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855 N PINE STPermit Types BLD ELE MEC PLM X Permit Number:BLD2009-Q2068 Issued:06/30/2009 INSPECTION REQUEST LINE: (714)765 -4626 Quarter Section:61 Site Address:855 N PINE ST Legs!Descri|Sfion;N TR1019 LOT 7 i ' CITY OF ANAHEIM BUILDING DIVISION 200 a Anaheim BLVD. (714)765-5153 Project Description:Upgrade electrical meter to 200 amps. Valuation; Construcion Types: Total Fees paid for Permit; N/A,, 136.73 People Associated with Project: Owner DANIEL HERNANDEZ 855 N PINE ST ANAHEIM CA 92805-1853 Permit Applicant ELIS HERNANDEZ Electrical Fixtures Qty TypeType Plumbing Rxtures Qty Type Mechanical iFxtures 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 ifispectbn 365 days from the date of permitissuance.A new permit is required to commence or continue work.fbid permit combo All applicable items below must be signed before utilities will be released. FINAL INSPECTIONS DATE INSPECTORCityofAnaheim Building Division Final Gas Test Electrical Final Plumbing Final Mechanical Final Cross Connection Control (714)755.4280 Engineering/Grading Final (714)755.512$ 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) 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 INSPECTIONS Setback/FormsH’ranches (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 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:BLD2009-02068 Issued:06/30/2009 CITY OF ANAHEIM INSPECTION REQUEST LINE: (714)765 -4626 Quarter Section;61 BUILDING DIVISION 200 S.ANAHEIM BLVD. (714)765 -5153 Site Address:855 N PINE ST Legal Description:N TR1019 LOT 7 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 to the applicable item{s)(Sec.7031.5 Business and Professions Code:any city or county which requires a permit to constructafter,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 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 and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for apermitsubjectstheapplicanttoacivilpenaltyofnotmorethanfivehundreddollars(S500). ^-1 ,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;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 Qwner-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 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 entirety by licensed contractors.I understand that a copy of the applicable law.Section 7044 of the Business and Professions Code,is available upon requestwhenthisapplicationissubmittedoratthefollowingWebsite:httD://www.leQinfo.ca.Qov/calaw.html. Bymy 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 cornply witjn all apf),ljcable city and county ordinances and state laws relating to building constructionIauthorizj■esftntBtives this city or county to enter the above-identified property for inspection purposes. Signature of Property Owner or Authorized Agent Date 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; Name of Agent: 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 Section 3700 of the J_abor Cgde,I sh^^forthwith comply with those provisions. Policy No.:Expiration Date; Phone No.: // >v// of A^licSignati Date Permit Number:BLD2009-02068 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 (SGC.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 Diwsion 3 of the Business and Professions Code,and my license is in full force and effect. Contractor Signature Date NUMBER EXPIRATION DATE LICENSE TYPE fS^ The permit shall expire by limitation and become null and void if the buildhg or work has not passed final inspection 365 days from the date of permit issuance. A new permit is required to commence orconthue 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 you with this form when you arrive.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 sybmUtedy«in ypur name listing yourself as the builder of thepropertyimprovementsspecifiedat^ 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 unless 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 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 acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property, 2.I 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. _3.I understand as an "Owner-Builder"I am the responsible party of record on the permit.I understand that 1 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. da %_4.I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5.1 understand if I employ or otherwise engage any persons,other than California 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"under state and federal law. 6.I understand if 1 am considered an "employer”under state and federal law,I must register with the state and federal government,withhold payroll taxes,provide workers’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. Vi MARCH 2009 200 S.Anaheim Blvd .Suite 145 Anaheim,California 92805 (7i4)765-5l53 Phone (714)765-4607 Fax www.anaheim.net/buil ding B72I Vfi^7.I 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 ai!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. W 8.I understand as an Owner-Builder if I sell the property for which this permit is issued,I may be heldliableforanyfinancialorpersonalinjuriessustainedbyanysubsequentowner(s)that result from any latent construction defects in the workmanship or materials. _9.I understand I may obtain more information regarding my obligations as an "employer"from the rnal 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 I-800-321-CSLB (2752)or www.cslb.ca.gov for more information about licensed contractors. _I0.I am 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 wn 11.I agree that,as the party legally and financially responsible for this proposed construction activity,1*;^ill abide by all applicable laws and requirements that govern Owner-Builders as well as employers, ijy 12.i agree to notify the issuer of this form immediately of any additions,deletions,or changes to anyoftheinformationIhaveprovidedonthisform.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 totheagencyisrequiredtobepresentedwhenthepermitisissuedtoverifythepropertyowner's signature. Property Owner's Signature:Date: PAGF:2 0F2 200S.Anaheim Blvd.,Suite 145 Anaheim.California 92805 (7141765-5153 Phone (714)765-4607 Fax www.anaheim,net/buil ding B72I