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50 S ANAHEIM BLVD (2)DATE ; 121;3/2000' - JOaADDriES`>S: 50 S ANAHEIM BLVD H -A LEGAL DESCRIPTION: P 1K 178 PG 22 PAR 1 CITY rb. kHEIM CONTRACTOR INFORty `.TION: 200' �dJHn�,::, (7:4). _ 755 -5153 INSPECT,ON. ,TUN!: (714). +35 5161 _ CENSUS CODE: 437 QUARTER SECTION: 83. ARCHITECT /ENGINEER INFORMATION: 1 02.84 APPLICANT: JOSEPH SILVA OWNER INFORMATION: ANAHEIM HOLUALOA 100 SANAHEIM BLVD ANAHEIM, CA 92805 JOB DESCRIPTION:Remove exsting roo Install new roo VALUATION:'. 2.800.00 OWNER- BUILOEi-tDECLARATrON - I hereby affirm under penally of perjury that lam exempt from the Contractcrs L ease Law for the following reason: ;Sec 7031.5 Business and Professions Code: a ny-city or county which requires a permit to construct alter, improve, deimlish or 'repair any structure, prior to its issuance;. also requires the app Hal for such permit to file a signed statement that he is Irut used pursuant to the provisions of the. Contractors L:canse Law (Chapter 9)(commencing with Section. 7000 of Division 3 of the Business and Professrms Code). or that he is exempt therefrom and the basis for the alleged - exemption. Any of Section. 7031.5 by any applicant for a permit - st iclects the applicant to a avil penalty of not more than five hundred dollars ($50 El I, as owner of property.. or my employees with wages as their sol a corm -ensation will do the work, and the structure is not intended or offered for sale (Sec 70=.14 Business and Professions Coder The Contractor's License Law does not zpply to an owner cf property who builds cr improves thereon, and who does such work himself or herself or through his or her ova; employees, provided that such improvements are not intended or offered fur sale. lf, however, the building cr improvement s sold with one yy'a of completion. the owner-. builder will have the burden of proving that he did not build or improve for the purpose of sa!e)'. ❑' i, as iheowre of the property, am exclusively contracting with licensedwntractors to construct the project (Sea 7044 Business and Professions Code: The Con:ranters License Law does not apply to an oz'rer of propert'' who builds or improves thereon, and who contracts for such projects with a contrador(s) Iicensed pursuant to the Con ° tor's L ice n ) 1 --- 1 .: I am exempt under Sec. C. for this Rate. L. /3 WORKER'S COMPE ,c ATION.DECLARATION I hereby affirm under penaity of perjury one • the following declarations: ci I -have and will maintain a certificate of wnsent to self - insure for worker: cempei:sation, as provided for: y Sect ion 3700 of the Labor Code, for the performance of «' wor< for which this permit is !3sued. - - - . _. I have 3 rd will maintain worker's compensation insurance, as reaulrea ..' Seddon 3700 of the Labor Code, for the performance of the work for which this permit is ism -:d my worker's Compensation insurance carrier and policy are Carrier: - Policy. Nu tuber. Thus section need not be completed if the permit is for one hundred dollars ($1Or, or less. ❑ - ) certify that in the performance of the work for which this permit Is issucd, 1 shall not employ any person in any manner so as to become suoject to the worker's compensation laws. of California, and agree that if I should become su bjed to the worker's compensation provisions of Section 3700 of the Labor Code, t shall forthwith comply with tr ase orcwisions. Date: li/13/2000 Applicant: WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL: AND SHALL SUBJECT AN'EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND- DOLLARS ($100,000), IN ADDi141ON TO THE COST OF COMPENSATION, DAM-AGES AS PROVIDED FOR IN SECTION 3700 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 at (Sec3097.Civ.C): Lender's Information: I certify that I have read this - application and state that the above information is corrode 1" agree to rummy with all city' ordjtoazirfs_ c state laws_ h • httjAi pas hereby authonte'eprescntives of this aty to enter upon the above mentioned property for inspection purposes. 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 permit is required to commence or continue work. PROCESS BY:- Mt.D LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that arir !icensed under provisions of chaptr r 9 (commencing with Section 7000) of.Divsion 3 of the Business . and _- Professions Code. 12/13/2000 Date: - NUMBER TYPE Contractor EXPIRATION DATE Fees paid for Permit: Total: - INSPECTION - DATE INSPECTOR Temporary Power Pole Inspector Final Plumbing (Drain/Waste Pipe) Plumbing Final - • Electrical Ground Electrode/Ufer Mechanical Final SetbacWForms/Trenches (Footings) Gas Test Do not install subfloor or pour floor slab until the following applicable items have been signed: Plumbing (Water Pipe.Sprinkler Valves) Engineering/Grading Final 765-5126 Mechanical (Groundwork) Fire Dept. Final 765 -4040 Electrical (Underground Conduit) Water Engineering 765- 5268 Pre- slab (Compaction/Membrane.Reinf: Sub List/Business License 765 -5194 Underpinning (Floor Joist/Girders) Zoning 765 -5139 Do not cover or conceal the work below until the" following applicable items have been signed: • 1st Floor Shear Building Final .((Last inspection- Onl After AboveComplet Firesprinkler: (Rough) 2nd Floor Shear Roof (Sheathing/Diaphragm/Frame) Masonry (ReinfJBond Beam /Pre -Grout) Rough Plumbing (Top Out) Rough Mechanical Rough Electrical (Dry Wall) Rough Electrical Framing (Only after Plbg:, Elec., Mech., and Fire) ; 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 INSPECTION RECORD PARTIAL INSPECTIONS Building Inspections Mechanical Inspections Plumbing inspections Electrical Inspections FINAL INSPECTIONS Date Inspector 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- Onl After AboveComplet INSPECTION RECORD PARTIAL INSPECTIONS Building Inspections Mechanical Inspections Plumbing inspections Electrical Inspections BUILDING PERMIT NO. BLD2003 -03271 T'PE OF PERMIT Tenant Improvement (Limited) . DATE: 9/9/2003 JOB ADDRESS: 50 S ANAHEIM BLVD LEGAL DESCRIPTION: P BK 178 PG 22 PAR 1 APPLICANT: FLORENZO VON. BERGER , OWNER INFORMATION: Holualoa Anaheim 100 S Anaheim Blvd Anaheim, CA 92805 JOB DESCRIPTION7enant improvement office VALUATION: - 38,000.00 ? PROCESSED BY: KBT - - a " O W N E R -B U I L D E TD E C LARATI O N I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason (Sec. 7031.5 Business and Professions Code: any dty or county which requiresa permit to construct apr, 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 !ice/toed pursuant to the provisions of the Contractor's License Law (Chapter 9)(commencing with Section 7000 of Division 3 of the Business and Profes ins Code) or that he is exempt therefrom ar9$he basis for the alleged exemption. Any violation of Section 7031.5- by any applicant for a permit su fects the applicant to a civil. penalty of not molethan five hundred dollars ($500). if (] I, as owner of property, or my employees with wages as their sole com t nation, will do the work, and the structure is not intended or offered for sale (Sec. 7044 Business a nd Professions Code: The Contractor's Licensew 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 rye employees, provided that such improvements are not intended or offered for sale. If however, the building or improvement is sold with one v r of completion, the owner- builder will have the burden of proving that he did not build or improve for the purpose of sale). ❑ I, as the owner of the property, am exduslvely contra ding with license ton trastca s io construct the project (Sea 7044 Business and Professions Code: The. Contractor's License. Lawdoes not apply to an owner of propert et, ho builds or improves thereon, and who contracts for such projects with a d contraor(s) licensed pursuant to the Co tractor's License Law). ❑ I am exempt,under Sec. B S: P.0 for this reason: Date: Owner: CONSTRUCTION LENDING AGENCY CONTRACTOR INFORMATION: TENANT WORKS, INC. • 5405 ALTON PKWY #462 i IRVINE, CA 926040000 BUSINESS PHONE: 714.541 -2256 1 . WORKER'S COMPENSATION DECLARATION r 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 worke4cornpensation, as provided for by Section 3700 of the Labor Code, for the performance of ale work for which this + -rmit is issued. 1 have and will maintain worker's compensation insurance, as required LV Section 3700 of Labor Code, for the performance of the work for which this permit is issubp. `My worker's mpensation insurance carrier and policy are: Carder: STATE FUND Policy Number. 1499067 -r-03 This section need not be completed if the permit is for one hundred dollars ($100 or less. n 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 ci mencation laws of California, and agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Lab • .ode, I sh al fo rt • rovions. ithcomply t! Date: 9/9/2003 - , Applicant: i� _._ --r WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVER\GE 19 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENA TIES 'AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDiT1ON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury that there is a construction lendmo ,._ ^cy for the performan of me work or wnich this permit i5 issued (Sec.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 representives of this, city to er upon the above mentioned property for inspecj purposes. • CC 7 j Date: 9 /9/2003 Signe ure 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. BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 CENSUS CODE: 437 QUARTER SECTION: 83 ARCHITECT /ENGINEER INFORMATION: LICENSED CONTRACTORS DECLARATION 1 I hereby affirm under penalty of perjury that I am licensed under provisions of • n er 9 (commons with Section 7001 of Divsin 3 r the Bu fd ss Professions C 9/9/2003 Date: Contractor NUMBER EXPIRATION DATE 738903 8/31/2005 TYPE C N Types: V Occupancy Groups: B Fire Sprinklered? T.I. Area: YES 2,100 Fees paid for Permit: Total: 990.88 INSPECTION DATE INSPECTOR Temporary Power Pole /3^n3 Plumbing (Drain/Waste Pipe) Plumbing Final f�, 4 4 _ 3 . . Electrical Ground Electrode/Ufer . Mechanical Final / /.J� - Setback/Forms/Trenches (Footings) t � �� Do not install subfloor or pour floor slab until the following applicable items have been signed: Plumbing (Water Pipe.Sprinkler Valves) - i Mechanical (Groundwork) Electrical (Underground Conduit) Fire Dept. Final 7654040 - `1-3, Pre -slab (Compaction/Membrane.Rei nf.) Water Engineering 765-5268 Underpinning (Floor Joist/Girders) Do not cover or conceal the work below until the following applicable items have been. signed: tst Floor Shear S Firesprinlder (Rough) 2nd Floor Shear Building Final ( Last Inspection Only J /01)14) / Roof (Sheathing/Diaphragm/Frame) Masonry (ReinfJBond Beam/Pre- Grout) Rough Plumbing. (Top Out) Rough Mechanical Rough Bectricaf (Dry Wall) Rough Electrical .- Framing (Only after PIbg.. Elec.. Mech.. and Fire/A-7_62,$4t Insulation (Sound/Energy) Do not tape or plaster until the following applicable items have been signed: if Drywall ` / ,iri / Penetrations (Fire Rated) Electrical Penetrations (Rre Rated) Mechanical Penetrations (Fire Rated) Plumbing Interior Lath . Exterior Lath GENERAL ITEMS Erderior Plaster (Brown Coat) T -Bar Electrical T -Bar Mechanical T -Bar Structural f� Pt, fi r( / ,�, a . • Sewer / / d Water Engineering Backflow Water Service FINAL INSPECTIONS D Date I Inc e , r Electrical Final - / / /3^n3 Plumbing Final f�, 4 4 _ 3 . . . Mechanical Final / /.J� - -G, t t � �� Gas Test A A 4— - - i Engineering/Gradi FinaI 765 Fire Dept. Final 7654040 - `1-3, Water Engineering 765-5268 Sub List/Business License 765 -5198 f f/ ` S Zoning 765 -5139 Building Final ( Last Inspection Only J /01)14) / INSPECTION RECORD PARTIAL. INSPECTIONS Building Inspections Mechanical Inspections Plumbing Inspections Electrical Inspections BUIL7;4■1ri PERMIT NO. BLD200S - 00539 ,w TYPE OF PERTVIIT Tehant Improvement (Limited) DATE: 4/24/2006 JOB ADDRESS: 50 S ANAHEIM BLVD LEGAL DESCRIPTION: P BK 174 PG 41 PAR 1 APPLICANT: PATRICK LE OWNER INFORMATION: RAYMOND JANAN TIC LLC %RAYMOND JANAN TIC LLC LOS ANGELES, CA 90036 3526 CITY CONTRACTOR INFORMATION: LOI V HOANG 12861 LUCILLE AVE GARDEN GROVE, CA 92841 0000 BUSINESS PHONE: 714 269 -1725 JOB DESCRIPTION: Tenant improvement for dental office. VALUATION: 45,000.00 OWNER- BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law fcr the following reason (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 such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chaoter 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 )f 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 dc 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 build or improve 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 Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law). ❑ 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: Ll 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. IV I have and will maintain worker's compensation insurance, as required by Section 3700 cf the Labor Code, fbr the performance of the work for which this pe pnit is issued. My worker's Compensation insurance carrier and policy are: Carrier: STATE FUND Policy Number: 1535918 -08 This section need not be completed if the permit is for one hundred dollars ($100) or Toss. -I') I certify that in the performance of the work for which this permit is issued, I shall not en 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, ! shaft forthwith comply with those provisions. Date: 4/24/2006 Applicant: WARNING: FAILURE TO SECURE WORKER'S CSMPEN ATIO COVE : IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI AL PENALTIES AND CIVIL ' S UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), I ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 •F THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. ONSTRUCTION LENDING AGENCY Date: 4/24/2006 HEIM 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: ( 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 city to enter upon the above mentioned property for inspection purposes. - Signature of Applicant or Agent Th permit shall expire by limitation an. • come 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. 4/24/2006 Date: PROCESSED BY: DUC NUMBE 71065 TYPE B Construcion Types: VN, , Occupancy Groups: B, Fire Sprinklered? T.I. Area: BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 CENSUS CODE: 437 QUARTER SECTION: 83 ARCHITECT /ENGINEER 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 • the Business and Professions Code. rector: C EXPIRATION DATE 8/31/2007 Fees paid for Permit: Total: YES 1,335 1.107.54 INSPECTION DATE INSPECTOR Temporary Power Pole ` DATE art° G%s'Z�' Plumbing (Drain/Waste Pipe) Gf - Z- q�j /- Electrical Ground Electrode /Ufer a Setback/FormsfTrenches (Footings) Do not install subfloor or pour floor slab until the following applicable items have been signed: Plumbing (Water Pipe /Sprinkler Valves) Engineering /Grading Final 765 -5126 Mechanical (Groundwork) Fire Dept. Final 765 -4040 Electrical (Underground Conduit) '2 ° 6 - ..--,- , Pre -slab Comaction /Membrane Reinf.) ( p ) Sub List/Business License 765 -5194 Underpinning (Floor Joist/Girders) Zoning 765 -5139 Do not cover or conceal the work below until the following applicable items have been signed: 1st Floor Shear Building Final (Last Inspection - Only After Above Complete) ` Firesprinkler (Rough) 2nd Floor Shear Roof (Sheathing /Diaphragm /Frame) Masonry (Reinf. /Bond Beam /Pre- Grout) Rough Plumbing (Top Out) 4f -- 2. •-OC 7 / Rough Mechanical 1-`°6 � � 4 Rough Electrical (Dry Wall) (.<- --`. / ,41 Rough Electrical Framing (Only after Plbg., Ele., Mec. And Fire) /$... $ ' Insulation (Sound /Energy) Do not tape or plaster until the following applicable items have been signed: Drywall 7"" �` l 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 ti T -Bar Mechanical 7 "l T -Bar Structural 7-4.96 - '' - Sewer Water Engineering Backflow Water Service FINAL INSPECTIONS INSPECTOR Electrical Final ` DATE art° G%s'Z�' Plumbing Final °, y ` °Y r Mechanical Final a Gas Test Cross Connection Control (714) 765.4280 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 After Above Complete) ` P e �{-� City of Anaheim Building Division INSPECTION RECORD PARTIAL INSPECTIONS Building Inspections c ' 22 - -44 Oz zL Mechanical Inspections Plumbing Inspections Electrical Inspections Av\akae-'(AN,V-P4 • • : : •: °: a.. • • • • IQ a.eaq 4 -r)( 0 • • • • • • ••a. se3 • • • • • • • 0 • • • • • • • • • 0 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 0 • • • • • • • 4 • • • • • • • • • • • • • • • • • • • • • • • • la. • • • • • • • • • • • Voltage A B C D 1001to5000 1/2 inch 1 /4inch 3/4inch linch 5001to10000 3/4 inch 1 /4inch 1- 1/8inch 1- 1/2inch 10001to15000 finch 1/4 inch 1- 1/2inch 2inch Y • •• •• •• •- • • ,• •• • • • • • • • • • • • • : • ••• • • • • • • • • • • • • • —, I mo- Altarw�1/1X 1/2eccewsa (Mk.3 per 1U) Listed sign section. NEC 600 -3. Consists of Insulating boots, insulating sleeves, plastic face, tube supports and channel letter. Suitable for damp, wet or outdoor locations unless marked for dty or indoor locations only. Tube support Neon tube. --�� Spacings maintained per spacing table. Plastic face Electrode insulating boot, GTO insulating sleeve provided with sign. Conduit Iocknut (typical) Drain holes iif used in damp, wet or outdoor locations. Listing marks: Listing mark sign section label shah be on each fetter and transfonner enclosure. The first blank space identifies the number of each sign section. The second blank space indicates the total number of sign sections. Wall varies in thickness and material LISTED by qualified electrical testing laboratory ELECTRIC SIGN SECTION NO. XX- 123456 of Seal building penetration(s) to comply with applicable building code requirements. Primal/ electrical sourcb• • • • • • • Et:690.5 • • • • • • • • • • • • •••• • • • • • • • • • • • • • ••• • Listed disc8nnect switch in primary to be within sight (maximum 50 ft.) of sign. (Many interpret tjwnsfoaner nek suv, • to be part of sigis), • : • • NEC 110 -3(b), eto-g. ; •• •• •• • Listed flex (metal shown) and listed GTO cable (secondary side only). See dwg C6 and C7 for detail requirements. For nonmetallic see dwg C6A and C7A. sr L ••• • • • • Spacings maintained per spacing table. All rights reserved. No part of this work covered by the copyright hereon maybe reproduced or used in any form or by any means - graphic, electronic, or mechanical, Including photocopying, recording, taping, or information storage and retrieval systems - without wdnen permission of the publisher, except that single copies of individual pages may be made by a bona fide electrical sign installation firm for the sole pupose of providing guidance on the installation of electrical signs or outline lighting, without the permission of the publisher. SPACING TABLE A. Between insulated high voltage wiring and 1) primary wiring and 2) dead • • Fetal where dead metal is parallels the high vokage wiring for more than 1' • •tIngth. t3, Between neon tubing and nearest surface. C. Between uninsulated high voltage parts and 1) dead metal and 2) insulated high voltage orsuppiyf conductors. D. Between uninsulated high voltage parts and 1) other uninsulated high voltage parts and 2) un insulated supply and low voltage parts. THE ISSUANCE OF THiS PE - r Listed sign section (consists of transform i' a = 1ato) E V I O L. A T I cr N 0 I ti suitable for damp, wet or outdoor tocations-un H I Len ODE s + c oGr�aia oF - rti- s marked for dry or indoor locations only. Attirress�z E i S AT HIS c ti NEC 600 -3, 600- 5(c)(1)(2), 600.7, 600.8, 600-9(d), 600 -21 & 600 -23. Grounded enclosure. t NU4 BUILDING DIVISION OF ANAHEIM Fasteners as required by local jurisdiction. A P P R O),/ ED • All elect. to be UL a r� UL Labels All transformers to be UL 2161 Compliant Disconnect on trans. Installation of signs listed per UL48 Note: Installation requirements only. Manufacturing requirements contained in UL48. ILLUMINATED CHANNEL LETTER INSULATING BOOT AND SLEEVE Scale None Ow UL48 - T1 D Dwg. No. See Attached • •• •• •• . . . . .•• • • • - • • • • • • • • • • • • • • s • • ••• •• • •• ••• • • •• • • • • • •• • • • • • • • • • • • • ••• • • • • • 1 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• • • • • • • • • • • • • ••• • • • • • • • •• • • ••• • •• • • • • • • • • • • •• • • tcfl IN1 Nam %LLOM(,., FIN- f. Lerre1 w r re TzE V '4%04. G . t_.vNA P. p5., (NC- 5O S• AuAt -ke(M BWD S'TE ga'6 Family Dentistry ,= 000 . .. •••• . • (W -rr+ -ev, 4 Scope of Work: INSTALL (1)12" channel Itrs + 24" logo LETTERS = 13.5 sq.ft. LOGO = 3.0 sq.ft. TOTAL: 16.5 sq.ft. PLANNING DEPARTMENT APPR1 a mD DATE -"SO -.-- ` BY FLOOD .ZONE_ i s _ l . .'_ (3 FRY \, /1.E ��: `; r;.� t •. T HtST� this na..e • ( {nitialsl. lrpte line ot;!: on �.. o e SEE EsUtLDI IG PERMIT FOR tY CONDITIO 1282 W. Lambert 110. Unit A t562I c 698 5622 FAX: [562) 600 -5623 {,A c r-r, 60 • • • . • • •.• • ••• •• •• •• • • • • • • • • • • • •• • • • • •. • • • •. • •,• • • • •• • • • • •• • • • • • • • • • •• • • • • • • • •• •• • • • •• • • tit - • • • • • • • - • •• • • j,.w tic.o cl•M c.-6 ' r 6eD Svrm eo 44)-46 r • OP c p 03 eze 11: a aQ O to � � o fa c Es 0C CP OP i sm . W. SIGN PERMIT NO. TYPE OF PERMIT New Attached to Structure Sign DATE: 9/5/2007 JOB ADDRESS: LEGAL DESCRIPTION: PERMIT APPLICANT: LOUIS LEE OWNER INFORMATION: ❑ I am exempt under Sec. Date: Owner: Carrier: NO EMPLOYEES SGN2007 -00114 50 S ANAHEIM BLVD P BK 174 PG 41 PAR 1 , B & P.C. for this reason: CITY :O A NAHEIM CONTRACTOR INFORMATION: ARCHITECT /ENGINEER INFORMATION: RAYMOND JANAN T1C LLC SIGN HAUS CO %RAYMOND JANAN TIC LLC 13426 ROSECRANS AVE #G LOS ANGELES, CA 90036 - 3526 NORWALK, 906500000 CA JOB DESCRIPTION: Install one (1) illuminated wall sign for unit# 202. The Chel Acupuncture" VALUATION: 2,500.00 OWNER BUILDER DECLARATION I 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 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 licensed pursuant to the provisions of the Contractors License Law (Chapter 9)(commendng 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 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 the work, and the structure is not intended or offered for sale (Sec. 7044 Business and rofessions 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 build or improve for the purpose of sale). TI I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law). WORKER'S COMPENSATION DECLARATION 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, 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 e performance of the work for which this permit is issued. My worker's Compensation insurance carrier and policy are: Policy Number: EXEMPT This se need not be completed if t he permit is for one hundred dollars ($100) or less. 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 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. Date: 9/5/2007 Applican WARNING: FAILURE TO SECURE1ny •RKER'S COMPENSATION COVERAGE IS UNLAWFUL, AND ALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITI0' 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 performance of the work for which this permit is issued (Sec.3097.Civ.C): Lender's Information: I certify that I have read th is 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 city to enter upon the above mentioned property for inspection purposes. Date: 9/5/2007 Signature 5T pplicant o Agent The permit shall expire by limitation and become null and void if the building or work has not passed final Inspectoin 365 days from the date of permit issunace. A new permit is required to commence or continue work. PROCESSED BY: MSM Quanity: Electric Sign (Y /N): BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 QUARTER SECTION: 83 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 (commend ng with Section 7000) of Divs;n 3 of the Business and Professions Code. Date. 9/5/2007 Contractor: NUMBER: EXPIRATION DATE: BUS2004 - 02194 9/5/2008 TYPE: C45 TYPE: BUS Y Fees paid for Permit: 1 Total: 356.11 SIGN PERMIT NO. SGN2004 -00178 TYPE OF PERMIT New Attached to Structure Sign DATE: 12/20/2004 JOB ADDRESS: 50 S ANAHEIM BLVD LEGAL DESCRIPTION: P BK 174 PG 41 PAR 1 APPLICANT: JIM ROE OWNER INFORMATION: 20 S Anaheim LIc 50 S Anaheim Blvd Anaheim, CA 92805 JOB DESCRIPTION: VALUATION: 1,125.00 OWNER - BUILDER DECLARATION I 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 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 licensed 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 subjects the applicant to a civil penalty of not more than five hundred dollars ($500) Li 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 build or improve for the purpose of sale). [l I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for such projects with i_ contractors) licensed pursuant to the Contractor's License Law). I I am exempt under Sec. B & P C. for this reason: Date: Owner WORKER'S COMPENSATION DECLARATION CONTRACTOR INFORMATION: AN S SIGNS 1634 ORCHARD HILL LN HACIENDA HEIGHTS, 91745 0000 CA Install (1) illuminated wall sign with 2 transformers. 12 "/ 24" height, 15' width. PROCESSED BY. EMA I hereby affirm under penalty of perjury one of the following dedarations ❑ 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. have and will maintain worker's compensation insurance, as required by Section 3700 of e Labor Code, for the performance of the work for which this permit is issued. My worker's ompensation insurance carrier and policy are: Carrier STATE FUND Policy Number EXEMPT This section need not be completed if t he permit is for one hundred dollars ($100) or less. El 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 California, and agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code, I shall f rthwith comply with those provisions Date: 12/20/2004 Applicant: WARNING FAILURE TO SECURE WORKE 'S COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EM OYER 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. I 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: 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 presentives of this city to enter upon the above mentioned property for inspection p s. CONSTRUCTION LENDING AGENCY Date: 12/20/2004 Signature of Applicant or Agent e per rnit shall expire by limitation and become null and void if the building or work has not passed final inspectoin 365 days from the date of permit issunace. A new permit is required to commence or continue work. BUILDING DIVISION 200 S. ANAHEIM BLVD (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 QUARTER SECTION: 83 ARCHITECT /ENGINEER INFORMATION: LICENSED CONTRACTORS DECLARATION I 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 mfess n • e. ate: 12/20/2 .04 NUMBER: EXPIRATION DATE: BUS1998- 061965 12/20/2005 TYPE. C45 TYPE. BUS Con tractor Quanity 1 Number of Transformers. 2 Fees paid for Permit: Total: 190.07 PLUMBING PERMIT NO. PLM2003 -01491 TYPE OF PERMIT DATE: 9/9/2003 JOB ADDRESS: 50 S ANAHEIM BLVD LEGAL DESCRIPTION. P BK 178 PG 22 PAR 1 APPLICANT: DEON MACDONALD OWNER INFORMATION: Holualoa Anaheim 100 S Anaheim Blvd Anaheim, CA 92805 4 4 M '4 ' - 't \ c C ITY''' / AHEIM o� a.�l8f. CONTRACTOR INFORMATION TENANT WORKS, INC. 5405 ALTON PKWY #462 IRVINE, 926040000 CA JOB DESCRIPTION: Plumbing for tenant improvement. BLD2003 -03271 PROCESSED BY CAL 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 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 licensed 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 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 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 town 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 build or improve 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 Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law). El 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 dedarations ❑ 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 hi : -emit is issued. I have and will maintain worker's compensation insurance, as required by Section 3700 of Labor Code, for the performance of the work for which this permit is issued. My worker's •npensation insurance carrier and policy are: Carrier: STATE FUND Policy Number. 1499067 -03 This section need not be completed if the penult is for one hundred dollars ($100) or Tess. ❑ 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 California, and agree that if I should become subject to t a worker's compensation provisions of Section 3700 of the Labor C , I shall forth c mpIy thos ovisions Date: 9/9/2003 Applicant: WARNING FAILURE TO SECURE WORKER'S 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 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: 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 representiv9s oj4his dt nter upon the above mentioned property for inspection g i1 ses. Date: 9/9/2003 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 permit is required to commence or continue work ARCHITECT /ENGINEER INFORMATION: LICENSED CONTRACTORS DECLARATION I I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000) of Divsiq 3 of the sine:nd Profe ;4L?► _ode. D. e: 9/9/2003 NUMBER: 738903 TYPE. B ITEMS Kitchen Sink Total: BUILDING DIVISION 200 S. ANAHEIM BLVD (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 QUARTER SECTION: 83 Contractor EXPIRATION DATE. 8/31/2005 Fees paid for Permit: 54.75 1 ELECTRICAL PERMIT NO. ELE2006 -00595 TYPE OF PERMIT Alteration or Addition to Existing DATE. 4/24/2006 JOB ADDRESS. 50 S ANAHEIM BLVD LEGAL DESCRIPTION: P BK 174 PG 41 PAR 1 APPLICANT' PATRICK LE OWNER INFORMATION: CONTRACTOR INFORMATION: RAYMOND JANAN TIC LLC LOI V HOANG %RAYMOND JANAN TIC LLC 12861 LUCILLE AVE LOS ANGELES, CA 90036 3526 GARDEN GROVE, 92841 0000 CA JOB DESCRIPTION: Electrical for tenant improvement for dental office. (Ref. BLD2006- 00595) 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 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 licensed 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 subjects the applicant to a civil penalty of not more than five hundred dollars ($500). n 1, 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 build or improve for the purpose of sale). 0 I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law). El I am exempt under Sec. Date: Owner: , B & P C. for this reason: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 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. a 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. My worker's Compensation insurance carrier and policy are: Carrier: STATE FUND This section need not be completed If the permit Is for one hundred dollars ($100) or less. DcI 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 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. Date: 4/24/2006 Applicant: WARNING: FAILURE TO SECURE SUBJECT AN EMPLOYER TO CRI THOUSAND DOLLARS ($100,000) PROVIDED FOR IN SECTION 37 Policy Number 1535918 -08 ORKER'S COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL NAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS 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: 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 city to enter upon the above mentioned property for inspection purposes. Date: 4/24/2006 Signatu : of Applicant The permit shall expire , imi ; ' • • • ecome 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. QUARTER SECTION: 83 ARCHITECT /ENGINEER INFORMATION: PROCESSED BY ENO LICENSED CONTRACTORS DECLARATION 1 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. Date: 4/24/200 NUMBE 71065 TYP B BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 Factory Wired Appl- up to 1hp Underfloor Raceways, each 100 ft. Receptacles, switches, lights INSPECTION REQUEST LINE: (714) 765 - 4626 Total: Contracto EXPIRATION DATE: 8/31/2007 Fees paid for Permit: 191.32 3 1 73 SIGN PERMIT NO. SGN2003 -00165 TYPE OF PERMIT New Attached to Structure Sign CITY ° ®F A! EI M 3 JOB ADDRESS: 50 S ANAHEIM BLVD APPLICANT: TRACEY DRENNAN OWNER INFORMATION: 20 S Anaheim LIc 50 S Anaheim Blvd Anaheim, CA 92805 JOB DESCRIPTION: VALUATION: 600.00 4 10 LEGAL DESCRIPTION: P BK 174 PG 41 PAR 1 WORKER'S COMPE SATION DECLARATION 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 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. ❑ 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. My worker's Compensation insurance carrier and policy are: Carrier: CONTRACTOR INFORMATION: ARCHITECT /ENGINEER INFORMATION: Install (1) wall mounted, non - illuminated sign. (40 ft by 48 ft) "The Knitty Gritty" PROCESSED BY: AEM 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 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 licensed 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 subjects the applicant to a civil penalty of not more than five hundred dollars ($500) U 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 sa . 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 or improve 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 e: 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' se Law) /2. —/2 exempt under er Sec. Ws.'" - �) Date: 7 Ow .�► Policy Number 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: 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 he = uthorr epre - ntives of this city to enter upon the above mentioned property for reason: Date: 12/12/2003 This section need not be completed if t he permit is for one hundred dollars ($100) or less. 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 California, and agree that if I s • - : come .. - o the worker's compensation provisions of Section 3700 of th = Lab. C 4 ,�,�i j hall fo hwith comply with those provisions i :II ■ Date: 12/12/2003 Applicant: WARNING FAILURE TO SECURyWORKER'S 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 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. 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 inspectoin 365 days from the date of permit issunace. A new permit is required to commence or continue work. Date: 12/12/2003 NUMBER: TYPE BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 QUARTER SECTION: 83 LICENSED CONTRACTORS DECLARATION I 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. Contractor EXPIRATION DATE: Quanity 1 Electric Sign (Y /N): N Fees paid for Permit: Total: 79.87 PLUMBING PERMIT NO. PLM2004 -01529 TYPE OF PERMIT DATE: 9/14/2004 QUARTER SECTION: 83 ARCHITECT /ENGINEER INFORMATION: PROCESSED BY CDL 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 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 licensed 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 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 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 build or improve 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 Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law) ❑ 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 dedarations. JOB ADDRESS: 50 S ANAHEIM BLVD LEGAL DESCRIPTION: P BK 174 PG 41 PAR 1 APPLICANT: PATRICK LE OWNER INFORMATION: 20 S Anaheim Llc 50 S Anaheim Blvd Anaheim, CA 92805 JOB DESCRIPTION: Tenant improvement for 1309sf dental office (REF: BLD2004- 02959). ❑ 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 thi ermit is issued. JI have and will maintain worker's compensation insurance, as required by Section 3700 of he Labor Code, for the performance of the work for which this permit is issued. My worker's Compensation insurance carrier and policy are: Carrier STATE FUND This section need not be completed if the permit is for one hundred dollars ($100) or less. ❑ 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 California, and agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code, I shall fo hwith com• ttrtl't"ose provisions Date: 9/14/2004 Applicant: WARNING FAILURE TO SECURE WORKER'S COM . ' OVERAGE 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 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: 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 hereb authorize representives of this . ty•to enter upon the above mentioned property for i p Lion p CONTRACTOR INFORMATION: K M N CONSTRUCTION 12861 LUCILLE AVE GARDEN GROVE, 92841 0000 CA Policy Number. 044 -03 UNIT 0022115 Date: 9/14/2004 Sig.: The permit shall e b limi nd 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 1 I hereby affirm under penalty of perjury that I am licensed under provisions of chapler_9- (commencing with Section 7000) • Lt on 3 of the Business and •fes rate: 9/14/21 .• NUMBER: 839805 TYPE. B ITEMS Water Heater Floor Sink Misc Fixture Water Distribution (mod. existing) Sewer - per 100 feet Total: BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 on tractor EXPIRATION DATE. 6/30/2006 " Fees paid for Permit: 253.41 1 1 5 1 1 MECHANICAL PERMIT NO. TYPE OF PERMIT Alteration to Existing DATE: 10/20/2003 JOB ADDRESS: 50 S ANAHEIM BLVD APPLICANT: JAY SEXTON OWNER INFORMATION: Holualoa Anaheim 100 S Anaheim Blvd Anaheim, CA 92805 JOB DESCRIPTION: Relocate registers and ducts for tenant improvement. BLD2003 -03271 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 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 licensed 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 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 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 build or improve 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 Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a _ ontractor(s) licensed pursuant to the Contractor's License Law) 1 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: ❑ I have and will maintain a certificate of consent to self- insure for worker's compensation, as prov' d for by Section 3700 of the Labor Code, for the performance of the work for which this rmit is issued. have and will maintain worker's compensation insurance, as required by Section 3700 of e Labor Code, for the performance of the work for which this permit is issued. My worker's Compensation insurance carrier and policy are: Carrier STATE FUND MEC2003 -01073 LEGAL DESCRIPTION: P BK 178 PG 22 PAR 1 CONTRACTOR INFORMATION: SELECT HEATING & AIR CONDITION 767 N MAIN ST ORANGE, 92868 0000 CA Policy Number 0019827 -2003 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: Date • 10/20/2003 AHEIM This section need not be completed if the pemmit is for one hundred dollars ($100) or less. ❑ 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 California, and agree that if I should become subject to th orker's compensation provisions of Section 3700 of the Labor Code, all forthwi co I ith those provisions Date. 10/20/2003 Applicant: /A-t l� UNLAWFUL, U W UL, AND SHALL SUB CT A E �'•LOY TO CRIMINAL PENALTIES TI S 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, I NTERESTM AND ATTORNEY'S FEES I certify that I have read this application and state that the above information is correct. I agree to comply with all city o dinances and state laws relating to building construction, and hereby authorize representivr of this city to enter upon the above mentioned property for inspection p .,.oses. Sig ' ture df"Applicant or Agent The per shall : pire by limitation and become null and void if the building or work ha not passed final inspection 365 days from the date of permit issuance. A new permit is required to commence or continue work PROCESSED BY. CAL Dafte: 10/20/20 NUMBS 445205 TYPE. Items Commercial Systems BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 QUARTER SECTION: 83 ARCHITECT /ENGINEER INFORMATION: LICENSED CONTRACTORS DECLARATION I I hereby affirm under penalty of perjury that I am licensed under provisions of c :pter 9 (commencing with Section 7000 of Divsion : of the B/ iness and Professions C R: " EXPIRATI 8/31/2005 C20 HTAC tractor N DATE. Fees paid for Permit: Total: 54.75 3 ELECTRICAL PERMIT NO. ELE2003 -01636 TYPE OF PERMIT Alteration or Addition to Existing DATE: 9/24/2003 JOB ADDRESS: 50 S ANAHEIM BLVD LEGAL DESCRIPTION: P BK 178 PG 22 PAR 1 APPLICANT: RICHARD THOMPSON OWNER INFORMATION: Holualoa Anaheim 100 S Anaheim Blvd Anaheim, CA 92805 CONSTRUCTION LENDING AGENCY CITY OF ? CONTRACTOR INFORMATION: ARCHITECT /ENGINEER INFORMATION: THOMPSON ELECTRICAL CONSTRUCT! 1401 N BATAVIA #112 ORANGE, 92667 0000 CA JOB DESCRIPTION: Electrical for tenant improvement office REF BLD2003 -03271 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 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 licensed 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 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 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 build or improve for the purpose of sale) 1 1 I, as the owner of the property, am exdusively contracting with licensed contractors to construct the project (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 contracts for such projects with e_gontractor(s) licensed pursuant to the Contractor's License Law) u 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: ❑ 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. 9t 1 have and will maintain worker's compensation insurance, as required by Section 3700 of e Labor Code, for the performance of the work for which this permit is issued. My worker's Compensation insurance carrier and policy are: Carrier STATE COMPENSATION FUND Policy Number 465 -03 UNIT 0000195 This section need not be completed if the permit is for one hundred dollars ($100) or less. ❑ 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 Califomia, and agree that if I should become s ct to the worker's compensation provisions of Section 3700 of the Labor Code, s forthw th those provisions. Date. 9/24/2003 Applicant: � �/./ � WARNING FAILURE TO SECU WORKERS Co PEN SA •N COVERAGE IS UNLAWFUL, AND SHALL SUBJ CT 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. 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: 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 - uthori - - presentives of this city to enter upon the above mentioned property for inspect 'n ou •.se Date: 9/24/2003 S' 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. PROCESSED BY AEM LICENSED CONTRACTORS DECLARATION I I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 (commencing with Sectio `000) of ; ''ion 3 ., he B si • -ss and Professions • ? . •/ l Date: 9/24/2003 NUMBER: 360849 TYPE: B TYPE. C10 BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE. (714) 765 - 4626 QUARTER SECTION: 83 Con tractor EXPIRATION DATE. 8/31/2004 Subpanels: Under 600 V, up to 200 amps Sub -pole (includes sub -panel and outlets) Receptacles, switches, lights Fees paid for Permit: Total: 133.70 1 1 50 ELECTRICAL PERMIT NO. ELE2004 -01995 TYPE OF PERMIT Alteration or Addition to Existing DATE: 9/14/2004 JOB ADDRESS: 50 S ANAHEIM BLVD LEGAL DESCRIPTION: P BK 174 PG 41 PAR 1 APPLICANT: PATRICK LE OWNER INFORMATION: 20 S Anaheim LIc 50 S Anaheim Blvd Anaheim, CA 92805 JOB DESCRIPTION: Tenant improvement for 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 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 licensed 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 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 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 build or improve 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 Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with e_gontractor(s) licensed pursuant to the Contractor's License Law). I am exempt under Sec. , B & P C for this reason: Date: Owner: CONTRACTOR INFORMATION: K M N CONSTRUCTION 12861 LUCILLE AVE GARDEN GROVE, 92841 0000 CA 1309sf dental office (REF BLD2004- 02959). WORKER'S COMPENSATION DECLARATION 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 worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which thi permit is issued. I have and will maintain worker's compensation insurance, as required by Section 3700 of t e Labor Code, for the performance of the work for which this permit is issued. My worker's ompensation insurance carrier and policy are: Carrier: STATE FUND Policy Number 044 -03 UN 0022115 This section need not be completed if the permit is for one hundred dollars ($100) or less. ❑ 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 California, and agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor C.- -, .II forth ith com. ' f (hose provisions Date: 9/14/2004 Applicant. WARNING. FAILURE TO SECUR= WORKERS CO ' ON COVERAGE IS UNLAWFUL, AND SHALL SUBJE T 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 P� j 816q� CITY OPANAHEIM \1 r te ' 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: 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 city to enter upon the above mentioned property for inspe. pur, Date: 9/14/2004 Sign .. e of Applic• ' gent The permit shall ex • e .y 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. QUARTER SECTION: 83 ARCHITECT /ENGINEER INFORMATION: PROCESSED BY. CDL LICENSED CONTRACTORS DECLARATION 1 I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000) -61j ion of the Business and. _- . --...- Profes ion Code. Date: 9/14/2004 NUMBER: 839805 TYPE. B Motors Up to 1 hp Receptacles, switches, lights BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE. (714) 765 - 4626 EXPIRATION DATE: 6/30/2006 Fees paid for Permit: Total: 142.36 2 60 PLUMBING PERMIT NO. PLM2006 -00552 TYPE OF PERMIT DATE: 4/24/2006 JOB ADDRESS: 50 S ANAHEIM BLVD LEGAL DESCRIPTION: P BK 174 PG 41 PAR 1 APPLICANT: PATRICK LE OWNER INFORMATION: CONTRACTOR INFORMATION: RAYMOND JANAN TIC LLC LOI V HOANG %RAYMOND JANAN TIC LLC 12861 LUCILLE AVE LOS ANGELES, CA 90036 3526 GARDEN GROVE, 92841 0000 CA JOB DESCRIPTION: Plumbing for tenant improvement for dental office. (Ref. BLD2006- 00595) 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 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 licensed 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 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 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 build or improve 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 Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's El Law). IJ 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: ❑ 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. P I have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code r the performance of the work for which this permit is issued. My worker's Compensation insurance carrier and policy are: Carrier STATE FUND Policy Number 1535918 -08 his section need not be completed if the permit Is for one hundred dollars ($100) or less. ?fi certify that in the performance of the work for which this permit is issued, I shall not employ any person in any anner 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. ONSTRUCTION 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: Date: 4/24/2006 Applicant: t AI %r — WARNING: FAILURE TO SECURE W '. RKER'S :MPENSATION COVERFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI AL PENALTIES AND CIVIL FINES U' • HUNDRED THOUSAND DOLLARS ($100,000), I ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370. OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. I certify that I have read this application and state that the above infprmatiori is correct. I agree to comply with all city ordinances and state laws relating to building constructiori; and hereby authorize representives of this city to enter upon the above mentioned property foo insprection purposes. ( Loy 1 « Date: 4 /24/2006 Signatu : of Applicant o e permit shall expire by limitation and become null and void if the building or work has of passed final inspection 365 days from the date of permit issuance. A new permit is required to commence or continue work. QUARTER SECTION: 83 ARCHITECT /ENGINEER INFORMATION Date: N BER: 710657 TYPE: B ITEMS Urinal Backflow - over 2 in Water Heater Water Closet Kitchen Sink Floor Sink Sewer - per 100 feet Total: BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE. (714) 765 - 4626 Contra, or EXPIRATION DATE: 8/31/2007 Fees paid for Permit: PROCESSED BY ENO 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. 452.50 1 4 1 1 5 1 1 MECHANICAL PERMIT NO. MEC2006 -00348 TYPE OF PERMIT Alteration to Existing ITYOA rbono C NAHEIM DATE: 4/24/2006 JOB ADDRESS: 50 S ANAHEIM BLVD LEGAL DESCRIPTION: P BK 174 PG 41 PAR 1 APPLICANT PATRICK LE OWNER INFORMATION: CONTRACTOR INFORMATION: RAYMOND JANAN TIC LLC LOI V HOANG %RAYMOND JANAN TIC LLC 12861 LUCILLE AVE LOS ANGELES, CA 90036 3526 GARDEN GROVE, 92841 0000 CA JOB DESCRIPTION: Mechanical for tenant improvement for dental office. (Ref. BLD2006- 00595) 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 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 licensed 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 subjects the applicant to a civil penalty of not more than five hundred dollars ($500). U 1, 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 build or improve 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 Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law). ❑ I am exempt under Sec. Date: Owner , B & P C. for this reason: WORKER'S COMPENSATION DECLARATION 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 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. Vde, for the performance I have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor ode, for the performance carrier and policy are: Carrier STATE FUND Policy Number 1535918 -08 This section need not be completed If the permit is for one hundred dollars ($100) or less. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in 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 forthwi comply with those provisions. Date: 4/24/2006 Applicant: C WARNING: FAILURE TO SECURE W• RKER'S COMPE SATION COVERAG S UNLAWF D SHALL SUBJECT AN EMPLOYER TO CRIMI AL PENALTIES AND CIVIL FINES UP TO 0 ' NDRED THOUSAND DOLLARS ($100,000), I ADDITION TO THE COST OF COMPENSATIoN, DAMAGES AS PROVIDED FOR IN SECTION 3706 • F THE LABOR CODE, INTERESTM AND ATTORNEYS FEES. ONSTRUCTION LENDING AGENCY ./ Signature of A. • ' -nt or .:nt 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: 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 ity to enter u • • • : above mentioned property for inspection purposes. Date 4/24/2006 The p rmit shall expire by imi . • 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. PROCESSED BY. ENO BUILDING DIVISION 200 S. ANAHEIM BLVD (714) 765 - 5153 INSPECTION REQUEST LINE. (714) 765 - 4626 QUARTER SECTION: 83 ARCHITECT /ENGINEER 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. Date: NUM': ER: 710 57 TY E: B Items Vents under 300 (dryer, range, etc) Total: Contract EXPIRATION DATE: 8/31/2007 Fees paid for Permit: 91.16 2 OWNER- BUILDER DECLARATION WORKER'S COMPENSATION DECLARATION MECHANICAL PERMIT NO. TYPE OF PERMIT Alteration to Existing DATE: 9/14/2004 JOB ADDRESS: 50 S ANAHEIM BLVD APPLICANT: PATRICK LE OWNER INFORMATION: 20 S Anaheim Llc 50 S Anaheim Blvd Anaheim, CA 92805 M EC2004 -01181 LEGAL DESCRIPTION: P BK 174 PG 41 PAR 1 CONTRACTOR INFORMATION: K M N CONSTRUCTION 12861 LUCILLE AVE GARDEN GROVE, 92841 0000 CA JOB DESCRIPTION: Tenant improvement for 1309sf dental office (REF: BLD2004- 02959). 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 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 licensed 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 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 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 build or improve for the purpose of sale) [i 1, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for such projects with c � ontractor(s) licensed pursuant to the Contractor's License Law). I I am exempt under Sec. , B & P.C. for this reason: Date: Owner 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 worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which hi permit is issued. I have and will maintain worker's compensation insurance, as required by Section 3700 of e Labor Code, for the performance of the work for which this permit is issued. My worker's om pen sat ion insurance carrier and policy are: Carrier: STATE FUND Policy Number 044 -03 UNIT 0022115 This section need not be completed if the permit is for one hundred dollars ($100) or Tess. ❑ 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 California, and agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code, I • rthwit com. • - : - provisions Date: 9/14/2004 Applicant: WARNING. FAILURE TO SECURE •RKER'S COM _ • OVERAGE IS UNLAWFUL, AND SHALL SUBJECT 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, INTERESTM AND ATTORNEYS FEES CONSTRUCTION LENDING AGENCY CITY:0 FANAH EI M y f•' \DAD 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: 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 his -city o enter upon the above mentioned property for inspe Date • 9/14/2004 Signature o ..licant or Agent The permit s - pure 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 BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE. (714) 765 - 4626 QUARTER SECTION: 83 ARCHITECT /ENGINEER INFORMATION: PROCESSED BY CDL LICENSED CONTRACTORS DECLARATION I I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 commencing with Section 7000) of Divsio e Business and Pro f -sk . e D e: 9/14/2104 _ NUMBER: 839805 TYPE. B Items Vents under 300 (dryer, range, etc) Commercial Systems tor EXPIRATION DATE. 6/30/2006 Fees paid for Permit: Total: 88.96 2 1 SIGN PERMIT NO. __TYPE OF PERMIT New Attached to Structure Sign DATE: 9/5/2007 JOB ADDRESS: LEGAL DESCRIPTION: PERMIT APPLICANT LOUIS LEE OWNER INFORMATION: RAYMOND JANAN TIC LLC SIGN HAUS CO %RAYMOND JANAN TIC LLC 13426 ROSECRANS AVE #G LOS ANGELES, CA 90036 - 3526 NORWALK, 90650 0000 CA Install one (1) illuminated wall sign for unit# 202. "The Chel Acupuncture" JOB DESCRIPTION: VALUATION. 2,500.00 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 city or county which requires a permit to construct, alter, improve, demolish or repair any str ucture, 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)(com me ncing 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 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 the work, and the structure is not intended or offered for sale (Sec. 7044 Business and rofessions 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 build or improve for the purpose of sale). n 1, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for such projects with a contractor(s) I icensed pursuant to the Contractor's License Law). I am exempt under Sec. Date: Owner SGN2007 -00114 50 S ANAHEIM BLVD P BK 174 PG 41 PAR 1 CITY I . fF: ANAH EI M CONTRACTOR INFORMATION: ARCHITECT /ENGINEER INFORMATION: , B & P.C. for this reason: WORKER'S COMPENSATION DECLARATION 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 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. have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code, for'_ e performance of the work for which this permit is issued My worker's Compensation insurance carrier and policy are: Carrier: NO EMPLOYEES Policy Number EXEMPT This se need nct be completed if t he permit is for one hundred doliars($100) or less. 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 California, and agree that 111 should become subject to the worker's compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 9/5/2007 Applicaii WARNING: FAILURE TO SECURE 6RKER'S COMPENSATION COVERAGE IS UNLAWFUL, AND ALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITIOji 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 performance of the work for which this permit is issued (Sec.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 representives of this city to enter upon the above mentioned property for inspection purposes. Date: 9/5/2007 Signature o pplicant o gent The permit shall expire by limitation and become null and void if the building or work has not passed final Inspectoin 365 days from the date of permit issunace. A new permit is required to commence or continue work. BUILDING DIVISION 200 S. ANAHEIM BLVD (714) 765 - 5153 PROCESSED BY: MSM INSPECTION REQUEST LINE: (714) 765 - 4626 QUARTER SECTION 83 LICENSED CONTRACTORS DECLARATION 1 I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 (commend ng with Section 7000) of Divs.n 3of the Business and Professions Code. Date. 9/5/2007 Contractor NUMBER: EXPIRATION DATE. BUS2004 - 02194 9/5/2008 TYPE: C45 TYPE. BUS Quanity Electric Sign (Y /N): Y Fees paid for Permit: 1 Total: 356.11