , " ,1
~' h' section need not be completed if the pennit is for one hundred dollars ($1 CC) or les~. TYPE
" , ,'certify that in the perfonnance of the work for which this-permit is j~tl.}:,! shall rot I
e lay ,any person'inany manner 50 as to becomes~bjectto thf;lwOr~&"3 C+i;pe;"l~af.ion laws I
of Califomia, and agree that-if I should becomesubjed to the worker's cornrf:n.C;-.:Jrinn
provisions of Section 3700 of the Labor od', I forthwith c~mply with f;;~,;.se D:"O\{isions. Construcion Types:
(\, VN, .
Date: 1/14/2005 Applicant: _~ Fire Sprinkler.d>
WARNING: FAILURE TO SECUR WORKER'S COMPENSATION r;OVER\,GE IS
UNLAWFUL, AND SHALL SUBJEC AN EMPLOYER TO CRIMINAL PENP,;:TIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), iN ADC,jT1<..'N To'THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTlo.'{3706 OF TI-lE
'LABORCOOE.INTEREST AND ATTORNEY'S FEES.
r CONSTRUCTION LENDING AGENCY .i_.
l.herebJ affirm under penalty of perjury that there is a construction lend:ng 2~iOncyfi:Yr th<3
pCrforma:nce of the, work for whid'! this pe~mit i~ issu~d (Sec. 3097 .eiv.C)' 1
L~nders lnrormation: ,~__L.;..;.c.:.:.:c,;i~_:::._~__~~':~-'
-- -'--~-,-"'''''-'''P'-_~o.C~'__''___ ---_,__ --'-.
ARCHITECT/ENGINEER INFORMATION:
Con1rFlc',or
NUMBER
EXP.IRATioN DATE
NO
I certi.fYthat I have read this application and state that the above information i;:; correct I
agree to comply with all city ordinances and state laws relatIng tobuilding construction, and
her 'I authoriZe representives of this city. to enter upon the aboye mentioned property for
ecticn pur sos. f.'
fees' paid for Perm~t:
Total:
206.89
Date, 1/1412005
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 peiniit is required to commence or continue work.
INSPECTION RECORD
" ,
,INSPECTION' " " DATE, INSPECTOR
Temporary Power Pole ,
Plumbing (DrainlWaste Pipe) ,
, Eledrical GroUnd Electrode/lifer '
SelbacklFormsfTrenches (Footings) . ,
Do not install subfloor or pour floor slab untilthe
fOllowing applicable items have,been signed:
Plumbing (Water Pipe.Sprinkler Valves) : '
Mec;hanical (GrouncWiork) , '
Eledrical (UndergroundConduil) ,
Pre-slab (CompactionlMembrane.Rernr.i ,
Underpi,nning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable"items have been signed: ,',
1st Floor Sltear ,
Firesprinkler(Rougl1) ,
2nd Floor Shear ' ,
Roof (Slteathing/DiaohraamlFrame) ~ ' ,
Masonry (ReinfJBond BeamlPre-Grou -0\ ' Lh, ., , '"
Rough Plumbing (Top Out) ',: ' -
Rough Mechanical. "
ROugn t:IectrJCallury wall' '
Rough Electrical ' " "
Framing , (OnlyafterPIIlg"~lec"Mech,,andF;re)
insulation (SoundlEnergy) , I'
90 Itottepe or plaster until the following epplicable I
,.tems have been sIgned: " , ' '
Drywall, : ,
Penetrations (Fire Rated) Electrical
,Penetrations (Fire Raled) Mechanical :
Penetrations (Fire Raled) Plumbing " I
Interior Lath , , ' .
Exterior Lath ,
GENERAL ITEMS ,
exterior Plaster (B~n Coat)
T .Bar Electrical ' , "
T-Bar Mechanical '
T.Bar Strudural "
Sewer " , , ' ,
Water Engineering Backflow" '
Water Service
-
FINAL INSPECTIONS , Date, Inspector
Electrical Final '" ' ,
Plumbing ,Final ' ' ,
Mechanical Final , '
Gas Test
Engineering/Grading Final 765,S126 ,
Fire Dept. Final 765-4040 ,"
Water'Engineering 765.5268 , ,
Sub List/Business License 765-51"9 " , ,
, ,
Zoning 765-5139 , , " ,./
Building Final \t"'st Inspection- Only , ~..6( fl'
, Iter Above Complete)
PARTIAL INSPECTIONS ' PZ,oh ' j)' ~S
" , ..- . ,
'. .
BUlldina InspectIons
Mechanical Inspections
PlumbinQ,lrispections
ElectricallnsDections