3737 E. Miraloma Ave.
TYPE OF PERMIT
Miscellaneous C I TV
DATE: 7/6/2005
JOB ADDRESS: 3737 E MIRALOMA AVE
LEGAL DESCRIPTION: P BK 172 PG 6 PAR 4
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
BUILDING PERMIT NO. BLD2005-02059
CENSUS CODE: 437
QUARTER SECTION: 148
APPLICANT: DONALD WRIGHT
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
DONALD WRIGHT
4060 CASSIA LANE
YORBA LINDA, CA 92886
JOB DESCRIPTION:lnstall powder coat booth.
VALUATION: 10,000.00 PROCESSED BY: SAM
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 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 pena~y of not more than five hundred dollars
($500).
~I' as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
al (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves
hereon, 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~buHder will 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, am exclusively contracting with licensed contractors to construct the project (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 contracts for such projects w~h
~ontractor(s) licensed pursuant to the Contractor's License Law).
U I am exempt under Sec. ,P.C. f r t' r Q:
Date: Owner:
WORKER'S CO SATION DECLARATION
I hereby affirm under penalty of perjury 0 e 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 perm it is issued.
D 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. My worker's
Compensation insurance carrier and policy are:
Carrier: Policy Number.
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.
7/6/2005
Date: Contractor
NUMBER
EXPIRATION DATE
This section need not be completed if the pennit is for one hundred dollars ($1 00) or less.
~ertify 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 Labor C e I shall forthwith comply with thos provisions.
TYPE
Date: 7/6/2005 Applicant:
WARNING: FAILURE TO SE EWORKER'S COMPENSATION CO R GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED THOUSAND 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
; hereby affirm under penalty of perjury that there is a construction lending agency for ttle
performance of the work for which this permit is issued (Sec.3097 .Civ.C):
Lender's Information:
Construcion Types:
VN, ,
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
hereby authorize representives of this city to enter upon the above mentioned property for
in",:e~.o os<ses. /! I, 4/ / J
~d'vvl~ Date: 7/6/2005
Signature of Ap~r Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed fi nal inspection 365 days from the date of permit issuance, A
new Dermit is reauired to commence or continue work.
Fees paid for Permit:
Total:
347,83
City of Anaheim
Building Division
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INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
Setback/FormslTrenches (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 Reinf.)
Underpinning (Floor JoisflGirders)
Do nof 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/Frame)
Masonry (ReinfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (SoundlEnergy)
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 '{ III fJ In /,~
Plumbing Final .
Mechanical Final '1/ > If) I (J1Av- <6
Gas Test I
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5266
Sub Lisf/Business License 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only fbji ts /JZt,v!8
After Above Complete)
PARTIAL INSPECTIONS
Buildina Insoections
Mechanicallnsoections
Plumbina Insoections
Electricallnsoections