5701 E. Santa Ana Canyon Rd.
TYPE OF PERMIT
Tenant Improvement (Limited) CITY
DATE: 611012005
JOB ADDRESS: 5701 E SANTA ANA CANYON RD L
LEGAL DESCRIPTION: DOMINGUEZ ESTATE LOT 3 POR OF lOT
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REOUESTlINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 185
BUILDING PERMIT NO. BLD2005-01305
APPLICANT: DONALD WEBB
OWNER INFORMATION: CONTRACTOR INFORMATION:
Canyon Plaza Shopping Center DONALD B WEBB
2424 SE Bristol St #200 6937 DOUGLAS FIR CIR
Newport Beach, CA 92660 RIVERSIDE, CA 925080000
JOB DESCRIPTION: Tenant improvement for dental office
VALUATION: '24,840.00 " PROCESSED BY: JNJ
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License aw or t e 0 oWIng reason ee. 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 such permit to file a signed statement that he is licen~;ed pursuant to the provisions of the Contractor's License 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 subjel~ts the applicant to a civn penalty of not more than five hundred dollars
($500).
o I, as owner of property, or my employees with wages as their sole compersation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's Ucense Larv does not apply to an owner of property who builds or improves
thereon, and who does such work himself or helSelf 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 year of completion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale).
o I, as the owner of the property, am exclusively contracting wtth licensed ccntl"actors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's Ucense Law does not apply to an owner of property WllO builds or improves thereon, and who contracts for such projects with
p..1fontractor(s) licensed pursuant to the Contractor's License law). '
U I 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 I have and will maintain a certificate of consent to self.;nsure 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.
~ave 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: EXEMPT Policy Number. EXEMPT
ARCHITECT/ENGINEER INFORMATION:
611012005
Date:
Contractor
This section need not be completed if the pennit is for one hundred dollars ($100) 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 Califomla, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I hall forthwith comply with thOS3 provisions.
NUMBER
709664
TYPE
EXPIRATION DATE
7/31/2005
B
Date: 6110/2005 Appllca :
WARNING: FAILURE TO SECiJREWORKER'S OMPENSATI N COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIViL
FINES UP TO ONE HUNDRED lHOUSAND DOLLARS ($100,000), IN ADDiTION TO THE
COST OF COMPENSATION, DAMAGES AS PROViDED FOR IN SECTION 3;'06 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
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 Information:
Construcion Types:
VN, ,
OccupanCY Groups:
B, , , ,
Fire Sprinklered?
T.I.Area:
NO
1,242
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
herebyautho ize representives of this city to enter upon the above mentioned property for
j nspection p rpo
Date: 611 0/2005
Fees paid for Permit:
Total:
987.43
nature of Applicant or Agent
The permit shall expire by limitation 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
FINAL INSPECTIONS
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 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only C?\(<>
". After Above Complete)
INSPECTION RECORD
INSPECTION
DATE INSPECTOR
I/')
L.... .,.....-Ir 1111.'-v-----
.
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
SetbacklForms/Trenches (Footings)
Do not install sublloor or pour 1I00r slab until the
following applicable items have been sianedYl
Plumbing (Water PiDelSDrinkler Valves) t J...l ./ All ~
Mechanical (Groundwork) I . /7
Electrical (Underground Conduit) I AlJ
Pre-slab (CompactionlMembrane Rein!.) v v
Underpinning (Floor Joist/Girders)
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/Diaphragm/Frame)
Masonry (Reinf JBond Beam/Pre-Grout)
Rough Plumbing (Top Out),
Rough Mechanical IM)I (
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
I /J
'Jtln'" l.<II^ V
, TJ
,1~/'7(dJl;::1'iJVI ./'
; "'0
~(/" --
Insulation (Sound/Energy) r '
Do not tape or plaster 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 Piaster (Brown Coat)
T -Bar Electrical
T-Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
r-r
.}....
lWl!o(1". ~
P/l.ll\, L.t: ~ l bnJl
iVH~ 11'- "''\'IV
/
PARTIAL INSPECTIONS
Buildina InsDections
-'
Mechanic~ections ~
~ DIQr' 1;0 o,!JR..,9 O'>t~ ~l ~
~
Plumbina InsDections
Electricallnsoections
BUILDING PERMIT NO. BLD2005-02164
TYPE OF PERMIT C
Tenant Improvement (Limited) ITY
DATE; 9/13/2005
JOB ADDRESS; 5701 E SANTA ANA CANYON RD 0
LEGAL DESCRIPTION; DOMINGUEZ ESTATE LOT 3 POR OF LOT
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE;
(714) 765 - 4626
CENSUS CODE; 437
QUARTER SECTION; 185
APPLICANT; JAMIE VANDERHOEK
OWNER INFORMATION; CONTRACTOR INFORMATION; ARCHITECT/ENGINEER INFORMATION;
CANYON PLAZA SHOPPING CENTER C E SNODGRASS CONSTRIJCTION, INC
2424 SE BRISTOL ST #200 3961 N WILLIAMS AVE
NEWPORT BEACH, CA 92660 0000 PORTLAND, OR 97227 0000
BUSINESS PHONE: 503282-7255
JOB DESCRIPTION:renant improvement, 1800sloffice remodel
VALUATION;
35,000.00
PROCESSED BY; JPD
OWNER-BUILDER DECLARATION
I-hereby affirm under penalty of perjury that I am.exempt from the on tractor's License Law for the following reason (Sec. 7031.5 usiness 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 such permit to tile a signed statement that he is licen!,ed pursuant to the provisions of the Contractor's License 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 Subj~ts 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 year of completion, the owner-builder will have the burden of proving that he
did not buUd or improve for the purpose of sale).
o I, as the owner of the property, am exclusively contracting with licensed c6ntractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of propertyw'ho 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. , B & P.C. for this reason:
Date: Owner:
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'sfompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
~ \ 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: LIBERTY NORTHWEST Poilcy Number. WC4-1NC010281
This section need not be completed if the pennit is for one hundred dollars ($1 00) Or less.
o \ certify that in the performance of the work for which thiS permit ~ issued, I shall not
employ any person in any manner $0 as to become subject to the worker's compensation laws
of Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, [ shall fa with comply with thos.e (J\I sions.
Date: 9/13/2005 Appiicant: ~
WARNING: FAILURE TO SECURE WORKER'S COMPENSATiO 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 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under pel1alty of perjury that thf:\re is a construction lending agertcyfor the
pertormance of the work for which this permit is issued (8ec.3097 .Civ.C):
Lender's Information:
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 representlves of this city to enter upon the above mentioned property for
in7~~~ Date: 9/13/2005
Sig ature of Applicant 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
new permit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisiensof chapter 9 (commencing
with Section lOaO) of Oivsion 3 of the Business and
:/~;;;0~~6~~~Y-' 0__
Date: Contractor
NUMBER
622933
TYPE B
EXPIRATiON DATE
7/3112007
Construcion Types:
V N, ,
Occupancy Groues:
8, , ;;,
Fire Spririklered?
1.1. Area:
NO
1,800
Fees paid for Permit:
Total:
1.186.71
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE
INSPECTOR
Temporary Power Pole
Plumbing (Drai st ipe) .
Electrical Groun Electrode/Ufer
SetbacklFormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane Reinf.)
Underpinning (Floor Joist/Girders)
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/Diaphragm/Frame)
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbin op Out
Rough Mecha .
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And F
~
.p,>
Insulation (Sound/Energy)
Do not tape or plaster 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 Coat)
T-Bar Electrical
T-Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS
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 765-51
Zoning 765-5139
Building Final (lastlnspactlon - Only
After Above Complete
PARTIAL INSPECTIONS
Building Inspections ,/1. _ .
~qlr/tJs' -6f.ceFPr 13/H1f1zU>Af ~
Mechanical Ins ec ions
Plumbing Inspections
Electrical Inspections