409 Meadowbrook Pl.
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81J1-1..D':.JG PER~iT NO:'
BlD2004-0\l734
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CITY o:~Ft~r\t~HEIM
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BUILDING DIVISION
200 S. ANAHEIM ElL VO.
.(714) 765 - 5153
.iNSPECT:ON REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 53
TYPE.O!= PERMIT
Residential Hemodel
DATE: 3/17/2004
,
JOB ADDRESS; 409 N MEAD0~VSROOK PL
LEGAL DESCRIPTION; N TR 2049 LOT28
ApPLICANT; PHIL TEAGUE
OWNER INFORMATION:
Phillip E Teague
409 N Meadowbrook PI
Anaheim, CA 92801
JOB DESCRIPTION;lnstaIl12.ftwlde bay window at living room. (Hi H)
VALUATION: 4,500.00 PROCESSED BY: ODe
I > . . OWNER-BUIL,OEF;UECL..RATION . ...
I heret;>y affir:m under penalty:of perjury that I am ,exempt.from the Contra;:rc-;:5.:-lir::e,l1s~ Law f()r t~~:followjng r~ason (Sec. 7031.5 Business and ,
P.rofessions Code:anydty or counlywhichrC3:quJres a- permit to construct,. ::i'~r~.~: lrrprove, dern6lish6rxepairany structure,. prior to. its issuance, also
;e:quires the appliO'.l/"!t for such ~;ermit to f~!f) G: S!Wlt::{.~ $~at~ment that He 1~ nc..'::'I~(fpi;rSlJaflttot~e,provisiOli~ of the. C0n.~ractor's License Law (ChaptFir
9){commencing with,S:ectlo~ 7000 of Divi~ior. .3 c.f h~e Bllslness and prot"ess<:rl's};'cde) or thal~~j~ exemptthe'refrom and the,basis for the alleged
exemptior'l, Ar"!Y violation of Section 7021.5 by .anyap::-iir;~nt for a permit su:.\czoets the aPl?I.icant..to'a,dvil penalty of not mere than five hundred dollars
($500). . .. , .' : . . .... . ..
o 'I~ as owner of property, ormy.employees with w~~~s,a~ I.heir sofe CCJTlr.F:saUon, wiU do ~he ,;~osls,,~and th~st;'(IC.ture'is'l1Qt intendedoroffererl'for
safe {Sec..7044Business and Professions Code: The Contractor's Ucer.se ~:,-:!w does'notapplyto;3~ ownei,'ofprop8rtywho .b~ljld.so-r Hnprovl3s .
thereon. and who does such workhimseJ~Or herself or tt:l/90:~ih'his or her C,^l: nrnployees:. proyid,ed that,s'uch irllp,?vementsarenqt inte!lded or
offered for sale, If;,howe'ver, theb.uijding or irnprovelll~n(iS':ipld. with Of'e y~> of completion;,:uie':"owner-bu-nder wilLhave the burden pf prol;:ng. that he
'fiic:.no~dorimprove'forthepJi"poseofsa'e)". ". ,1" .. , . .'" ", '.
~~sfheowner 9f th'7 p~operty, am exclusively contracting with iiCe(IGe~ >..mtr~ctors t-;:. cpnstruct th&prc;e:ct.<Sec ,70.44 B.L:_Sine~$ and Professions
Code: The COf,tractor'sU:ense Law does not apply to 'an owner c.f ~rope-!~'>!!:,0 bl)iJds,or improves thereon. and who contracts fOI such projects witt,:.
~ontractor(~) licensed pt:rsuant to the c(}ntr~8ct ~ 's ' icense ~~W),. : i " I ~ .
U Jam .m t under Sec. S . "~f'?-~" . re n. I
/!!late: e:i Owner. {j'L, -,:2::-- ,,--"
, . WORKER'S COMPE SATlO DECLARATI~__~,~~~~_==::J LICENSEO CONTRACTORS DECLARATION I
I her~l:;y affirm under penalty of perjury one of the following declaration~:.. . . I here~y affirm unrierpem'lfty of..'perjury th~Jt : :J:ni ~
o I hava', and will ftlaintain a certificate of oonrent to Se>1f-insure for w~r~e,-'} '::,'~c;m.(;r$iltiQn. licensed. u6r.fer plOvislons dfchaiJter 9 (ccilime:-'!cing
as p,rovided-for by~ectlon 370..0 of th~ Labor Code, for the perform:;!r,;::e rl~ t:l~.W{)lk 'fer which with Section70o.C) of D!VsiOn 30f the Business .:mo'
this permit is issued.. t 'Professions C,xts.
D.. I have arid will maintain worker:'~'{?(Jmpens<ltion insl.lrance, as rt~qui,c,j ~.J $,::ictii)n3700 of 3/17/2004 ______---'-~
thE' LatJC( Cvde, fcr'~he Performance of the work for which thIS permit is ;5511-1:1. i'l/1y worKer's Date: Gf.nt!':"l::tf}:"
CompensatIOn insura nce 'carrier and policy are: ~
C:"l,rrier: . . Policy Nu rT'ber: ;
"Th!s.sectioh need not becpmpleted if the pennit is for one hundred dollars {$1~d:)r 1355. . TYPE.
n., !certify tha.tin' the performan'ce oT the work for w.blch.thit; perm!t1b'issu;:~,1 ,~A'J~lF'00t '
employ any person in any manner.so a's to becorr.,e subject to,the wur.~~(:;; (;C:;','F.~is~trcin laws
?f _Califomia, and agree thatif.I~~ould b~c9me ~ .d~ to" the wo.rker'r!:~'c~q;y.p':~'1~~tr~~~y;~:-;.
provisions'of Section 3700 of the Labor Cod, all. fq hWlth y,,witl:l,~.;'\I.'f';ei~N1W.ons,
D8t.e: 3t17/2004 Applicant: k:. . .., .;.. > .,'
WARNING: FAILURE TO SECUREW RKER'S .OMPENSATI COVF.~;'.8E.IS,..
UNI.AWFUL, AND. SHALL SUBJECT AN EMPLOYER TO CRIMJNf.CPEc:" ';, IE;3"liNOCIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS {$100.oci6~S~ .ADD'nO!J,~Q;THE .
COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN 3ECT10'l ;!7Q6-CF'rHE
LABOR CODE, INTEREST AND ATTORNEY'S FEES, ..'". .. '~.
I CONSTRUCTION lENDING AGENCY. . .. .,. .'.
"h ereby 'affirm unde r pena lty of perjury that the're is a 'construction I end ing~tg;I~;'..for the
peifc,rmance of the work foi-which,thispE,lrmit is issued (Sec.3097 .Gil/.C)" ..
L~I1.d~r'~ tof0rm,ation:, . ____~..________
CONTRACTOR INFORM/,lION;
,
. ARCHitECT/ENGINEER INFORMATION;
1
~JUMBER
'=XPIRATION DATE
Con~trucion Types:
VN. ,
Fire Sprinklered?
NO
..
I
I
-'..-~_..~ -
{certify that fhave read'thisappHcation.and state that the above informatiOl1 is correct. J
agree ta rompiy with all city ordinances. and state laws relating to building COt!:::truction. and
I)ete'b aut . e r~presentives 0 is city to enter upOn the above.mentioned property far
insp s
.Fees paid for Permit:
Total:
0.50
Date' 3/17/2004
Signature of App' nt o'r Agent
Th~ p~rmits all ~xpire by Ii tation and become null and void ifthe bUllding.or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
INSPECTION RECORD
INSPECTION . .. DA,E INSPECTOR
T empor;ory Power Pole
Plumbi ng (Drain/Waste Pipe) . .
Eledrical .Ground Electrode/uter . .
Setbai:klForrnsirrenches(FOQtil!gs) . . .
DO not.install subfloor:or pour floor slab untilthe
following applicable items have been signed: . -
Plumbing (Water Pipe.Sprinkler ValVes) . .
Mechanical (GrOundwork)
Eledrical (Underground Conduit)
Pre-slab(C!lmp;octionlMembrane.Rei nf.
Underpinning (Floor Joist/Girders)
.Do not. cover or toncealthe wor!< belQW unt.llhe .
following applicable items have been signed:
1 s.t. Floor Shear ..' .
. Firesprinkler(Rough)
2nd Floor Shear . . .
. Roof (Stieathing/DiaohragmlFr;me) .
Masonry (ReinfJBondBe;m/Pre-qro(Jt) . .
Rough Plumbing (Top Out) .
Rough Mechanical .. . . . .
Rough t:Jectrical (Dry Wall) . .
Rough Electrical .' .'. ,/1
Framing.' (Only after Plbg, Elec :Mechand FireR '-J\.-JOdi' .
Insulation (SoundlEriergy). . '. .. (j"-I' .1 ..'
Do ;,ottape or plaster unlilthe fOllowing applicable !
items have bee," sign'ed: . , ' .
Drywall .. . . .
Penetrations (Fire Rated) ElectriCal
Penetrations (FiieRated) Mec;hanical ." .
Penetrations (Fire Rated) Plumbing
Interior Lath .
Exterior Lath . . .
. .. . GENERAL ITEMS 'j
Exterior Plaster (Brown Coat) _I';.o'f I,.-h /'
T -Bar Electrical . .. ..
-T-BarMechanical
T-Bar Structural .. .' .
Sewer .
Water Engineering Backflow . . . ..
Water Service ..' .
.
,.
.. .
FINAL INSpeCTIONS . . . Date. Inspec;tor
Electrical Final 5/'1/c'/ y':J.. /'-
'. .-/
Plumbing Final '.
Mechanical Final . .
Gas Test . . .
..
Engineering/Grading Final 765-5126 ..
Fire Dept. Final 765-4040 . .
Water Engineering 765.5268 . . ,
Sub List/Business License 765-519 . ,.
Z<;Jning 765-5139 . .
.
Building Final ~ast Inspection- Only ~-4.co GA .'""'?f
fler Above Complete)
PARTIAL INSPECTIONS.
Buildina Inspections
Mechanicallnsoections '.
Plumbina Inspections
Electrical Inspections