2552 W GREENACRE AVEPiirmit Typ.33
BLD ELE MEC PLM
X
Permit Number:BLD2009-01749
Issued:06/03/2009
INSPECTION REQUEST LINE:
(714)765 -4626
Quarter Section:25
Site Address:2552 W GREENACRE AVE
Legal Description:NTR2118 LOT 85
CITY OF ANAHEIM
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765 -5153
Project Description:Electrical to upgrade electrical service to lOOamps.
Valuation:
Construcion Types:
Total Feespaid for Permit:
N/A,
136.73
People Associated with Project:
Owner EMPIRE GROWTH-GREENACRE
DAVID BULFER
%KIRIANOFF,PETER P 0 BOX 2248 LA HABRA CA 90632-2248
Permit Applicant
Electrical FixturesType Qty Type Plumbing Fixtures Qty Type Mechanical Fixtures Qty
Meter/Disc Sw -under 600 V,up to 200
amps
1
The permit shall expire by limitation and become null and void if the building or work has not passed final hspection 365 days from the date of permit
issuance.A new permit is required to commence or continue work.fuij permit comb'
All applicable items below must be signed before utilities will be released.
FINAL INSPECTIONS DATE INSPECTORCityofAnaheimFinalGasTest
Building Division Electrical Final
Plumbing Final
Mechanical Final
Cross Connection Control (7i4)76s-s28o
Engineering/Grading Final (7i4>76s-5i26
Fire Dept.Final (714)765-5041
Fire Sprinkler Final (714)765-5Q41
Water Engineering (714)765-4591
Do not occupy this building until the final inspections have been made.
BUILDING PERMIT DOES NOT AUTHORIZE ELECTRICAL,PLUMBING,OR
MECHANICAL INSTALLATIONS -SEPARATE PERMITS ARE REQUIRED.
Sub List/Business License (714)765-5194
Zoning (714)765-5139
Building Final (Last Inspection -
Only After Above Complete)
INSPECTION DATE INSPECTOR
Do not pour concrete until the following applicable items have been signed:
Plumbing (Ground/Underfloor Drain Waste)FINAL INSPECTION must be approved by the Building Division.
Electrical Ground Electrode/Ufer PARTIAL INSPECTIONSSetback/Forms/Tranches (Footings)
Do not install subfloor or pour floor slab until the foilwing applicable items have
been signed;Building Inspections
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Floor (Joist/Girders)
Underfloor Insulation (Raised Foundation Only)
2nd Floor (Floor Nailing)
IVIechanical InspectionsDonotcoverorconcealtheworkbelowuntilthefollowingapplicableitemshave
been signed:
1st Floor Shear
Firesprinkier (Rough)(Fire Dept.)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Duct (Mechanical)
Plumbing InspectionsRoughMechanical
Rough Electrical
Framing (Only after Ptbg.,Ele.,Mec.&Fire)
insulation (Sound/Energy)
Do not tape or plaster until the following applicable items have been signed:
Drywall
Drywall Penetrations (Ele.,Mec.&PIbg.)
Interior Lath
Exterior Lath
Electrical InspectionsGENERALITEMS
Electrical Service Meter
Exterior Plaster (Brown Coat)
T-Bar (Struct.,Ele.,or Mec.)
Sewer
Water Engineering Backflow (Testable Only)
Water Service
Permit Backs Master-2008.xls
P'ermit Types
BLD ELE MEC PLM
X
Permit Number:BLD2009-01749
Issued:06/03/2009 CITY OF ANAHEIM
INSPECTION REQUEST LINE:
{714)765-4626
Quarter Section:25
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765 -5153
Site Address:2552 W GREENACRE AVE
Legal Description:N TR 2118 LOT 85
OWNER -BUILDER DECLARATION:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License State Law for the following reason(s)indicated below by the
checkmarks)I have placed next tothe applicable item(s)(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 applicant for the permit to file a signed statement that he or she is
licensed pursuant tothe provisions of the Contractors'State License Law Chapter 9 (commencing with Section 7000)of Division 3 of the Business and
Professions Code)or that he or she is exempt from licensure and the basts for the alleged exemption.Any violation of Section 7031.5 by any applicant for apermitsubjectstheapplicanttoacivilpenaltvofnotmorethanfivehundreddollars(S500).
I.as owner of property,or my employees with wages as their sole compensation,will do (Y )all or ()portions of the work,and the
structure is not intended or offered for sale (Sec.7044 Business and Professions Code:The Contractors'State License Law does not apply to anownerofpropertywho,through employees'or personal efforts,builds or improves the property,provided that the improvements are not intended
or offered for sale.If,however,the building or improvement is sold within one year of completion,the Owner-Builder will have the burden of
proving that it was not built or improved for the purpose of sale).
I,as the owner of the properly,am exclusively contracting with licensed Contractors to construct the project (Sec.7044 Business and Professions
Code:The Contractors'State License Law does not apply to an owner of property who builds or improves thereon,and who contracts for the
projects with a licensed Contractor pursuant to the Contractor's State License Law).
I am exempt from licensure under the Contractors'State License Law for the following reason:
By my signature below I ackonowledge that,except for my personal residence in which I must have resided for at least one year prior to completion of
the improvements covered by this permit,I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entiretybylicensedcontractors.I understand that a copy of the applicable law.Section 7044 of the Business and Professions Code,is available upon request
when this application is submitted or at the following Web site:http://www.leQinfo.ca.QOv/calaw.html.
By my signature below,I certify to each of the following:
I am the property owner or authorized to act on the property owner's behalf.
I have read this application and the information I have provided is correct.
I agree to comply with all applicable city and county ordinances and slate laws relating to building construction
I authorize rep ntatjy^of thisci r county to enter the above-identified property for inspection purposes.^/Vd ^Signatdmbf Pjpp^^::0?vner or Authorized Agent Date
WORKER’S CX5MPENSAT10N DECLARATION:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000),IN ADDITION TO THE COST OFCOMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OR THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consentto self-insure forworker’scompensation,issued by the Director of Industrial Relations as providedlorbySection3700oftheLaborCode,for the performance of the work for which this permit is issued.
I have and will maintain worker's compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the work forwhichthispermitisissued.My worker’s Compensation insurance carrier and policy are:
Carrier:
Name of Agent:X I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subjecttotheworker's compensation laws of California,and agree that,if I should become subject to the worker's compensation provisions of Section3700oftheLaborCode,I shall forthwith comply with those provisions.
Policy No.:E>q3iration Date:
Phone No.:
Sig i^ure oO^plicant'^r/Date
Permit Number:BLD2009-01749
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY:
I hereby affirm under penally 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 Name:
Lender's Address;
UCENSED CONTRACTORS DECLARATION;
I hereby affirm under the penalty of perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000)of Division 3 of the
Business and Professions Code,and my license is in full force and effect.
Contractor Signature Date
NUMBER EXPIRATION DATE LICENSE TYPE (S^
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 permit is required to commence or continue work.
fbid permit combo declare
Cjty of Anaheim
PLANNING DEPARTMENT
BUlLDrNG DIVfSiON
Acknqwilepcment anp Information Verif[catiqn Form
propeity owner,w'ili be coming to our office to (.et a permit,we wiil provide youwitht-.iUorm v.hen you arrive,f you are sending your ageni.please complete,initial,and sign the infoimal'mnbelow.Also make sum that you have provided your agent with a signed Aurhorb.gtiQn rp Art on Behalt of theJifOpeity-Qwng.r j-ormi.with the required forms of idemification ‘
Dear Propeity Owner;
An application for a building permit has been submitted
property improvements specifiea at your name (isting yourself as the builder of the,Anaheim,CA.
We are providing you with an Owner-Builder Acknowledgment and Information Verihcation Form to makeyouawareofyourresponsibilitiesandpossibleriskyoumayincurbyhavingthispermitissuednameastheOwner-Builder.
in
2.S.S2 Greenacre,
in your
We will not issue a building permit until you have read,initialed your understanding of each provisionSigned,and returned this form to us at our official address Indicated An agent of the owner cannotexecutethisnoticeunlessyou,the property owner,obtain the prior approval of the permitting authority
Owner's Acknowledgment and Verifigation of iNFORMAn^fuDIRECTIONS;Read and initial each statement below to signify you understand or verify this information
i
^<_i.1 understand a frequent practice of unlicensed persons is to have the property owner obtain anOwner-Builder'building permit that erroneously implies that the property owner is providing his or hownlaborandmaterialpersonally,h as an Owner-Builder,may be held liable and subject to seriouslinandalriskforanyinjuriessustainedbyanunlicensedpersonandhisorheremployeeswhileworkingonmyproperty.My homeowner s insurance may not provide coverage for those injuries.1 am willfullyactingasanOwner-Bujlder and am aware of the lirriits of my insurance coverage for injuries to workers onmyproperty.
er
^permits are not required to be signed by property owners unless they arerespoyiiwlefortheconstructionandarenothiringalicensedContractortoassumethisresponsibility.
^Y (understand as an "Owner-Builder"J,,,the responsible party of record on the permit,1 understatha.I may protect myself from potential financial risk by hiring a licensed Contractor and having thepermitfiledmhisorhernameinsteadofmy¬
na
own.
i understand Contractors are required by law to be licensed and bonded in California and to listtheirlicensenumbersonpermitsandcontracts.
5.I understand if i employ or otherwise engage any persons,other than California licensedContractorsandthetotalvalueofmyconstructionisatleastfivehundreddollars($500)including laborandmaterialsImaybeconsideredan"employer''understate and federal law
*understand if 1 am considered an ''employer"under state and federal law,1 must register with thestateanafederalgovernnnent,withhold payroll taxes,provide workers'compensation disability Insuranceandcontributetounemploymentcompensationforeach"employee."1 also understand my failure to abidebytheselawsmaysubjectmetoseriousfinancialrisk
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1^7'California Contractors'State License Law,an Owaer-Bu.lder who builds sinslefamilyresidentialstructurescannotlegallybuildthemwiththeintenttoofferthemforsaleunISperformedbylicensedsubcontractorsandthenumberofstructuresdoesnotexceedfolfr'7thln an^al^ai year,or all of the work is performed under contract with a licensed general building Contractoi.'sell the property for which this permit is issued,I may be heldlableforanyfinancialorpersona!miuries sustained by any subsequent owner(s)that resul fror>-,anylatentconstructiondefectsintheworkmanshipormaterials11la.result trom an>
1 understand I may obtain more information regarding my obligations as an "employer'from therSSmallBusinessAdministration,the California Depart^Vrrt ofBenefit,ayments,and Lhe California Division of Industrial .Accidents.I also understand I may contact theCaliforniaContractors'State License Board (CSLB)at I-800-32I -CSLB (2'752)or www csib ca gw f7'7oreinformationaboutlicensedcontractorswww.csio ca.go/to,more
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*am dwate of and consent to an Owner-Builder building permit applied for in my name and
1.1 agree that,as the party legally and financially responsible for this proposedIwillabidebyallapplicablelav/s and reQuirements that construction activity,govern Owner-Buiiders as well as employers.
immediately of any additions,deletions,or changes to anyoftheinformationhaveprovidedonthisform.Licensed contractors are regulated by laws designedprotectthepublic.If you contract with someone who does not have a license,the Contractors'StateLiceribeBoardmaybeunabletoassistyouwithanyfinanciallossyoumaysustainasaresultofacomplaintYouronlyremedyagainstunlicensedContractorsmaybeincivilcourt,It is also important ForyoutounderstandthatifanunucensedContractororemployeeofthatindividualorfirmisinjuredwhileworkingonyourproperty,you may be held liable for damages.If you obtain a permit as Owner-BuiiderandwishtohireContactors,you will be responsible for verifying whether or not those Contractorproperlylicensedandthestatusoftheirworkers'compensation insurance coverage.
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Before a building permit can be issued,this form must be completed and signed by the propertvandreturnedtotheagencyresponsibleforissuingthepermit owner
Note:A copy of the property owner's driver's license,form notarization,or other verification acceptable totheagencyisrequiredtobepresentedwhenthepermitisissuedtoverifythepropertyowner's signature
Property Owner's Signature:,//Date
7^'
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