2121 E. Winston Rd. (2)
CONTRACTOR INFORMATION:
J & W CONSTRUCTION SPECIALTIES
10142 SHOEMAKER
SANTA FE SPR INGS, CA 906700000
BUSINESS PHONE: 562906-1469
JOB DESCRIPTIONlnstall compressor pad in existing warehouse
VALUATION: 7,000.00
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 Business,and
Professions Code: any city or county which requires a permit to construct, a~er. 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 301 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 subje~ts the applicant to a civil penalty of not more than five hundred dollars
($500).
o I. as owner of property, or my employees with wages as their sole comper'sation, 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 helSelf or through his or her own E!mployees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale).
o I, as the owner of the property, am exclusively contracting 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:-JO builds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractor's License Law). .
o 1 am exempt under Sec. , B & P .C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of peljury one of fhe following declarations:
o I have and will maintain a certificate of consentto 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 Bection 3790 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: CLARE DON
BUILDING PERMIT NO. BLD2005-02359
TYPE OF PERMIT
Tenant Improvement (Limited)
DATE: 81512005
JOB ADDRESS: 2121 E WINSTON RD
LEGAL DESCRIPTION: SEC 24 T 4 R 10 SE114 NW114 NW114
APPLICANT: RJ. PERKINS
OWNER INFORMATION:
CLYDE ASSOCiATES
1 POST ST
SAN FRANCISCO, CA 94104 0000
ElM
BUILDING DiViSION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 116
ARCHITECTIENGINEER INFORMATION:
MARK VANDERZEE
PROCESSED BY: MJF
POlicy Number. 03KR0027t\13
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
gertify 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 jf I should become subject to the worker's compensation
provisions of Section 3700 of the bar Code, I shall fort with comply with those provisions.
"
Date: 81512005 Applicant:
WARNING: FAILURE TO SECU WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SU ECT AN EMPLOYER TO CRIMINAL PENALTiES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITlON TO THE
COST OF COMPENSATION, DAMAGES AS PROVi DED 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
pertormance of the work for which this permit is issued (8ec.3097 .Civ.C):
Lender's Information:
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby author e representives of this city to enter upon the above mentioned property for
i ~ection rpo . _ t\ -.
o Date: 81512005
Signature of Applicant or Agent
The ermit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with S ion 7000) 0 'vsian 3 of the Business and
Professio Cod.~ r .......
Construcion Types:
V N, ,
Contractor
B
C51
A
Fees paid for Permit:
Tol.l:
252.02
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Gr d Electrode/Ufer
ormslTr nches F tin 'I L-<>
Do not install sub loor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane Reinf.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reinf./Bond BeamlPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
INSPECTOR
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
Penetrat.ions (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior lath
Exterior lath
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T-Bar Electrical
T-Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5288
Sub List/Business license 765-5194
oning 765.5139
Building Final (Last Inspection - Only ql
After Above Complete)
DATE
INSPECTOR
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbina Insoections
Electrical Inspections