8086 E. Santa Ana Canyon Rd. (2)
TYPE OF PERMIT
Tenant Improvement (Limited) CITY
DATE: 4/25/2005 UNIt'. ~? 4
JOB ADDRESS: 8086 E SANTA ANA CANYON RD
LEGAL DESCRIPTION: PM 255-1 PARS 11 & 17 POR. OF
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD~ '
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE" 437
QUARTER SECTION: 207
BUILDING PERMIT NO. BLD2005-01168
APPLICANT: MARGUERITE HOCHANADEL
OWNER INFORMATION: CONTRACTOR INFORMATION:
ARCHITECT/ENGINEER INFORMATION:
JOB DESCRIPTION:Tenant improvement, remodel exi.st. Rest.(add restroom. an.d changing room) Transfer permits oVer to tenant. (REF BLD2005-00244)
I
VALUATION: 5,800.00 ' PROCESSED BY: SAM.
I OWNER-BUILDER DECLARATION L
I h-ereby 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 C~e: any city or county which requires a permit to construct, alte~jmprove, demolish or repair any structure, prior to its iSsuance, a'lso .
requires the applicant for such permit 1<;> file a signed statement that he 'is licen 'd -pursuant to the provisions of the Contractor's License Law (Chapter
9)(pommencing with Section 7000 of Division 3 of the Business and Professio sCode) " 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 subjetts the applicant to a civil penalty of not.more than five hun"ured dollars
($500). . . . . . I . ..
o . I, as owner of. property. or my employees with. wages as their sole.compe~sation,. will do the work, .and the struGture is not intended or. offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's' License LaYi"does not apply to an owner of,property who bU,ildS or improves .
thereon, and who does such work himself or herself or through his or her own employees, provided that such irJ:lprovements 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
~. otbuild or improve for the purpose of sale). . .~. '." ,
, as the, owner of the property, arpe xci us. ively contracting with licensed ~ntrac:tors to cOlJstruct the project (Sec. 7044 Business and Professions
o : The Contractor's License.Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with
ontractor(s) licensed pursuant to the Contractor's License Law). i,. " '.
I am exempt under Sec.' B . .C. for this on:' :, . , '
Date: . Owner: /' '- I' .
WORKER'S PEN All N DECLARATION
I hereby affjrm .under penalty of perjury one of te following declarations: i
D I have.and \ViII maintain a certificate of consent to self-insure for worker's'~ompensation,
as provided lor by Section 3700 01 the Labor Code, lor the pertormance of the.worK lor which
this' permJt is issued. '. )
o I have and Will maintain worker's compensation !nsurance, as required by 'Section 3700 of
'the Labor Code, for the performance of the'work for.which this permit is issued.' Myworker's
ComRensation insurance carrier and policy are:
Carrier: PoUcy Number..
This section need not be completed Il the pennlt is lor one hundred dollars ($100) Or less.
~ertify that in the performance of the work for which this pl;:'lrmit is issue<:( I shall not
e 0 a~y person in any~manner so ~s to become subject to the worker's corppensation laws
of a ~omia, and agree that if I should become subject to the worker's com~~n
provisions of Section 3700 of the ~aborcode, I. shall forthwith c .. ply with~.oVis;ons. .
Date: 4/25/2005 Applicant: ... /
WARNING" FAILURE TO SECURE
UNLAWFUL, AND SH.ALL SUBJECT A EMPLOYER TO RIMINAL PENALTIES AND CIVIL
FINESUPTOONE HUNDRED THOUSAND DOLLARS ($100,000):\N ADDllION 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 a construction lending,agencY,.for the
performanceofthework for which this permit is issued (Sec~3097 ~Civ.C):J..:: >
Lender's Information:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penaltY. of perjury that, Lam
licensed under provisions of chapter 9 (commencing
with Section 7000)01 Divsion3 of the Busness and
Professions Code.
.4/25/2005
Date:'
Contractor
.NUMBER
EXPIRATION DATE
TYPE
Co'nstrucion Types:
VN,' ,
Fire Sprinklered?
YES
I certify that I ~ave read this application and state that the above inform.ation is correct. I
agree to comply with. all:city ordinances and stat lating to building construction, and
hereby authorize representives of thi .ty to e er upo he above mentioned prope'rty for
inspection purposes.
Date: 4/25/2005
Fees paid for Permit:
Total:
71,53
Signature of Ap . ant or -Agent
The p mit shall expire by Ii itation and becorne 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.
)
INSPECTION RECORD
. INSPECTION. .. DATE. INSPECTOR
Temporary Power Pole . . . / .
Plumbing (DrainIWaste Pipe) .
Electrical Ground Electrode/Ufer . .
SelbacklFormslTrencheS (Footings)
00 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 (Compaction/Membrane.Reinf. .
Underpinning (Floor Joist/Girders)
00 not cover or conceal the work below .untll the
following applicable .items have been signed:
1st Floor Shear
Firesprinkler (Rough) .
2nd Floor Shear . . .
Roof (ShealhII1!lfDiaphragrn'Frame)
Masonry (ReinfJBond BeamlPr~rout)
Rough Plumbing (Top Out) <5- :..DZ;
Rough Mechanical . ~ u~ . tn.
Rough ElectrICal (Ory Wall) ~r:;
Rough Electrical. . . f
Framing .{OnJy.after.Plbg.. Elec.. t...1ech. and Fire&
Insulation (SoundlEnergy)
Do not tape or plaster .until the following applicable
items have been signed:. . . . /'>-
Drywall . .. s;---zo.:>
.Penetrations (Fire Rated) Electrical . I
Penetrations (Fire Rated) Mechanical
Penelratlons (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
Fire Dept, Fimil 765-4040
W~ter Engineering 765.5268
Sub List/Business License 765-519
Zoning 765-5139
Building Final fLast Inspection- Only /ll.
. .. After Above Complete) -06
PARTIAL INSPECTIONS.
Build/no InsDections
MechanicallnSDections .. . . .
1'--/~<:;- &mI-t2bMf ~II-fw~ ~..;. ~
Plumbina InsDections
ElectricallnsDections
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