180 S. Lakeview Ave. (2)
TYPE. OF PERMIT CITY
Blockwall/ Columns
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. ';,:N~HEIM
\~c#i~~l
BUILDING DIVISION
200 S: ANAHEIM BLVD.
(714)765 - 5153
. INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 565
QUARTER SECTION: 168.
BUILDING PERMIT NO. BLD2004-04456
DATE: 12/20/2004
JOB ADDRESS: 180 S LAKEVIEW AVE
LEGAL DESCRIPTION: P BK 71 PG 26 PAR 1
)
APPLICANT:
OWNER INFORMATION:
. MIGUEL ESTEVEZ.
180 S Lakeview Ave
Anaheim,CA 92807
CONTRACTOR.lNFORMA nON:
BASIX CONSTRUCTION
. 2222 MICHELSON #4600
IRVINE, CA 926120000 .
BUSINESS PHONE:' 949 955.l)039
JOB DESCRIPTION: Install 15 feet of 5' foot high 'retaining wall :
VALUATION:! PROCESSED BY: JNJ
I OWNER-BUlLDE:S)H=CLARATION . --1
I hereby. affitm under penalty of perjury that I am exempt from the COI;tractor:~ ~.icen~'e' Law for the ,following reas~:m {Sec. 7031.5 Business and
Professipns Code: any dty or county which requires ~ permit to construct, a:1t.:';:r, improve; demolish c:>r repair any ~tr~ctur~, prior to its.is...<;uarlce. Cllsc
r.equires.the applicant for-such permit to tHe a signed. statement that h::: ie Ij,,::<:;~~:ed pursuant to the proviSions of the Contractor's.License Law (Chapter
9}(commencing with.Section 7000 of Division 3 of the Business and'Pr'ofessic'-',~s Code) or that tIe is.-exempt therefrom 3nd the basis for tr!e a,ileged
exemption. Any violation of Section 7031.5 by an\' applicant for a permit sub!;!tts ttle appik~ant to a dvil penalty of Iiot mQre tha" five hundrea dollars
($500).. .... " .
01, as owner C?; property, or my ernDtoyee_~with wages as -the:rr.o-l-e {;clrl~'i'1sdtic:"'" wili de U",e work, and the structure i..." not intended qr offered for
sate (Sec. 1044 Business and Professiqns Code: The Contractor's Ut;t:nse. L~vl dees nct ~ppl)' to an oWl1er of property who ,puiids or improves
thereon; and who does such work himself or herself or through his of her Qwn.~mployees. picvided that such improvements are not, intended or '
offered for sale. If, however, tbe building or improvement :s sold with dha ye;:::;. ()f compif,tlon, the owner-builder wiil have the burden of pro\!in.gth3t he
did not bu.ild or improve for the purp'ose of sale). . , . .' '_ ,-', -~:..." .: . . . _ .
[1 '!.as the owner of.the propertY, am exdusjv.ely contracting witi', Iic~,j1se6:c':r.tmctors to construt:t the project (Sec.' 7044 Business an9 Professions
Code:,' The Contractor's License Law poes, not apply to.an owner of pruP~rtY'l::10 olli!.ds or improves th-erecn, an~ wno contraCl's for stich projectc;w1th
MOfwactor(s) HcenSed pursuant to the Contractor's U~nse Law). .'< /}_ ..',
U I-am exempt under Sec. ~---.:. . B '& P .C. for this .re-ason: ___~.,'_~.,,-,-_. -..-_
Date: Owner:
L~. . WORKER'S COMPENSATION DECLARATIONC7"":=_____~ .!
I hereby affirm under penalty' of perjury one 'of the foll9win9 declaration6 ~ ,:>,,! ..
o .I.have and will maintain a certificate ,of consent ill self~insur~ for wc,_rker'-3"::~,r(!,~ensation,
as provided for by Section. 3700otthe.LaborCode. for the performC:lnceoi~h~"'i(jI~;'fcr which
this perm~ is issiJed. . . , '. .- ./'
!7"rhave and will maintain worker's compensation insurance, as reqo;red tiy '3..::ct!on ;~7009f
$'e Labor-Code, for the performance of the work. for \vhich this permit is:rssu€.t~,r\-1yv1o!"ker's
Corn'pensation insurance carrier and policy are:' , ,",:
Carrier: STATE FUND PoliOf NumbeF: 1801~!363 :
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION
I tlereby affirm under pena T erji..iry that I am
licensed under provtsions of'J commencirlg
with Section 7000) of.j)ivs. u",'ness and
Professions. CadP-o
12/20/2004 . ~
Date: / .
I
J
NUMBER
840401
This section ne~ not be 'completed if the pennit is for one 'hundred dollars(~"!nC) f.--!'"' jess. TYPE B
.0 I certify' that in the performance of the work for which this permit :S.i~'~l!e~" l'sfl<:lU not t .
employ any person in any manner so as to become subject to the wcrke!~;,% corr.~ensgtion laws, '
,of California, and agree tha~ if I shou!d become su. t 'he woiJ<er's COTps~;sr.t;~~
provisions of Section 3700 of the labor Code, I I it comply witi~)t~.t~' prtpision;s. Construcion Type~:
Co , ,VN,
Datec 12/2012004 Applicant:',:. _ I .
WARNING: FAILURE TO SECUR WORKER'S AT!ON COVgK:l'.'~" IS 1
UNLAWFUL, AND SHALL SUBJ TAN EMPl.OY TO CRIMII"lAl PE;(),';..L'i'SS AND CIViL
FINES UP TO ONE HUNDRED lHOUSA!{D' ,tARS ($100,000'), IN.~f.lDnI2N TO THE :
COS:T;-OF-CO~APENSATIOfo.J. DAMAGtS;....'.J_P:'Rl)V1Qr.:l~~tFCR.I!'.!_-~-i-~~r...:.i;..!.-:};.-.7J-~-:ta::-~"
__~L-\,fY.~~. CCL~:=;-:i~T2i"~:..::5j"J:\i"iJL)- ArrL:RNEy'$ fE~S:
r-
,
,
! hereby 'affirm under penalty of perjury that there is a construction lending agencyJorthe,
. performanGe of the work" for whid1 this permit is issued (Sec.3097.Civ.C): '
Lender's Information:
.* ,;
CONSTRUCTION lENDING AGENCY .
ion and state that the above' information is corr~ct. I
and state laws relating to building ,construction, and
i Gi7 to enter upon the above mentionedproperty for
.~ ~ Date: 12/20/2004
Signature of Agent ...
TMpermit shall expire by Ion and become null and void if the building or
work has not passed fjrial i eetion 365 days from the date of permit issuance. A
new permit is required to 'commence or continue work.
I certify that I have read. this applic
agree to .romply with all city or .
herebyauthorizerepresentiv
inspection purposes.
Fees paid ,!or _P~rmit:
Total:
. 250.69.
iNSPECTION RECORD
INSPECTION ,
, DATE, INSPECTOR : '
TemporarY Power Pole cc' /
PlUmbing (Drain/Waste Pipe) ,
Electrical Gr,ound Electrode/lifer' ."'- /
SelbatklFormsfTrenches (Footings) 111;\ i~ I'll 'IV
Do not install sub floor or pour floor slab l\nti the
following applicable jtemshave been signed: '
Plumbing (Water Pipe.Sprinkler ValVes)
'Mechanical (Groundwork) .' '
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane.Reinf. ' ,
Underpinning (Floor Joist/Girders) ,
Do not cover or conceal the work below until the ,
following applicable ,items have been signed: ' ,
1 st Floor Shear ,
Firesprinkler (Rough)
2nd Floor Shear ' "
Roof (SheathinQ/Diaphragm'Fr"""" ,-
Masonry (ReinfJBond' BealilPre-Groutt 4'k1oS' ~I
Rough Plumbing (Top 0.1.\ . - , , :,
Rough Mechanical I :<
,Rough l:IectrlcallDry Wall)
Rough Electrical , ' ,
Framing . (Only after Plbg.. Elee.. r..lech.. and Fire)
Insulation (SoundlEnergy) cc
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 , ,
Extenor. Lath ,
, GENERAL ITEMS ' ,
Exterior Plaster (Bl'l71Nn, Coal) , ,
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 I "
, "
Engineering/Grading Final 765-5126 ' '
Fire Dept.- Final 765-4040 ,
Water Engi"eering 765-5268 ,
Sub List/Business License 765-519
Zoning 765-5139 ,
~uilding Final ~.st Inspection. Only , aufo( 1. AA .1
c fter Above Complete) .1,.'''....v.
PARTIAL INSPECTIONS
Buildina Inspecti~ ' ' ~ .' ,AtAL. ',____
?It/or, fS' r~ , ~ 7~
. '
Mechanical'lnSDections
Plumbina InsDections
ElectricallnSDections