2931 E. White Star Ave.
JOB DESCRIPTION:Seismic retrofit.
VALUATION: 20,000.00
I 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 Busmess and
Professions Code: any city or countywhjch 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).
o I, as owner of property, or my employees with wages as theirsolecompe:1sation, 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 :3mployees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one yeal of completion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale).
o I, as the owner of the property, am exclusively contracting with licensed o)ntractors 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).
o I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to seJf~insure for warker's~ompensatian,
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
abor Code, for the performance of the work for which this permit is issued. My worker's
ompensation insurance carrier and policy are:
Carrier: EMPLOYEE SERVICE GROUP Policy Number. 280605
BUILDING PERMIT NO. BLD200S-033S6
TYPE OF PERMIT C T
Tenant Improvement (Limited) I Y
DATE: 10/19/2005
JOB ADDRESS: 2931 E WHITE STAR AVE
LEGAL DESCRIPTION: P BK 123 PG 46 PAR 4
APPLICANT: JIM WI LLlAMS
OWNER INFORMATION:
A J ENTERPRISES LLC
2931 E WHITE STAR AVE
ANAHEIM, CA 92806
CONTRACTOR iNFORMATION:
INNOVATIVE STRUCTURES INC
5222 PI RONNE CT #301
SALlDA, CA 953680000
BUSINESS PHONE: 209545.6040
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
INSPECTION REQUEST LiNE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 140
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: MSM
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
o I certify that in the perfonnance 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 bee e subject to the rker's compedsation
provisions of Section 3700 of the Labo Cd, I sha~ for h amply with those provisions.
'w. 'd--
Date: 10/19/2005 Applicant: ....
WARNING: FAILURE TO SECUR
UNLAWFUL, AND SHALL SUBJE AN MPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED OUSAND DOLLARS ($100,000), IN ADDITJON TO THE
COST OF COMPENSATION/D MAGES 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 agencyfor 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 co Iy with all city ordinan and state laws relating to building construction, and
hereby au 0 e repre~ntives t I. city to enter upon the above mentioned ,:.':"cperty for
i nsp io p P?ses.
Date: 10/19/2005
Signature of Applicant or Agent
The per 'tshall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance, A
new permit is required to commence or continue work
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) ivsion 3 of the usiness and
Professions e.
10/19/200
Date:
Contractor
NUMBER
762722
TYPE
TYPE
TYPE
EXPIRATION DATE
5/31/2007
A
B
C51
Construcion Tvpes:
VN, ,
Fire Sprinklered?
NO
Fees paid for Permit:
Total:
386.19
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormsfTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable Items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/DiaphragmlFrame)
Masonry (ReinfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
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
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T-Bar Electrical
T-Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS DATE INSPECTOR
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765.5268
Sub List/Business License 765-5194
Zoning 765-5139 t"'I
Building Final (Last Inspection - Only \1\(~lX 1..- A. 'J-.. .- J...-
Ailer Above Complete) 1<...04 '--
PARTIAL INSPECTIONS
~:;In~t;~ fL-- A,
Mechanical Inspections
Plumbing Inspections
Electrical Inspections
BUILDING PERMIT NO. BLD2005-03231
TYPE OF PERMIT
Tenant Improvement (Limited) CITY
DATE: 11/10/2005
JOB ADDRESS: 2931 E WHITE STAR AVE
LEGAL DESCRIPTION: P BK 123 PG 46 PAR 4
APPLICANT: JIM WILLIAMS
OWNER INFORMATION:
A J ENTERPRISES LLC
2931 E WHITE STAR AVE
ANAHEIM, CA 928060000
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 140
ARCHITECT/ENGINEER INFORMATION:
DAVID D ROBERTS
343 THIRD ST
LAGUNA BEACH, CA 92651
PROCESSED BY: KBT
OWNER-BUILDER DECLARATION
I hereby affirm under penalty 0 perjury that I am exempt from the ontractor's License Law for t e 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 Jicem:ed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subj~i;ts the applk:ant to a civU penalty of not more than five hundred dollars
($500).
o I, as owner of property, or my employees with wages as their sole compersation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License La'v 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 tmployees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year ,of completion, the owner.builder will have the burden of proving that he
did not build or improve for the purpose of sale).
o I, as the owner of the property, am exclusively contJacting with licensed ccntractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of property w")O builds or improves thereon, and who contracts for such projects with
tl-Rontractor(s) licensed pursuant to the Contractor's License Law). , ..
U I am exempt under Sec. , B & P .C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
r hereby affirm under penalty of perjury one of the following declarations: ,',
o I have and will maintain a certificate of consent to self-insure for worker's ifompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the"\vork for which
this permit is issued. ;
1k? I have and will maintain worker's compensation insurance, as required by ~;ection 3700 of
,the Labor Code, for the performance of the work for which this permit is issued1 My worker's
Compensation insurance carrier and poliO} are:,
Carrier: EMPLOYEE SERVICE GROUP Policy Number. 280605
This section need not be completed if the pennil is lor one hundred dollars ($1 00) 0( less,
o I certify that in the performance of the work for which this permit is issu,ed,l shaU 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 bject to the~Orker'S c mpensation
provisions of Section 3700 of the labor Code a<< forthwith co th those provisions.
.;;?<J.,. ~
Date: 11/10/2005 Applicant:
WARNING: FAILURE TO SECURE WORK'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN PLOYER TO CRIMINAL PENALTI?:S AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 DF 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 ofJhe. 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. J
agree to comply with all city ordinances and state laws relating to building construction, and
hereby author e epresentives~f this oj to enter upon the above mentioned property for
inspection p p s.
... ./ _ } .
..., l--</... Date: 11/10/2005
Signature of AppJJcant or Agent
The permi hall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury t at I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of .VSio~3 of the au .ness and
Professions Code...! '::-...
11/10/200 - -,
Date:
NUMBER
762722
TYPE
TYPE
TYPE
Contractor
EXPIRATION DATE
5/31/2007
A
B
C51
Construcion Tvpes:
VN, ,
Occupancy Groups:
B, , , ,
Fire Sprinklered?
T.\. Area:
YES
7,594
Fees paid for Permit:
Total:
2.608.60
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE
Tern ora Power Pole
Plumbin DrainlWaste Pipe
Electrical Ground Electrode/Ufer
SetbacklFormsrrrenches Footings)
00 not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbin Water Pipe/Sprinkler Valves
Mechanical Groundwork)
Electrical Under round Conduit
Pre-slab Compaction/Membrane Reinf.
Underpinning (Floor Joist/Girders)
00 not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (SheathinglDiaphragm/Frame)
Mason Reinf.lBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
INSPECTOR
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T -Bar Electrical
T -Bar Mechanical
T -Bar Structural
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
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)
PARTIAL INSPECTIONS
~~:r;!:nuctions .
II :p, ;;vI 02;, jJtf
Mechanical Inspections
PlumbinQ Inspections
~ Electrical Inspections
p
INSPECTOR
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