1233 E. Willow St.
TYPE OF PERMIT
Blockwall / Columns
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CITY QE?~iNi\]H ElM
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BUILDING DIVISION
200 S, ANAHEIM BLVD,
(714) 765- 5153
INSPECTION REQUES{L1NE:
(714) 765 - 4626
CENSUS CODE, ' 434
QUARTER SECTION: 93
BU!LDING PERMIT NO. BLD2004-04102
DATE: 11/1 0/2004
JOB ADDRESS: ,1233 E WILLOW ST
LEGAL DESCRIPTIO"l: N TR 1770 LOT 123
APPLICANT:
OWNER INFORMATION: CONTRACTOR INFORM.l,TION: ARCHITECT/ENGINEER INFORMATION:
Elai ile M Kerchner FELIX-SALAZAR
PO Box 906 ' 680 S PROSPECT
Anaheim, CA 92815. .ORANGE, CA 926590000 ,
JOB DESCRIPTION:Build 79 linear feet of 6 foot high block wall per city spedications:
VALUATION: 3,500.00 PROCESSED BY: MSM
I OWNER-BU1LDEn DECLARATION
I hereby affirm underpenal.ty ofpe~ury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5.Business and Professions
Code: any aty or COU\ltywhich requires a permit to ronstnlct, alter, improve, den'loUsh or,repair any structure. prior to its issuance, als'o requIres the applicant
for such permit to file a signed statement that he is. licensed pursuant to.the prc\\;sions of the Contractor's License Law iChapter 9)('oommencing \'llith Section
7000 of Division 3 of the Busine.ss and Professions Code) or 1hat heis exempt.r.lsrefrom and the basis for. the alleged exemption. Any -v.iolation of Section
. 7031.5 by any applicant for a permit subjec~ the applicant to a civil. penalty of m~t more than five. hU.ndrad dollars ($500). - .
. - - l
D.' -I; as owner of prOperty, army empl~yees with wages as their sole comper)ation, win do the wor.<:, and the's~ucture is n'ot inte~ded or offered for saie
(Sec. 7944 Business. and Professions COde: The Contrac~or's License Law doe~ .not- apply to an owner of property who builds or improves' thereon, alid \\110
does such \rvork. himself or herself'or through h.is or her own employees, provide,j that Sllch improvements are not intended or offered for sale, If, however, the
building or improvement is sold with one year of completion, the owner-ouilden"jlJ have the burden of proving that he-aid not build or improve for the pUiPose
. of sale).' '. . t,. ' . - - -.
. D '.. as the owner .of.the property; am exclusively contjclctin~ with Iice(lsed coitractcrs to constructlhe project (Sec. 1044 Busir:-:ess and Professions Code~
The Contractor's License ,Law does not apply to an owner of propertywhc. bUlld:.(;or improves ~hereon, and who contracts for SUdl projects with a contractor(s)
~nsed pursl.l~nt to t~e Contractor's License ~w).. '. i"
w. I am exempt under Sec. ,B & P.C. for this reason: __!
Date: Owner: ~
, I WORKER'S COMPENSATION DECLARATION ~]
I hereby affirm -mder penalty of perjury one of the fOllowing dedaration~:
D I have and wm maintain acerUncate of consenttoself';'insure for workers 6)i11pensation, as
.' provided for by Section 3700 of the Labor Code, .for.the perfonnance of the Vvo:1<.'{cr ,^11ich, this
pennit is issued. . !; ,
iJ( I have, . and \r'~U r~a:ntaln W?rker's oompensatio~ insu~nce, ~s. ~uireobY 5i~ction ?700 of t~
)giber Code, for the performance of the work for whIch this permit IS ISSUed. M{:'Nmkers
CcmpensaUon insurance carrier and policy are:' . . II
Carrier: Polic umber; EXEMPT
!. section need not be completed ifthe permit i ne uridr d dollats($100;IJ!' less.
, " I Certify that in the performance .of thework fa fch this p it is issued, ~. Sf",',~lI not employ" I
any person in any manner so as to become sub t the wotkP. s cOl11pensat;,:~"lI;;ws of California,
and agree that if t should become subject to'the er's ompe sation proViS.k.'lolS of Section 3700
of the labl?'" Code, 1 shall forthwith comply wi prov ion .
C
S DECLARATION ]
al of perjury that I am
.a t9r9 (commenting with
au . and
11/10/2004
Date:
Contractor:
NUMBER
386097
TYPE
EXPIRATION DATE
12/31/2005
C29 MAS
Date: 11/10/2004 Applicant:
WARNING: FAILURE TO SIOCUR WOR 'S
AND SHALL SUBJECT AN EMPLOYER TO'CR NAL PENALTIES AND CIVIL FiNES UP TO
ONE,HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO TI-IE; COST 0['
COMPENSATION, DAMAGE.S AS PROVIDED FOR IN SECTION 3706 OF TH" tA8()~ CODE.,
INTEREST AND ATTORNEY'S FEES.
I ' CONSTRUCTION LENDING AGENCY
I hereby affirrl) unde enalty of perjury tilat there isa construction lendiny ag.snq' Jcr the I
perfcrmance of thl'l ~ for. h~t.li~ permitis issued (Sec.3097,Civ.(): " ' J
- Le-tld~r's-:nfoim'afl6
, I
I ,certify that I ha~ '
comply with all ci .
repr . s~ntives.of
Construcion Types:
VN, ,
Fire Sprinklered?
NO
Fees paid for Permit~
Total:
125.04
Date: 11/10/2004
ture'of Applicant or Agent ..
h'e by limitation and become null and void ifthe building orwork has
not passed final in ection 365 days from the date of pennit issuance. A new permit is
re,quired to commence or continue work.
INSPECTION RECORD
'. INSPECTION . DATE' . INSPECTOR
Temporary Power Pole
Plumbing (DrainIWaste Pipe) . . .
Electricaf Ground Electrode/lifer . .
SetbacklFormsfTrenches (Footings) . .
Do not install subflooror pour floor slab until the .
following applicable items have been signed:
Plumbing (Water Plpe.Sprinkler Valves)
Mechanical (Groundwork),
Electrical (Underground Conduit) .
Pre-slab (Compaction/Membrane.Rei nt.
Underpinning (Floor Joist/Girders) . .
Do not cover or conceal the work below until the i
following apP'li.c<!ble items have been signed:', . .
1 st Floor Shear . . .
Firesprinkler (Rough) . . . '
2nd Fioor Shear
Roof (Sheathing/Diaphragm/Frame) '. A A
'Masonry (ReinfJBond BeamlPre-Glo\Jt) Z.'2.7..w1 7. /'7/
Rough Plumbing (Top Out) //
Rough Mechanical , I.~
RougnElectriCaI (Dry wall) ,
Rough Electrical . .'
Framing (Only' after Plbg" Elec. r.-lech and Fire)
Insulation (SoundlEnergy) . I . .
00 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 (B.-n Coal)
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 Oep!. Final '7654040 . , . , '. .'
Water E,ngineering 765.5268 ,
Sub list/Business License 765-519 .... .
Zoning 765-5139 - /'
Building Final . ~ast Inspection- Only' rz~~o..e~ 'e1 :;?(,
. . fter Abqve Complete) PARTIAL INSPECTIONS V
BuildinQ Insoections
MechanicallnSDections
PlumbinalnsDeCtions
Electrical Inspections
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DING pE
SEt. \3 I~ CONO\\IONS
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THE ISSUANCE OF THIS PERMIT DOES
NOT APPROVE VIOLATION OF ANY OF
THE BUILDING CODES OF THE CITY.
THE HOLDSR OF TH1$ PE.RMIT
F'ROCEED3 AT HIS OWN RISK.
NOV 1 0 2004
BUILDING DIVISION OF ANAHEIM
APPRQVe;g
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