1421 N. Stonyhaven Ln.
TYPE OF PERMIT CITY
Repair
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 16
BUILDING PERMIT NO. BLD2005-01955
DATE: 6/24/2005
JOB ADDRESS: 1421 N STONYHAVEN LN
LEGAL DESCRIPTION: N TR 7658 LOT 3
CONTRACTOR INFORMATION:
LELAND PACIFIC INC
1130 E 25TH ST
SIGNALL HILL, CA 907550000
BUSINESS PHONE: 714826.9860
JOB DESCRIPTION:Repair fire damage to roof over 1419 - 1423, interior repairs in.unit 1421.
APPLICANT: MIKE VAN MAANEN
OWNER INFORMATION:
Keneth L Willie
1421 N Stoneyhaven Ln
Anaheim, CA 92801
ARCHITECT/ENGINEER INFORMATION:
HANS C HANSEN
17371 IRVINE BL #200
TUSTl N, CA 92780
VALUATION: 80,000.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that \ am exempt from the Contra.ctor's License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, atter, improve, demolish or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's Ucense Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professions 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 subjects the applicant to a civil penalty of not more than five hundred dollars
($500).
o I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one yea~ of completion, the owner-builder will have the burden of proving thathe
did not build or improve for the purpose of sale).
D I, as the owner of the property, am exclusively contracting with licensed c':>ntractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of propertyvlho builds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractor's License Law).
o I am exempt under Sec. ,8 & P.C. for this reason:
Date: Owner:
I
PROCESSED BY: FAN
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to self-insure for worker'scompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
"Fill I have and will maintain worner's compensation insurance, as required by Section 3700 of
ftlet.abor Code, for the periormance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier: STATE FU ND
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 mmencing
with Section 7000) of Divsio of Business and
Professions Code.
6/24/2005
Date:
Policy Number. 1750930-2003
NUMBER
453414
TYPE
EXPIRATION DATE
10/1/2006
This section need not be completed if the pennit Is for one hundred dollars ($1 00) or less.
o I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the worker's compensation laws
of Califomia, and agree that if I should become subject to the ar's compensation
provisions of Section 3700 of the Labor Code, I sh h campi with those provisions.
B
Date: 6/24/2005 Applicant:
WARN ING: FAILURE TO SECURE ORKER'S COMPEN TION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITlON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
~ heieby a:Tiim under pena.ity of perjury trrat there is a construction lenclng agencyior me
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
Construcion Tvpes:
VN, ,
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city or .nanees and state laws relating to building construction, and
hereby authorize represen. s of this city to enter upon the above mentioned property 'for
inspection po
Date: 6/24/2005
Fees paid for Permit:
Total:
603.04
Signature of pplicant or Agent
The ermit shall expire by Iimi1ation and become null and void if the building or
work has not passed fi 001 inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing OrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklForms/Trenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing Water PipelS rinkler Valves
Mechanical (Groundwork)
Electrical Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor JoisVGirders)
Do not cover or conceal the work below until the
following applicable Items have been signed;
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphra m1Frame)
Masonry (Relnf JBond BeamlPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele.... Mec. And Fire)
Insulation (Sound/Energy)
Do not tape or plasfer until the following applicable
items have been sign
Drywall f}
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Depl. Final 765-4040
Water Engineering 765-5268
Sub LisVBusiness License 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only
After Above Complete)
DATE
I
INSPECTOR
""
tzl,s/.
PARTIAL INSPECTIONS
~e..1r
Buildina I:::;tions
Jlo 1'al1 /; d-- i../~.
Mechanicallnsoections
Plumbina Inspections
GENERAL ITEMS
Exterior Plaster (Brown Coat) Electrical Inspections
T -Bar Electrical
T -Bar Mechanical
T -Bar Structural
Sewer
Water Engineering Backflow
Water Service