400 S. Windmill Ln.
TYPE OF PERMIT
Blockwall/Columns CITY
DATE: 6/3/2005
JOB ADDRESS: 400 S WINDMILL LN
LEGAL DESCRIPTION: N TR 8153 LOT 24
ElM
. BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
INSPECTION REQUESTLINE:
(714) 765.4626
CENSUS CODE: .434
QUARTER SECTION: 163
BUILDING PERMIT NO. BLD2005-01661
CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
M GONZALEZ LANDSCAPE AND MAINTENANCE
275 W WOODCREST ST
RIAL TO, CA 92376 0000
BUSINESS PHONE: 951 312-4332
JOB DESCRIPTION:Build 62 linear ft. of 6' hi9h block wall per city standards.
VALUATION: 4,000.00 ,
APPLICANT: MACEDONIO. GONZALEZ
OWNER INFORMATION:
Jan Meiserman
400 S Windmill Ln,
Anaheim, CA 92807
. PROCESSED BY: ENO
I
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Ucense Law for the following reason (Sec. 7031.5 Business and.
Professions Code: any city or county which requires a permit to 'construct, alter, improve, demolish or repair any structure, prior to i:ts issuance, also
requires the applicant for such permit to file a signed statemelJt that h.e is licensed pursuant ~o the plOvisions 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 faT the alleged
exemption. Any violation of S"ection 70,31.5 by any applicant for a permit subjects the- applicant to a civil penalty of not more than five hundred doll'ars
($500).
o . I, as owner of property, or my employees with wages as their sole compen~ation, will do the work, and the ~tructure is not intended or offered for
sale (Sec.7044 Business and Professions Code: The Contractor's Ucense Law does not apply to a,n owner of property who builds or improveS
thereon,. and who does such work himself or herself or-through his or her own enployees, provided that such improvements are not intended or
offered fC/r sale. Lf, 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 saie).' .
o /, as the owner of the property, am, exclusively contracting with licensed cOhtractors to construct the project (Sec. '704.4 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
a contractor(s) licensed pursuant to the Contractor's License Law)~ . -
o I am exempt under Sec. ' , B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o J have and will ma'intain a certificate of consent to'self-insure for worker's compensation,
as provided for by Section 3700-of the LabOr Code, for the performance of.thewoJ1<, for which
this permit is issued. .
~ I have and will maintain-worker's compensation insurance, as ~quired by Section 3700 of
ffie. Labor Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insuranqe carrier and policy are:
Carrier: STATE FU ND
Poli0' Number:" 1753679
6/3/2005
Date:
This section need not be completed if the pennit is for one hundred dollars ($1 00) or less.
ff'icertifythat in the: performance of the wo~k for which this permit is issued,l shall not
employ any person in any manner so as to become subject to the worker's compensation laws
of Califomia, and agree that if I should become SUbject to t worker's compensation
provisions of Section 3700 of the Labor COdCf,I'J hall ~ort th campi w' thas rovisions.
Date: 6/3/2005 Applicant:
WARNING: FAILURE TO SECURE 0 K 'S COMPENSATION C ERAGE IS
UNLAWFUL, AND SHALL SUBJE AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED OUSAND DOLLARS ($100,000), IN ADOIllON TO THE
COST OFCOMPENSATtON" AMAGES AS PROVIOED FOR IN SECTION'3706 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 aget1cy for the
performance of the work for which this permit is issued (SeG. 3097.Civ.C):
Lender's Information: .
NUMBER'
750006
TYPE
EXPI RATION DATE
5/31/2006
C27
Construcion Types:
VN, ,
Fire Sprinklered?
NO
Fees paid for Permit:
Total:
125.79,
? Date: 6/3/2005
ig a ure of Applicant or Agent
The p mit shall expire by limitation and become null and void if the building or
work s not passed final inspection 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/lifer ' I /
SetbacklFormsfTrenches (Footings) ~/Moi .\A ~ot.\Su..1
Do not install sllbfloor or pour floor sla~tn~lthe
following applicable items have been signa :
Plumbing (Water Pipe.Sprinkler Valves)
Mechanic:al (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compactio!lfMembrane.Reinf. ,
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work belowunlilthe
following applicable items have been signed: ' ,
1st Floor,Shear
Firesprinkler(Rough) '" ,
2nd Floor Shear
Roof (Shealhing/D1aphragmlF~ ~
Masonry (ReinfJBond BeamJPr t) 1 V~\
Rough Pluml>ing(Top Ollt)
Rough Mechanical
Rough Bectrical (Dry Wall),,' , ,
Rough Electrical
Framing (Only after Plbg:, Elee:. Mach.. and Fire)
Insulation (SoundlEnergy)
Do not tape Or plaster until the fOllowing applicable
items have been'signed: _ . . _-
Drvwall ,
Penetrations (Fire Rated)" Electrical ' ,
Penetrations (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 Englneering,BaCkfJow " ,
W"ter Service'
FINAL INSPECTIONS Date Inspector '
Electrical Final
Plumbing Final I
, ,
Mechanical Final ' " ' '
Gas Test "
Engineering/Grading Final,76s.5126
Fire Depl. Final 765-4040
Water Engineering 765-5268,
Sub List/Business li'cense765-519
Zoning 765-5139 ,
Building Final \l-astlnspection- Only 1Mlo)", rr:~f~
' fter Above,Complete)
PARTIAL iNSPECTIONS
Buildinq Inspections
Mechanical Inspections
Plumbinq Inspections
Electrical Inspections
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