203 S. Melrose St.
TYPE OF PERMIT
Blockwall/ Columns
DATE: 9/15/2005
JOB ADDRESS: 203 S MELROSE ST
LEGAL DESCRIPTION: SMITH & DEANS RESUB LOT 19 AND 20
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 83
BUILDING PERMIT NO. BLD2005-02938
APPLICANT: RODOLFO ZUNIGA
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
DOLORES MCCLUCKI E
625 N CLEMENTINE ST
ANAHEIM, CA 92805
JOB DESCRIPTION:Build block wall 115 linear ft. at 6' ft. high per city specificaMns.
VALUATION: 5,200.00 PROCESSED BY: ENO
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's license Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, alter,' 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 licenE'ed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Profession;; 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 sUbjer;ts the applicant to a civil penalty of not more than five hundred dollars
-~. .
~. J, as owner of property, or my employees with wages as their sole compeJ'lsation, 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 compfetion, 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 propertywi~o builds or improves thereon, and who contracts for such projects with
ontractor(s) licensed pursuant tothe Contractor's License Law).
am xe t under Sec. , B & P.C this reason:
q , 0\ Owner: -
WORKER'S M SATI CLARATION
I hereby affirm under penalty 0 rjury one of the following declarations: .
o I have and will maintain a certificate of consent to self.insure for worker's compensation,
as provided for by Section 3700 of the labor Code, for the performance of the work for which
this permit is issued.
o I 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. Myworker's
Compensation insurance carrier and policy are:
Carrier: Policy Nu mbe r:
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
N-~ certify that in the performance of the work for which this permit is issued, I shall not
~y any person in any manner so as to become subject to the worker's compensation laws
of California, and agree that if I should become SUbject to the worker's compensation
provisions of Section 3700 of the bor Cod shall f rthwith comply with those provisions.
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 Cod e. .
9/15/2005
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Date: 9/15/2005 Applicant:
WARNING: FAILURE TO SECUR ORKER'S C PENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJ T AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRE THOUSAND DOLLARS ($100,000), IN ADDITION 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:
VN, ,
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
herebyauth . e representives of this city to enter upon the above mentioned property for
in ion urposes.
Date: 9/15/2005
Fees paid for Permit:
Total:
199.32
of Applicant or Agent
The p mit shall ex re by limitation and become null and void if the building or
work as not passed final inspection 365 days from the date of permit issuance. A
new ermit is required to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground ElectrodelUfer
SetbacklFormsfTrenches (Footings) 9\1cl\6~ I ~ tt...A
Do not install subfloor or pour flodr slab untiltht
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor Joist/Girders)
Do 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 (SheathinglDiaphragm/Frame)
Masonry (ReinfJBond Beam/Pre-Grout) "l?,.t:. .... IF LA
) . 1/.'
Rough Plumbing (Top Out) !
Rough Mechanical (
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (Sound/Energy)
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 (Brown Coat)
T-Bar Electrical
T-Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS DATE INSPECTOR
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 765.5194
. Zoning 765-5139
Building Final (Last Inspection. Only '-~'Q5 fJ- 1/
After Above Complete) I "'7
/
PARTIAL INSPECTIONS
Building Inspections
MechanicallnsDections
Plumbing Inspections
ElectricallnsDections
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THE ISSUAN E OF THIS PERMIT DOES
NOT APPRO VIOLATION OF ANY OF
C" l:)' II ,..,,1 'S I"'.--.~...."c:s OF THE CITY,
2:.':\:_;"~c.;;,,- ",:., \,)i-' 'Tr"iIS PERM I'
,;~i:::.. .:.'- "j" HIS OWN RISK.
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iViSION OF ANAHEIM
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