1345 S. Petal Pl.
TYPE OF PERMIT
BJockwall/Columns CITY
DATE: 1/13/2004
JOB ADDRESS: 1345 S PETAL PL
LEGAL DESCRIPTION: N TR 2637 LOT 29
BUILDING DIVISION .
200S. ANAHflM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 85
BUILDING PERMIT NO. l3LD2004.00084
APPLICANT: RAFAEL BUENROSTRO
OWNER INFORMATION:
Rafael BUenr(lS~ro
1345 S Petal PI
Anaheim, CA 92805
JOB DESCRIPTION:lssue permit for 47 If block wall 6' high and 45 If block wa'14' high to city specs.
VALUATION: 2,208.00
I OWNER-BUILDER OECLARATlON
I hereby affirm under penalty of perjury that I am exempt from the ContraCto(s License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any oty or cOuntywhicD requires a permit'to cOnstruct, alt~r, improve. 'demonshor repainmy struc~re, prior to its issuance. also
. requires the"applj~nt forsuch permit to file;a signedstaternent that he is I}censed pursuant to the provisions of the, Contrac:tor"s license law (Chapter
9}(commencing with Section 7000 of Division 3 of the Business and Profess;ons 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 suii6Cts the applicant to a dvn penalty of not more than five hundred dollars
($500). '. ;' ...... :
~~s..,owner of property, or. illY employees with wages a. s their sole com R;!nsation, will do the work, and th~ structure is not intended or offered for .
, ~-(~c. 7044 Business and Professions Code: The Contractor's License l:.<:lW does not apply to ~m owner of property who builds or improv_es .
thereOn: and who does such :work himself or herself or through his orher _o_wh employees, provided that such improvements are not intet'lded or .
offered for sale. If, however, the .building or impr6verrient is sold with one yel~r ofoompletion, the owner-builder.will have-the burden of prov!ng'thathe
did not buUd or improve for the purpose of sale). .':) '. . .
D I,' at? the owner of the property, am exdusively contracting with license<t,:ontradors to construct the proj~t (See. 7044 Business and ProfeSs19ns
Code: The Contractor's Lice.n~ law -does not apply to an owner of propert~ \:iho buUds or improves thereon, and who oontracts for such projects' with
~~rad::or(s) .licensed pursuant to the Contractor's License Law). .
U"amexemptunderSec. . . B& P.C. for this re on:
Date: Owner: .
CONTRACTOR INFORMAflON:
. .
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: CAL.
WORKE S CO PENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of ron-sent to self-insure for worker",: compensation,.
as previdedfor by Section 3700 6f the Labor Code, for the ~rformance of tt':~ wolk for whidl
this permit is issued. " . .
o I have and will m3'intain worker's compensation insurance, a~ required'b, Section 3700 of
the.LaborCode,'forthe performance.ofthe work for which this permit is issu.:u. Myworker's
Compensatio~ insurance .canier and policy are:
Carrier: .. Policy Number:
This section need not be completed if fhe ""omit is for one hundred dollars ($10c.:. or less,
'~tib:..that in, the perfQnnBnee of the work forw.hich this. permit is iss~ed.1 shaU not
~ any pers()n in any manner so as to become SUbject to the worke(s.'c~:mpensation laws
of CalWomia, and agree that ff I should become subjecllo thewbrkefs comPensation.
prov~ions'of Section 3700 ofthe Lab:or Code, I shan forthwith comply with th?se provisions..
Date: 111312004. Applicant:
WARNING: FAILURE TO SECU RKER'S COMPENSATION COVEEI\GE IS
. UNLAWFUL, AND S~ALL SUBY:;OCTAN EMPLOYER TO CRIMINAL PENAI.TIES AND CIVIL
FINES UP TO ONE HUNDREDlHOUSAND DOLLARS ($100,000), IN ADO:T1ON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY
. r herepy.affirm under penalty of perjury that there is a- construction lending a~encyfor the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
l.ender's I.iformation: . - . . ,
LICENSED CONTRACTORS. DECLARATION
I hereby affirm under penalty of perjury that I <:1m
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divslon 3 of the Business and
ProfessionS.Code.
1/13/2004
Oate: Contractor
NUMBER
TYPE
EXPIRATION DATE
Construcioil Types:
VN" .
I certify that I have read this application and state that the above information is correct. I
agr~e to oomply With all city ordinances and state laws relating to buijding' construction, and
hereby authorize representives of this city to enter iJpon the above mentioned property for
. .inspection purposes. .
.V~-<( /"':./?,__~ ..' Date, 111312004
_____ \"" Signaltjre of Applicant or Agent
The permit 5001.1 ~xpire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of pernut issualCe, A
new permit is required to cOmmence or continue work.
Fees paid- for Permit:
Total:
196.04
INSPECTION RECORD
. INSPECTION . DATE INSPECTOR .
T empQrary Power f'ole .
f'lumblng (DrainlWaste Pipe) .
Electrical Ground Electrode/uter . . .
. Setback/FormsfTrenches (Footings)
Do not il1!;tall sub floor or pour floorslab unlillhe
following applicable ilems have been signed: .
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork) . ..
Electrical (Underground Conduit) . .
Pre-slab (Compaction/Membrane.Reint. .
. Underpinnin\! (Floor Joist/Girders) . .
!J'?nol cover or conceallhe.work below unllllhe
following applicable items have been signed:
151 Floor Shear. .
Firesprinkler (~Ugh) .
2nd Floor Shear' . . . . '.
Root (Sheathing/Diaphragm/Frame)
Masonry (ReinfJBond BeamlPre-Groul) . .
Rough Plumbing (Top Out).
Rough Mechanical .'
KOugh l:Iectncal (ury wall) .
Rough Electtjcal
Framing (Only aherPlbg.. Elec.. Mech ana Fire)
Insulation (Soul1d1Energy) . .'
Do not tape or plasler. unlillhe following applicable
items have been signeq: _, _ -. . .
Drywall' . .
Penetrations (File Rated) Electrical .
Penetrations (File Rated) Mechanical
Penetrations.(File Rated} Plumbing .
Interior Lath . I'
Exterior Lath . . .
. GENERAL ITEMS
Exterior Plaster (BlOWn Coat) .
T -Bar Eiectrical o'
T -Bar' Mechanical' . .
T -Bar Structural .
Sewer . . ,
Water engineering Bacldlow
Water Service
FINAL INSPECTIONS. 9ate .Inspector .
Electrical Final . . .
Plumbing Final .
Mechanical Final
Gas Test . .' . .'
.
Engineering/Grading Final 765-5126 .
.
Fire Dept. Final 765-4040. . ..
Waler Engineering 765-5268
Sub List/Business Liceose765-519' .
Zoning 165.5139 , i .
Building Final ~astlnspectioil. Only ~/~/o+ RRr ;t,1'J(11J~
fter Above Completel
PARTIAL INSPECTIONS .
BUildina Inspections
.
Mechanical Insoections .
Plumbina Inspections
Electric:allnsoections.
JcJhl/l
7/'1
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PLANNING DEPARTMENT
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FLOOD Z!CJNE.rc
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H~,DISTRICT, R,EVIEW:
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