5711 E. La Palma
TYPE OF PERMIT
Tenant Improvement (Limited) C I TV
DATE: 11/1012003
JOB ADDRESS: 5711 E LA PALMA AVE
LEGAL DESCRIPTION: PM 85-20 PAR 1 POR OF PAR
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
, INSPECTION REOUESTL1NE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 184
, BUILDING PERMIT NO. ElLD2003-04379
CONTRACTOR INFORIV.ATION:
PREFERRED PAVIN~~ (OMPANY, INC
2850 E LA CRESTA AVE'
ANAHEIM..CA 9280600,})
BUSINESS PHONE: 714 3\21414
JOB DESCRIPTION:TenanlImprovement. Inslali1 new ramp al5799 and'tJ?cate 1 van accessible parlllng staliln fronl of 5755.
VALUATION: 4,OOO.00.i PROCESSED BY: J.jJ,
I OWNER-BUI!:'OE,.~DECLARATION "
. I hereby affirm under p~n311y cfl.?erjury that l.am _exempt from the Contrar.!q's License.Law for the following reason (Sec. 7031.5 Business and,'
P(Of~Sion,~ Cod,e: any city or qq.untywhic,,,,h rer",uires a permit, to construct, ~:ter".jmprove. demolish, or repair any structure, prior to its ISS, uance. also
~ lequires the applicant for such permit to file a signed statement that he ls/ii;ensed pursuant to the provisions of the Contractor's License law (Chapter
9}(comm'encing wlthSectiO"_7000 of Division 3 of the Business and Profei~!ons Code) or that he 'is exempt therefrom and the basis for the alleae-j
exempti911, ',Ari}(yiolation of Secti9n 103'1.5 by any applicant for a permit s;,;)jects ,the applicant to a dvU - pena~y of not more than five hundred donars
($500): '; ,~";~ '~, . , ',-, ,_' 1 .' , _ " .
o I, as, owner of property, or my employees w-ith wages c:.s their sale com'ilel1Satioo, will do the work, and the structure is not intended or'offered for
sale ($ec::7044 ausinessand Prof€'!$sions Code: The Contractor's Licer.st:Lawdoes not apply to an owner of praperty-who builds or improves
therean, and who doe~such work himself or herserf or through his or her 0);1 employe.es, provided that such improvements' are not intended ar
affered for sale. If, however, t~e b\tildlng ar improvement if: $old with ons: yi'C:lr of CO:lTlpletion, the owner~builder wUI have tha burden of proving that he
did not buUd or improve for the pwpose of sale).
o ,I, as the ,~wner of the_property, am exdusively cont:'".acting With liCer1:?c"~- cOntractors to. construct the project (Sey. 7044 Business'and .Professiq.ns .
Code: The Contractor's License Law does not apply, to an owm~rsf pr-'':::{:'~':~' who builds or impro~s thereon, and who contracts for such projects With,
?-~ntractor(s) licerlSed pursusntto theContral;tor's license 4w), ' .
.' U. I am exempt under See; __ .,B & P .C. for this ,Cdsun:
Date: OvvTIer: . '
I
APPLICANT: DAVID, WILKINSON
OWNER INFORMATION:
Raymond Spehar
6937 E Avenida De Santiago.
Anaheim, CA 92807
ARCHITECT/ENGINEERINFORMATION:
WORKER~!l COMPENSATION DECLARAT10t<
I hereby affirm under'penalt'j of perjury one of m~ fo~lowiJ1g d.:l-::ial?tions: .
o I have an(~ 'Ni'J f1"';Eir;t.;:j,i i1 c"lrtin~1p, vf 0::n:3$111 to ~~eJ-ii:S!1re for work:3rs compensation,
as provo led-for try Sid:on 3700 of th0LClborCod~, tOI t:-:ep:~iformance Of,. e woddorwhich
thie .rmit is issued. '" '
1 have and will mamta]n worker's compensation insurance, as reCjuil1:1d /" Section 3700 of
, Labor Code, for the performance of the_work fo(which this permit"is'is..-;'''::l1.M'yworker's
,Compensation insurance carrier and policy are:
Carrier. STATE FUND Policy Number. 04613"; ';2003
LICENSED CONTRACTORS DECLARA,ION '
I hereby a 'irm.under penalty of perj!Jry that lam
licensed und'crprovisions .of chapter e (comm.encing ,
with Section ~ ) af Oi~ion 3 of the Business and
~~:~;~~; C tJltLihf-
Date: Contra~mr
This section need not be completed if the pennit Is for one hundred dollars_{$1~~:} or less,
o I certify that in the pe'rfolll.1ahc'e of the_ work far w~Jch this permit is'iku",.:t I shaij .oat .
eml"lo-y any person in _any manner so as to becom_e'subject to the work~r's c~mpensation.laws
of Califomia._.and 'agree that. if I should become ,Subject. to.theworKer's compt.nsation
provisions af Se,ction 3700 of the Labor Cod i shall forthwith camply withp':'Jse pravisions.
'tt/.
NUMBER
, 497892
TYPE
EXPIRATION DATE
. 9/3012004
C12 EXCA
Date: 11/1012003 ' Applicant:,'
WARNING: FAILURE TO SECUR ORKER'S COMPENSATION COVEF~GE IS
, UNLAWFUL, AND SHALL SUBJ T AN EMPLOYER TO CRIM INAl' PEN;,' .TIES AND CIVIL
FINES UP TO Ol'/E HUNDRED THOUSAND DOLLARS ($100,000), IN ADi'nlON TO THE
COST OF COMPENSATiON. DAMAGES ASPROVIDEDFOR iN SECTION 3706 OF THE
,LABOR CODE, INTEREST AND ATTORNEY'S FEES. '
I CONSTRUCTION LENDING AGENCY .
I hereby affirm under penait'/ of Pf'!r!'lrvJ_hat ther.oka congt!"IJdion I~n:-!:r.c ::,:~'''nr~''f':'r ihQ
performance of the work for which this permit is issued (See. 3097 .eiv.C):
Lender's Infarmatlon:
Construcion Types:
VN, ,
Fire Sprinkle'red?
NO,
I certify that I have read this applIcation and state that the above information '$ correct. I
agree to comply with all City ordinances_and state laws relating to building construction:and
here!?y authorize representlves of this city to enter upon the above m,:ntioneJ property for
i)fkln purpo~. ' _
.' " I,{(u1. ! / h /...J./ j Dale: 11/10/2003
",.,. 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 contiJiue'work. '
Fees paid for Permit:
Toful:
205.67
INSPECTION RECORD
INSpECTION DATE INSPECTOR .'
.
Temporary Power Pole
Plumbing (Dl3lnIWaste Pipe)
Electrical GrouridElectrodelUfer .
SetbacklFormsfTrencheS (FOOtings)
Do not rnstall subfloor or pour floor slOlb until the
following applicable items have been signed:
Plumbing (Water Plpe.Sprinkler Valves)
Mechanical (Groundwork) . .
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane.Rei nt.) .'. .
Underpinning (Floor Joist/Girders) .
Do not cover or conceal the work below. until the
following applicable items have been s'ighed: .
1st Floor.Shear . .
Aresprinkler (Rough) . .
2nd Floor Shear , .
Roof (SheathinlllDiaphiagm'Frame)
Masonry (ReinfJBond BeamlPre'Grout) .
Rough Plumbing (Top Out)
Rough Mechani,cal '. ,
Rough f1ectrlcal (Dry wal/l ,
Rough Electrical .
Framing (Only afterPlbg... Elec.. Mech. and Fire)
Insulation (SoundlEnerllYl
Do, n,"ttape or plaster until the following applrcabfe
items have been signed: .' ,.. , . ,
Drywall , .
Penetrations (Fire Rated) Electrical .
Penetrations (Fire Rated) Mechanical . ,
Penetrations (Fire Rated) PllImbing , "
Interior Lath ' , , ,
,Exterior Lath , , ,
, " , GENERAL ITEMS
exterior Plaster (Brown Coat)
T-Bar Electrical
T -Bar Mechanical '. ,
T -B\lr Structural
Sewer ,
Water'Engineering Backflow
Water Service
FINAL.lNSPECTIONS Date Inspector,
Electrical Final . , ,
Plumbing Final ,
Mechanical Final "
Gas Test ,
Engineering/Grading Final 765..s126 , ,
Fire Dept. Final 765,-4040 ,
,
Water Engineering 765~5268 .
.
SuI) list/Bushiess license 765-519 .
Zoning 765-5139 . ... , . .
.. .
Building Final ~ast Inspection- Only ..
fie, Above Complete)
PARTIAL INSPECTIONS
BUildinalnspections
Mechanical Inspections
. Plumbina Inspections
Electrical Inspections
PE RMI T'. E X PI R ED
. INSPECTION
NOT COMPLETED
DA TE:~ ()~r()4
.' f.