420 S. Sleepy Meadow Ln.
APPLICANT:
OWNER INFORMATION:
o T O'Brien
420 S Sleepy Meadow -Ln
'Anaheim, CA 92807
JOB DESCRIPTION: Retaining wall for pool equipment; SW12005-00017
VALUATION: . 950_00
I .OWNER-BUILDEfl r.;IECLARATION
I hereby atffrm under penalty of perjury that I am exempt from the Contractor:S!:i(ler.se Lawfor the following reason (Sec. 7031.5 Business and
professions Code: any, city or county which requires a permit to construct, 3tt~!if.:.np'rbve, demolish or repair'any structure, piiOr to its iSsuance. also
requiies the appHcant fo~ such permit to file a signed statement that he is t-'cs'n$j~d;p':.Jrsliant to th~ provisions of the Contractor's License Law (Ch~pb9r
9)(~o.mmencing .with Section 7000 of Division 3 of the Businp,ss a nd Profe.ssicr.:; 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 sub;e~ts.tl1e a pplicanJ to a dvil pen"!lty-of riot more tha-n five hUndred dollars
($500)_ . '.c'" _ ---- , .
D. \, as owner of property, or my employees with wages as their ~fe coml:>eI':5EtiOl1. wi:! do the work, and the structure is not intended or offered fer
sale (Sac. 7044 Business andProfe>..ssions Code: The Contractor's License l:."1\\':pces not apply~o an owner of property who builds or tn1prcves
t11ereon, ,End who does such work himself or _here.elf or through his or her ov/" ("iiJployees,.p'rovided that such improvements are not int~nded or, .. _ '
offered for sale, ,If, however, the building or improvement is s"Old with .one yearbf completion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale). .' '_, , ' .
o I, as the owner of the property: .am exdusively contractil.iq with iic~nsed ~; ';",.tr2:':-,(O;-S tc construct the project (Sec. 7044 Business and Professions
Code: The ContraCtor's License law does not appfy to an owr.e~ of propertv....,.j,q builds or improves thereon, and who contrac~s for such proje-.::ts witt!
FlJ1ontractor{s) licens.ed pursuant to the Contractor's U~nse_l3W). '
U r am exempt under Sec. . ,.8 & P.C. for_this reason: "
Date: Owner: ,.,' f.
I WORKER'S COMPENSATION DECLARATiON ~y= 1
I hereby affirm under' penalty of perjury olie of the foliowing deciarations: I
o I have and witlmaintain a certificate. of roil sent to self-iilsure for worker';;'~Oi1i~"'msatiCI1:
as provided for by Section .3700.-of the Labor Coc.:e, for the performance.cjLh(,~,ioJKfor which
this permit is issued, " .-t",'
~ave @ndwillmaintainworker's compehsatioi'l insurance, as required ty Hection 3700 of
the? labor Code, forthe performanc~ oHhe work for which this permit i-, i$ue:l Myworker's
Compensation inSLTance carrier' and polley <:tre: " '
Carrier: Polley Number: .
BUILDING PERMIT NO, BLD2005-00668
TYPE OF PERMIT
Blockwall/ Columns. C I TV
DATE: 3/10/2005
. JOB ADDRESS: 420 S SLEEPY MEADOW LN
LEGAL DESCRIPTION: N TR 8418 LOT 42
BUILDING DIVISION
200 S_ ANAHEIM BLVD.
(714)765-5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CPDE: 565
QUARTER SECTION: 169
s.2
CONTRACTOR "INFORMATION:
ARCHITECT/ENGINEER-INFORMATION;
PROCESSED BY: JNJ
]
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penaity of perjUry' thvt 18!!l
licensed under plQvisionsof cha.pter 9 (commencing
wfth Section 7000) of ivsion3ofthe Sus:ness 3nd
Professions' ...
3/10/2005
D
NUMBER
This section need not be completed if the pennit is for or.e ,hundred dOllcfrs ($1 OIJ} or I~S;:
[J i certify-that in the'perforrrlance of the work for which this permit is ir..s.uett I ~~Jpot
employ any person in any manner so as to become subject to the worken's ~M~:1~,at!on taws
of California, and agree tha_t if Ishould qeco":le subject to the.worker's ,com~;isat~ci!).;',
provisions of Section 3700 of the labor l;(od shall forthwith comply with tro('~e pr9yjsions.
TYPE
Construcion Tvpes:
VN, ,
Date: 3/10/2005 Applica
WARNING: FAILURE TO SE REWORKER'S COMPENSATION COVER'."E IS
UNLAWF.UL, AND SHALL SU JECT AN EMPLOYER TO CRIMINAL PENALT;ES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITiON-T(l THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370~'OF THE .
LABOR CODE, INTEREST AND ATTORNEY;S FEES_' .' - ~
j . '. : CONSTRUCTION LENDING AGENCY. , - __
I h9reby affirm 'under penattyof perjury that there is a construction .lendingbge~GY fer the '.
performance of the work for wt-aich\t'"!is permit is .issuec! (Sec..3097.,Civ._Qt:.~.,__ __ ___!_____
:...:::~~..:f;;"!;.fi..::ii";:it;.j;'"i: ... '.. ~-"",.,..".",.,.-.. .-'
I certify that I have read this application and state that tlie above information:::; correct~ I
agree to' oomply with 'all city ordinances and state laws relating to building construction, and
hereby authorize representives of this city to enter upon'the above mentioned oropertyfor.
i(sped~-on rr:eses, . /J. .. .
Z _L ,J A'\ ~O J Qate: 3/10/2005
" Signat1iYe of Applicant or Agent
The permit shall expire by Iimitation- and become null and void if the building or
work has not p;lSsed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
;1j P---
Contractor
EXPIRATION DATE
Fee~ paid for Permit:.
Total:
249.94
.' . INSPECTION RECORD . . FINAL INSPECTIONS Dille Inspector
. . INSPECTION . DATE INSPECTOR .Electrical F.inal " . .
. .
Temporary Power POle . , Ptllmbi~g Final
Plllmbing (DrainlWaste Pipe) . . . . . Mechanical Final . .
Electrical Ground ElectrodQlUfer
Gas Test . .
SetbacklFormsrrrenches (Footings' .
Do. not install sllbflqor or pour floor slab untH the Engineedng/Grading Final 165-S126 . .
following applicable items hcwe-been signed:. . .
.
Plumbing (Water Pipe.Sprinkler Valves) . Fire Oep!. Final 1654040
Mechanical (Groundwork) . . Water E.ngineering 165-5268 .. .' , '. .
Electrical (Underground Conduit)
Sub List/BUsiness Licerise:765-519'
Pre-slab (CompactionlMembrane.Rei.nf.
Underpinning (Floor Joist/Girders) .' . Zoning 765-5139 .
Do not cover or conceal the wor1< below lint" the .' . Bllilding Final !tast Inspection. Only . .11A/( r--1~
following _apP'li.cqpl~ items have been signed: '. . .. . . . fter Above Completel
1 st Floor Shear . ., PARTIAL INSPECTIONS ih L .'~
FireSprinkler (Rough) . . , '" .
2nd Floor Shear . 'Buildinq Inspections
Roof(Sheatl1ing/Oiaph~ ~ . . . :.
Masonry (ReinfJBond Be ) , ~:\ ' IeUJ /I . .
RoughPlllInbing(Top Out) " . .I .
Rough Mechaoical . . ./ . . .'
IRo~he~tt~a(OryWall) .
. . .' ,
Rough Eleciricill , . . , .
Framing (Only after Plbg', Elec.. Mech and Firel .' . .
Insulation (Sound'Energy) . .' . .
Do not tape or plaster until the following applicable Mechanicalll1spections
items have been signed:. " . . '-. , .
DryWall ' . .
Penetrations (Fire Rated) EI~trical .
Penetrations (Fire Rated) Mechanical . ,
Penetrations (Fire Rated) Plumbil1ll . '.
Interior Lath . . .
Exterior Lath. .. '.' ..... Plumbina InsDections
GENERAL ITEMS'. . .. . . .,: .
Exterior Plaster (Brown Coat) . . ,
T -Bar Elec:trical .
T -Bar Mechanical ,. . . , . . ,
. .
T -Bar Structural .
Sewer
Water Engineering Backflow . ElectricallnsDllctions
Water Service .. . . " ..
. .