2528 W. La Palma Ave.
BUILDING PERMIT NO. BLD2004-00583
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714) 765. 5153
INSPECTION REQUEST LINE:
(714)765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 25
TYPE OF PERMIT
Tenant Improvement (L,imited) CITY
DATE: 7/19/2004
. JOB ADDRESS: 2528 W LA PALMA AVE
LEGAL DESCRIPTION:SEC 7 T 4 R 10 POR NW1/4
APPLlCANT:.DAVID KOO
OWNER INFORMATION:
In C Chu rCh
11428 187Th St
Artesia..CA 90701 ,
JOB DESCRIPTION:renant improvement, re 'odel restrooms for ccessib~:it;:::;0;r.pfian('..e
VALUATION: 7,500.00 c' PROCESSED BY: ODC
I.____~__'._ OWNER-BUIL!)~;;:!ir;CLARATION "
I hereby affirm under penaity of periury that I a(11 exempt fr0m,th~ Contrc:.:d,il:';~:fLicerlse Law for the following rcason (Sec. 70:~1.5 Business and .
professions Code: a;'y city or Cf)untywhich reqLiires a perml, to (;0nst"_=:Jc,t':.:f\\~~!-, knp'rovt:!, demolish or repair any structure, prior to its'issuance.,also.
requires tf1t:' applics.r.t for suct:l permit to file a signee! s1atemt.-:r.t tho:Jt hels ir.'~>'sed pursuant to th~ provisions of the Contradorls License Law (Chapter
.9)(commancin ith Section 7000 of Division 3 of the Busino$s ar.d P:"ofe'}~,;~);;S Code) or tnat he is. exempt there.from ;;'Incl theb?sis for,the alleged
exemp'!ian ny violation of Section 7031.5 by any applicant for d perm:i s:/':]::-:;'5 the. :3pplicant to. a civil penalty of not more ~han five'hundred dollnrs
( 500 /. 'i' . . .
, as O'.lvner of praperty, or my employees wi~h wages ~s.HI~ir sO!t'Uj'o:-r:~~-'i:'i-<>at!or.; wiil de the work, and th~ structure is not !nt~nded Or offered fo:-'
sale (Sec. 7044 Business and Professions Code: Th:3 ContiactOf's U.::enf:~>,a.v ,j,:)cs not'::ipplyta a::. owner of property who t,uil~s o.r Impraves
thereon, ~Jd. who. daes such work himself ct' herself o.r through his ar.,h~r:~\;i:,;,h~r!1::lrJie~s;'Grcvided that such ilr:provemcnts are hot intendeq 9r
affared. for ~le. !f, however, the building. or improvement is sClld witrl 0:113 :r~J; qt. wmptetion, the owner~t.u;lde-r will have the olJrdGn of pro\'~g that h~
~Hd notiJuild or improve for the pur~ose af 5aie). . ..:..." :!' . ., .
,[2]1, <::I$'the owner afthe property, am e?,dusively contracting wiih !:'(;e:':~8d',;:...(mtr<.cta(s to Gon.,ttUCt th~ ~Iroject (See. 7IY...a., 3usin('...,s and Profbssic-r;:?
Code: The Contractor's License Law does not al3pty to 3n owner of p'0r)'.:lI~"l; '/lio bl..;!lds or Irnpro"€!s thereon, ~nd who .ccrtt;acts for such projectz wit-h
Jj~ 1omractor(s) lIcensed pursuant to the'" tract':)('s Ucen~e LclW}.
'~te:hi;?mmnderse~wnee- ,~P.C. cor.th." ,a~on: -~~~J~-~-:----- ----------:--
~~ WORKER'SCO PE SA ,C). ECtARATIDr. .;.__--1J I'" LICENSED CONTRACTORS DECLARATlON-l
I hereby affirm u'nderpena!ty of perjury one of the fo!lowing cecl'3rat\c,ns: , t I hereby 3ffi,rm urider penarty of pefJurj that I am-
o I have and will maintain a ce~ifJcate Of. consent to:;e. If-insure fOi' vv6rk,:.,;,\ ~(O;1:c.c;:r,satjon, I licensed undfr provision~;'of chapter ,9 (commencing
aspr()vided for.by Sectian 3700 aHhe labor Code, for the performan~, .::fI:l.~ work fo; which. with Section 7000) of Divsion 3 of the Bu.siness and
this permit is issued. .. .. j . I Professions Cc-de.
o I have "nd will maintain worker's compensation insurance, as ft9:qL;;!l-).;J I~Y Sect\')P. 3700 011 7!19f20"04
theL<.Jbor Cade,. for-the performance of the workior which this p.l:'r!""lit is i~~i>d. r..~yworkc!"'s . uate:
. Compensation insuianee canier and policy are: .., ; I
Carrier: PollOI Nwml'er. ..j NUMBER
;
CONTRACTOR INFCRI';',ITION:
ARCHITECT/ENGINEER INFORMATION:
.J
Contractor
E:XPIRATION DATE
Thisscction nee::l.nOt be completed if the pennit is fer one hundrEd doll~~s (11C~;...:;;r less.
Ii ; I certify that in the perfonn~nce of the work for which th~.~ermit.:$'i~;J,;.j,.t~hGl:J not
employ'any perso/') in any .manner so as to become subject to 'the wg-~~E;t~':-.<~~:np.ensafion ,laws
of Califomia,.and agree that if,J should become f:ubjed to.the worker's'cql'~;~~n5:;:ticn
. provisions of Section 3700 of.the L. ab ar e, hall faw ~~ Ply......w.i.'.~'t..i1,,;Sj p.ovt;ions.
Date: 7/19/2004 Applicant: . . . ~._:...
WARNING: FAILURE TO SECURE WORK 'R;~ OMPENS TIONX:OiiEfiAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIt,1INA('PEN,,'..TIES AND CIVIL
FINES UP TO ONE: HUND RED TH OU SAND DOLLARS ($100,000), IN ..;6s; nON :ro THE'
CQST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIOi 3~06' OF THE
. LABOR CODE, INTEREST AND ATTORNEY'S FEES.' .,
I CONSTRUCTION LENDING AGENCY F
I hereby affirm under penalty of pe:"jL!ry that there is a construction lenriio1g::~~>:.:-tcyfor the.....
"performance,ofthe work for which this permit is ::;;sued (Sec.3097 .C:v.,Cj: ~~: _
-~~...~""""-;-::"'!~~,;:;!-;;'~'.-.-:----------:---- - - ...~..~. - ... ..... '.- -.
TYPE
.Canstrucion Tvoes:
V 1HR, . .
Flre Sprinklcred"?
T.1. Area:
YES
.310
I certify that I have read this application and state that the above informaoon is correct. ,
i3gree to. 00 y' h all city ordinances and state laws relating to building construction, arid
hereb ere resen' es of. t is cit)/to e'nter upon the above mentioned property for
insp rlX>
Fees paid.for Permit:
Total:
308.79
Date' 7/19/2004
ignature of Applicant or Agent
ThEi permit shall expire by limitation and become null and void if the building or
work has not passed.final ,nspection 365 days from the date of perillit issuance. A
new permit is required to commence or continue work.
INSPECTION RECORD
- INSPECTION . DATE. INSPECTOR
Temporary Power. Pelle .
Plumbing (Drain/Waste Pipe)
Electrical Groun.d 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 (CompactionlMembrane.Reinf. .
Underpinning (F1oor.J.oistlGirders) .
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 (SheathinalDiaphragmlFrane)
Masonry (ReinfJB'ond BeamlPre-Grout) . . .
Rough Plilmbing (Top Out) .
Rough Mechanical
Rougn t:Iectrical (ury Wall) . .
Rough Electrical . . . .
Framing.' (Drily after PJbg.,_EJec.. Mech,. and Fire) I~ ~A'-
Insulation (SoundlEnergy). . ~
Do not tape or plaster until the following ppl/cable "
items have been signed: " _ , . .
Drywall ~lIqJD~ .r-
PenetrationS (Fire ~ed) Electrical , . ..
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing .
Interior Lath
Exterior Lath
GENERAL ITEMS .
Exterior Plaster (Brown Coat)
T -B" Electrical .
T -Bar Mechanical . .
T -Bar Structural ~
Sewer ' ,
WaterEngineerirlgBackflQw
Water Service . . .
FINAL INSPECTIONS.. .
Electrical Final
Plumbing Final
Date
Inspector
Mechanical. Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-519
Zoning 765-5139
Building Final (Last Inspection- Only
After Above Completel
. PARTIAL.INSPE.CT ON
.?fd~~ti~.~ p~)N(~ .
'. F{~mM&fI~7;~1~'t:~
Mechanical Inspections
PlumbinQ Inspections
Electrical Inspections