561 S. Paseo De Luna
'>"'"{:1:"
BUILDINC PERMIJ NO.
BLD2004-02229
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. CITY tjf1J'~~~i\.aEIM
~ "h~i! 7J · .
. \~c'~~ii..;;~9 .' .
. .BUILDING DIVISION.
200 S. ANAHEiM BLVD.
(714) 765- 5153
INSPECtiON REQUEST LINE;
(714)765. 4626
CENSUS CODE; . 434
QUARTE'OR SECTION; 198
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TYPE.OF PERMIT
Residential Addition
DA TE:6115/2004 .', .
JO~ ADDRESS; 561 S PASEO DE LUNA
LEGp.L DESCRIPTION;' N TR 8455 LOT 34 .
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APPLICANT; CRAIG BEINI.ICK
OWNER INFORMATION: CONTRACTOR INFORMJrION; '. ARCHITECT/ENGINEER INFORMATION;
Ellis E Moo", C R BEINLlCH &'SONSC.ONSTRUCllQN co
561 S Paseo De Luna 5525 E 7THST . 't
Anal:1eim. CA 92807 _ LONG BEACH. CA 90804ltQOo. . .
JOB DESCRIPTIONRoof!l,Addition. Family room extension and spiral staircasf at 1st floor. Exercise room.at 2nd floor. (HIH)
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VALUATION:' 67,000.00 :' PROCESSED BY: CAt
OWNER-BUILDERiDECLARATION
,I hereby _affirm under penalty 0. perjUry t at I am exempt from the Contractor:',t License Law for the following' reasoh (Sec.7031.5 Business and
Professions Code: any city or'cotmtywhich requll"f?s a permit to construct, ait~r. ,improve, demolish or repair anystruciure, prior to its issuance, alsO-
requires the applicantfor sum permit to file a signed' statement tliathsdslic~hsed pursuant'to the provisions of theoContra<:tQr's License Law (Chapter'
9)(<;ommeflcing'with,Section 7000 of Division 3 of the Business and Profess~ns Code) or that heis exempt therefrom andthe'basis for .th,e.alleged "
'exemption. Pony violation of Section 7031.5 by any applicant for a permitslllJfeds thG applicant to;) civa penaltyof not more than fiye nundred dollars .
. ijO~)~s 9wnerof property,or my., employees. with wages as their SO.'le oom~nsatio.n, will do Ihe work, and'the structure is nOt.inten.d~ or offered for
,sale (Sec;,7044 Business and Professions Code: TheContractor's lic~n.se-4'-:lw doe~ r.ot'applyto an owneraf.property ~ho buj!d~ or improves'-' ':
thereon. and who does sum work himself or herself or through his or her 0.....';:.. employees. provided that such impl'O\.'ement~'a.renot'intende(:i .or ., .
off.ered for sale. If, hO.Never, the building or improvement is sold with one y4~r cf completion, the owner-builder will have the burden of proving tr.at he
did-not build or improve.for the, pu lpose of sale). .. ' Jj _' " ....' .,' '.' '. . '
,0 I, as the 9'Nner of the property, amex.ch.i~ivelycontractjng :with Ilcens~d;:qofitr3Jors :0 COI"!str...II-..t the project (See: 7044 Busirle~s alid Profe~ions
Code: The Contractor's License Law does not apply toanowner of propet1~\~vho bulldf::> or improves thereon, and who oontra'c~ts fot'suCh projectsw~h
'~ontractor(s) licens~ pursuan,t to the ?ontractor's.Uoonse Law). : f . ,
U I am.exemlJtunder Sec. . 8&P,C. for this reason: _II
Date: ' Owner: :H_._-,-_
I. WORKER'S COMPENSATION DECLARATION <; . '1
I.hereby affirm under penalty of perjury one of the following declarations: ','
'0 I have and will maint~in a certificate of consent to self-inSure for worker"i compensation,
as provide:~ for by Section 3700 of the Labor CodE;!, f0r the performance ofu{,b wock for which
this R it is iss,ued. . _' ','
I have and \ol(ifl maintain V)/. Oli<. er's.compensation Imwrance. as required bI~. Secticn:3iOO 0(1
e abor Code, for the peiformance of. the work for which this permit isi~.su.',d, My woyker'$
pensation insurance Garner and policy. ?Ire:. ' . . :'.
Carrier: STATE FUN~ , . , _. POlicyN.~mber: 076355~!:02 .
This section need not be completedifthepennit is for one hundred dollars ($1Pf'fotless.
D r c"ei-tity th~~ in the perfolTl1ance of the WO~k for wh!chfhis permit is ~sslis~j:'Sh~ll not '
employ any person in-any manner: so as to become subject to theworker's':;)i;tJ7pen$lation laws -
of Cal ifo mia, and agree that if l'should b~co:me sUbje,ctto the worker's comfj<JnscWon '
provisiqns,of Section 3700 6fthe Labor Code, I shall orthwith comply,wlth:W~e prpvisiomL ,
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LICENSED CONTRACTORS DECLARATION J
I hereQY affirmunder:penal~y of perjury that! am
licensed under provisions.of chapter:9(cominencing
with Section 70.00) of Ofvsion 30f the Business a'nd
Pl'Ofes. $ions~. e. '. /L . . .' .
6/15/2(104 .. . .. ~ '.' '-"-
Date~ -.'. . ..,. Contractor
NUMBER'
EXP.IRATION DATE
3/31/2060
590761
TYPE
TYPE
B
HIC
Date: 6/1 5/2004 Applfc,i :
WARNING: FAILURE TO SEC ",WOR' R'S COMPENSATION COVEF:\GE' IS' . .
. UNLAWFUL, AND SHALL SUBJECT AN MPLOYER TQCRIMINALPEW<..(!ES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), INADDiTtOJ'i, r.OTHE
COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECT!O~ ~.Tcf~OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. . "'"":;',,
I CONSTRUCTION LENDING AGENCY "-.' ,
I hereby affirm 'under penalty of perjurY-that. the~e is'a construction lendin9;~~:,:'.~fic.y',;for the
~r1;':;'i.--:-:ai'i'::'Z-d:!:\J'~'..c.r:'''-:'::i' 'i..bi~j:h;s-p.:;;;'~...;~';,~: i-.;>i;u""c;\O~~C~7;:::,;Y--:c-j."'+4;J-" '~-- - '" ~
Lender's Information:. ,
Oonstrucion Tvpes:
VN, ,
fire Sprlnk"~red?
DwellinQ Units:
Livin!2J Area:
NO.
1
608.
I certify that "have read this-application and state that the above information iscorrect. I
agree to ,cOmply with aU city 'ordinances and state laws relating to buijding construction, and
hereby authorize repreS:entives of this' dty to enter uport the above mentioned property ~or
insp ion pur $8S.
Date: 6/15/2004
Fees paid for Permit:
Total:
6,70
Signature of Applicant-or Agent
The perrmt shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from th9 date or. penr.t issuance. A
new permit is required to !lOII1mence or eontinue work.
. : :'.' ..... . INSPECTION RECORD . . . fiNAL INSPECTIONS. Date .insp&ctor ;,-.
, '. . INSPECTION. .... . DATE INSPECTOR' ,: J:. Ill.C.triClll F. inal~.. ..' f-;t/~st':/,^"
. TemporaryPowerPole .' ..... '.. PIUmbingFinal~J( ii' "J'.:h' ~..."
:' Plumbing (DrainiWa$te Pipe) . ..' I..... . . /, -I, 'N.L RIP .A.'
ElecttiC'a1<>reund ElectrodefUfer .' .... .. .... . '.' M.llchanical Final . t I 1,
. Setbll(;k1FormslTrenChes (Footings)' fi,:-Zi4~ tlli.. -..;-. .' GasTest (!);<r~VW .' n\vJcIlf ""--4-\'.
.. ClO hot install sub floor or pour floor sl;ro IInlil. the . -/. . . Engineering/Grading 1';081'765-6126 . .' : . . . .
: fOllowing applicable items have ~en signed' . . F.', .
: plumbing (Water Pipe,Sprinklef Valves)' : . . . . Fire Dept. FinaI765-40411<.' '. . .. ' .
Mechanical (GrOundwork) ". Water Eiigineerin~ 765-521/8 . '. :.'. . '.'
. EleWical (Underground Conduit) '. '. '. .'
.' Ple-slao (1;.( ompact.iOnlMembrane.Rei ,?..q~~ .--. Sub LisUB"sinllssLicense 765'519 ....,.. :.'. ..' ....
.. Underpinning (Floor JoistlGirders) '. . 1"/ ..' Zoning 765.5139 '.
.~ n~t cover,or conceal t.he ",ork below until the . . . .
. following applicable Il~ms ha~e.been signed:,.. '. .... /'. BulldingFinal lLasuns".ection.OnIY ..\.hhIL~' "0' 0
. .' .' 1\fterAboY.eComplele) .~ I..t:IlAi.f
. 1st Floor Shear "':' , C'. d', /u-- . '. '. '. PARTIAL INSPECTIONS · ;/,L
Filesprinfd8f (Rough) '. .' . .' . B "Id' I" 1'1.... ~ _.
2n.dFloorShiuir '.' 7.... ......f:.:zL..' UI mQ ns;ectlon~ '
ROof{Sheathing/DiaphragIl'V'Frll!TlllI5 c. '~/,' Apr! tf.4J..~ if "';)~~-tf~
. Masqmy(RIiinfJBond BeamJPre-Grout), .... . .....
~oughPlumbing (Top Out) . .... . . .. '. .
Rough Mechanical '. . . . . . " '.
l<Ougn l:leetric . __II) . .' . . .~. . .. . : .... ". . . ..' .
~ough Electrical '. '.' ." .' '.
. Framing (Only aner Plbg.. EIee., Mec" . and Fire) =r4...1'ftA: .
In$lilatiOn (SoundlEneravl . .., : d
. PO not lape or'.pla~;ter until the followiAg applicable
Item.s have been sIgned:.. . ':'. I
. DrYwall . ?.;.IZ~:"I
PelIetrlllions (Fire Rated) Electrical .' . .'. .
Penetratiol1S IFlre Ratlld) Mechanical . . .
Penetrations (Fire Rated) Plumbing '. . . .
. Interior. Lath .' ...... '. ". . '. ..~.
Exterior Lath .. '. . : . 11\, .
. GENERAllT!,MS . ../
Exterior Plaster (Brown Coat) . ~ oIr111/1
r.sarElectrical .:..... '. '. .'
r.sar .Mechanical
· T.ear Structural
Sewer ... . .
Water Engineering Backflow
Water Service' .
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Plumbinq Inspections
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. . Electrical Inspections
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