2104 Sunrise
BUI.LDING PERMIT NO. BL02003-04714'
TYPE OF PERMIT
Blockwall/Columns CITY
DA Tf: 12/9/2003
JOB ADDRESS: 21.04 W"SUNRISE AVE .
LEGAL DESCRIPTION: . tffi 2878 LOT 22
.
BUILDiNG DNlSION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 39
APPiJCANT: PEDRO AYALA
OWNER INFORMATION:
Pedro.p Ayala
2104 W Sunrise Ave
Anaheim, CA 92801.. .
JOB DESCRIPTION:Build 68 If of 6 ft high block wall per city standards,
VALUATiON: 2,000.00 .
I . OWNER-BUILDE~ 9ECLARATION
;..:1 hereby ~ffjrrT1 under penalty of perjury that I am exempt from the Co:ntr~ctGr$ Licel')se l,aw for the following reason (Sec. 70.31.5 Business and
Professio.ns Code; any diy or countywhictl requ{resa permit to construct, aft:)r, improve, demolish or repair any structure, prior tq its issuance, also
requires the. applicant for such permit to file a signed statement'that he is' licel1sed,pursuant to ~he provisions of the Contractor's License Law (Chapter,
_9)(col"Dmencingwith Se.ction 7000:of Division 3 of the Business and ProfessK,ins Code) or that he is exempt therefrom and the basis.forthe alleged
exemption.,',AITj violation of Section 7031.5" by any applicant fora pei/111t::su:;!ectS the' applicant to a dvil penalty of not more than five hundred dollar::!
($SaO)" '. ..... . I .... . .'. . '. '" .
'0 I, as owner of property: or my employees With wages-as their sole comYl'msation, .will'~o ~hework, .and the structure is not i,:"tended or offer~d for
sale (Sec. 7044 Business and Professions Code: The Contractor's licen~s ,_kw does'rlot apply to an owner of property who bui.k1s or improves
thereon, an(jwho does such work himself or'herself or through his or her oWI!'employeas, provided that such improvemen~sare not intended or
off~redfor $at . If,_however, the'buildjng or improvement is sold with ore~' ':',\j'cf completion. the owner-builder will have the burden of prqving that he
- di not . or improve for the purPose of sale). . . I . , . . .
. , as the owner of the property, am exdusi'Jely contracting with licen$cd l::ontractors to construct the project (See. 7044 Business and -Professions,
Code: .rhe-'Cbntractor's License Law does- not apply to an owner of prc?ert"f~lVho builds or Improves thereon, and who oontractsfor such projects with
ontrador(s) licensed pursuant to the Contractor's lice Law). .!
I ,
la . exempt under Sec.. . :,B ' . or is re .
ale' -A:t- 9-';OR~;;~ COMPENSATION DECLARATI N' .':'~ --J
. . f hereby affirm under penalty of perjury' one of the following declar3!!cr;s:.: .
o I have and will. maintain a 'certificate of oonsent to self-insur:1 for worker':t c::llnp"ensatiori,
.'- a~ provided for by Section 3700 of the Labor Code, for. the perforl"'1Dnce oft;'f ':\orkforwhich
this permit is issued. .. j
'0 I have'snd 'will maintain wurker's compensation insurance, as requirectJ 8ec.lion3700 of
'the Labor'Code, for the performance of the, work for which this perrriit is iSSl:'}.::!. Myworker's
ComPensation insurat1cecarrier and policy are:
Carrier: . PolicyNumber:
CONTRACTOR INFORMt,TION:
ARCHITECTlENGINEIOR INFORMATION:
PROCESSED BY: ODe
l
LICENSED CONTRACTORS DECLARATION'
I hereby affirm under penalty of perjury that I am
licensed un.de( proviskins of c~apter 9 (commencIng
with Section 7000) of"Oivsion 3 of the Business and
Professions COde:
1219/2003
Dale;
Contractor
NUMBER
. EXP;RATION DATE
, . ., - ..
. '. '. . ~ .
This section. need ,not be COf.11pleted if the pennit is for one hundred dol!~ ($1Q!';::cr less.
0.. ': certify that in the, performance of the work for whichtl:Jjs penni(is i~u~~'!;_rsha}l not
employ_any person in any manner so as to become subject to the work~.r'~~,rrlpens3tion l~ws
of Cal.ifomia, and agree that if I shou ld 'become subject ,to the wO.rker'scOn:~:h1;tation
provisions of ~ection,3700 of the Labdr~ sha.1l ~rt~~omp - wit~_t! #~,~rovisions:
'Date: 1219/2003 Applicant: 77:,~ Ul .::r.. "L
WARNING: FAILURE'TO SECUREWORKER'S COMPENSATIO OVER';GE IS
UNLAWFUL,ANDSHAlLSUBJECTAN EMPLOYER TO CRIMIN. . PEN~li"IES AND CIVIL
FINES UPTO ONE HUNDRED 1HOUSAND DOLLARS ($100,000); IN AoE:,hoN TO THE'
COST OF COMPENSATION, DAMAGES ASPROVIDED FOR IN ~ECT:Ot137l;6 OFTI:iE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .... ,,! c;'i, , .
I, '.' . CONSTRUCTION LENDING AGENCY . ';}Jr
I hereby affirm wider penalty of perjury that there is a construction tending al'~n_c?l'!of the
perforr:nan~ oft~e work for which thi's permit is issued (Se~;3~7.piv,.C): ; 'f,
--. :':'-':'iiC:~f<i :;)f'::'iTI,ali,,;'i;
TYPE
.Construcion Types:,
VN, ,
Fire Sprinklered7
NO
I
'.certify that I have read. this application and state that the above infbrmation i5correct.. I
ag'ree to oomply withal! city'ordinances and state laws relating to building COilstruction, arid
'herebY'authorize repro tives of this city. to enter upon the above mentioner; propertY for
inspection pui'
Fees paid for Permit:
Total:
111.69
Date 1219/2003
. Signature of Applicant or A t
TOOpermitshall 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 {&qUired to commence or continue work.
INSPECTION RECORD
. INSPECTOR'
INSPECTION . DATE
Temporary Power Pole '. .
.' Plumbing (Drain/Waste pipe) .'.
. Electrical Ground ElectrodelUfer ,
SetbaCklFormslTrenches (FoOtings) .
OQ not install subfloor or pour floor,slab until the
fallowing applicable items have been. signed: '
Plumbing (Water .Plpe.Sprinkler Valves)
Mechanical (Grotindwork).
Electrical (Underground Conduit) .
Pre-slab(CompactionlMembrane.Rel nf. .
Underpinning (Floor JoistlGirders) . ' .
Do not cover Or conceal the wOtk below until the .
follDwing applicable items have been signed: " ,
1 st Flooi'Shear . .
,Firesprinl<ler '(Rough) . .
2nd Floor ShOar '. . B
Roof (Sheathing/Diaphraam/Frame) '.' .'
Masonry (ReinfJBond Belll'l!/Pre-Grout) n~
Rough Plumbing (Top Out) , ;y'
Rough Mechanical ' .
I Rough Electrical (Dry wall)
. Rough Electrical
Framing (Only after Plbg.,Elec,. f..lech.: and Fire)
Insulation (SoundiEnergy) M
Do not tape or plaster 'until the following applicable
items hav~, been -signed: - , . I,',
Drywall '. , .
"
Penetrations (Fire Rated) Electrical .,
Penetrations (Fire Rated) Mechanical .' .
Penetrations (Fire Rated) PI umbi Ilg .'
Interior Lath .. " .
I P
. Exterio, Lath . ' " .
. . GENERAL ITEMS .
Exterior Plaster (Brown Coat)
T-Bar Electrical. '.' .
'. T-Bar Mechanical .
T-Bar Structural ,
sewer . , ' .
Water Engineering Backflow. ' . E
Water Service "
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading F,inaI765-5126 ",
,'Date
Inspector,
Fire Dept" Final 765-4040
Water Engineering 765.5268
Sub ,List/Business License 765.51
Zoning 765-5139
Building Final It.ast Inspeclion- Only
, After Above Complete)
PARTIAL INSPECTI
uildina h,spections
eChanicallnspections
lumbina Inspections
lectricallnspections
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PLANNING DEPARTM
AP~~gVED
D ATE Ia.-I" =t.lQ:?
BY ~~C"ON -kw I
fLOOD ZONE X Utlitia.\~}
uti
-
C DISTRICT REVIEW,
S'"le stamp _n,i~ oafoe
'Ie (1fle 1;;ft 2.bove line
SEE BLJllD!'IG F'ERMIT FOR
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