411 N. Lakeview Ave (4).
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LEGAL DESCRIPTION: RANCHO SANTIAGO DE SANTA ANA LOT i
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CONTRACTOR INFomJ1iON:
KAISERfOUNDATION ~iEAL TH PLAN
3355 E 26TH ST , I
LOS ANGELES, CA"9002:),OOOO
BUSINESS PHONE:213'2S~"4310 ,
JOB DESCRIPTtONrenant Improvement. TI on 3rd floor at Lakevle..v MedicalPffice Building.
. VALUATION: 110,000.00 .i,
L OWNER.BUllDEJ[;ECLARA TION
! hereby affirm under penalty of perjury that.1 am exempt from the Contractc~'s License Law for the foliowing re8$on (Sec. 7031.5 Business and
Professions Code: any city or county which requjres a permit to conetr~(':t,..~;ler. improve, demolish ::If repair- any structure; prior to its issuance, also
requires the applicant for such permit to file a'signed statementthat h~ i31b4nsed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencjng with Section 7000 of Division aof the Business ac;~ ~fe~~?n,s Gode) or that he is exempt therefrom and the basis for t.he alleged
exemptio~. Any violation of Sec~ion ~031,5 by any applicant for a permit su!:~ects the appli~ant to a dvil penalty of not more than fjv~ him6red do1!ars-.
($500). , ,;! , , ,
o I, as owner of property,'or my employees with wages as their sOfe com~"k('Jsation, will do the work, and the stru~ttire is no.t intended or offered for
sale (Sec. 7044 Business ar'id Professions Code: The Contractor's license ,g.aw does not apply to an owner of property -who buildsotimproves .
thereon, and who does such'work himSelf or herself or through his crher O\'siempIOyees, provided that such improVF:lrnents are not"intended'or '
offer~d for sale. If, however, the building or improvement is sold with one'~l"1qr of completion, the owner-bLlilder wit! ha'/e the burden of proving tha,t he
did not build'or improve' for the purpose of sale). \:.~ . .
o I, 'as the owner oftne property, am exdusively contracting with lic~nse<;l{oontraciors to construct the project (Sec. 7044 Bu.siness and Professbn5:
. Code:. The Ccntractor's ~i~nse Law does not apply to an owner of prorert(who builds or improvss therec;'J, and who contracts for such projects with
- ~ontract.or(s) licen&ed pursuant to the Contractor's License Law)..~' -
U I am exempt under Sec. ,B & P.C" for'this reason: .: :'f
DatG: Owner: -~i
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BUilDING PERMIT NO.
8LD2004.02825
TYPE OF PERMIT
Tenant Improvement (Limited)
DATE: 10/11/2004
JOB ADDRESS: 411 N LAKEVIEW AVE
APPLICANT: WENDELL JEFFREY
OWNER INFORMATION:
Foundation H Ka iser
393 E Walnut $1
Pasadena,CA 91188
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE:
(',14) 765" 4626
CENSUS CODE: 437
QUARTER SECTION: 167
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: CDL
WORKER'S COMPENSATiON"DECLARATION ,', I
I he~ affirm under penalty of perjury one of the ~oJldWing dec1arations:-f J-';: '.. '. .
IZd" I have and will rnaintain a certificate of consent to self;'in~un~ for WOrker"s cO:l1pellsation,
as provided, for by Section 3700 of the. Labor Code, for the perform'an'ce o.f u.~ work for whicl1
this permit is issued. _ ." i'-
0, I have and will maintain worl<er's compensation insurance, as required t Jr Section'3700 of
the Labor Cede, for the performance of t~e work for which this permit is'issl..! ;:i. My- worker's
Compensation insurance carrier andpolicy are: ' -j .
Carr~er: SE!-F INSURED Policy Number., 1dB'~_' '
This section need not be cdmpleted if the pennit is for one hundred dollars ($1Q.r} or I~s,
01 certify that in the performance of the work for Whi~h this. permit is iSSG~~, I shall not
em'ploy !'tny person in any manner.~o as to become subject to the worker's 'c.,npensation taws
of Califomia, and agree ,that if I should become subject to the worker's coni" ,msation
provisions of Section 3700 of the ~abor Code,! aU forthwi c ply' 'it J.';;e provisions.
Date: 10/11/2004 Applicant:
WARNING: FAtLURE TO SECURE WORKER'S COMPENSA
UNLAWFUL, AND SHALL SUBJECT AN 'EMPLOYER TO C PENfi;'_T1ES AND CIVIL
, FINES UPTO ONE HUNDRED THOUSAND DO~lARS ($100,000). iN ADb,nON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIOfl3706 Of THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. '"
tJr.~[Oh" -~ffirm .I~~or r~~~~~~~r~~?t~~?~~:~_~~~I~.:_~~~~:n~~~.=_J;~'~'ifn~~~~ _-~=l___
~- -- ,._~-""-,_"....-"",...." ~.-.'."'_'.__ .-." _"_._._o..-."'.__.c.<,~-.-._.,.._.....,~_:._..":"._-_..".".___.__"'."",,"~_~__,...,._._-"_' .
performance of the work forwhictdhis permit is. issued:(Sec. 3097 .Civ;C): .
Lender's Information:
I certify that I-have re<;id this application and state that the above information is correct. I
agree to comply'with all city ordin"ances and state laws relating to building cO,lstruction, and
hereby authorize representives of this ci t ter upon the above mentioned property for
inspection pur es. .
Date: 10/11/2004
Sig.nature of A
The permit shall expire by on a eco"", null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to cOmmence or continue work. .
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LICENSED CONTRACTCRS DECLARATION
I hereby affirrn-.uilder penalty of perjury that I am
licensed under pf:Ovi$.i<;)TtS of chapter 9 (commencing
with ~ection 7000) Jf-oi ion 3 of Po ,?usin s_ <3
Professions Code.
10/11/2004
Date:
NUMBER
370871
TYPE
EXPIRATION DATE
, 3/31/2005
B
Construcion Types:
V 1HR"
Occupancy Groups:
82, ' , ,
Fire 8orinklered?
Number o(Stories'
T.I.Ai"ea:
NO
3
330
Fees paid for Permit:
Total:
1,160,94,
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INSPECTION RECORD
Inspector
INSPECTION
DATE,
A, '
.~ )'2.""
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GENERAL ITEMS
Exterior Plaster (Brown Coal) ,
:r .Bar Electrical, " ,
ToBar, Mechanical , ,',
T .BarStructural
Sewer
Water Engineering BackfJow
Water Service
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,iJrv ~r
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FINAL INSPECTIONS
INSPECTOR Electrical Final
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T emporary_ Power Pole
Plumbing (DrainIWaste Pipe).:l,
Electrical Gr9unClElectrodelUt'er
SetbacklFormsfTrenches(Footings),
Do not install sUl:iflqor or pour !Ioor slab until the
foHowin'g 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 coileror conceal the work below until the
following appllcEible items haVe been signed:"
1 st Floor Shear '
Firesprinkler (Rough)
'2nd Floo'r Shear
,Roof (Sheathing/Diaphragm/Frame)
Masonry (ReinfJBOnd BeamlPre-Gl'O\It)
Rough Plumbing (Top Out) 3. "1..' 0\
Rough Mechanical "
KOugri E1ectricallUl)l Wall) ,l
Rough Electrical' 'II (1lui If)( J(/ (;bf
Framing {OnlyafterPlbg..Elec..Mech and Fire) l/11~/~r mil W
Insulation (SoundlEnergy) , ' ,
Do not tape or plaster' until the following applicable '
items h,ave been signed:.' . . I , '- ~
Drywall "", ~
Penetrations (Fire Rated) Electrical I ,.
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbil1!l
Interior Lath
Exterior lath
~ le-
nA
'VVV vv ,
Plumbing Fin,al
Mechanical Final
Gas Test'
, ' Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
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. Water E,ngineering 765-5268
Sub list/Business License 765-519
Zoning 765:5139
Building Final '(Last Inspeclion- Only .
After Above Complete)
PARTIAL INSPECTIONS
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Plumbina InSDections
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Electricalln~~ections .' " ' " '_,
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