7055 E BLACKBIRD LN (7)Permit Types
BLD ELE'MEC PLM
X
Permit Number:BLD2009-01684
Issued:05/27/2009
INSPECTION REQUEST LINE:
(714)765 -4626
Quarter Section:210
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765 -5153
Site Address:7055 E BLACKBIRD LN
Legal Description:N TR 8465 LOT 1
Project Description:Electrical for residential remodel:Upgrade electric panel to 200 amp service.
Valuation:
Conslrudon Types:
Tola!Fees paid lor Permit:
N/A,.
136.73
People Associated with Project:
Owner THOMAS MORTON
THOMAS MORTON
7055 E BLACKBIRD LN ANAHEIM CA 92807-4401
Permit Applicant
Electrical Fixtures Qty Type Plumbing FixturesType 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 inspectton 365 days from the date of permit
issuance.A new permit is required to commence or continue work.tbld pormii combo
AH applicable items below must be signed before ulilities will be/ehaaseri^
FINAL INSPECTIONS DATE INSPECTORCityofAnaheim
Building Division
Final Gas Test
Electrical Final
Plumbing Final
Mechanical Final
Cross Connection Control (714>765-4280
Engineering/Grading Final (714)765-512b
Fire Dept.Final (714)765-5041
Fire Sprinkler Final (714)765-5041
Water Engineering (714)765-4591
Do not occupy this buildinQ 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
INSPECTION Building Final (Last Inspection -
Only After Above Complete)
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/Trenches (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)
Mechanical InspectionsDonotcoverorconcealtheworkbelowuntilthefollowingapplicableitemshave
been signed:
1st Floor Shear
Firesprinkler (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 PIbg.,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
Permit Types
BLD I ELE MEC PLM
X1
Permit Number:BLD2009-01684
Issued:05/27/2009 CITY OF ANAHEIM
INSPECTION REQUEST LINE:
(714)765 -4626
Quarter Section:210
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765 -5153
Site Address:7055 E BLACKBIRD LN
Legal Description:N TR 8465 LOT 1
OWNER -BUILDER DECLARATION:
I h^eby 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
checlenark(s)I have placed next to the applicable item{s)(Sec.7031.5 Business and Professions Code:any city or county which requires a permit to construct,alter,improve,demolish or r^airany structure,priorto its issuance,also requires the applicant forthe permit to file a signed statement that he or she is
licensed pursuant to the 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 andthe basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for apermitsubjectstheapplicanttoacivilpenaltyofnotmorethanfivehundreddollars($500).
—I,as owner of property,or my employees with wages as their sole compensation,will do (_,)portions of the work,andthe
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
oi^ffered for sale.If,however,the building or improvement is sold within one year of completion,the Owner-Builder will have the burden ofpfovingthatitwasnotbuiltorimprovedforthepurposeofsale).
)all or (
I,as the owner of the property,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 priorto 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 requestwhenthisapplicationissubmittedoratthefollowingWebsite:http://www.leainfo.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 state laws relating to building constructionIAuthorizerepreserilativesofthiscityorcountytoentertheabove-identified property fo^inspection purposes.iN
/Signature of Property Owner or Authorized Agent late
WORKER'S CX)MPENSA710N 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 OF
COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OR THE LABOR CODE,INTEREST,AND ATTORN EY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self-insure for worker's compensation,issued by the Director of Industrial Relations as provided
for by Section 3700 of the Labor Code,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 for
which this permit is issued.My worker's Compensation insurance carrier and policy are:
Carrier:
Name of Agent:
L Jxertify 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 subjectV/to the worker's compensation laws of California,and agree that,if I should become subject to the worker's compensation provisions of Section
3700 of the Labor Code,I shall forthwith comply with those provisions.
Policy No.:EjqDiration Date:
Phone No.:
/
ature of Applicant Date
Permit Number:BLD2009-01684
DECLARATION REGARDING 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 Name:
Lender's Address:
LICENSED 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 theBusinessandProfessionsCode,and my license is in full force and effect.
Contractor Signature Date
NUMBER EXPIRATION DATE LICENSE TYPE fSt
The permit shall expire by limitation and become null and void if the building or work has not passed final inspection 365 days fromthe date of permit issuance.
A new permit is required to commence or continue work.
fbid oermit combo declare
City of Anaheim
PLANNING DEPARTMENT
BUILDING DIVISION
Owner-Builder Acknowledgment and Information Verification Form
*Per California State Law,if you,the property owner,will be coming to our office to get a permit,we will provide youwiththisformwhenyouarrive.If you are sending your agent,please complete,initial,and sign the information
below.Also make sure that you have provided your agent with a signed Authorization to Act on Behalf of the
Property Owner Form with the required forms of identification
Dear Property Owner:
An application for a building permit has been sulamitted in your name listing yourself as the builder of the
property improvements specified at "Zo.nr
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make
you aware of your responsibilities and possible risk you may incur by having this permit issued in your
name as the Owner-Builder.
/
We will not issue a building permit until you have read,initialed your understanding of each provision,signed,and returned this form to us at our official address indicated.An agent of the owner cannot
execute this notice uniess you.the property owner,obtain the prior approval of the permitting authority.
Owner's Acknowledgment And verification of Information
DIRECTIONS:Read and initial each statement below to signify you understand or verify this information,
i.I understand a frequent practice of unlicensed persons is to have the property owner obtain an
"Owner-Buiider"building permit that erroneously implies that the property owner is providing his or her
own labor and material personally.1,as an Owner-Builder,may be held liable and subject to serious
financial risk for any injuries sustained by an unlicensed person and his or her employees while working
on my property.My homeowner's insurance may not provide coverage for those injuries,i am willfully
acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on
my property.
2.1 understand building permits are not required to be signed by property owners unless they are
responsif^le for the construction and are not hiring a licensed Contractor to assume this responsibility.
,3.1 understand as an "Owner-Builder"1 am the responsible party of record on the permit.I understand
that I may protect myself from potential financial risk by hiring a licensed Contractor and having the
permit filed in his or her name instead of my own.
,4.1 understand Contractors are required by law to be licensed and bonded in California and to list
their license numbers on permits and contracts.
yr 3.I understand if I employ or otherwise engage any persons,other than California licensedC^cThtractors,and the total value of my construction is at least five hundred dollars ($500),including labor
and materials,I may be considered an "employer”under state and federal law.
(^,t.I understand if I am considered an "employer"under state and federal law,I must register with thestateandfederalgovernment,withhold payroll taxes,provide workers’compensation disability insurance,
and contribute to unemployment compensation for each "employee,”1 also understand my failure to abide
by these laws may subject me to serious financial risk.
n
a.
MARCH 2009
200 S.Anaheim Blvd.,Suite 145 Anaheim,California 92805 (714)765-5153 Phone (714)765-4607 Fax www.anaheim.net/buil ding B721
^7,I understand under California Contractors’State License Law,an Owner-Builder who builds singlefamilyresidentialstructurescannotlegallybuildthemwiththeintenttoofferthemforsale,unless all work
is performed by licensed subcontractors and the number of structures does not exceed four within any
calendar year,or all of the work is performed under contract with a licensed general building Contractor.
^8.I understand as an Owner-Builder if I sell the property for which this permit is issued,I may be held
liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any
latent construction defects in the workmanship or materials.
^9.1 understand I may obtain more information regarding my obligations as an "employer”from theInternalRevenueService,the United States Small Business Administration,the California Department of
Benefit Payments,and the California Division of Industrial Accidents.I also understand I may contact the
California Contractors’State License Board (CSLB)at I-800-321-CSLB (2752)orwww.cslb.ca.gov for more
information about licensed contractors.
£.10.lam aware of and consent to an Owner-Builder building permit applied for in my name,and
erstand that I am the party legally and financially responsible for proposed construction activity at the
following address;
u
/£_!1.1 agree that,as the party legally and financially responsible for this proposed construction activity,iVill abide by all applicable laws and requirements that govern Owner-Builders as well as employers.
.12.1 agree to notify the issuer of this form immediately of any additions,deletions,or changes to any
e information I have provided on this form.Licensed contractors are regulated by laws designed to
protect the public.If you contract with someone who does not have a license,the Contractors’State
License Board may be unable to assist you with any financial loss you may sustain as a result of a
complaint.Your only remedy against unlicensed Contractors may be in civil court.It is also important for
you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while
working on your property,you may be held liable for damages.If you obtain a permit as Owner-Builder
and wish to hire Contractors,you wiil be responsibie for verifying whether or not those Contractors are
properly licensed and the status of their workers’compensation insurance coverage.
Before a building permit can be issued,this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit.
Note;A copy of the property owner's driver's iicense,form notarization,or other verification acceptabie to
the agency is required to be presented wh^n the permit is issued to verify the property owner’s signature.
Property Owner’s Signature:
£o
7/0-71.Date:
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200 S.Anaheim Blvd..Suite 145 Anaheim,California 92805 (7141765-5153 Phone (7141765-4607 Fax www.anaheim.net/buil ding B72I