3643 Myra
APPLICANT: MYLINH DO
OWNER INFORMATION:
MYLlNH DO
3643 W MYRA AVE
ANAHEIM, CA 92804
JOB DESCRIPTION:lnstaIl30' linear feet of 6' feet high block wall per city standards
VALUATION: 1,500.00
I OWNER-BUILDER lJECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Bus ness 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 penalty of not more than five hundred dollars
($500).
D 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 Lz.w does not apply to an owner of property who builds or improves
thereon, and who does such work himself or helSelf or through his or her own employees, provided that such improvements arenot intended or
offered for sale. If, however, the building or improvement is sold with one YI~ar of compJetion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale).
~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 with
~ontractor(s) licensed pursuant to the Co tractor's License Law).
U I am ex mRt nder Sec. & . or this reason:
Date: Or- Owner: (
WORKER' ATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
t:J , 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 fhe pe rtormance of the wort< for which
this permit 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. Myworker's
Compensation insurance carrier and policy are:
Carrier: Policy Number.
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
t2r I certify that in the pertonnance of 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 com ensation laws
of Califomia, and agree that if I should become ~ ct to the worker' nsation
provisions of Section 3700 of the labor Code, I s I orth }JJPly'with those provisions.
BUILDING PERMIT NO. BLD2005-02331
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TYPE OF PERMIT C
Blockwall/ Columns ITY
DATE: 7/26/2005
JOB ADDRESS: 3643 W MYRA AVE
LEGAL DESCRIPTION: N TR 3501 LOT 172
CONTRACTOR INFORMATION:
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 565
QUARTER SECTION: 3
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
Date: 7/26/2005 Applicant:'<:::;::'"
WARNING: FAILURE TO SECUREWORKE ENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN YER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED n;OUSAND 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: ~.
I certify that I have read this application and state that the above information is correct. I
agree to comply w' all city ordinances and s relating to building construction, and
hereby authorize r sentives of .~ er upon the above mentioned property for
inspection purpo ,/
Date: 7/26/2005
natu pplicant or Agent
The permi pire by limitation and become null and void if the building or
work ha ot passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
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.
7/26/2005
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Construcion Tvpes:
VN, ,
Fees paid for Permit:
Total:
125.79
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormslTrenches (Footings) T-:rr-~ 'f(, PUi/Zt ! !
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 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 (Sheathing/Diaphragm/Frame)
Masonry (Reinf./Bond Beam/Pre-Grout) 11V't/t6" ~ZJwviJ
Rough Plumbing (Top Out) "I
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ere., 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 ~.r05 ;l.1C/(?nll
After Abovt! Complete)
PARTIAL INSPECTIONS
Building Inspections
MechanicallnSDections
Plumbina InSDections
Electrical Inspections
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