2175 S. Madrid St.
TYPE OF PERMIT
Blockwall/ Columns CITY
DATE: 7/11/2005
JOB ADDRESS: 2175 S MADRID ST
LEGAL DESCRIPTION: N TR 3127 LOT 22
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTlINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 89
BUILDING PERMIT NO. ~L02'005-02129
APPLICANT: FRANCISCO RAMIREZ
OWNER INFORMATION: CONTRACTOR INFORMATION:
FRANCISCO RAMIREZ
2175 S MADRID ST
ANAHEIM, CA 92802
JOB DESCRIPTION:Build 85 linear ft. block wall at 6' ft. high per city specifications.
VALUATION: 4,000.00
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: END
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 'cense Law for the following reason ( ee. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, a~er,_ 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
~OO).
JdtOI, as owner of property, or my employees with wages as their sole compel1Sation, 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 with 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),
o I, as the owner of the property, am exclusively contracting with licensed ccntractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of propertywl1o builds or improves thereon, and who contracts for such projects with
$ntract, or(s) licensed pursuant to the Contractor's License Law).
exempt under Sec. . ' B . f r this reason:
ate. .' _ -0 ... Own. ..
WORKE COMPENSATION DECLARATION
I hereby affirm under penalty perjury one of the following declarations:
o I have and will maintain a certificate of oonsent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the 'rVork for which
this permit is issued.
o \ 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 worker's
Compensation insurance carrier and policy are:
Carrier:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
I"ensed under provisions of chapter 9 (commencing
with Section 7000) of Diveion 3 of the Business and
Professions Code.
7/11/2005
Date:
Contractor
Policy Nu mber:
NUMBER
EXPIRATION DATE
This section need not be completed if the pennit is for one hundred dollars ($1 00) or less.
-!;2t) certify that in the performance of the work for which this permit is issued, I shall not
Amlproy any person in any manner so as to become subject to the worker's compensation laws
of Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 the Lab ete, I shall forthwith comply with those provisions.
TYPE
Date: 7/11/2005 Applican
WARNING: FAILURE TO SEC EWORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUB. ECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED'l1-IOUSAND DOLLARS ($100.000), IN ADDIllON 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 Information:
Construcion Types:
V N, ,
Fire Sprinklered? NO
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereb authorize representives of this city to enter upon the above mentioned property for
insp ion purpose
Date: 7/11/2005
Fees paid for Permit:
Total: 125,79
Signature of Applicant or Agent
Th 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.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/
SetbacklFormslTrenche ( ootings)
00 not install SUD r or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane Reinf.)
Underpinning (Floor Joist/Girders)
00 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 (Sheathing/Diaphragm/Fr
Masonry (Reinf./Bond B Pr -Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (Sound/Energy)
00 not tape or plaster until the following applicable
items have been signed:
INSPECTOR
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 Back1low
Water Service
,
.
FINAL INSPECTIONS DATE
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub LisllBusiness License 765-5194
Zoning 765.5139
Building Final (Last Inspection - Only t:t
Alter Above Complete)
INSPECTOR
PARTIAL INSPECTIONS
Building Inspections
Mechanical Insoections
Plumbina Insoections
Electricallnsoections