1040 N. Stephenson St.
TYPE OF PERMIT
Residential Remodel CITY
DATE: 11/18/2003
JOB ADDRESS: 10,10 ''''STEPHENSON ST
LEGAL DESCRIP'rioN: Tract 16359 Lot 50'
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, BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714)765-4626
CENSUS CODE: 434
QUARTER SECTION: 31
BUILDING PERMIT NO, BLD2003-04505 .
APPUCANT:WA N WINN
OWNER INFORMATION:
RANDY SLAVIN
1040 STEPHENSON ST
Anaheim, CA 92801
JOB DESCRIPTION Install new wallin garage:
VALUATION: 2,000.00
I;, OWNER-BUILDEHOECLARATlON
i hereby aff,ir~ u;1der penalty of,perjury that larn:'exempt f:oom ~l1e ContractQf}.License law for the follOWing, ~eason (Sec. 7031,.5 Business and
Profession~r,C"'de:,anydty or county which requires:3 permit ~o i;onstruct~ 8;:,.~t". improve, demolish or repairany structure, priorto its .issuance" also
. requires_th~:~pp!icant forsu~ permit to Tile a signedstateme:n!,that tie, is liCS';lse,d_pui"5Ul:mt to ,the provisions of the Contractor's license law(Chapte~
9)(commencin,g with-Section 7000 of Divis!on.3 of the _~u~in.;s~)"Llnd Professi,;ns 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 permitsut~~\ects the'applicant to a dvij penattyof not more than five hundred dollars
~?)~s own~r OfP'ro perty, O'r my emPIOye~ with wages as their SOle' co~~:nsatio~',Will do the wqrk, and the struc~ure j~ n9fjnt~i1d ed 0 r offered fo-r
Sale {Sec. ?044 Bu~iness and Prof~sj()ns Code:. The Contract?r's Ucense L:~W does'not apply to an owner of property,who, builds or improves
t/1ereon, $nd who does such work himself or herself or through his or her 0\...< employees, provided that such improvements are not intended or.
offered for sale. If, however, the buirdingor Improvement is sold with one :I:"~i' of completion, the-ow\"\er-builde~ will have the burden of prov:ng that ~e
did not build or improve for the purpose of sale)." " j' , . " " "
o -I; 'as_ the owner Of the property, am exdusively contracting with lice Sfdfontra~ors to construct the project (Sec. 7044 'Business and Profe:>>ions
Code: _:The_Contractor's License law does riot app to 0 of .upertyfvhoQuildsor improves thereon,and who (Ontra~ts for sU<;h.projeets with
ontra~or(s)_licensed pursuant to the Contracto I l~1M . -! . .
am,e," mp nderS€c.' . . ,8& hi e">oO' '~A"
Date' la,; j;" Owner: ~ z...' q&;
WORKER'S COMP SATION DECLARATION i
I hereby affirm ,und~rpenalty of pe~ury. one of the following declarations:._.
0, I have arid will maintain a certificate ofcrinsent to self-insure for worka,;J compensation,
as provided for by Sedion 3700 of the labor Code, for-the peiform2nceoftt;~.....ork. forwhid1
this permit is-issued. ," , .
o I have and will maintain worker's compensatio'n. insurance, as.require:d ei 5edion 3700 of 11/1812003
the-Labor Code, for the performanceofthe work forwhich.this perm iUs issl,;;.'J. Myworker's Date:
Compensation insurance carrier and pqlicy are: ..)
. Carrier: . Policy Nurnt:ler.
This section need not be Completed if the pennit is for one hundred dollars ($1';..:;,;-or I_ess.
o I certify that in the pedo rrnance of the work for which thiS permit is i~ut.}.J ,~ha"_ not .
.employ any personin'any manner so as to become s '~ctt...e w~~. mpensation !aw$
of CaHfomia, and agree. that if J should becom . ..e,'!'f, r'sY~~.;Il~at1():1,.
provisions of Section 3700 of the lab r Cod hwit mp ,,-w) n "::,)*"fprovisiorts..
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CONTRACTOR INFORM,~T'ON:
ARCHITECT/ENGINEER INFORMATiON:
pROCESSED BY; AEM
I
I
LICENSED CONTRACTORS DECLARATION 1
I h~reby aff\rm und~r penalty.of perjury that I am <
. licensed under'provisiol's of chapter 9 (commencing
with Section 700Q) of Di\''Sion 3 of the 'Business arid
Professions Code. .
Contractor.
NUMBER
EXPIRATION DATE'
,TYPE
Date: 1111B12oo3 Applicant:
WARNING: FAILURE TO SECU WOR ER'S COMPENSATION COV:',": \GE IS-'
UNLAWFUL, AND SHALL SUB CT AN EMPLOYER TO CRIM INAL PEN.. ',TIES'AND CIVIL
FINES UP TOONE HUNDRED IH OU SAND DOLLARS ($100,QOO), ,IN ACl,o. TI ON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SiOCTIQi: 37060F.THE
LABOR CODE, INTEREST"AND ATTORNEY'S FEES. ' '! .. ;
I ,,' CONSTRUCTION LENDING AGENCY ! '"
l'h,~{~bX a~ir'.l' under penalty ~f. perju.ry__~hat !h~r~.is a constructi~O~ I~~dj?~ a~~,~~j:'!~Yf~r the'
f'~rf('lfm.-'1ncp..ofthe work for whldl thls.l'J:3rmlt IS Issued (Sf!~3G~1 .C.:'...r._I_ __';"~_. '.
Lender's'lnformation: .
Construcion Types:.
VN, "
Fire,Sprinkleted?
NO
e that the above information IS correct. I
ws relating to building eOllStruction, and
pon the above mentiore:t property for
Date: 11118/2003
Fees paid 'for' Permit:
Total:
. 142.96
. Signature of Applicant or Agent
The permit shall expire by limitation and become null andvoid if the building 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 . . DATE INSPECTOR
Temporary Power Pole : . .
Plumbing (DrainNVaste Pipe)
Electrical Ground Electrode/llfer .
SelbacldFormslTrencJ1es.(Footings)
Don.ot install subflOOr or pour floor slab until the.
fOllOwing applicabl.e items have been signed:
Plumbing (Water Plpe.Sprinkler Valves)
,MeChanical (Groundwork) . .
Electrical (Underground Conduit)
I t'/lil-slab (COmpaction/Membrane.Reinf. . . . .
Underpinning (F100rJOisllGinlers) . . .
Do not cover or conceal the woll< below unlll the
following applicable it~ms have been signed: .
1st Floor Shear '.
Firesprinkler (Rough) .
2nd Floor Shear . .
Roof (Sheathing/DIaphragm/Frane) . . . .
Masonry (ReinfJBond .EleanlPreoGroilt)
Rough Plumbing (Top Out)
Rough Mechanical' . .
HDugn J:Iectrical ,II) .
Rough Electrical .
Framing (Qn~ affer PJbg. Elec.. t..lech.. and Fire) ,
Insulation (SoundlEnergy) . . .
Do not tape or plaster. until the following applicable
items have been sign.ed: . . '. .: . f
Drywall ..' . . . .'
Penetrations (Fire Rated) Electrical . I
Penetrations (Fire Rated) Mechanical '. I
Penetrations (Fire Rated) Plumbing ,
'nteri!)r Lath '. .. .
Exterior Lath. . . '. .
. GENERAL 'ITEMS
. .' Exterior Plaster (Brown Coat) .
T -Bar Electrical . .
T-Bar Mechanical ..
T -Bar Structural . .
Sewer .
Water Engineering Backflow . . . . . .
Water Service . , .
.-
FINAL INSPECTIONS ." '. Date . Inspector .
Electrical' Final .
Plumlling Final . '.
Mechanical Final' .
Gas Test . , . .' .'
.
Engineering/Grading Final 765<i126 . . '.
,
Fire Dept. Final. 7654040 .'
. .
Water En'gineering 765-5268 .. . .
. . .
Sub List/Business License 765-519 .
Zoning 765-5139 . . ". :
Buildin9 Final \l-ast Inspection- Only. .
Iter Above Complete) . .
. PARTIAL INSPECTIONS
Buildina Inspections
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.av~ ;ei~e~k~-__'- .....
Mechanical Inspections
Plumbina Inspections
.Electrical Inspections
PERMIT EXPIRED
INSPECTION
NOTCOMPLE~ED
DATE:
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