4549 E RIVERDALE AVE (5)i
Permit Types
BLD °
ELE
MEC
PLM
X
Permit Number: BLD2009-04063
Issued: 01 /20/2010
INSPECTION REQUEST LINE:
(714) 765 - 4626
Quarter Section: 167
Site Address: 4549 E RIVERDALE AVE (V15RIZON WIRELESS).
Legal Description: JONATHAN` WATSOU TR LOT NELY -5.22 AC
C
°A
Y_ f=NAI E I M
200 S ANAHEI -BLVD.
(714) 765 - 5153
Project Description: Tenant Improvement: Install new Time Warner cable, one (1) fiber pack, one (1) LTE battery and one (1)
LTE 6201 rack inside existing shelter.
Valuation:
$15,000.00
Construcion Types:
N/A, ,
Fire Sprinklered?
No
Cool Roof
No
Total Fees paid for Permit:
490.12
People Associated with Project:
Owner CITY OF ANAHEIM %ASSISTANT FINANCE DIR P O BOX 3222 ANAHEIM CA 92803-3
Contractor TOTAL TELCO SPECIALIST INC 350 PATCHETT RD SAN LUIS OBISPO CA 934010000
Permit Applicant DOUGLAS MILLER
Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Type Mechanical Fixtures Qty
Miscellaneous Items
1
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 new permit is required to commence or continue work. fbid_permit_cornbo
City of Anaheim
Building Division
Do not occupy this building until the final inspections have been made.
BUILDING PERMIT DOES NOT AUTHORIZE ELECTRICAL, PLUMBING, OR
MECHANICAL INSTALLATIONS - SEPARATE PERMITS ARE REQUIRED.
INSPECTION I DATE I INSPECTOR
Do not pour concrete until the following applicable items have been signed:
Plumbing (Ground/Underfloor Drain Waste)
Electrical Ground ElectrodelUfer
Setback/Forms/Trenches (Footings)
Do not install subfloor or pour floor slab until the follwing applicable items have
been signed:
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre -slab (Compaction/Membrane Reinf.)
Floor (JoistlGirdem)
Underfloor Insulation (Raised Foundation Only)
2nd Floor (Floor Nailing)
Do not cover or conceal the work below until the following applicable items have
been signed:
let Floor Shear
Firesprinkler (Rough) (Fire Dept.)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reinf.IBond BeamlPre-Grout)
Rough Plumbing (Top Out)
Rough Duct (Mechanical)
Rough Mechanical
Rough Electrical
Framing (Only after Plbg., Ele., Mac. & Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable items have been signed
Drywall
Drywall Penetrations (Ele., Mee. & Plbg.)
Interior Lath
Exterior Lath
GENERAL ITEMS
Electrical Service Meter
Exterior Plaster (Brown Coat)
T-Bar (Struct., Ele., or Mec.)
Sewer
Water Engineering Backflow (Testable Only)
Water Service
All applicable items below must be signed before utilities will be released.
FINAL INSPECTIONS
DATE
INSPECTOR
Final Gas Test
Electrical Final
Plumbing Final
Mechanical Final
Cross Connection Control plat 7w 80
Engineering/Grading Final p14t7ess12e
Fire Dept. Final (714) 765.5041
Fire Sprinkler Final (714) 765.5041
Water Engineering (714) 765-4591
Sub List/Business License (714) 765-5194
Zoning (714)765-5139
Building Final (Last Inspection -
Only After Above Complet
r
FINAL INSPECTION must be approved by the Building Division.
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections
Permit Backs Master-2008.xis
Permit Types
BLD ELE MEC PLM
X
Permit Number: BLD2009-04063
Issued:01/20/2010
CITY OF ANAHEIM
INSPECTION REQUEST LINE:
BUILDING DIVISION
(714) 765 - 4626
200 S. ANAHEIM BLVD.
Quarter Section: 167
(714) 765 - 5153
Site Address: 4549 E RIVERDALE AVE (VERIZON WIRELESS)
Legal Description: JONATHAN WATSON TR LOT NELY 5.22 AC
OWNER - BUILDER DECLARATION:
I hereby affirm under penalty of perjurythat I am exempt from the Contractor's License State Law for the following reason(s) indicated below by the
checkmark(s) I have placed next to the applicable item(s) (Sec. 7031.5 Business and Professions Code: any city or county which requires a permit to
construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors' State License Law Chapter 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code) or that he or she is exempt from licensure 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).
I, as owner of property, or my employees with wages as their sole compensation, will do (_) all or () portions of the work, and the structure is not
intended or offered for sale (Sec. 7044 Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who,
through employees' or personal efforts, builds or improves the property, provided that the improvements are not intended or offered for sale. If, however,
the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for
the purpose of sale).
I, as the owner of the property, am exclusively contracting with licensed Contractors to construct the project (Sec. 7044 Business and Professions Code:
The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a
licensed Contractor pursuant to the Contractor's State License Law).
I am exempt from licensure under the Contractors' State License Law for the following reason:
By my signature below I ackonowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the
improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application
is submitted or at the following Web site: htto://www.lecinfo.ca.gov/calaw.html
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owners behalf.
I have read this application and the information I have provided is correct.
I agree to comply with all applicable city and county ordinances and state laws relating to building construction
I authorize representatives of this city or county to enter the above -identified property for inspection purposes.
Signature of Property Owner or Authorized Agent
WORKER'S COMPENSATION DECLARATION:
Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES
AS PROVIDED FOR IN SECTION 3706 OR THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
I hereby affirm under penalty of perjury one of the following declarations:
--I have and will maintain a certificate of consent to self -insure for workers compensation, issued by the Director of Industrial Relations as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
I have and will maintain workers compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers Compensation insurance carrier and policy are:
Carrier: CONTINENTAL CASUALTY COMPANY
Name of Agent:
Phone No.:
Policy No.: 2082421287
Expiration Date: 3/1/2010
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
workers compensation laws of California, and agree that, if I should become subject to the worker's compensation provisions of Section 3700 of the
Labor Codee,,;I shall
forthwith comply with those provisions.
ire of Applicant ate
Permit Number: BLD2009-04063
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY:
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec.3097.Civ.C):
Lender's Name
Lender's Address:
LICENSED CONTRACTORS DECLARATION:
I hereby affirm under the penalty of perjury that I am licensed under provisions of chapter 9 (c(
Busines Professions Code, and my license is in full force and effect.
C ntra r Signature Date
i
NUMBER EXPIRATION DATE LICENSE TYPE (S)
720587 3/31/2010 INSURI
C7
with Section 7000) of Division 3 of the
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 new permit is required to commence or continue work.
fbld permit combo declare