236 N. Larch St.
TYPE OF PERMIT
Blockwall/Columns CITY
DATE: 1/12/2005
JOB ADDRESS: 236 N LARCH ST
LEGAL DESCRIPTION: N TR 1428 LOT 44
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BUILDING DIVISION,
200 S, ANAHEIM BLVD,
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765- 4626
CENSUS CODE: 434
QUARTER SECTION: 102
BUILDING PERMIT NO. BLD2005-00082
APPLICANT: ARLENE HERNANDEZ
OWNER INFORMATION:
Frankie Hernandez
236 N Larch St
Anaheim, CA 92805
'JOB DESCRIPTION:I~staIl20 lineal feet of 6 foot high blocK wall per city spe,ifications,
VAL,UATION: 480,00; PROCESSED BY: MSM
I ' , ' , " Oy/NER-BUILDEF:DECLARATJON " " ' "
I hereby affirm under penalty of perjury that I am. exempt from the CqntractCl;'s License Law fQr the following reason (Sec. 7031.5 Business and
Professions Code: ,any city or county which requires a permit to-construct. 9~;er, improve. demolish or repair any structure.- prior to its issuance, afso
. requ ires the applicant for such permit tc?, file a signed sta~eri1ent that he is j;c~nSed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section TOOO'of Division 3 ,of the Business and Profes::;;ens 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$;,;bjects the applicant to a dvil penalty of not more than five hundred dollars
g($ 0), ' ;, ' " "'"
I, as .owner of property, or my employees W"ith wages, as their salt! cor'l~~, :nsation, will do the work, and the structure is not intended or offered for
e (Sec. 7044' Business and Professions Code: The Contractor's Licenst! L;:iw does not apply to an owner of property who builds or improves
_, ,ereon, and who does such work himself or herself or throlJgh his OJ r.er ow:n employees, provided that such improvements are not intended or
offered for sale. If. however, the buil~ing or improvement is seld with-one }~Ear of rompletion, the owner-builder will have ,the burden of 'proving that he
did not build or improve'for the purpose of sale)., ';. '
o I, as the owner of the property, am exdu'sively contracting with iicense4a:mtractors'to construct the project (Sec. 7044 Business and Professions
Code: The.Contractor's License Law'does not apply-to an Qvmer of propelt:.l:who buCds or improves thereon, and who rontracts for such'projects with
iiJi, on, tractor(s) licen,sed pursuant to the Contractor's License' ~~aw),',' !.
W I a xe t ~der See" I, & P or this reason: ':, ,,' .
Date. I ( !::7, Owner: . ' ^., _ -_-~
, WORKER'S CO ENSATION DECLARATION
I hereby affirm under penalty of pe~ury one of the following deolarations:
D I have (3Dd will maintain a certificate of ronsent to self-insure for worker:; compensation,
as provided for by Section 3700 of the labor C'ode. for the perfcrmanre of U:ework for which
this p:ermitis issued.
o I have and will maintain worker's compensation insurance. as reqwired bi Section 3700 of
the labor Code, for.the performance of the work for which this permit is issL:~. Myworker's
Compensation insurance carrier and policy are:
Carrier:
CONTRACTOR INFORMATION:
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Se.ction 7000) of Divsion 3 of the Business' and
Professions Code.
1112/2005
Date:
Contractor
Policy Number:
NUMBER
ExpiRATION DATE
~.hi section need not be ~mpleted if the pemiit is for one hundred dollars ($10(.) or less:
I-certify that in, the perfonnance'ofthe'work,for which,this permit is issuEid. I shall not .
. lay any person in a ny manner soas'to become subject to the workel'Z c::Hflpen.sation laws
f California, and agree_ that if ,I should become subject to the worker's cOOlp.~nsation
pro,visionsof Section 3700 of the labor Code, I hall forthwith comp v with tr.'Jse provisions.
TYPE
Date: 1112/2005 Applicant: ,
WARNING: FAILURE TO SECU, EWORKER'S COMPENSATION COVER~GE IS
UNLAWFUL, AND SHALL SUBJECT AN EM PLOYER TO CRIM INAL. PENNTIES AND CIVIL
FINES UP'TO ONE HUNDRED THOUSAND DOlLARS ($100,000),JN ADr":,T10N TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIO" 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.'
I CONSTRUCTION LENDING AGENCY,
I hereby affirm under penalty of perjury that there is a ccnstructionra.t:cthlg 2['ency for the
performance of the work for which this permit is Issued (8ec.3097 :CiV~C):
Lender's Information: .
Construcion Types:
VN, ,
Fire Sprinklered? NO
I certify that I have' read thisapplication and state that the above,information is correc~. I
agree to oomply' with all city- ordinances and state laws relating. to bu i1ding construction, and
hereby authorize representives of this city to ,enter upon the abovementioned-property for
'ns i(ct~, u.r s,'
L.Z _ Date: 1112/2005
Signature of Applicant 0 ent
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 r~quired to commence or continue work. '
Fees paid for Permit:
Total: 125.04
INSPECTION RECORD
INSPECTION. , DATE 'INSPECTOR
Temporary Power Pole .
Plumbing (Drain/Waste Pipe) , . ..
Eledrical Ground Electrode/uter U"
SelbacklFormslTrenches (FO(ltings) , II 1m;, .,
Do not install subfloor or pour floor, slab until the
following applicable items have been signed: '
Plilmbing (Water ,Pipe.Sprinkler Valves)
Mechanical (Groundwork)
Eledrical (Underground Conduit)
Pre-slab (CompactionlMembr_.Reinf. I
Underpinning (Roar Joist/Girders)
Do not cover or conceal the work below, until the
foHowing applicable items have been signed: . . .
1 st Floor Shear .
.
Firesprinkler(Rough) . '
2nd Floor Shear .
. R!Jof (SrieathinalOlaphraomlFrame) . ..
Masonry (RelnfJBand BeamlPre-Grout)
Rough Plumbing (Top Out) . .
Rough Mechanical
Rough E1ectrlCallDry Wall)
Rough Eledrical .
Framing . {Only after Plbg" Elec.. Mech. and Fire}
Insulation (SoundlEnergy)
. 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 (BraNn Coat)
T -Bar Electrical . .
T-Bar Mechanical ' .
T -Bar Structural .
,Sewer ' . ,
Water Engineering Backflow
Water Service
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040 .
Water Engineering 765-5268 '
Sub List/Business License 765-519
Date . Inspector
.
.
.
Zoning 765-5139,
.
/
Building Final
'c-
J
(Lastlnspeetion- Only flj f~-r 1XI//7 (, ,
Aljer Above Completel V" i'('j W()1 A P,
PARTIAL JNSPECTrO~ S
Buj.Jdina InsAtions ' ' .
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Mechanical Inspections
Plumbing Inspections
Electrical Inspections
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GOv--Y
9.LfD
HE ISSUANCE OF HIS PERMIT DOES
OT APPROVE VIO ATl N OF ANY OF
HE BUILDING CO ES OF T E CITY
HE HOLDER 0 T .
ROCEEDS AT IS OWN RISK.
2 2005
BUILDING DIVISION OF ANAHEIM
. APPROVED
BlCBOClS-0008d.BY .
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