212 E VERMONT AVEPermit Types
BLD ELE MEC PLM
I X I^ej^rnit Number:BLD2009-02071
Issued:06/30/2009
'.JCITTOF ANAHEIM
INSPECTION REQUEST LINE:
(714)765 -4626
Quarter Section:85
Site Address:212 E VERMONT AVE
Legal Description:N TR1245 LOT 19
BUILDING DIVISION
200 s.Anaheim blvd.
(714)765-5153
Project Description:Electrical to upgrade service to 200 amps.
Valuation:
Construcion Types:
Total Fees paid for Permit:
N/A..
136.73
People Associated with Project:
Owner TERRY WILSON 21855 HEATHERWOOD LN.YORBA LINDA CA 92887
Permit Applicant TERRY WILSON
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 inspection 365 days from the date ofpermitissuance.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 (?i4)705-4200
Engineering/Grading Final (714)705-5126
Fire Dept.Final (714)765-5Q41
Fire Sprinkler Final (714)765-5041
Water Engineering (714)765-4591
Do not occupy this building until the final inspections have been made.
BUILDING PEFIMIT 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/Forms/Trenches (Footings)
Do not install subftoor 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 (Sheafhing/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 ELE MEC PLM
X
Permit Number:BLD2009-02071
Issued:06/30/2009
INSPECTION REQUEST LINE:
(714)765 -4626
Quarter Section:85
CITY OF ANAHEIM
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765-5153
Site Address:212 E VERMONT AVE
Legal Description;N TR 1245 LOT 19
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 thecheckmark(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 toconstruct,alter,improve,demolish or repair any structure,prior to its issuance,also requires the applicant for the permit to file a signed statementthatheorsheislicensedpursuanttotheprovisionsoftheContractors'State License Law Chapter 9 (commencing with Section 7000)of Division 3ofthe^usiness and Professions Code)or that he or she is exempt from licensure and the basis7031^by any applicant for a permit subjects the applicant to a civil penalty of not more than fiy€hundred dollars (S500).
the alleged exemption.Any violation of Section
I.as owner of property,or my employees with wages as their sole compensation,will do
intended or offered for sale (Sec.7044 Business and Professions Code:The Contractors’State License Law does not apply to an owner of property whothroughemployees’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 forthepurposeofsale),
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 alicensedContractorpursuanttotheContractor's State License Law).
I am exempt from licensure under the Contractors’State License Law for the following reason:
)all or ()portions of the work,and the structure is not
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 theimprovementscoveredbythispermit,I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entirety by licensedcontractors.I understand that a copy of the applicable law,Section 7044 of the Business and Professions Code,is available upon request when this applicationissubmittedoratthefollowingWebsite:httD://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 comply with all applicable city,^ac!d county ordinances and state laws relating to building constructionIauthorize-fst^etentatives^f this,city or ceuQW to enter the above-identified property for inspection purposes.
6-^0-^7aSignatureofPropertyOwnerorAuthorizedAgentDate
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 provided for bySection3700oftheLaborCode,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 thisipermitisissued.My worker’s Compensation insurance carrier and policy are:
/Carrier:Policy No.:Expiration Date:
Name of Agent:Phone No.:
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 subject to theworker’s compensation laws of California,and agree that,if I should become subject to the worker’s compensation provisions of Section 3700 of theLabor'Code,I shall forthwith com iJh those provisions.
r:)
Signfeture of Applicant Date
Permit Number;BLD2009-02071
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 fS^
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.
fbld oermit combo declare
CITY OF ANAHEIMINSPECTIONREQUESTLINE:
(714)765 -4626
Quarter Section:85
Permit Number:BLD2009-02071
Issued:06/30/2009
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 improvementsspecifiedat212EVERMONTAVE.
We are providing you with an Owner-Builder Acknowledgement and Information Verification Form to make you aware of yourresponsibilitiesandpossibleriskyoumayincurbyhavingthispermitissuedinyournameastheOwner-Builder.
We will not issue a building permit until you have read,initialed your understanding of each provision,signed,and returned thisformtousatourofficialaddressindicated.An agent of the owner cannot execute this notice unless you,the propertyobtainthepriorapprovalofthepermittingauthority.
Directions:Read and initial each statement below to signify you understand or verify this information.
1.!understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder"buildingpermitthaterroneouslyimpliesthatthepropertyownerisprovidinghisorherownlaborandmaterialpersonally.I,as anOwner-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 thoseinjuries.I am willfully working as an Owner-Builder and am aware of the limits of my insurance coverage for injuries toworkersonmyproperty.
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.
3.1 understand as an "Owner-Builder"I am the responsible party of record on the permit.I understand that I may protectmyselffrompotentialriskbyhiringalicensedContractorandhavingthepermitfiledinhisorhernameinsteadofmyown.
4.I understand Contractors are required by law to be licensed and bonded in Californiaand to list their license numbers on
permits and contracts.
.I understand if I employ or otherwise engage any persons,other than Caliifornia 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.
6.1 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 unemploymentcompensationforeach"employee".I also understand my failure to abide by these laws may subject me to serious financialrisk.
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 all work is performed by licensedsubcontractorsandthenumberofstructuresdoesnotexceedfourwithinanycalendaryear,or all of the work is performedundercontractwithalicensedgeneralbuildingContractor.
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.I 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 DivisionofIndustrialAccidents.I also understand I may contact the California Contractors'State License Board (CSLB)at
1 -800-321 -CSLB (2752)or www.cslb.ca.gov for more information about licensed contractors.
owner,
\
12?
\
rbld_owner_buiIder_inlb verif
Permit Number:BLD2009-02071
lO.lam 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:212 E VERMONT AVE .
11.1 agree that,as the party legally and financially responsible for this proposed construction activity,I will abide by allapplicablelawsandrequirementsthatgovernOwner-Builders as well as employers.
12.I agree to notify the issuer of this form immediately of any additions,deletions,or changes to any of the information Ihaveprovidedonthisform.Licensed contractors are regulated by laws designed to protect the public.If you contract withsomeonewhodoesnothavealicense,the Contractors'State License Board may be unable to assist you with any financiallossyoumaysustainasaresultofacomplaint.Your only remedy against unlicensed Contractors may be in civil court.It isalsoimportantforyoutounderstandthatifanunlicensedContractororemployeeofthatindividualorfirmisinjuredwhileworkingonyourproperty,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 oftheirworkers'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 is requiredtobepresentedwhenthepSirmUsissuedtoverifythepropertyowner's signature.
\
Property 6\Amer's Signature Date;
l'bkl_owner_buildcr_inro_verif