1178 N. Willow Woods Dr. A
CONTRACTOR INFORMATION:
KENNETH S LAMB
2169 MINER ST
COSTA MESA, CA 926270000
BUSINESS PHONE: 949631-0739
JOB DESCRIPTION:Construct a new door from the garage to the kitchen.
VALUATION: 900.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License 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 its issuance, also
requires the a.pplicant for such permit to file a signed statement that he is Iicen'3ed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professiors Code) or that he is exempt thelBfrom 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
($500),
o I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
sale (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 does such work himse~ or herself or through his or her own /!mployees, 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 C<lOtractors 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
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 I have and will maintain a certificate of consent to self~insure for worker's Gompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
ih' permit is issued.
I have and will maintain worker's compensation Insurance, as required by 3ection 3700 of
t Labor Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier: STATE FUND
BUILDING PERMIT NO. BLD2005-02794
TYPE OF PERMIT C
Residential Remodel I TV
DA TE: 9/6/2005
JOB ADDRESS: 1778 N WILLOW WOODS DR A
LEGAL DESCRIPTION:
APPLICANT: KENNETH LAMB
OWNER INFORMATION:
JIMMIE J HICKS
1778 N WILLOW WOODS DR #A
ANAHEIM, CA 92807
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION:
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: MSM
Policy Number. 1263662
This section need not be completed if the pennit is for one hundred dollars ($1 00) (w less.
o I certify that in the perlonnance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the worke~s compensation laws
of Califomia, and agree that if I should become subje 0 t e worker's compensation
provisions of Section 3700 of the Labo e, I shall rt th comply with those provisions.
0;
Date: 9/6/2005 Applicant:
WARNING: FAILURE TO SECUR WOR ER'S 0 PENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJE T AN EMPLOY TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED OUSAND DOLLARS ($100,000), IN ADDITlON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED 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 agency for the
performance of the work for which this permit is issued (Sec. 3097.Civ.C):
Lender's In1ormation:
I certify that J have read this application and state thaUheabov.:e infQrmation i.icorrect. I
agree to comply with all ci ordinances and state laws relating to building construction, and
hereby authorize repre ntiv s of this city to enter upon the above mentioned property for
insp; i n purpo
Date: 9/6/2005
of Applicant or Agent
The permit shall ex' 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 required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of ch r 9 (commencing
with Section 7000) of Divslon of he Business and
Profession L
9/6/2005 ~
Date:
NUMBER
422856
TYPE
EXPIRATION DATE
5/31/2006
B
Construcion Types;
VN, ,
Fire Sprinklered?
NO
Fees paid for Permit:
Total:
113,63
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainIWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormsfrrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane 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
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical I
Rough Electrical (Dry Wall) crm/v' n (J,(jj,
Rough Electrical /
Framing {Only after Plbg., E'e., Mec. And Fire) f1/2Y ur JrZiL IE,
Insulation (Sound/Energy) ,
Do not tape or plaster until the following applicable
items have been signe :
Drywall IQ (I" D/Ut\J (Ii
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 l/ok/,J 7Y7AllE
Plumbing Final J
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water E~gineering 765-5268
Sub List/Business License 765-5194
Zoning 765-5139
Building Final (Last Inspection . Only q 111.) fnRU
After Above Complete)
PARTIAL INSPECTIONS
Building Inspections
,
Mechanical Inspections
Plumbing Inspections
Electrical Inspections