3172 Stonybrook
TYPE OF PE~MIT CIT.Y
Palio Cover
BUILDING DIVISiON .
200 S. ANAHEIM BLVD.
.(714) 765 - 5153
INSPECTION REQUEST liNE:
(714) 765 - 4626
CENSUS com;:: 434
QUARTER SECTION: 10.
. BUILDING PERMIT NO. BlD2004-04191
DATE: 11/18/2004
JOB ADDRESS: 3172 WSTONYBROOK DR
LEGAL DESCRIPTION: N TR 7241 LOT 71
[
CONTRACTOR INFORMP!rION:'
r
I
I
I OWNER.BUILDERPECLARATION
I he~ebyaffirmunder'Penattyof perjury that I am ~exempt from the Contractor'Pe,License law for the following reason (Sec.7031.5 Business, and '
Professions Code: aQY city or county which requi,res a permit to construct, alttt; improve, demolish or repair any ::;n:ucture~ prior toils issuance, .also' .
requires the applicant fr?r such permit to file a signed statement that he is Ijc~~q pursuant to the provisions of the Contractor's license Law (c. hapter
9)(commencing with Section 7000 of Division 3 of the Business and Professil)tfsCod'e) or that he is exempt therefrom and the basis foJ' the alleged ,
exemption. Any violation of Section 7031.5 by any applicant for a permit sub~kcts the applicant to a civij penalty of not more than five hundred dollars
($500). .'. . . 1.. '. . '.
~. !~ ,as owner of\P~ope~, or n:'t e~oyees with wages ~s their :So~e ccm~?(~sation, wil! do ~he work, and the structure is not ~ntend~ or offered for
$a,,~, \Sec:'7044 Busmess and ProfessIons Code': The Contractor's LIcense Lb\'V9oe-s not applY to an owner of property who bUIldS or Improves
thereon, and who does sum work himself or hemelf or through his or her ow~'"employees, provided that such if"r'-PrtlVernentsare not intended or
;. offered for sale. . If, however, the building or improvement is sQld with oneYo?l' t, of completion, the owner,.bullder will,have t.h~ burden of proving that he
did not build or improve for the purpose of sale)... ,: .,' .
o !, as the ,owner of the property, am exduswely contracting with licensed Jxmtrnctoi$ to constructthe project (Sec.:7044 Busine"5s and Professions
Code: :The Contractor's license Law does not ap~ly to an owner of propeny t{no builds or improves thereon, and ",ho contracts for such projects with
tjontractor(s) licensed pursuant tathe ontrac. tor's License law), J . '.
m ex . /TIpt und r-Sec. _ ,i! & ~.C. for this re,!sonj. ___1__
:n 0 ~~ ~ ~. I
WORKER'S ENSATION DECLAAATIO~_~._ '.=:1
I hereby affinl) under penalty of pe jury ('lne of the following declarations:! ' '
o I have an~j,wi!lmaintain a certificate of oonsentto setf-insureforworker'i-::;~rr;pf!rlsatjon.
as provided for by Sedion 3700 of the labor Code, for the performance of th.:. wO"" for whim
this permit is issued; _ .. . - ~. .
O. I have and will maintainwQrker's compensation insur~nce, as req\,lirec b~ !,=,"ciion 370_0 of I 111"18/2004
the. Labor Code, for the performance of the, work for which this permit is is.su~j. MY"'.forker's Date:
Corr.~)'ensa1ion insurance carrier and polic~(are: . '
Carrier: Policy Number.
APPLICANT: DAVID PARK
OWNER INFORMATION:
David C Park .
3172 W Stonybrook Dr
Anaheim, CA 92804
JOB DESCRIPTION: Install new 264 square feet patio cover
VALUATION: 3,000.00
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
~ENSED CONTRACTORS DECLARA'f.ION
I hereby affirm under penalty-of perjury that I am
licensed under p roVi$iOns of chapter S (commencing
with Section 7(00) of Divsron 3 of the Business and
Professions Code. '
C~ntractor
NUMBER
EXPIRATION DATE
This section need not be completed if the permit is for one hundred dollars ($1 00:: crlest"
~I certify that in' the performance of the' ark fOr which this permit is .lssue'~, -I shall not. '
employ any person in any nnerso as ,become subject to the worker's cC'flpensation laws
of Califom-ia, arid agree that i should come .subjectto the waTker's corn~msation
pr:ovisionsof Section 3700 ofth Lab de, I shall forthwith comply with Hlds.e provisions,.
. .~
TYPE
Date: 11/18/2004 Applicant:
WARNING: FAILURE TO SECU E W '8 COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUB CT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP to ONE HUNDRE THOUSAND DOLLARS ($100,000), IN ADDlnON TO THE
COST OF COMPENSATION DAMAGES A.S PROVIDED FOR IN SECTioN $706 OF THE
LABOR COD E, INTERES'r AND ATTORNEY'S FEES, .
I CONSTRUCTION LENDING AGENCY
I h,sreby.affirm under penalty of perjury that tf:lere is a construction lendlng af;..;r1cyfor.tha
pc;fotmancecflhe,workforwhich thisoerrrnt is issued lS~c.3097.Cjv.C): 1-.'_..'-...
Lender's Information: -
Construcion Types:
VN, ,
Fire Sprinklered? .
NO
J certify that' have read this application and state that the above information is correct. I
agree to comRly with all citY ordjnan,ces and state .laws relating to bunding cor:~truction, and
. hereb auth representives of this city to enter upqn theabove mentioned property'for
sp ion p $as.. ' . .//. .
~ ~VC-- Date: 11/1812004
Signature of Applicant or Agent
t p 't shall expire by limitation and become null and void if the' building or
ork has not passed final inspection 365 days from the date of permit issuance. A
w permit is required to commence or continue work.
Fees paid for Permit:
TOlal:
456.62 .
INSPECTION RECORD
,
,
INSPECTION DATE INSPECTOR
Temporary Power Pole, ' ,
Plumbing (DrainlWaste Pipe) , '
Electrical Ground Electrode/uter ,
Setback/FormsfTrenches (Footings)
00 not install subfloor or pour ftoor slab until the
following applicable items have been signed: "
Plumblnil (Water Pipe.Sprinkler Valves) I ,
Mecha,lliCal (Groundwork)
Electrical, (Underground Condu it)
t"re-slab (CompactionlMembrilne.Reinf. ,
Underpinning IAoor Joist/Girders) ,
00 not cover or conceal the work. below until the
following applicable items have been signed:
1 st Floor Shear , , ,
Firesprinkler (Rough)' ,
2nd Flocir Shear
Roof (She'athingfDiaphragmlFrame)
Masonry (ReiilfJBond BeamlPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
, , KOugn t:lectrlCatlury wall}
Rough Electrical
Framing (Only after Plbg:, Eiec.. Mech.. and Fire)
Insulation (SoundlEnergy) , ,
po not tape or pla~ter. until the following applicable
Items have been SIgned: '", .
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated} Mechanical
,Penetrations (Fire Rated) Plumbing , ,
Interior Lath ' " "
Exterior Lath ,
'. GENERAL ITEMS '
E$rior Plaster (Brown Coat) , ,
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 Oept. Final 765-4040 ' ,
Water Engineering 765-5268
Sub List/Business License 765.519 " " .
.zoning 765-5139 ,
Building Final ~ast Inspection. Only ttl, \o{ 1'<1.'--\11\
, ' fter Above CQrnplete) ',~ ,
PARTIAL INSPECTIONS
Buildina fnSDections , '
Mechanical InsDections
PlumbinQ InsDections
EI~al)J:1;,ctio,1; , "
.,' i '. Wi.~
4./~