874 S. Lime St.
BUILDING PERMIT N9:,. BLD2004-01814
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765. 5153
INSPECTION. REQUEST LINE:.
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECT-ION: 104
TYPE OF PERMIT C
Blockwall/ Columns . ITY
DATE: 5/18/2004
JOB ADDRESS: 874 SLIME ST
LEGAL DESCRIPTION: N TR 1254 LOT 33
APPLlCANT:ALVARO ROSALES
OWNER INFORMATION: CONTRACTOR INFORM.oTION:' ARCHITECT/ENGINEER INFORMATION:
Alvaro Rosales
874 S.Ume St
Anaheim, CA 92805
. JOB DESCRIPTION:lnstaIl751.f block wall 6' high to City specs.
VALUATION: 1,800.00 PROCESSED BY: CAL
I .OWNER-BUILDERDECLARATiON.I.
I hereby affirm 'under pena.lty of perJury that ,I ~m exempt from the Contract~rt.s License Law for the following reason (Sec. 7031.5 Business and _ .
Professions CoPe: any?ity or county which requires a permit to construct, ah;,!r, irnprov.e, demolishor repair any structure; priorto itsi~uance,-also
requires the applicant for such permit to file a signed staternentthat he is Ib=nsed pursuant to the provisions of the Contractor's Lice'nse Law (Chapter
9)(commencirlg with Section 7000 of Division 3 of the Business <=!ndProfessi,ns Code) or that he is'exempt therefrom and the basis for the alleged'
exemption. Any'viOlation of Section 7031.5 by any"applicarit for a permit sllhlects the applicC!nt to a ,civil penalty of not more than ~ve'hundred dollars
($500). . .' . . .' . ....
o 'I,' as owner of property, or my employees with wages as their 'solecoml=t1nsation', will d0 the work, and the structur.~ is not intended'or offered for
sale' (Sec. 7044 Business andProfessions Code: Trye.Goptractor's Licens.e I/:lwdo.es n.ot apply to anowne.r of property who builds or improves
. there~n,- and. who does sudl work himself or herself or through his or hero\o~:'.r employees, prOVIded that 'such i,mprovementsare not, intendedor
offere for sale. If, how'ever, the bl:lilding or improvement ,is -sold with one y'ec:.r of completion, theowner':builder \o/ill have. the burden"of proving that he
did ,tbU'ild or improve for the pu rpose of sale); " , , ,', ' . " ' '
I,,' as the owner ofthe'pr:operty.-am e'xdusively contracting with licensed,oontractors t6 construct-the project (See. _7044 Busines"sand Professions-,
e: _ TheContractor!s Lice.nse Law :dOes not apply to an bWl)e~ of property~~ho builds or improves thereon, and, who corHract$ for sum projects with
~ontractor(s) I~~.ensed pursuant 10 the Contractor's License Law).,'
. U I am exempt under Sec. , ' " ,C. ,for this reas.on:
Date:.. ' Owner:
WORKER'S COMPENSATION DECLARATION
I hereby affirm .under penalty of perjury one: of the following ',declarations:,_ .
o I have and will niaintain a certificate of oonsent to self-insure forworKeri~ c~mp~nsation,
as provided for 'by Section 3700 of the labor CocIe~ ,for the performance of tt"':e wo"rk for which
this P.8rmit is issUed. . . .
01 have and will maintain worker's compensation insurance,a~ required b{ Section 3700 of
the labor Code, for-the performanc'e of the work for-which,this permit is iSsu.l::i. 'My worker's .
Compensation insurance carrier and policy are:' .
Carrie" Policy Number.'
LICENSED CONTRACTORS DECLARATION
. I hereby affirm underpehalty of perjury-that I am
licensed.under provisions of chapter 9.(commencing
with SectiOn 7000) of Divsion 3 of the Business ,a'nd
Profes$ions Code. . .
5/18/2004
Date:
Contractor
NUMBER
EXPIRATION bATE
This secti n need n_at be- completed iflhe 'pennit}sfor one hundred ~ollars ,(~1 G'~) ql," less.
. ertify .that in:the performance of the work for which this permit is issued,l shall not
oy any perspn in any manner so as to becom-e subject to the worker's c'.IQlpensation la\Vs
ofCalif6mia, and agree. that if tshould become subject totheworker's com:)(Jnsation
proviSions of .Section 3700 o{the-laborCod . orthwithco'mply with tr.o~e provisions:
Date: 5/18/2004 AppUcant: .
WARN ING: FAILURE TO SECU ORKER'S COMPEN SA TION COVER,XGE IS'
UNLAWFU(,AND SHALL'SUBJECT AN EMPLOYER TO CRIMINAL PENA'.TiESANDCIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,QOO), IN AD;'-':1l0N TO THE
COSTOF COMPENSATION, DAMAGES AS PROVIDED cOR IN SECTlof. :3706 OF THE
LABOR CODE, INTEREST. AND ATTORNEY'S FEES. ..' .
I CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that thereiSa ~onstruction I~ndinga!lencyfbr the
~oerfor~n('.e bfthe-work forwhkh,this p"ermit !sissued (SeC'..3097_Civ.C): . __- '
Lender's Infonnation:
TYPE
Construcion.Tvpes:
VN"
I'certify that I have read' this application and state that the above infor'matien is correet. I
agree to oomply witli all city ordinan.ces 'and state laws relating to bu"ilding construction, and
herebyauthO~ritIV"S of Ihls city to enler upon the above mentioned property for .
.nspectlOn pur , ~ .
>{ , ~ '~ <.".../ Dale: 5/18/2004
,/ Signature of Applicant or Agent , .
The permit shall expire'by limitation and become null and void if th€ building or
work has not passed final inspection 365 days from the date of permit issuance. A
new per!l1it is required to commence or continue work.
Fees paid for Permit:
Total:,
~.50
~,
INSPECTION RECORD
, I " "IN$PECTlON , , , "
Temporary p,ower Pole
Plumbing (DrainlWaste Pipe) ,,'
, Electri,cal GroundElectrodel'
SetbllCkfForms'fTrench8!(fFootingsj) ''''{2-<>,I'.3r 0- \...
Do not installsubfloor or,ROlJrtloor slab until the ,/ , ,
following ,applicable items haVe been signed:
Plumbing (Water Pipe;Sprinklervalves) , "
Mechanical (Grouridwork) ,
Electrical (Underground Conduit) , ' "
Pre-slab (Compaction/Membrane.Remf. '
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until tne
following applicable items have been signed:
1 st FloOr Shear' ' ,
FiresprinkJer (Rough) ,
2nd,FloorShear ' , , '
Roof (ShelllhingJDiaphragmlFrame) , ~ '. 4
Ma$onry (ReinfJBond BeamlPr.Grout~fj-M-Q.'3 "'7T -~'
Rough Plumbing (Top Out) , / "-
'Rough Mechl!nical ' " , ' ( /
RQughBectrlCaJ (Dl'ywalll, '
Rough Electrical '
Framing (Only after Plbg.. EJec..J-;1ech; and Fire)
Inslllatlon (soundlEnergy) , , ,
po not tape or pla~ter <mtil 'the following, applicable,
'terns have been sIgned:, '" ' , ',.'
,
Drywall " "
Penetrlllions(l'ireRated) E/8!itrical ','
Pen,etratlonS (Fire Rated) Mechanical
Penetrations (Fiie Rated) Plumbing, '
Interior Lath, -
Exterior Lath "
, , GENERAL ITEMS
Exterior Plaster (Brown Coat)
T .Bar Electrical '" "
T .:sar Mechanical'
T-Bar Structural '
Sewer ' '
Water Engineering Bl!Ckflow ".
Water Service '
DATE,
IN$PECTOR I, , Electrical,Final
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'Plumbing Final
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Mechanical Final
Gas Test
Engineering/Grading Final 765,6126
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Fire Dept. Final 765-4040
Water Engineering .765-5268
Sub List/Business LiCense 765-519
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, " Zoning 765-5139
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Building Final ILa,SI InspeCliOn", Only '::n.:.-<' '\. I ",LV "-k . ,.<Ii.'
, ',After Above Complete) - -'" ~ ~~
, PARTIAL INSPECTIONS ,,"
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" "MechanicaJ-lnspections
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Plumbinalnspections
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Eleetricallnspections
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