2099 S. State College Blvd. (8)
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BUILDING Fi,:~MIT NO. ElLD2004-04457
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TYPE OF PERMIT
T e~ant Improvement (Limited)
CITY
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BUILDING DIVISION
2QO S, ANAHEIM BLVD.
(714)765- 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 108
DATE: 2/2512005
JOB ADDRESS: 2099 S STATE COLLEGE BLVD 500
LEGAL DESCRIPTION: T 4 R 10 SEC 26 POR NE1/4
CONTRACTOR INFORMnJON:
TlCON GENERAL CONTRACTORS
17500 REDHILL AVE
IRVINE. CA 926140000 :
BUSINESS PHONE: 9492':1-1212
JOB OESCRI~TION:Tenant Improvement - office: suite 500. :
VALUATION: '85.000.00
I OWNER-BUILD!'?; DECLARATION
, I hereby affirm under penalty of perjury that I am exempt from the Coritracto~'.$;Ucense law forthe following reason (See, 7031.5 Business and
Professions Code: any dty or county which requires a permrt to ccnstr\lct, ~~;er, improve, demolish or repa ir any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement tnat he is iiC?rised pursuant to the provisions of the Contractor's.Lice~e J.;aw (Chapter .,
9)(commencing with Section 7000 of DiVision 3 of the Business and r(Of~";ip,,sCode) OJ:' that he is exempt the~from and th.e hasis for,the alleged
exemption. Any violation of Section 7031.5 by any aoplicantfcr iJ, pormit ~;;ut\)ects the applicant to a dvil penatty,of not more t.han,five'hum1n?ddollars
($5PO).' '" .' . ,'" '~,'. _... , ,'. ,: ,"_ .'
D. I, as cw~er of property, or my employees with wages as their sole 90in;r.ensation; wil! do the'work, and 1he s,tructure'ls-not inJenaedor offered for
sale (See, 7044 Business and Professions Code: The Contractor's, Uc.ens":lltaw does l)otabp_lyto an owner of property who build::; or improves. .
tt;e(~on, and who- does such work himself or heiSe!{ 0'r thrqug h his or her ov~h employees, p'rcvidec that such improvements a'j'e net intended or
offered tor &:lie, Jf, however. the building 0r improvement ;s sc.fd with one l~pf of.colTlplettO;1, the ownel"-buUder wijl have tria burden 'of proving tt~at he,
did not huild or improve for the purpose of sale).' '",,'. , . ,'. '_:
o I, as thE" owner of the prC'gerty, am exdusively contractir.g with :!ccrsc.(!I';:cntrddorS-to construct the project(S~c, 7044 Bu~iness and 'i=>r6fess/ons
Code;, the Ccnttador's License LaW does not 3pn/y to an owner of pro;jc.r.,~\Nr.o ~:.lUUd3 or !rnpro1p;S ti1erecr.: and who contract.~ for such projects wp:h
~ontractor(s) llce'n.~ed plifsuantto the ContraGtor's License Law). ~.
U I am $xempt under Sec. _' , 6(s,P.C.for this rea::>oo; .--_..r---_
Date: Owner: ' "
C_ WORKER'S COMPENSATION DECLARATION -,;__~.-.J
'.hereby affinn under penalty of perjury one of the fc:lowing dec!arstions: \, .,_ ,
. 0 I have and wiUmaintain.B certificate of cor_sent to self-insure for worI<'6f{s'coOlpensatiotl,
as provided for by SeGtiOn 3700 of the Labor Code, for the performallce" of tt1&wori<: for which
~'hi. ,permit is ~t-Iled. . ' . ,~'" "
. ~. 'hav, e and wl!l maintain wO,w,er~s compensati,on msiJra'nce, as reqUi(~C, i),'i 3eOh,'O n :'>700 of 2/25/2005
eJ_abor CodE:"'; for the performance of the work for which this permit ~<;; j8-o;w~d. My worker's I Date:
. ompensafion insurance carrier qnd policy are: ' , '.i
Carrier: STATE COMPENSATION FUND Policy Number: 16430.3~~,
,
,This section need not be completed if the pennit Is for one hundred dolla;" ($1 DO' 'or less.
o ,1 certify that in the perlo/TTlanc;e of the work for which this permit is !ssu~:d, I s~U not
'. emplOY any person in any manner sa as to become subject to the worker's c:'l:npensation laws
of California, and agree that if J should become subject to the worker's CO'TI~~!1S ti.on
prOViSions of Section 3700 of the labor Code, i shall forthwith co ly. rovisions.
APPLICANT: MASON SCHULER
OWNER INFORMATION:
Douglas G Melugin
2099 S State College Blvd
Anaheim, CA 92806
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: MSM
.-- , '
LICENSED CONTRACTORS DECLARATION
I hereby aff!rmunder penalty of perjury that ,; arr:
licensed under provis1o'ls cf chapter 9 (comrnen'cing
'with Sec~ion 7000) of Divsion;) of the' BUs in a d
'Professions
Contracto!
NUMBER
720895
TYPE
TYPE
EXPIRATION DATE
4/30/2006
B
HIC
Date: 2/2512005 Applicant' ~
WARNING: FAILURE TO SECURE ORKER'S COMPENSATION COVER>.GE IS
UNLAWFUl,.. AND SHALL SUBJE, AN EMPLOYER TO CRIMINAL PENAI,.TIES AND CIVIL
FINES UP TO ONE HUNDRED OUSAND DOLLARS ($100,000). IN ADD/TION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIOti 3706 OF THE
LABOR CODE. INTEREST AND ATTORNEY'S FEES.
I ' CONSTRUCTION LENDING AGENCY _,
I hereby affirm under penalty of perjury that there is a construction tending a~)~,...cy for the
performance of the work for which this permit is issued (Sec,3097 .Ci'l ,C),
Londer!s Information:
Construcion Types:
I FR. "
Occuoancy'Grouos:
B. . . .
Fire Sorinklered?
T.!. Area:
YES
4.000
I certify that 1 have read this application and state that the above information is correct. I
agree to comply withal! city ordinances and state laws relating to building cO;lstruction, and
her y authorize representives Of~hjSci . 0 e _ pon the above mentioned property fot
'os ction ~rposes, ' , .
, Date: 2/2512005
Signature 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 permitis required to commence or continue work.
Fees paid for,Permit:
Total:
2.542.36
,..
- .,
INSPECTION . DATE. INSPECTOR Electricall=inal . . ~,~li~ A. ~I/
Temporary Power P.ole . ' Plumbing Final . >'2S-C>'" 1J.,.u...u -.
.
. Plumbing (Drain/Waste Pipe) Mechanical.Final ~:l"S"':c; ,4.1"~ ;g"
Eiectrical Ground Electrode/lifer
. ./VfI'( IV/A'
SetbacklFormslTrenches (Footings) - . . G,as Test .
Do not install subfloor or pour floor slab until the EngineeriilglGrading Final 765.0126
fOllowing a.pplicaQle Items have been signed:.
Plumbing (Water PipecSprinkler Valves) Fire Dept, Final 765404(1 .
Mechanical (Groundwork) Water Engineering 765-5268 -. .
Electrical (Underground Conduit) Sub 1.istlBusiness License 765-519
Pre..slab (GompactionlMemllrane,Reinf. ..
Underpinning (Floor JoistlGirders) ZOhing 765-5139 . .
D<>. not cover or cOnceal the work belOW. until the Building Final*ast Inspection- Only q!~l' c" 1f?. 7...-
following applicable items have been signed: .. .. Iter Above Complete)
1st Floor Shear, PARTIAL INSPECTIONS .
Aresprinkler (Rough) Buildina InSDections
2nd Floor Shear . . 0'[ (;v_~ . /
Roof.ISheathina/Diaphragm'Frame) -z...';'ZX-O) r,r.::;--. )~
Masonry (ReinfJBond BeamlPr~lOUt) . k',J.c_/..~_ ,,.4,.-. ~ . . /..ch ~ .
. Rough Pluml)ing (Top.Out) ~~..... ~ A'./7/ 7-tl-o~ #J--</ / ,R ~.L 'ch . . ~
--- . .. .. ~,.~t;~
Rougn t:lectrlCallury WillI -b.l_V'l 4'&<. A. J:;;J..,..~ ~/r/::Z:V
Rough Electrical .. . - ~
Framing (OnlyafieIPU1~cj..andF;re) 3-:l?-o6 ' ) .. .
Insulation (Sou rgy)' .. . . .. '
po not tape or pla~ter until tile following applicable . MechanicallnSDections
.tems have been sIgned:: , . . ~ /, ..
Drywall /OUrz..V) ~'8"O'S / ::,.- .. .
. .
PenelratlonS (Fi/ll Rated) Elec~cal . .
Penelratlons(FI/II Rated) Mechanical ..
Penetrations (Fi/ll Rated) Plumbing
Interior Lath .
exterior Lath . PlumbinalnSDections .
. . . GENERAL ITEMS .
Exterior Plaster (Bl'!lWn CoatI -c-
T -Bar Electrical J~,,>-cr<; ~.
T -Bar Mechanical . '2.-Z.'> ~ .
T.sar Structural
. . . -
Sewer. .
. Water Engineering Backffow . ElectricallnSDections
Water Service . .... ..
. iNSPECTION RECORD.
FINAL INSPECTIONS ,
Date
inspector