1110 N EAST ST^Perrxiit Types
BLD ELE MEC PLM
X
Permtt Number:BLD2009-02035
Issued:06/26/2009
INSPECTION REQUEST LINE;
(714)765 -4626
Quarter Section:91
Site Address:1110 N EAST ST
Legal bescri|Mbn:N TR 1825 LOT 149
CitY OF ANAHEIM
/BUlLDlNGi.DIVISIC3N
200 S.'ANi^EIM BLVD.(714)76^^5153
Project Description:Plumbing for residential remodel:Replace gas line from meter to apartment building.
Valuation:
Construcion Types;
Total Fees paid for Permit:
N/A,,
136.73
People Associated with Project:
Owner JAIME V ABURTO
Permit Applicant JAMIE V ABURTO
431 N DEERFIELD ST ANAHEIM CA 92807-2940
Electrical RxturesType Qty Type Ptumbing Rxtures Qty Type Mechanical Rxtures Qty
Gas System (1-5 outlets)1
The permit shall expire by Gmitation and become null and void if the building or work has not passed final kispectbn 365 days from the date of permitissuance.A new perntit is required to commence or contfrtue work.
All applicable items below must be signed before utilities will be released.
FINAL INSPECTIONS DATE INSPECTOR
Final Gas Test
Building Division Electrical Final
Plumbing Final
Mechanical Final
Cross Connection Control (7i4)765-4200
Engineering/Grading Final (714)755-5126
Fire Dept.Final (714)765-5041
Fire Sprinkler Final (714)765-5041
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)
DATEINSPECTION 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/FormsrTrenches (Footings)
Do not install subfloor or pour floor slab until the follwing 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
GENERAL ITEMS Electrical Inspections
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 ELE MEC PLM
X
Permit Number:BLD2009-02035
Issued:06/26/2009
INSPECTION REQUEST LINE:
(714)765 -4626
Quarter Section;91
CITY OF ANAHEIM
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765 -5153
Site Address:1110 N EAST ST
Legal Description:N TR1825 LOT 149
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
checkmark(s)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 basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for apermitsuWectstheapplicanttoacivilpenaltyofnotmorethanfivehundreddollars(S500).
I.as owner of property,or my employees with wages as their sole compensation,will do )all or {)portions of the work,and the
structure is not intended or offered for sale (Sec.7044 Business and Professions Code:^e 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 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 Slate 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 oftheimprovementscoveredbythispermit,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.aov/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 c
I authorize rdlyiply with all applicable city and county ordinances and state laws relating to building constructionrepresentativesofthiscityoyrountytoentertheabove-identified property fojyinfection purposes.
^^-
Sigrr^fure of Property Owner or Authorized Agent
V
D^te
WORKER'S COMPENSATION 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 ATTORNEY'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 providedforbySection3700oftheLaborCode,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:
VName of Agent:
V 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!should become subject to the worker's compensation provisions of Section3700oftheLaborCode.I shall forthwith comply with those provisions.
Policy No.:Expiration Date:
Phone No.:
\
J ~-^^
ignatur^f Applicant Date
Permit Number:BLD2009-02035
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:
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 the
Business and Professions Code,and my license is in full force and effect.
Contractor Signature Date
NUMBER EXPIRATION DATE LICENSE TYPE (St
The permit shall expire by limitation and become nuli 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 contiiue work.
fbid permit combo declare
CITY OF ANAHEIMINSPECTIONREQUESTLINE:
(714)765 -4626
Quarter Section:91
Permit Number:BLD2009-02035
Issued:06/26/2009
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765 -5153
OWNER-BUILDER ACKNOWLEDGEMENT AND INFORMATION VERIFICATION FORM
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
Improvements specified at 1110 N EAST ST .
We are providing you with an Owner-Builder Acknowledgement 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 unless you,the property
owner,obtain the prior approval of the permitting authority.
Directions:Read and initial each statement below to signify you understand or verify this information.
^1.1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder"building
permit that erroneously implies that the property owner is providing his or her own labor and material personally.I,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 working 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 responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
^Ll 3.1 understand as an "Owner-Builder"I am the responsible party of record on the permit.I understand that I may protect
myself from potential 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.
5.I understand if I employ or otherwise engage any persons,other than Caliifornla licensed Contractors,and the total
value of my construction is at least five hundred dollars ($500),including labor and materials,I may be considered an
"employer"understate and federal law.
6.1 understand if I am considered an "employer"under state and federal law,I must register with the state and federal
government,withhold payroll taxes,provide workers's compensation disability insurance,and contribute to unemployment
compensation for each "employee".I also understand my failure to abide by these laws may subject me to serious
financial risk.
7.1 understand under California Contractors'State License Law,an Owner-Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale,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.
-O'8.1 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 the Internal Revenue
Service,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 1-800-321-CSLB (2752)or www.cstb.ca.gov for more information about licensed contractors.
(//
II
l'bld_owncr_bui lder_inlb_verif
Perniit Number:BLD2009-02035
4 10.1 am aware of and consent to an Owner-Builder building permit applied for in my name,and understand that I am the
party legally and financially responsible for proposed construction activity at the following address:1110N EAST ST.
11.1 agree that,as the party legally and financially responsible for this proposed construction activity,I will 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 of the 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 will be responsible 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 license,form notarization,or other verification acceptable to the agency isrequiredto^e presented when the permit is issued to verify the property owner's signature.
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Prorcrty Owner's Signature Date:
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