3210 W. Stonybrook Dr.
TYPE OF PERMIT CITY'
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BUILDING DIVISION
200 S, ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 165 - 4626
CENSUS CODE: 434
QUARTER SECTION: 6
BUILDING PERMIT NO. BLD2004-04001
DATE: 111212004
JOB ADDRESS: 3210 W STONYBROOK DR
LEGAL DESCRIPTION: N TR 1646 LOT 2
, ~
I
CONTRACTOR INFORMATION:
ERIC, PENNINGTON .:,'
7610 GARDEN GROVE BL "'j
WESMINSTER, CA 92&,31')000
BUSINESS PHONE: 714 72J 146?
JOB DESCRIPTION: Tear off existing & reroof 21 sq with 30 yr composition 5h~gres.
,j
. VALUATION: 3,150.00 ;"
I OWNER.BUILDER,DECLARATlON
"I hereby affirm und€!r.penatty of perjury that I am exempt from the Contracto};; Lice11Se Law for the following reason (Sec. 7031.5 Business ard
Professions.Cod,a: a'ny city or co~ntywhich requires a permit to Gonstruct, al~(',r; improve; demolish or repair any structure, prIOr to Its .is.c;uance, als'o
requires the applicant for such permit to file a signed statement that he is Iic:4nsed purt>uaf"!t to the provisions of the Contractor's License.LaW (Chapter
. 9}(commencing with ,Section 7000-of Division 3 of the Business:3 rid,Profes5}:>,$. Code) or that he is exempt th~refrolT! and the basis for the aileged
exemption. Any-violation of Section'7031.5 by any ~pplicant for a perrr~it su~{e(:ts. iRe applicant to a evil Pe~altyof Ilot more than five hi;mdre"d dollars' .
($500).,' .). .. .'
O. I, as owner of property', or IJ1Y employees with wages as their sole com;q:br'tEtion,v.-,jll do the work, af"!d tr.e strucbre_ls. notfntendcd or IJff.;red for
salE: (Sec. 7044 Business .and Professions Code: The Contractor's liGenSe,l~;:)w does noL3pply to 211 owner of property who b~jlds or Improves.
thereon: and who does sucra work himself or helSelf or through his ,or herow:~ employel';S, !J(oviaed ihat such implOVerMnts ere not lntp.-nded or
offere~ for S<l!e.,lf, however, the building or improvement is sold with one Yr.;.~: '.)f completion,_ the owner":ouilder wi!l.have trli3, bL.rden of prOvlil9_thathe
.-didnotbu~dor-improveforth~purposeofsa'e)" ,. ,) .."....
0, lias the owh~r of t'1e property, am exClusively contracting with Iicensecl:'t.ontractors io COl1strl1ct the project (See. 7044, Business and Profess-ions
Code: Trie Contractor's license law does.not apply to an owner of .propertY~lho builds or improves ,thereon, and 'w:ho contracts for such projects with
.~ontra<:tor(s)licensed pursuanttoth,~C6nfractor's,uce~se Law). L ' .- " - ,.
U I am exemptunder,S~(;... ,8 & P.C.-forthls reason: --1
Date: Owner: L
j . WORKER'S COMPENSATION DECLARATION L
I hereby"affirm under penalty of perjury one 'of the following declarations: '\
o I have ar.d will maintai':l a certificate of consent to self-insure for workel:?,calTlpe:1saV,on, f
as_provided f.or by Section 3700 of the Labor Code, for the performance of thE. WorK for wnich I
this permit is: issued.. . _ _ ".1 _ , . I
'Q" I have arKiwill maintain. worker's compensa. tion insurance, a's required ~{Secflon 3709 o-f
e:..lab.or Code, for: the performance 'of the work for which thjs permit is issu.:!c. MY\"Jorker's I
Compensation insurance carrier and policy are: \
Carrier: EXEMPT . - Policy Number. NO EMPrOYEES
,
ihi section need not be completed lIthe pemut is lor one hundred dollars ($10o! '" I..s.
I certify that in the performance of the work for whICh this permit is ISSlle'J. 1 shall not
mploy any person in any manner so as to become subject to the worke;'s cc;r.Peosation laws
of Califomia, and agree that if I should become subject to e worker' co p...f ation I
provisions of Section 3700 of the Labor C-o ,I shall rth th c mpl th t ~~e OVlsio"'s, CoflstrUCIOtI TVDes,.
VN, ,
Date: 11/212004 Applicant:
WARNING: FAILURE TO SECU E W R'S COMPENSATION COVERAGE IS.
. UNLAWFUL, AND SHALL SUBJECT PLOYER.+O CRIM INAL PENAi'TIES AND CIVIL
FINES UP TO ONE HUNDRED THOU .' 0 DOLLARS.{$100,OOO), IN' ADD,: nON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI()~! 3!06 OF THE
LABOR CODE, INTEREST' AND ATTORNEY'S FEES. ' .
I CONSTRUCTION LENDING AGENCY
I hereby affirm onde'r penatty of perjury that there isa .c,onstrL1ctron lendir:g ag~n<::y fer t!"a~
'r:erfnrm~nI'F! of .[hi=>. '~v0rk:f<j-r.-'Nh1-:h th!s-per~:N:.t !e.;':>;;''''';:~1dH;;,0S;3eS-Z~.;:...''R~---;'-'; ~
'.;'-Lende(s~llifOfmation:" - .. " '
APPLICANT: ERIC PENNINGTON
OWNER INFORMATION:
MATTHEW J EDINGER
3210 W Stonybrook Dr
Anaheim, CA 92804
ARCHITECTIENGINEER INFORMATION:
PROCESSED BY: MJF
-,
I~UMBER
784685
TYPE
EXPIRATiON DATE
. 913012006 .
B
state that the above informatiOn is correct I '
state laws relating to building construction, and
to enter upon t~e above mentioned property for
Date: 1'1/212004
fees paid for ~ermit:
Total: '
235.33
Signature of Applican, or Agent ,
shall expire by limitation and become null and void if the building or
work not passed final inspection 365 days from the date of permit issuance. A
new p mit is required to commence or continue work.
. .
INSPI!CTION DATE INSPECTOR Electrical Final . .
. . .
Temporary Power Pole . . Plumbing Final
Plumbing (Orain/Waste Pipe) . I .'
. Mechanical Final
Electrical Ground Electl'!idellJfer .
SetbacklFormsfTrenches (FootilJ9S1 Gas Test
Do not .install.subfloor or pour floor slab until the Engineering/Grading Final 765'5126 .
following applicable items have. been signed:
Plumbing (Water Pipe.Sprinkler Valves) Fire Dept. Final 765-4040 '.' .
MechaniCal (Groundwork) . Water Engineering 765.5268 .. :
Electrical (Underground Conduit) . Sub List/Busine.... License 765.519
Pre-slab (compaction/Membrane.Rei nt. .
Unclerpli'lOing (Roor Joist/Girders) . . . . Zoning 765.5139 .
Do not cover or conceal the work below until the Building Final .Il-ast Inspection. Only ~k . -,/2,.
following applicable items have been signed: . . fter Above Complete) -/C,,, k..~
1st Floor Shear .. . . . PARTIAL INSPECTIONS
Firesprinlder (Rough) . .' . .
2nd Floor Shear BuildinQ Inspections
Roof (Sheathina/DiaPhragrnfFrame) . ..
Masonry. (ReinfJBond BeamlPre-Grout) . ~ry/ . S-,.,"'- -t',,/';/ . . .~ ~;6.li.-, .
.." 8A
Rough Plumbing (TopOut) ....../. '/ r;;r. . .
~ough Mechanical. . ~.
Rough t:Iectrical (Dry wall) . ,
.
RouahElectrical .
Framing . (Only aft~r PJbQ:. Elec.. Mech. and Fire) .'
Insulation (SaundlEnergy) . .
Do'not tape or plaster until'the following applicable' . Mechanical Inspections .
items have. been signed: .' . . . /. . . .
Drywall .
Penetrations (Fire Rated) Electrical.
Penetrations (Fire Rated) ~chanical .
Penetrations (Fire Rated) Plumbing . . ..... . '.
: .
Interior Lath . .
Exterior Lath' . P.lumbina Inspections
. .. GENERAL ITEMS '. .
Exterior Plaster (Brown Coat) .
T .Bar Electrical . . : '., .
. .
T.Bar Mech'anical .
T -Bar Structural .
Sewer .
Water Engineering Backflow . ElectricallnsDections
Water Service . .
INSPECTION RECORD
FINAL INSPECTIONS
'Date
Inspector