997 S. Matthew Way
BUILDING PERMIT NO. BLD2004-01845
TYPE OF PERMIT
Blockwall/ Columns CITY'
DATE:.5119/2004
JOB ADDRESS: 997 S MATTHEW WAY
LEGAL DESCRIPTION: N TR 12686 LOT 62
APPLICANT: SANDRA NUNEZ
OWNER INFORMATION:
Richard Wiles
997 S Matthew Way
Anaheim,' CA. 92808
BUilDING DIYISION
200 S. ANAHEIM BL YD.
(714}765- 5153
INSPECTION REQUESTLINE:
(714) 765- 4626
CENSUS CODE: 434 .
QUARTER SECiION:215
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY:. HRO
;..,..,
CONTRACTOR lNFORMi:,T10N:
F M LANDSCAPE & MAS;.JNRY
4474 ADAMS ST .
RIVERSIDE, CA 9250424(0
BUSINESSPHONE:90968;)-3214
JOB DESCRIPTIONl3ullt 42 lineal ft of.blockwaIl5' 6" ft hl9h percity s.landards'. (HIH)
YALUATION: 1,008.00
I OWNER-BUIL[jE~DECLARATION
'-hereby'affirm under penalty'of perjury that I am exempt from the Contractor:sLlcense Law for the following reason (Sec. 7031.5 Business an9
Professions CQde:any dtyorcountywhich requires a, p'ermit to construct, 'alter, :improve. demolish or repair any structure, priorto its isSuance..also
requires tlie appl!cant for such permi~ to file a signed statementU-:,athe is licdrl5ed pursuant .to. the provision's of the Contract.or's License Law (Chapter
9)(commencing with Section 7000 of D\vision,3 of the Business and Profe<3s]l;ns Code) or that he is exempt therefrom 'and the basis for. the alleged
. ~xemption. Any violation' of Section 7031.5' by any applicant for a p'ermit sub. acts the applicant to'8 ,d\!iI" periatty of 'not more than five hundred'doUars
~~ '. . . . .
0:1, as owner o~ property, or my ei'n~loyees with wages as their sole comr::~iis~tion, will do the wo~k, and the struc;ture )s n,otintended Of .offered for
sale (Sec. 7044, Bustnessand Professions Code: The Contractor's'Ucense t'p:w'does not apply to an Qwnerof property who builds or improves .
thereon, and who does such work himself_ ot herself of through his, or hero'.-vr\ empioyees, provided that such improvements are notintended,or
offered for Sale. If, howeVer, the' building.or improvement is sold with on'e ye~.r of completion, .the owner-builder will tlave the burden of proving that he
did not build or improve for the purpose of sale). " , ' _ " ' ' , .
o I,as_ the owner ofthe property,' am Elxdusively eontracting with license~l~:or.trad.ors,to construct the project (Sec. 7044 Busin_ess and Professions
Code: The Contractor's License law does not apply to an owner ofproperty:......ho builds or improves thereon, and who contracts for such projel?ts with
~olltraCt.or(s) Iicens~d pursuant to the Contractor's Ucen~~ law), ' .
L.) I am exempt under Sec. - " B & P.C. for this reMon: '
Date: Owner:
L WORKER'S COMPENSATION DECLARATION :=-----.J
.!. hereby affirm ,under penalty of Pl?rjury one of the. following declaratjo~s:
D I,have and.will'maintain 'acertificate of consent to self-insure forw.orke(ecompensation,
as provided for by Seption 3700 of the-Labor Code,. for the perforrnanceoftt....;_wo..k for Which
this permit is--issued. , .,
~.! have'~nd will maintain worker's compens~tion insurance, as ,required t.;, Section 3700 of
the labor Code, for the performance of the work for which this permit is issu,~j. Myworker's
Compensation inSUrance carrier and policy are: .
Carrier: EVEREST NATIONAL INS. Policy Number. 3800000::54.031
. ,
. .
This s-ection need noH>e: com(?leted jf the pennit is for one -hundred d<?lIars($1 o6~ cr leSs:
o I certify that"in the performance of the work forwhichthls permitis iSSU€.:i, I ~a-ll not
employ any person in any manner so as.to become subject to the worker's_CI\T1pensation laws
of Califomia, and agree that if Ishoufd.becon-le subjed.to the wQrk.er's compl~'nsatfon ,
prOVi$iOn~. of Section 3700 OftheLa.~. rCoRe, I sh Uforthwllh.comPI.,y.,W. ilh....ttc.t:~tovisions.
Date: 5/19/2004 Applicant; ~ . .~ "'.--:...;;.
WARNING; FAILURE. TO SECURE 'IV RKER'S COMPENSAT\6N COVERAGE is
UNLAWFUL, AND SHALL SUBJECTAN EMPLOYER TO CRIMINALPE~ALTIES.'AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ApD)llot~:TO THE
COST OF COMPENSATION., DAMAGES AS PROVIDED. FOR IN SECTlpN 370B'QF. THE
LABOR CQDE, INTERESTAND ATTORNEY'S FEES. ",X .;~:..,
r- '.. __ __--__~,,_CO!:~TRf~2T!O~I-tEN~~NG-ACF:~iCY" ..,-,:-.,~.
-- -! nt;:fC:i.'y anirm under penalty of perju!y th::lt th~re is a construction-lend ing agan'cy fOf the
performance of the;. wariC fer- which this permit is issued (Sec.3097.Civ.C):
lenaer's Information:
I certify that I have read 'this application and state that the above information is correct. I
,agree to:comp/y with all city -ordinancesan(fstate laws relating to building cOll$tructi9n, and
hereby authorize representives of this city to enter upon the above_me{'ltionedproperty for
.Insp~.. .... , Date;5it9/2004
0(:.. Si9nature of AP~ or Agent .. .
The permit sh;lll expire by limitation and become .null and void ifthebuilding or
work has not passed final inspection 365.days from the date of permit j>lsuance, A
n~w permit is requiref:l to commence- or. c.ontinue work,
LICENSED CONT~CTORS DECLARATION .'
~ hereby affirm under penalty of perjury that lam
Jicensed.u nder provisions of -chap~er 9, (commencing'
. with Section 7000) ofQivsiori 3 of the Business 'and
p.rofessionscod~.' '-.' ,,'. .' ..2-.... .
5/19/2004 "~" .' .
Date: , Contrac or '
NUMBER
654792
TYPE
TYPE'
TYPE'
Construcion Types:
VN, , .'
Fire Sprinklered?
EXPIRATION DATE
9/30/2004
C27
HIC
C29 MAS
NO
,-':"
Fees. paid for Permit: .
Total:
0.50 .
INSPECTION RECORD
. . .
: ..
INSpECTION '.' .... DATE. . INSPECTOR
TemporaryPow'er Pole . '. '.
Plumbing (DrainiWaste Pipe) '. . '. . .
. Electrical GrOund ElectrodelUfer '. ." '., ".
.. S<<b;JC~FQrI'!1SrrrenChes (Footings) . '. ~ I~ IfVl,u :
Do not Install subtklOrorpourf/oorslabuntll the' ..:1111 . . .
following applicable items .have be.en signed:' .
Plumbing (WlIterPipe.Sprinkler valves) . I
Mechitnical(GrOundwork) ..... J '.
. . . .
. Electr~ (Underground Conduit) . .' .
pre'slab (Compaction/Meinbrane.Reim.j / .'
. Underpinning (Roar JciistlGl mers) .'. / . .
.uo not cover or conceal the wori< below Jnt.. the .
folloWing applicable items have been sign ~:: '. . ..' .
1 stFloor Shear' .:' I . '. I: . '"
, Firesprinkler(Rough) . . Y'.
2nd Floor Shear . . .' I , ~"~/I'
.' ROof (Sl1ealllii1g/Diaohragmlframe) ./ . /1
MaSonry (ReinfJBond 8l!amlPre,Groutt ~ ~/:S--o.
.R!!ughPlumbing . (T!!p Out) . .' ..F....
.. ~ough Mechanical . .' . .'
. l'<Ough l;lectrlClII (Lll')' wall}
Rough Electrical . '.
Framing (Only after Plbg.. Eh::<;.. r...lech. and Fire) ..' '. '.
In.sulation (SoundlEnergy) .. . . . . '.
. po not tape or.pla~ter until tfle following applicable
.tems bave been signed:.. . : . . . .
Drywall '. .' .... .
Penetrations (Fire Rated) Electrical .. .
Penetrations (File Rated).Mechanical . .' .
PenetratiOns (Fire Rated) Plumbing" '. . '.
,IriteriorLath. '. ..' . .
Exterior I,.ath . .... . '
. GENERAl,. ITEMS . . .
. Exterior Plaster (Brown Coat) .' .':
T.Bar Electrical. . . '.' "
'T.Bar Mechanical' . .' . .
T .Bar Structural '. .
Silwer . .' . .
'Water Engineering Backflow '. ..
Water Service . .
FINAL INSPECTIONS, .
Electrical Fin'l'
Plumbing fin'll
Mechanical Final
S'lS Test
Engineerill9'Grading Final 765-5126 .
. Fire Dept.' Finai 765-4040
Water Engineering 765.5268
Subl.JstlBuslness I,.icense 765.519
Zoning 765-5.139'
'Buildlng "inal lLast Inspection.'Only .' <12" .
" . . After Above CompleteL 7-..0
. PARTIAl- INSPECTIONS
Buildinqlnspections
Date . Inspector .
. .' Mecllanical UlsP&ctions
'-
Plumbina"nspections
, '.
Electrical.lnspections