3177 W. Monroe
BUILDING PERMIT NO. ElLD211"5-01218
-.
ElM
BUILDING DIVISION
200 S. ANAHEIM .BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 8 .. ') .
. l ,.L-
TYPE OF PERMIT
Blockwall / Columns CITY
DATE: 4/2812005
JOB ADDRESS: 3177 W MONROE AVE
LEGAL DESCRIPTION: N TR1820 LOT 122
APPLICANT: RANDALL BROWN
OWNER INFORMATION: CONTRACTOR INFORMATiON:
Brown Randall L Tr
3177 W Monroe Ave
Ahaheim, CA 92801
JOB DESCRIPTION:Build 65 ft. linear dividing block wall 6' ft. high per city specifications.
VALUATION: 3,500.00
ARCHITECT/ENGINEER tNFORMA TtON:'
PROCESSED BY: ENO
OWNER-BUILDER DECLARATION
J .hereby affirm under penalty of perjury that r am exempt from. the Contractor's.Ucense 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 rsp.air ,any structure, prior to its issuance, also
requ'ire~ the applicant for such permit to -We a,signed statement that he is licensed pursuant to the provisions'of the Contractor's License Law (Chapter
9)(comrriencing 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). ... . . .
~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
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 orherserf Or through his or her own emplqyees, provided that such improvements are not intended or
offered for sale. If, hOwever, the- building or improvement is sold with one yearof 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 contractors to constru9t.the project (Sec. 7044 Business and professions
Gode: The Contractor!s License Law does not apply to an owner of property who builds or-improves thereon, and who COntracts for such-projects with
~ontractbr(s) licensed pursuan~ to t Contractor's License Law).
U I-am exempt under See: ' . 8)& P.C.jor !pis reas :
ate: .:~r-tJ Owner: ~~_
WORKER'S OMPENSATION ECLARATION
I hereby affirm under penalty of perjury one of the following declarations:.
D I have and will maintain a certificat~ of oor')sent to self-insure for worker's compensa~ion,
as provided for by Section 3700 of the Labor' Code, for the perlormance of the Work for which
this permit is issued.
o I have arid will maintain work~r's compensation insurance, as required by Section 3700 of 4/28/2005
the Labor Code, for the performance of the work for which this permit is issued. Myworker'.s Date:.
Compensation_insurance,carrier and policy are:
Carrier:, . Policy Number.
This section need not be completed if the' pennit is for one hundred dollars ($1 00) or'less.
g.. I certify that in the perfonnance o.f the work for which this permit is issued, I shall not
employ 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 work"er'g compensation
provisions of Section 3700 of the Labor C hall f,orthwit~ c~1y with th~se pr<:>visio~.
Date: 4/28/2005 Applicant: ~,
WARNING: FAILURE TO SECUR WO R'S CO PENSATI VERAGE IS
UNLAWFUL, AND SHALL SUBJ T AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED OUSAND DOLLARS ($100,000), IN ADDIllON TO THE
COST OF COMPENSATION, AMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereQY affirm' under penalty of perjury th.at there js.a construction lending agency for the
performance of the work for which this'permit is'issued (Sec.3097 .Civ .C):
Lender's Information: - -
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code.
Contractor
NUMBER
EXPIRATION DATE
TYPE
Construcion Types:
VN, ,
Fire Sprinklered?
NO
I certify that I have read thi$ 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 uthor" e repre$6ntives of this city to enter upon the above mentioned property for
sp . io u~ ~s.
Date: 4/28/2005
. Fees paid for Permit:
Total:
125.79
Sig e of Appfi ent
e permit shall expire by limitation and becolTe 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.
. INSPECTION RECORD
INSPECTION . DATE INSPECTOR
Temporary Power Pole
Plumbing (DralnlWaste Pipe)
.ElectricalGround Electrodel!lfer I t\ I IN,0
SelbacklFormsfTrflnchesl(FootfriliS) I..."e:,~ \L.-
Do not install subfloor or p.o1ll'1T"oor slab until the .
fOllowing applicable items have been signed:
Plumbing (Water Plpe.Sprinkler ValveS) .
Mechanical (Groundwork)
Electrical (Underground Condu it) .
Pl'll,slab (Compaction/Membrane.Reinf. .
Undel:pinning (Floor Joist/Girders)
Do .not cover or conceal the work below until tne
following applicable items have been signed:
1 st Floor Shear.
Firesprinl<ler (Rough) .
2nd FlOOr Shear . . .
Roof (SheathinglDiaphragmlF~ .1. ^ C .
Masonry (RelnfJBond BeanllPr t) "".,IAC' AV~
Rough Plumbing (Top Out) . ,
Rough Mechanical .
Rough BectricallDry wall) . ..
Rough Electrical . .
Framing (Only after Plbg., Elec., Mech., 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
Watflr Service
. ,
-
FINAL INSPECTIONS ./ , . . Date ..Inspector
Electrical Final
Plumbing .Final. . . .
Mflchanical Final
Gas Test . .
Engineering/Grading Final 765-5126 -.
Fire Dept. Final 765-4040 . .
Water Engineering 765-5268 .
Sub List/Business License 765-519
Zoning 765-5139 , /"\ '
Building Final *ast Inspection. Only ~l,\ 6'S\. j\I1\1YJ..
. fter Above Complete)
PARTIAL INSPECTIONS
Buildinq Inspections
. Mechanical Inspections
Plumbinq Inspections
Electricallilspections
/
LI '/vCtJ I;f/ 4</ "-
THE ISSUANCE OF THIS PERMIT DOES
NOT APPROVE VIOLATION OF ANY OF
THE aUILO\~J~ (':(";:\<;.3 OF THE CITY.
THE HOi.._:-'c.~'~ 0;'~,THIS PERMIT
PROCEF"':'D'3 T HIS OWN RISK.
~
DATE
BY
RTMENT
EO
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FLOOD ZONE
1/1/ 'i-
HIS, Ie DISTRI T REVIEW:
N/ Sea sta p this .pa~e
Irete one on a ove line
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