1213 N. Maplewood St.
.sUILDINGPERMIT 11I0. BLD2004-04498
TYPE OF PERMIT CITY
Repair
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BUILDING DIVISION.
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 ,'4626
CENSUS CODE: ,434
QUARTER SECTION: 91
DATE: 12/27/2004
JOB ADDRESS: 1213 N MAPLEWOOD ST
LEGAL DESCRIPTION: N TR 2021 LOT 4
APPLICANT: ROY HOLLINGSWORTH
OWNER INFORMATION:
Rqy'A Hollingsworth
1213 N Maplewood St
Anaheim, CA 92805
JOB DESCRIPTION: Replace 4151 square feet of drywall due to fire damage
VALUATION: .1,000.00 .
I OWNER-BUILDERPECLARATION
!'hereby affirm under penalty of perjury that I am exempt from the Contractor~ License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, art:~;" impro\/e, demolish or repair any structure. prior to its issuance, also
requires'the applicant fOf_such permit to file a signed statement that he is_liCE<i.-red pursuant to the provisions of the Contractor's License law (Chapter
. 9)(commencing with Section 7000 of Division 3 of the Business andProfessict~s Code) or that he is exempt therefrom and the basis for the alleged
exemption. 'Any violation of Section 7031.5 by 'any applicant for z permit sl..!t~ects-the applicant to a dvil penalty of not more than.five hundred dollars
. ',}" .
($500). . . I . '. . '.
~ as owner of property, or my employees with wages as their sole cornp-:nsation,will do the work, and the structure is not intended or offered for
-';~(Sec. 7044 Business and Professions Code: The Contractor's License'l:"dw 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 hel ow;'~ employees, provided that such improvement's.are not intended or
offered for sale: If, however, the building or improvement is_sold with one y~;lr of compfetion, the owner-builder wiJJ 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, 8m exdusively contracting with licensed ~xntractors to coroSt"Uct ~e project (See. 7044 Business and Professions
Code: The Contractor's License Law does'not apply to an owner of propertyl.vho builds or Improves thereon, and who contracts for sum projects with
~ontraCtor(s) Iicen~ed pursuant to the Contractor's License Law). . f
U I am exempt under Sec. ,B P .C. fer th!sr.sason: ,_~
Oat... . .~ 0 Owner: '(,
W RKER'S CO.M?ENS TION DECLARATION C
! hereby affirm, under penalty of perjury one ~f the following declaratfcns: ~ I
o I have and will maint_aina certificate of o)nsent to self-insure for workerl~ompensation.
as provided for by Section 3700 of the labor Code, for the performance cf th~ woik fo.r which
.this permit is issyed. i'l
D I have_and will maintain worker's compensation Insurance, as reQlJi~d b:;:,Section 3700 of
the Labor C~e. for the'performal')ce of the work for which this permit is iSStl~d. Myworker's
...Compensation insurance carrier and policy are:
Ca~rier:
, .
CONTRACTOR INFORMA.T10N:
, ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
I
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury, that I am
. licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code.
12/27/2004
Date:
Contractor
Policy Nu mber:
NUMBER
EXPIRATION DATE
jEiS;section need not be completed if the pennit is f~ one hundred dollars ($1 00:; C:' less.
. .' certify that in the perfonnahce of the work for w'hich this permit is issuz~, i shall not
employ any person in any mann~r so as to become subject to the worker'1ii cdmpensation laws
of California, and. agree that if I shou Id become.su bject to the worker's, comj:'iinsation
provisions of Section 3700 of the labor Co~e, I sh,al! forthwith comply with'ti'-:)Se provisions.
Date: 12/27/2004 .' App;icant: )o~ f,~t"'""r4'D~'
WARNING: FAILURE TO SECURE WORK 's COMPENS ION COVER.;,GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAlTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN Al:lD:'nON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTiON 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I. . CONSTRUCTION LENDING AGENCY "
! hereby affirm under penalty of perjury that there Ls a construction lendir.g9IJ,_:llcyfor the
nerforrnanoo of the work fqr which this pEwf1]l.t is issued IS-eG 3097_Gb!. G):
--cend~;r:s'im',j:-rriafion:'-' -'c,-----,--..,-,--- ---:-:;---. .
TYPE
Construcion Types:
VN. ,
I cert,ify that I have read this application and state that the above ,information is correct. 1
agree to comply with all city ordinances and state laws relating to bu i1ding construction. a,nd
hereby authorize representives: of this city to enter upon the above mentioned property for
inspection~ses. ,
. :>- . ~a~~gent --. Date: 12/27/2004
. 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.
Fees paid for Permit:
Total:
445.25
INSPECTION RECORD
INSPECTION , PATE' INSPECTOR
Temporary Power Pole
Plumbing (D.ainlWaste Pipe)
'Electrical Ground Electrodl'lUfer
SetbaeklFormsrrrench!lS (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
, Pre-slab (Compaction/Membrane.Rei nt. ' ,
Underpinning (Floor Joist/Girders)
Do not cover or concealthe work below until the
following applicable items have been signed: ,
1 st Floor Shear
Fiiespri nlder (Roug h)
2nd Floor Shear ,
Roof (Sheathing/DiaohragmlFrane)
Masonry (ReinfJBond BeanlPri>-Grout)
Rough Plumbing (Top Out) ,
Rough Mechanical ,
Rough E1ectrlCaI\Dry Wall) , ,
Rough Electrical ~ ~
Framing (Only afterPibg" Elec" Mech" and Fire) ~ 1.5""';', 'P"@::
Insulation (SoundlEnergy) , _L~~(;~ '//.
po not tape or pla~ter until the following applicable ','
Items have been signed: ' '
Drywall ~:. ""V "U'
Penetrations (Fire Rated) Electrical / )
Penetrations (Fire Rated) Mechlll}ical '--
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
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,
ZO,ning 765-5139
Building Final (Last Inspection. Only . /~ 0,
After Above Complete) , '
PARTIAL INSPECTIONS
Buildina Insoections ,
,
Mechanicallnsoections
Plumbina Insoections
Electricallnsoections
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