5781 E. La Palma
.TYPE OF PERMIT
Tenant Improvement (Limited) CITY
DATE: 3/24/2005
. JOB ADDRESS: 5781 E LA PALMA AVE
: LEGAL DESCRIPTION: PM 85-20 PAR 1 POR OF pAR
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765-5153 .
INSPECTION REOUESTLlNE:
(714)765-4626 '
CENSUS CODE: 437
QUARTER SECTION: 184
BUILDING PERMIT NO. BL02005-00791
APPLICANT; TOM WARE
,OWNER INFORMATION:
Raymond Spehar"
6937 E Avenida De Santiago_
Anaheim, CA 92807
\
CONTRACTOR'INFORM.iTiON:
PROGRESSIVE BUILDE\<S
371 N OAK PL' ,r
BREA, CA 921321 0000 7>:
. BUSINESS PHONE: 714523.;737,
JOB DESCRIPTION,enan! improvement.250st remodel .
ARCHITECT/ENGINEER INFORMATION: "'~-
I .
I OWNER-BllILD~e-,)ECLJl.RATION
I hereby affirm under penalty of perjury that I am exempt from the Contract(jJ':; License law for the following reason (8ec,7031.5 Bus.iness and
ProfessionsCcxle: any dty or countywhicn requires a permit to con~trlJ(:t, att~'r;_ jmprov~,dernolish orrepair anystrudure, prior to its issu6.nce, also .
requires the applicant.tor such permit to file a signed statement thClt he is iic<:,;c;seu pursuant to the provisions cfthe,Coilt,-ador's License Law (Chapter
9)(ccmmencing with Section 7000 !=If Division 3 ofthe BusinessaprJ Profes~_':ihs C..)de) or that he rs e;<empt- therefrom and the basis for the.all~(.~j
exemption. Any violation of Section 7031.5 -by any app:ic3r.t for a permit s~t't':'r.:ts the applicant toa civii' pena!tycf notm,Jre than fiVl'~ hundred ci6li.:::rs
($500). , ' , ! , '. " -' , , '
o I, as ownerof-pmperty. or my employees with wages i:lstheir sote comrfn.-5~t;on. .wiil dothaw~rk. and the structur~ k:; not il)1en~ed or offered f!Jr
sale (Sec. 7044 Business and Prof.Jssions .Gode: ,he Contractor's Licens.~ ;J~'N do?s not apply to an o...msr of property who bllituS or improves
thereon. and who does such work. hirnself 'or herself or throL'gh his or h'3rowh"~;(iployees. t:lrovided'that such improvemenfsare not,intGn(h;id:or '
offered for sale. If, however, the buading or irnprovernent is sold with c;r'!e ',(P.:h: cfccnip~etioll. the OV.JnN-cui:derINiI: have the biJrdeilcf proving that he
did 110t buiid or improve forthe pUlpo~e of sale), ) , .' ' , '
o I. as the owner 6fthe property, .flm exdu~ively contmCling' "....ith Ifcehc;eci f:r:r;tradors to con~truct the project (See: 7044 l:311s1l1ess,and ProfeS$lcnz
Cede: The Con~r~ctor's License ~.aw doe::> not_ apply t~ an owr.eiof j::m.)r::~rtYI'i!!~u t;uitU~. Or!ni(..rovc~ thereon, c:nd whn ~.1trC'!ct, fon~ud1 projects with
i2-J!ontrac:tor(s) l~ce~sed pursuant to theG/)ntractor's License Law). . l''- '_ : .' . . -.
U lamexe:mptunderSec. _.~ ,B&P.C.forth;sreason: -i~ . ..... -. ,'-. . ", '
Date: O-lmer: \
I ' WORKER'S COMPENSATION OECL8RATION-~~~_ ~, i
i hereby affjrm.und.er penalty o.f periury one of the fallowing deci3rations: [ , I
~ I hav-e'and will maintain a_ce,iificate of co!l~$nno seW-insure fed' wOlk.:.;" ':::,or.lpen~atjcn.
a~ provided for by Section 3700 of-thflLabor-Gode, for the pe rforman 0:.:: cf tll~-. -....or'''' for whim I
'this permit is -iss~E;d.. t' .
~ave and will maintain worker's compens8ticn insurance, as reqlJirsd t,1 5p-ctfon.3700 of "
the. La_bor Code, for the performance of the work (0'( which thi::; p€rmit L"> if:SlJ::. iviyworker's -"
Compensation insurance carner and polley are:
Carrier: STATE FUND
VALUATI6N:
7,000.00
, PROCESSED BY: MJL
liCENSED CONTRACTORS DECLARATION i
l h~rehy arr:rnl unccr J:'snalty of perjury that TSiil~
l.icensed u :-:der provJs\;ons of c.rmpt r C (corrirnericing
.....ith Ser.tion 7000) 0" I ion. 8:.ls!l1es-s and
P'ro'fe5!3iOfls CGC:! e
3/24/?00~~....
Oat~~ ' .Contractor
Policy Number. 17009oQ:.:
NUMBER
564313
TYPE
EXPIRATION DATE
11/30/2005
This section need not be complete.d iftlie penliit is fOr-one hundred dollars {SHIC.ipr less; .
o I ce~ify that in tho.performance C?tths work for which this perrnit is iSSI:e;jf!::sha'u' not
employ any person in any ~anner so~sto become subject to' the worker's cr::lf.p~::msation laws
of California, and agree that if I should become subject to trie rk 's com:;3nsatfon
provisions of Section 3700 pft~e Labor.Code, al forthw' c ply wlt~ tr:>i::eprovisions.
B
Date: 3/24/2005' I',pplicant: .
WARNING: FAILURE TO SECU EWORKER'S COMPENSATION COV;oR':GE IS .
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENt.:.lIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADD'TION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTiO:-i370S OF TfjE
LABOR CODE, INTEREST AND ATTORNE'f'S FEES,
I ,CONSTRUCTION LENDING AGENCY .__~',' '
! hereby_ affirm under pene:..~ of perjury that there is.a,~:;r;\[:_tr.lJction ~~r:~iri~J ~~.~!'1c':'.t..1.:::\o-"--#-~~ ~ ~;..-.:..,.~-::--:-~
iJeitorrT16nce of me work fui which this -permit is issued (8e'O.3097 .Civ.C): ' ~
Lender's hlfoimation: . '
Construcion Tvpes:
VN,. ,
Occupancy Groups: ~
B. . , ,
Fire Sprinklered?
T.I.Area:
NO
250
.1 certify that I have read thisa'pplication and state that the above information is correct. I
agree to comply w.ith all city ordinances=and ,state laws relating to building corstruction, and
~ere, b,y.auth?riz, e repre~nf~f thiS, city to enter upon the above m, entio ned property for
I~Ori~_~.~ -,<. --; . . . .
/~~ ' ", .,'. Oate:3/2412005
....... Signature ofApplibant 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. '
Fees paid for Pe:rmit:
. Total:
573.22
i, .
.INSPECTION RECORD
INSPECTION pATE . INSPECTOR'.
, T !!lnporary Pow!!r Pol!!
plumbi ng (PraintWast!! Pip!!) .
Eklctrical Ground EI!!c:trodelUfer .
Setback/FormslTren.ches (Footings) . . .
Do not illStall sub floor or pour floor slab unti I the ...
following applicable items have been signed:
Plumbing (Wat!!r Pip!l.Sptinkl!!rValves)
Mechanical (GrounclwQrk) . . . '. .
Ektdrical (Unoorground Condu it)
Pre-slab (CompactionlMl!I1lbrant!.Rlli m. . .
Underpinning (Floor JoistlGird!lrs)
. lJ() not cover or conceal the work below until too
. following applicable items have been signed: . .
t$t Floor Sh!!ar
Firesprink/!lr(Rough) . . .
2nd Floor Sh!!ar . .
.. Roof (Sheathing/DiaphragmlFram!!)
Masonry (ReinfJBond BeamlPre-Grout)
Rough Plumbing (Top Out)' hi MIX .011./
Rough M!!chanical . I . ..
Rough Electrical aU) . .
Rough EI!!ctrlcal .. r 61110<; . ~l
Framing (Dilly after Plbg.. Elec.. Mech.. and Fire) 1c;{,\,\O(
Insulation (SoundlElll!rgy) . / . ..
Do not.tape or plaster until the following applicable :
it!!ms have been signed: . .
Drywall . . ..
P!lnetrations (Fire Rated) Electrical
P!ln~ions (Fire Rat!!d) Mechanical
P!lnetrations (Fire Rated) Plumbing ,
Interior Lath .
Exterior Lath ....
. GENERAL ITEMS .
Exterior Plaster (Brown Coat) .
T-Bar Electrical
T-Bar Mechanical
T -Bar Structural
S!!wer
Water Engineering Backflow
Water Servic!!
".
FINAL INSPECTIONS. Date In.spector
EI!!ctrical Final. . 51 /7/0( 1'. A(twtJL.
Plumbing Final < 1110( "tA\~
Mechanica,l Final ... .
Gas T!!st . .
.
EngiMering/Gracling Final 765-9126
Fire Pep!. Final.765-4040 .
Wat!!r. Engln!!!!rlng 765-5268
- -
Sub List/Business License 765.519
Zoning 765-5139 . .
.
Building Final *astlm,pectiono Only. ~~(Q( r:M~c9
. .. fter Above Complete)
. PARTIAL INSPECTIONS
Buiidina Inspections
Mechanical Inspections .
Plumbina Inspections
Electrical Inspections