3180 Stonybrook
TYPE OF PERMIT CITY..
Reroof
BUILDING DIVISION
200 S. ANAHEIM BLVD
(714}765, 5153.
INSPECTION REQUES:FLINE
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION;.10
BUlLDING PERMIT NO. BLD2004.02738
DATE: 7/1212004
JOB ADDRESS: 3180 W STONYBROOK DR
LEGAL DESCRIPTION; N TR 7241 LOT 73
CONTRACTOR INFORMJ.!ION:
ROYAL ROOFING COMPANY
81111 COMMONWEALTH A"'E
BUENA PARK, CA 9062~ =0.
BUSINESS PHONE: 714 521,0100
JOB DESCRIPTION,ear off and install25sq of "Eaglelite tile per ICBO #4660":(5.9Ibs)
VALUATION: 7,500.00
I OWNER.BUILDERDECLilRATION
I hereby affirm under pef1:.alty of perjury that I ~m exemptfrom the Contractor;:::> License Law for the following reasor.. (Sec: 7031.5 Business and
Professions Code: any citY"or countywhichrequires a permit to construct, a'fr, improve, demolish or repair any structure, prior to its issuance, also
requires'the applicant for such permit to file a signed statement thathe is Iir;~~')sed. pUrSIJant to the provisions of th~ Contra,dor's License Law (G.hapter:
9){commencing with Section 7000 of Division 3 of the Business and Professk'ns Code) or that he is' exempt therefrom and the'bas\~;or the alleged
exemption.. Any violation of Sectior:. 703,1.5 bya'ny applicant for a permit ~U!1~ct$ the applicant to a civa ren"'Jlty of not mere than f!v~ !1:...lildred dollars
(S500). . . . I,. . .
o I, as owrerof property: or my employees with, wages as their sole com~"~'lsatiol\. will do the work,. and the structure (S 11.0t iotex-.ded or offered for
sale (Sec. 7044 Business arid Profession's Code: The Contractor's License L';3W uoss not apply to an owner of property who buHd5 or improves
thereon, and who does sudl work himself or hClbelf or through his or h~r .a....).) employees,'provjd~d that such improvements are not in tel ld ed or
offered for sale,. If, however, the. building or improvement is sold with one idir Of compl~tion, the c:iwner-biJilder will have.the berden of proving 'that i1e
did notbuUdorimprova forthe'purposeofsale). ' ., . . ,('. , ..
o I, as the owner of the property, am exclusively contracting with lic17nSed'".:;ontraC!:t..lfS to construct 1:-:."3 project (Sec.' 7044 BUSiness ~md Profession!:::
Code: The Contr3C?tor's UC':lose L!3\'V does not apply to an owner of proper~y;\f:ho buildS, or improves th~reon. and who rontracts for such projects wi:h
iUi.l"'Ontractor(s) licehsed pursuant to the Contractor's License Law). i :
LJ I am exempt under Sec.' . , B & P .C. for this reason: __
Date: . ,Owner: '-h,t ~
I WORKER'S COMPENSATION DECLARATION _::[::::.~~
I hereby affirm under penalty of pedl:ll)i~ne of the following declarations: I
,0 I have and will maintain a certjficate of con.sent to self-insure for wnrke':-'~ co.npensatiorl,
as provided for by Sedien 3700 of the Labor Code, for the performance of t!'i:~'\t'JOfk io~ which
this peimit is issued.
~ '.. have arid will maintairi wOrk,er:s compensation insurance. as, l'equi'red y./ Section 3700 of
:th&-ulbor Code, for the perform~nce of the work for which this permit is iss-..:"",rj Mywo!'"k~r's
CompensatiOn insurance carrier and policy are:
Carrie,' NATIONAL UNION FIRE PolicyNurnber. 910112;
This seCtion need not be col1'pleted it the pennit is for one hundred dollar-~ ($1 O'?lci': tess. I
D. 1 certify that in t!1e performance of the work for which thi~' permifis iSS\I~'(!, ! s"a"11 not
employ any person in any manne" ' . e subject to the,wor:. r's C::. ;5ensativn laws
of Califomia, and agree'that if I sho ecome su'bjed to the wo.rke~'s .orr:p: ,s3ticn
. provisions of Section 3700 of . the Labor ode',1 c< an forthwith co lyo If, (th : )~~'provjsl"Jns Construdcn Types,
Date: 7/12/2004 Applicant: -~ . :_. .. . ~i'~'S~rinklered?
WARNING: FAILURE TO SECURE RKER'S COMPENSATI COVEF;.~GE.lS I
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TOCRIMINAL PENf.;_ nes AND CIVIL .
FINES UP TO.. ONEH.UND. RED "rH OUSAND DOLLARS (S.100,OOO),.IN A..D. U'.'D..O. ~...'T O. TH.'E. I
COST OF GOMPENSATION; DAMAG!"S AS PROVtDED FOR IN SECTIOr-. 3706, OF THE
LABOR CODE, INTEREST AND ATTORNEY:S FEES. .. .: ; i:( . .
I . . . CONSTRUCTION LENDING AGENCY . /-t__.. ..
I herebv affirm ,under pt:>11~lty of p~rju...... that tr.~~a ;;::':? (;~!''''1::rur:I;",~,:!,L;:.:~,.;:::t:~ ::+~':,~;;:-"')F~f-'--- I' ~~-,_.---:-- "'-~-~~_..~-'~--.-
. perfOirr.ance oftnework 'for which this permit is issued (Sec.3097 .blv.C)~
Lende~s "\formation:
APPLICANT: PAUL POWDERLY
OWNER INFORMATION:
Church 0 Stanton
3180 W Stonybrook Or
Anaheim, CA 92804.
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: HRU
I
.~.
-"-.-
LICENSED CONTRACTORS DECLARATION
t ere aU..![m under penalty of ~ry that'lam
llcer'lse, under pro.(isionsofcnapt ~r 9 (coT(m;;encing
with 3ec. n 7000) of Divsion 3 df t Busi santi
. ProfessiO~' ode. .~. . .
#(il2i2004 .. ...
Oete: ..' on a,ctor
NUMBE" EXPIRATION DATE
678705 .113112005
TYPE C39
. TYPE HIe
N.O'
I certi I have read this application and state that the above information is correct. I
. gree to rompl ith all city ordt ness"and state laws refati,ng to bunding construction, and
he eby a.utho' representi es of is ci to enter upon th7 above mentioned property for
insg . n puc.r~se.s. J,
- - . Oat.: 7/12/2004
Signature pplicant or Agent _
The permit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance, A
newpermit is required to conimence or continue work.
Fees paid for Permit:
Total:
181.4~
INSPECTION RECORD
INSPECTION DATE, INSPECTOR,
..
T elllPorary Power Pole ,
Plumbing (DrainJWaste Pipe) ",
Electrical Ground Electrode/lifer "
SetbacklFormsfTrenches (Footings) ", '
Do not install subfloor or pour floor slab until the
following applicClble items have been signed: 'I
Plumbing (Water Ape.Sprinkler Valves)
Mechanical (GroUndwork) ,
Electrical (Underground Condu~)
Pre-sl,ab (CompactionlMembranl!.Rei!U.,
Underpinning IFJoor Joist/Girders)
!Xl not cover or conceal the work below until the
,following C1pplicable items 'have been signed:, '
1 st Floor Sheac , "
Firesprinkler (Rough)
2nd Floor Shear ,
Roof ISl1ealhing/DiaphragnV'Frame) '-
Masonry (Reinf$ond Beam/Pr...G~ut) " I
Rough Plumbing' (Top Out) , '
Rough Mechanical , ,
~ugn t:lectncal lory Wall) ,
Rough Electrical ,
Framing , IOnlyafterPlbg.. Elee" Mech: and Fire} , "
Insulalion ($oundlEnergy) , ,
Do not tape or plaster until the following applicable
items have been signed:' , ,
Drywall , , ' ' , ,
Penetr.alions (Fire Raled) Electrical , , ,
Penetrations (Fire Raled) Mechanical " ,
Penetralions IFireRaled) Plumbing I
Interior 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 ,
Plumbing Final ,
Mechanical Final "
Gas Test ,
Engineering/Grading Finai 765-6126
Fire Oeli!. Fi~aI7654D4D ,'" ,
Water Engineering 765-5268
Sub List/Business License 765~519 "
"
Zoniilg765-5139 " ' '
Building Final ' ~.st Ihspection- Qnly Ib-X'-^ V./J ..l ~
I', ' , fter Above Complete), , VJ IY}V/ ~
PARTIAL INSPEC:nONS '
Buildirialnspections
Mechanical ,Inspections
Plumbina Inspections
,EII~ctricallnspections '
.-