20 S ANAHEIM BLVD'f"Fc Gr PERMIT
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CITY OF J NAHEIM
CON INFORid;TION: - ARCHITECT /ENGINEER INFORMATION:
nstall new roof
SUB_C ?`ESMiT NO. BL4200P• -3398
DATE 1 2/13/2000
JOB ADDRESS: - :20S ANAHEIM BLVD'
LEGAL DESCRIPTION: P BK 178 PG 22 PAR 1
APPLICANT: JOSEPH SILVA
OWNER INFORMATION:
ANAHEIM HOLUALOA
100S ANAHEIM BLVD
ANAHEIM, CA 92805
JOB DESCRIPTIONRemove existing roc
'VALUATION: - 3,200.00 - ` PROCESSED BY: MLD
OWNER- BUILDE` -: DECLARATION.
I tie .by affirm under penalty of perjury ; inot 1 am exempt from the Cant ac r.;s License Law for the following reason (Sec. 7031. Business and
PrOfessions Coda any dty or countywhich requires a permit to construct', erec improve, demolish or repair any structure; prior to its issuance; also .
require_: the applicant for such permit to fife a signed statement that he is he •r +sed pursuant to the provisions of the Contractor's License Law .tChapter .
9)(cornniencing Section 7000 of Division 3 of the eusinessand Prr fess :ins Code) or that he is exempt therefrom and the basis for the alleged*
-exemption. Any violation of Section 7031.5 by any applicant for a perm t sutjects the applicant to a avil penalty of not more than iive hundred doilers
I, es owner of property , or my employees with wages as their sole come_ nsanc. , will do the Work. and the structures not intended or offered for
sa■o, (Sec. 7844 Business and Professions Code:- The C ontractor's 1 - n e is -w does rota pply to an owner of ore perry who builds or im proves
thereon, and who does such work himself or herself or through his or her ova e. pi ogees, provided that such improvements are hbt intended or
offered for sale. If however, the building cr imprcvemert s acrd with one ygpr of completion, the owner-tu Ilder will have the burden of proving that he
did not build or improve for the purpose of sale). t
.❑ I, as the owner of the prooerty,am exclusively contracting with licensed contractors-to construct the poled (Sec. 7044 Business and Professiors
Code: The Contractor's License Law does rot apply to an owner of pro)ert; who builds or impro.es thereon, and who a :tracts for such projects with
rcntracor(s) licensed pursuant t the Contractx's Licerse L9wj
J I am exempt underSec B . for this
Date /2 • /3-700•.7 Owner
WORKER'S COMDENS ION DECLARATION' 1 LICENSED CONTRACTORS DECLARATION : 1
I hereby affirm under penaity of perjury one of the following declarations: I hereby affirm under penalty of perjury that Ism
❑ " t have and will maintain a certificate of consent to stiff insure for:.. ,rke• s compensation, : . licensed under previsions of cnapter 9 (commencing
as fircrided` for by Section of the LaborCbde, for the pertoi man cc c:1, work which with Section 7000 }of - Divson 3 of the Business and
this permit is issued. - • - - Profession Code:
Fin have and will maintain workers compe.isation insurance as reguir3d rr Section 3700 of . 12/13/2000
the Labor Code, for the performance of the work for which this permit s ism M. My workers 'Date`
Compensation insurance caner and policy are:. -
Carrier; - Policy Numb-I
.
This sec need not be completed if the permit is for one hundred dollar i$101_) x le.=s
ri I certify that in the performance of he work for which this permits issucd, I: shall not
employ any person in any manner so as to become subject to the workers c laws
of California, and agree that if I should become subject to the worker's coin,aeration
provisions of Section 3700 of the Labor Code, I stall forthwith odmply With arose orovisions.
Data 12/13/2000 Applicant.
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVEN A -,GE IS UNLAWFUL, AND SHALL$UI3JECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN AD-CATION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI ow. 3706 OF THE
LABOR CODE INTEREST AND ATTORNEY'S FEES
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending ncy for the
performance of the work for which this permit is issued (Sec3097.Civ.C):
Lender'sInformation:
_ , ;•, f' that; d 55. - read this abjuration and state that the al o:-. infuirnatior eorrert. t I - - •
agree to comply with all city ordinances and state laws relating to building - c istruc: or., and
hereby authorize representives of this city to enter upon the above mentioned property . for
inspection purposes.
Date: 12/13/2000
SignatureofApplicantorAgent
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
NUMBER
TYPE :
Construcion 1 vpes:
V N,
Fire Sprinkler
•
BUILDING Dit%ISION.
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION: REQUEST LINE:
(714)765 - 5161
CENSUS CODE: 437
QUARTER SECTION: 83
Contractor
EXPIRATION) DATE
Fees paid for Permit:
Total:
115.92
INSPECTION .. -
'DATE
- INSPECTOR
Temporary Power Pole
_
Plumbing (Drain/Waste Pipe)
Electrical. Ground Electrode/Ufer
Setback/Forms/Trenches (Footings)
Do not install subflooror pour floor stab until the
following.applicable items have been signed:
Plumbing (Water Mpe.Sprinkler Valves)
Fire Dept Final 7654040
, Mechanical (Groundwork)
Water Engineering 765-5268
Electrical (Underground Conduit)
Sub List/Business'License 765 -5194
Pre- slab (Compaction/Membrane.Reinf.)
Zoning 765 -5139
Underpinning (Floor Joist /Girders)
Building Final /ILast Inspection-Only
AfterAbove Complete)
Do not cover or conceal the work below until the
following applicable items have been signed:
1st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry "(ReinfJBond Beam/Pre- Grout)
Rough Plumbing (Top Out)
Rough Mechanical
-
-
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Ptbg Elec.,Mech and Fire)
.
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable
items have been signed:
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T -Bar Electrical
T -Bar Mechanical - -
-
T -Bar Structural'
Sewer
Water Engineering Backflow
-
Water Service
FINAL INSPECTIONS '
Date
Inspector
Electrical Final
_
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 7654126
Fire Dept Final 7654040
Water Engineering 765-5268
Sub List/Business'License 765 -5194
Zoning 765 -5139
Building Final /ILast Inspection-Only
AfterAbove Complete)
INSPECTION RECORD
Building Inspections
Electrical Inspections:
PARTIAL INSPECTIONS
Mechanical Inspections
Plumbing Inspections
DATE
JOB ADDRESS
LEGAL DESCRIPTION
OCCUPANCY
ADDRESS
CITY
PHONE
VALUATION
150(
TYPE CONST.
DWELLING UNIT(S) GARAGE AREA
CENSUS CODE ZONE
OWNER
1:71 L £J ta.F
ADDRESS
CITY
ANAHEIM
PHONE
7 14? . 75
APPLICANT
1 1) FIRE ER FE.c inN
CONTRACTOR
N &, 0 FIRE' PRO TL
ADDRESS
1205 DEECH 141
CITY
HACIENDA HE I6
PHONE
(626)369-5491
ARCHITECT /ENGINEER
STATE
ITEM
ISSUANCE F E
MICROFILM F EE
'WILDING PERMIT
STATE TAX CATAGC
PERMIT NUMBER
TYPE OF PERMIT
PLAN TRACK #
MVE
STATE
CA
CITY LICENSE #
STATE
CALIF. REG. #
PRIOR BLDG. USE
# OF STORIES
5Q. FT.
ZIP CODE
ZIP CODE
ax) ,.
ZIP CODE
JOB DESCRIPTION
RELOCATE F : PPINF 3.rt?':s — UNITS
QUANTITY
TOTAL FEES
FEE
CITY OF ANAHEIM
QS
To obtain this permit, the undersigned hereby files this application and agrees, certifies
and declares: That notice has been given me that this permit may be used only in
compliance with the Anaheim Municipal Code, and all other applicable ordinances and laws.
That this permit does not allow occupancy, and that no occupancy is permitted, of
the construction for which this permit is issued until it has been approved in writing by
this office for occupancy after final inspection.
That this permit does not allow, and separate permits are required for, any plumbing,
electrical, heating and air conditioning work.
That a double fee will he paid for any permit issued after any work thereby allowed
has been commenced.
1 agree that the City may enter upon the job premises at any reasonable time to inspect
any work installed under this permit, and to otherwise act as and when required by the
Anaheim Municipal Code.
OWNER- BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License
Law for the following reason (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 such permit to file a signed
statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9) (commencing with Section 7000 of Division 3 of the Business and Professions
Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).
❑ 1, as owner of property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale (Sec. 7044 Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or herself or
through his or her own employees, provided that such 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 he did not build or
improve for the purpose of sale).
D I, as the owner of the property, am exclusively contracting with licensed contractors
to construct the project (Sec. 7044 Business and Professions Code: The Contractor's
License Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law).
LICENSED CONTRACTORS DECLARATION
I hereby affirm under 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.
License Class 5 0' Lic. Number Cir' "'
Contractor
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
D I have and will maintain a certificate of consent to self - insure for worker's
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
n ' 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
workers' compensation insurance carrier and policy number are:
Carrier GOLDEN EAGLE
Policy Number )'s i4,. c -kf A -" -'
(This section need not be completed if the permit is for one hundred dollars ($100) or
less).
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 the workers'
compensation laws of California, and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with
those provisions.
I hereby agree to indemnify and hold harmless the City of Anaheim, it's officers and
employees from any liability for damages incurred by any person, of persons, resulting from
work or activities undertaken pursuant to this permit.
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
OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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
I certity that 1 have read mis app tttatlan`ant1tarrlsa TS--ab e 1nfe��
I agree to comply with all city ordinances and state laws relating to building construction,
and hereby authorize representatives of this city to enter upon the above mentioned
property for inspection purposes.
THE PERMIT SHALL EXPIRE BY LIMITATION AND BECOME NULL AND VOID
IF THIS WORK IS NOT COMMENCED OR SUSPENDED AFTER A PERIOD OF
., c DAYS NEW PER IS REQUIRED TO COMMENCE WORK.
BY r P
OWN - AGENT- BUILDER - OFFICER
CASHIER VALIDATION ONLY
BUILDING DIVISION
200 S. ANAHEIM BLVD.
INSPECTION REQUEST LINE
Exp. Date'a i
DATE
Building Inspections
PARTIAL INS°ECTIONS
INSPECTION RECORD
Type d !nspectijn Date
Inspector
Plum bing (Drain /Waste Pipe)
Electrical Grourd Elecircce /Ufer
1
Setback /Forms /Trenches (Footings)
Plumbing (Water Pipe /Sprinkler Valves)
Mechanical (Groundwork)
Pre -slab (Oompacticn /Membrane /Reint.)
_
underpinning (Floor Joist /Girders)
I 1st Floor Shear
Mechanical Inspections
Firesprinkler (Rough)
2nd Floor Shear
Rao` (Sheathino /Diachragrn /Frame)
Ma sonry (FleirL /BonJ Beam /Pre - Uncut)
Rough Plumbing (Top Out
Rough Mech.
Rough Elect. Walls
Rou gh Electrical
Framing (Only after PIbg., Eaeo. Mech., and Fir
Insulation (Sound /Energy I
Drywall
Interior Lath
Exterior Lath
Plumotrq Inspections
GENERAL_ ITEMS
Exl. Piaster (Brown Coat)
Permanent Electrical Pole
Const: uction Pole Serv
T -Bar Electrical
T -Bar Mechanical
T -Bar Structural
Sewer
l "✓ater Service
Electrical Final
Plumbing Final
Mechanical Final
_lectrl inspectior
Gas Test
Engineering /Grading Final inal 765 -512
Fire Dent. Final 765 -4540
Water Engine rind 765-5 _
-_,—.
_-
Sub List /Business License 765 -5194
Zoning 7 65 - 5139
Bui ldin g Final (Last inspertio,a
Building Inspections
PARTIAL INS°ECTIONS
INSPECTION RECORD
Type d !nspectijn Date
Inspector