342 S. Silverbrook Dr.
!3UILDING PERMIT NO. !3L-D2004-04324
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 565
QUARTER SECTION: 180
TYPE.OF PERMIT
.Blockwall/Columns CITY
DATE: 12/2/2004
JOB ADDRESS: 342 S SIL VERB ROOK DR
LEGAL' DESCRIPTION: N TR 8783 LOT 65
APPLICANT: CHUCK LEE
OWNER INFORMATION:
Carolyn ,Jones
. 342 S Silverbrook Dr
Anaheim, CA 92807
JOB DESCRIPTION: install 75 linear feet of 6' foot high wall per city slandards
VALUATION: 6,500.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License ,Law for the following reaspn (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, aller, improve, demoli!Sh.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 License Law (Chapter
9)(comniE;lncing with 'Section 7000 of Division 30f the Business andProfessk>ns Code) or that he is exempt therefrom and the basis forthe alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit sUbJ'ects the applic~nt to a civil penalty of not more than five hundred dollars
. ($500). . '; \\~. '.
D I, as owner of property, or my employees with wages as their sole comp~nsation, will do the work, and the structure is not intended 01' offered for
sale (Sec. 7044 Busfness 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 owri employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold, with one ye~'tr of oompletion, 'the owner-builder will have the burden_'of proving that,he
did not bu ild or hnprove for the purpOSE;l of sale).' :'.' "
"0 I, as the owner of the property, am exdusively contracting with licensed ~ritractors to construct the project (See. 7044 Business and Professions
Code: The Contractor's Licen~ Law does not apply to an owner of property~vho builds or improves thereon, and who contracts for sudl projects with"
p.J(ontractor(s) licensed pu~u~nt to the ContrCJctor's License Law).' ~
U ] am exempt under Sec. , B & P.C. for this reaSon:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o'f have and:will maintain a' certificate of ronse"t to self-insure.for worker's compensation,
as provided for by Se_ction '3700 of the labOr Code, for the performanCe oftht~ work for which
this perm.it is issued. "" I"
o I have and will mai~tain worker's compenSation insurance, as required by,Section ~700 of
,the Labor Code, fbrthe performance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier:
CONTRACTOR .INFORMATION:
ARCHITECT/ENGINEER INFOR.MATION:
PROCESSED BY: JNJ
:i
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty 0 perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code.
12/2/2004
Date:
Contractor
Policy Number.
NUMBER
EXPIRATION DATE
. .
This section. need not be completed If thepennit' is for one hundred d~lIars ($100) "or" less.
D I certify that inthe performance of the work for which this per~it is issued,I_~h~1I not _ .
employ any person in <;lny manner so as to become'subject to tJ1e worker's c:c..nperisation laws
of Califomia, and agree'that if I should become subject to the worker's compensatfon;~:
provisions of Section 3700 of the Labor Code, I shaH forthwith comply with these proVisions.
TYPE
Date: 12/2/2004 Applicant:
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED lHOUSAND DOLLARS ($100,000), IN ADDITION. TO. THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706. OFT-HE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of,perjury that there is a construction lending age:ncy for the
performance of the .work for which this permit is issued (See. 3097 .Civ.C):
Lender's Information: J -
Gonstrucion_Tvpes:
VN,. , .
I certify thatl have read- this application and state thatthe above information is correct. I
agree to rom ply with all city ordinances and state laws relating to building construction, and
hereby authorize repre~entives of this city to enter upon the above mentioned property for
inspection purposes. "
Date: "12/2/2004
Fe~s paid for Permit:
Total:
125.94
Signature of Applicant or Agent
The permit shall expire by limitation and become null and void if the building or
work lias not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
INSPECTION RECORD
INSP!'CTION DATE ItjSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/' If Dr ~
Setback/FormsfTrenche:n..ootin~ /1ff
Do not install subfloor loor slab until the /
following applicable Items have been signed:
Plumbing (Water Pipe.Sprinkler Valves) r
Mechanical (GrOundwork) ~
Electrical (Underground C\>nduit)
Pre-slab(C\>mpa<:tioofMembrane.Rei nt. .
Underpinning (FloorJ\>istlGirders)
00 not cover \>r ronceal the work below 4ntil the .
foliowingapplicable items have been signed:
1 st Floor Shear ..
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/DiaphragmlFr-D\ -lit!f- .
Masonry (ReinfJBond BeamlJ'fe.Grouf) ~
~Rough Plumbing (Top Out) .
Rough Mechanical .
Rougn ~ectrlCal (Dry Wall) .
Rough Electrical
Framing . (Only after Plpg., EJec..Mech.. and Fire)
Insulation (S!>IindlEnergy) ~
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
Exterior Plaster (Brown COal) .
T .Bar Electrical . - .
T-Bar Mechanical
.T-Bar .Structural
Sewer
Water Engineering Backflow -c-
Water Service
. .
FINAL INSPECTIONS .~. Date . Inspector
Electrical Final .
. . .
Plumbing Final ..
Mechanical Final .
.
Gas Test
Engineering/Grading Final 765-5126 .
Fire Dept Final 765-4040 . . .
Water Engineering 765-5268
. . .
Sub List/Business License 765-519 .
Zoning 765-5139
Building Final ~astl~spectio~' O~ly -zlv7lo~ ~ -/
fter Above Complete)
PARTIAL INSPECTIONS (
Buildina Inspections
Mechanical Inspections
Plumbina Inspections
Electrical Inspections
TYPE OF PERMIT
Blockwall/ Columns CITY
DATE: 12/2/2004
JOB ADDRESS: 342 S SILVERBROOK DR
LEGAL DESCRIPTION: N TR 8783 LOT 65
ElM
BUILDING DIVISION
200 S.."'NAtiEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 565
QUARTER SECTION: 180
BUILDING PERMIT NO. BLD2004-04324
APPLICANT: CHUC K LEE
OWNER INFORMATION: CONTRACTOR INFORMATION:
Carolyn Jones
342 S Silverbrook Dr
Anaheim, CA 92807
JOB DESCRIPTION: Install 75 linear feet of 6' fool high wall per city slandards
VALUATION: 6,500.00 PROCESSED BY: JNJ
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any dty or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance. also
requ ires the appUca nt for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professiqn.s 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
~OO~ i
"'f.;?,[J1, as owner of property, or my employees with wages as their sole complrnsation, will do the work, and the structure is not intended or offered for
~e (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 sum work himself or herself or through his or her owrl employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one yenr of completion, the owner-builder will have the burden of proving that he
did not build or improve for the pu rpose of sale). j
D I, as the owner of the property, am exdusively contracting with licensed oontractors to construct the project (See. 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 contracts for sum projects with
p.....qontractor(s) licensed pursuant to the Co~tractor's License law).
U I am exempt nder Sec. , B & P C fa is reason:
Date: Owner:
ARCHITECT/ENGINEER INFORMATION:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe~ury one of the following declarations:
o I have and will maintain a certificate of consent to self-insure for worker's: compensation,
as provided for by Section 3700 of the labor Code, for the performance of the work for which
this permit is issued. .
o I have and will maintain worker's compensation insurance, as required by' Section 3700 of
the Labor Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier: Policy Number:
This section need not be completed if the pennit is for one hundred dollars ($100)0.. less.
~ I certify that in the performance of the work for which this permit is issued,l shall not
~ploy any person in any manner so as to become subject to the worker's compensation laws
of California, and agree that if I should become subject. to the worker's compensation
provisions of Section 3700 of the labor Code, I shall forthwith comply with those provisions.
,
Dale: 12/2/2004 Applicant: _
WARNING: FAILURE TO SECUR OR~'8 OOMf[l~SATIOI~ COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is '\ 70nstruction lending agency for the
performance of the work for whid1 this permit is issu~ (See. 3097 .Civ.C):
Lender's Information:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
,Professions Code.
12/2/2004
Dale:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Construcion Types:
VN, ,
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby authorize representives of this C(ity to enter upon the above mentioned property for
insp ion purposes.
Dale: 12/2/2004
Fees paid for Permit:
Total:
125.94
Ignature of Applicant or Agent
The permitshail 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
new Dermit is reauired to commence or continue work.
,.' :;J
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