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3181 W. Polk Ave. TYPE OF PERMIT C Blockwall/Columns ITY DATE: 6/9/2005 JOB ADDRESS: 3181 W POLK AVE LEGAL DESCRIPTION: N TR 1820 LOT 41 ElM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 CENSUS CODE: 434 QUARTER SECTION: 8 BUILDING PERMIT NO. BLD2005-01764 APPLICANT: FRANSISCO GUZMAN OWNER INFORMATION: CONTRACTOR INFORMATIONI ARCHITECT/ENGINEER INFORMATION: Vicente Pineda 3181 W Polk Ave Anaheim, CA 92801 JOB DESCRIPTION:Build 6' high 65' long block wall per city specifications. VALUATION: 3,500.00 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 licensed pursuant to the provisions of the Contractor's License Law (Chapter 9)(commencing with Section 7000 of Division 3 of the Business and Professiors 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 sal (Sec. 7044 Business and Professions Code: The Contractor's Ucense law 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 are not intended or offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the pUlpose 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 Ucense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's Ucense Law). D I am e e pt )jllder Sec. . . forthis soo: "6) . ~~ WO 'S COMP NSATION CLARATION I hereby affirm under penalty of perjury one of the following declarations: D 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. 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. a I certify that in the performance of the work for which this permit is issued. I shall not enipIoy 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 worker's compensation provisions of Section 3700 of the labor Code forthwith c ply with t e provisions. r LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000) of Oivsion 3 of the Business and Professions Code. 6/9/2005 Date: Contractor NUMBER EXPIRATION DATE TYPE Date: 6/9/2005 Applican . WARNING: FAILURE TO SEC E~OR "'S COMP ATION COVERAGE IS UNLAWFUL, AND SHALL S JECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UPTO ONE HUN ED THOUSAND DOLLARS ($100,000), IN ADDlllON TO THE COST OF COMPENSA ION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OFTHE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 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 hereby authorize representives of this city to enter upon the above mentioned property for in e iorf pur Date: 6/9/2005 Fees paid for Permit: Total: 125.79 Signature of Applicant or A The permit shall expire by limitation and become 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 reCluired to commence or continue work. City of Anaheim Building Division ~,..,..".c"'. o 0 , . , ') u j> '''''OI.JNDrf~l. INSPECTION RECORD INSPECTION DATE INSPECTOR Temporary Power Pole Plumbing (Drain/Waste Pipe) Electrical Ground Electrode/Ufer Setback/Forms/Trenches (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 (CompactioniMembrane Reinf.) Underpinning (Floor Jolsl/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 (Sheathlng/Diaphragm/Frame) Masonry (RelnfJBond Beam/Pre-Grout) ..IA Rough Plumbing (Top Out) " Rough Mechanical Rough Electrical (Dry Wall) 'Rough Electrical ,Framing (Only after Plbg., EIe., Mec:. And Fire) !Insulation (Sound/Energy) ! Do not tape or plaster until the following applicable i items have been signed: Drywall !Penetrations (Fire Rated) Electrical i Penetrations (Fire Rated) Mechanical ! Penetrations (Fire Rated) Plumbing I Interior Lath I Exterior Lath I GENERAL ITEMS Exterior Plaster (Brown Coat) T -Bar Electrical T -Bar Mechanical T-Bar Structural Sewer Waler Engineering Backflow Waler 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 Lisl/Business License 765-5194 Zoning 765-5139 / Building Final (Last Inspection - Only l~i5 4AlJoWS/L.. , After Above Complete) I PARTIAL INSPECTIONS B";ldln~~ ~ ~a ,~k ~)?4-r Mechanical Inspections Plumbina Inspections Electrical Inspections o 00. C\. IJ\. ~ ~ j'-- c:S' S ." 5.(, ~ --J~ 0~ ~ 2 "'( ,1 . , ~ .......... ~ '-- Il.J ;,' <t;: ..!( ~. <:) '\ ~ ~ --j- ~ '" >- \L W ,~tJ1-~'f, / / / .' .' --- ~~ -.. ",-' , QU) 0,' \r);o\-.} r LJ ()('t(' \;).)\ ( ~J' :2>)"'"1~ , <-it;; ~ 0 ~ '/ r-'" ~ d;,,:'S '" " ~ i <" I;J '4\ ::> <> .....s::. y- ~ ~ ~ \ , "",',.-. <::) ~ Ii <:S ~ ~~~lR1(o)W[Erm ItU , JUN ," 05 I.W ~I " . " WMENT I PLAN\,\INGr?EPA/,.:.O \ 1\ PPI"",O\7 b. I r\~' : : 6--1_.-e:>~-:~ OA1-,~n\O~) BY ! Ollit\&ld \ " )( - \ FLOOD ZON~ . R\C1 REVIEW: 0\51 " H\S ,\ ~fJP, st"j:1':Q. tni~ p8.g,e~ ,I \ N/ ' '.bove l\Oe V . de one 011 ~ T FOR DING pERM\ SEE 8~~~ COt.wIlTIONS ~~ b ( ( (~LIL (/vat! () J. Of. S ~'L-u <.oJ, : . \ 1:~0 ; I ~ JJHEj ANCE OF THIS PERMIT! DOES ~OT P OVE VIOLATION OF ANY OF 'l<HE\ I DING CODES OF THE! CITY. ~HS H L.,Oe:;R of THIS PERMIT ~ROCE D3 AT HIS OWN .RISK. ~ ..., -d. '7. .'" \.g' I BUILDI 'JUN 0 ~ Z005 G DIVISION OF ANAHEIM PPROV.E_D BY ~ 4