3123-3127 W. Lincoln Ave.
TYPE OF PERMIT C TV
Ught / Flag Pole I
DATE: 6/8/2005
JOB ADDRESS: 31233127 W LINCOLN AVE
LEGAL DESCRIPTION:
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
INSPECTION REQUEST LINE:
(714) 765.4626
CENSUS CODE: 570
QUARTER SECTION: 8
BUILDING PERMIT NO. BLD2005-01725
APPLICANT: CHERYL STUMP
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
Anaheim Redevelopment Agency BROOKFIELD HOMES SOUTHLAND INC
201 S Anaheim Blvd 3090 BRISTOL ST #200
Anaheim, CA 92805 COSTA MESA, CA 926260000
BUSINESS PHONE: 714427.6868
JOB DESCRIPTION: Install (1) private lighting pole per city standard- Public Works design # 742.
VALUATION: 2,500.00 PROCESSED BY: SAM
OWNER-BUILDER DECLARATION
hereby affirm under penalty of perjury that I am exempt rom the ontractor's License law for the fo lowing reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, atter, improve, demolish or repair any structure, prior to its issuance, also
requires the appficant for such permit to file a signed statement that he islicenood 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
~~. .
o 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 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-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 wfth 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
i!-Qontractor(s) licensed pursuant to the Contractor's License Law).
U I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one 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 \vori< for which
this permit is issued.
~have and will maintain worker's compensation insurance, as required by ~ection 3700 of
th bor Code, for the performance of the work for which this permit is issued. Myworker's
C mpensatian insurance carrier and policy are: '
Crier: OLD REPUBliC iNSURANCE COMPAN'lf'olicy Number. MWC11101400
This section need not be completed if the penni! is for one hundred dollars ($100) or less.
o I certify that in the perfoJlTlance 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'pensation laws
of Calitomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I shall forthwith comply with thos~ provisions.
Oate: 6/8/2005 Applicant:
WARNING: FAILURE TO SECUR 0 KER'S C PENSATION COVERAqE IS
UNLAWFUL, AND SHALL CT AN EMPLOY R TO CRIMINAL PENALTIES AND CiViL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITlON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR iN SECTION 31'06 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:
LICENSED CONTRACTORS DECLARATION J
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencin 9
with Section 7000) of Divsion 3 of the Business and
profeSSi~Codel'l0 "'--=r>
6/8/2005 . I ~ ~
Date: - d Contractor
NUMBER EXPIRATION DATE
736657 6/30/2005
TYPE B
Construcion Types:
V N, ,
Fire Sprinklered?
NO
I certify that I have read this application and state that the above in10rmation 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
inspection puq:;!oses.
Date: 6/8/2005
Fees paid for Permit:
Total:
114.59
Signatu
The ermit shall expi 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 reauired to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
Setback/FormslTrenches (Footinas)
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 Reinl.)
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
Rool (Sheathing/Diaphragm/Frame)
Masonry (Reinf JBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Me<:. 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
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
After Above CompJete)
PARTIAL INSPECTIONS
Buildina Insoections
Mechanicallnsoections
Plumbina Insoections
Electricallnsoections