1205 N. Lance Ln.
TYPE' OF PERMIT
Tenant Improvement (Limited)
DATE 8/3/2004
JOB ADDRE.SS: 1205 N LANCE LN
LEGAL DESCRIPTION: P BK 106 PG 16 PAR 1
BUILDING DIVISION . . '.
200 S. ANAHEIM 8LVD. .,
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS. CODE: 437
QUARTER SECTION: 140
BUILDING PERMIT NO: . BLD2004-01851
APPLICANT: GREG BOSWELL
. OWNER INFORMATION: . CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
GREG BOSWELL
-1205 N. LANCE LANE
ANAHEIM, CA 92801j
JOB. DESCRIPTION:renant improvement, remodel 792sf warehouse to retail $cles and remodel 573sf of office
,
VALUATION; 30,000.00' . PROCESSED BY: DOR
I . ......... .' O.Yft.!ER-BUILDER OECLARA TION '. . .' . .
I hereby affirm under penalty of perjury that I sIn exempt frcm the Contractor'i. License Law for the following reason (Sec. 7031.5 Business and
ProfeSsions C.ode: any dtY or county whit;:h requires a' perm!t to construct. alt~~r, improve, demolish, or'repa ir any structure, priOr to its issuance, also' .
. reqtlireS-the "aW!i?3r:t for such permit to .fib asigr.ecl stat~m(mt that he-is lice::sed' pursuant to the provisions of the Contraclor's'LiCense LaW (Chapter
9)(commencing w;th Section 7QOO of Divisiqh.3 of the Business and professic~ls C0ge) or that he is exe,mpt therefrom and th~ basis for the alleged
exemption. Any: violation. of Section 7031.5 by.any appJical')t for a permit subf:-.::ts the applicant to.a: Civil penalty of not more than five hundred dollars
($500). . . '. '. . ."". ..' '..
D. _I,as 6~ner ofproperty.., or my employees with wages as t~eirsole comp~nsation, will do the work, and' the structure is nO,t intend~ or o~ered tOr
sale (Sec. 7044 Business ~nd .Pro~essior:)~Code: The Contractor's license L:lW ~oes not appfyto-an owner of property who builds or improves .
there~m. and who does'such work'himself or herse!fortlm.luchhis or her'owrfemployees, providep that such improvements are not intended or "
off~red forrols. 'a, however, the' bu!!tilng 0r improvQmerrt is :3Gld with one ye~r of co:ilpletion"the ow,.,er~bulfder will !lave the burden of proving that he
d!dnot !::>ui~d or :mproy.e for the ;Julp~se of sale)..; . "
[] !,~ClS fheo\r'.:':1er ofrhe prope.rty, am exdusively contracting with licensed;~.>ntra'ctors to construct the project (Sec. 7044 Business and Professions.
, Code: The Ccnt(a0k1i"s Uoin~: La"." dces not apply to an owner of property ::-';ha builds Of improves'thereon, and who ,oontractS for_such projects with
a.f?JrHrClt;:tC,j(Srncen.'Sed pursuant' to the Contractor's LicenSe Law). . _ 'l
L..!, j J:!f!l .J^~~wtunder~)ec.~.', A" B'&-p.t.-forthis're~ . _,;.:-,
D~tc: OWner:....:.../,"'-'t ' ~ "_' ,
I . WORKER'S COMPSNSATlON DECLARATION ""
I hereby,affirm under penalty Qf perjury one of the follOwing c;:feclarations:
o -I have and will maintain a'certificate of ~nsenqo Self;'insureforworker'dcompensatiar'l,
as provided for by Secti~n 3700 oithe l<;ibor.Code, for th-e perfofn,ance' ofthF work forWhich
. this permit. is issued., ' . _ ~
o I hayeand willmaintain worker's ~ompensation insurance, .as requi'red bi Section 3700 of 8/3/2004
the Labor Code"for the performance of the, wqrk for which this:permft is isswk. Myworker's Date:
CompenSation insurance carrier and policy are: '
Car~ier: ~olic:y Number:
Thi.s section need not be compleJedlf:the pennit is,forone hundr~'dollars ($100} orl~s.
o I certify that_in'{he~rfoffi\ance~fthe work for which this permit is issue,j, I shall-not
employ any person in any manner so as to become subject to the worker's ccmperisation laws
of California, and agree that jf I 'should. become subject to the woi'ker's, comper:s'ation
provisions of Section 3700 of the Laborco~' shall forthwith complY with thoso proviSions.
Date: 8/312004 .Applicant: rt / .,,- ~ . . .;.
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS ." .
uNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO QNE HUNDRED THOUSAND DOLLARS ($100,000), IN ADOI nON TO THEO
COST OFGOMPENSATION, DAMAGES AS PROVIDED FOR' IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. ,
I. CONSTRUCTION LENDING AGENCY __
.1 hereby affirm under penaftyof perjI,Jry that there is fl construction lending-a~~I~eYfor ~e
~if6rnY.:)nce otthe work for ~hich this permit is issued (Sec.3097 .Civ.C): '
:"5/iu-c.i'';:; :i;f~i"''-ICili0r.: - ~
J
LICENSED CONTRACTORS DEClARATION
I hereby a ii'm under penalty of perjury that I am
licensed under .provisions 'of chapter 9 (~ommencing
with Section 7000) of Dlvsion'3 ot!he Bu'si ness and
Professions Code.. .
Contractor
NUMBER
EXPIRATiON DATE
TYPE
ConstruciQn Types:
VN.. ,
Fire Sprinklered? NO
T.!. Area: 573
t certify that '.have'read.this application and state that .the above infOrmation is correct. I
agree to qomply with all city o~dinances and state laws relating to building COflst(Uotion, and
herebyauthCirize representives of this city to enter upon the above ,m,entioned property for
ins i,?n pur
Date: 8/312004
Fees paid for Permit:
Total; . 1.534.56
Signatl:lte ,of Applican.t or Agent
The permitshall expire by Iimitatioll and become null and void iHhe building or
work has not passed fi nal i nspectiori 365 days frOl)l the date of permit issuance. A.
new permit is required to commence or continue work.
FINAL INSPECTIONS
Electrical' Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 165..4040 .
Wate~ I;rigineering 765~5268
Sub List/Business License 765,519
Zoning.765-5139
Building Final . (Last Inspection. Only
. After Above Complete)
PARTIAL INSPECTIONS
, Buildinalnspections
<
INSPECTION RECORD
. INSPECTION' ..' DATE 'INSPECTOR
. .Temporary Power Pole ." .. , ".
Plumbing (DrainIWaste Pipe)
Electrical GrQUnd Electrode/uter .
SelbacklFormslTrenches (Footings)
Do not install subfloor or pour floor slab until the . .
fOllowing applicable items have been s.igned:. .
Plumbing (Water Pl"".Spril1kler Valves)
Mechanical (Groundwork) '. .
..
Electrical (Un<lergroundConduit) .
. Pre-slab {CompaetiOlliMembrane.Reinf. .
IJRdflrp;nnlng (Floor Joist/Girders) . . ..
Do not COVer or conceal the WOrk below until the
!ollowingapplicable items have been signed: . .
1 st FfoorShear .., '.' . .'
l'iresprinkler(Rough) .
2nd Floor' Shear .'
Roof (ShealhiIl!llDiaphragmfFrame)
MasOnry (ReinfJBond BeamlPre-Grout)
RoughPluinbing (Top Out) .' "
ROUgh Mechanical. . ntf//tI>
Rough J:Iectnc31 . all)" '. .' .~ ~. .
RoughElectrical . . '. .
Framing {Only after Plbg.. Elec.. Mech.. and Flre-} )Jul, '. .
Insulallon (SoundlEnergy) J
Do not tape or plaster. until the following applicable
'items have been signed: . 0 . " ,
Drywall. " " ...... . fhs'llj . I!IJAA>:'
Pfllletralions(Fire Rated) Electrical , . '.
Pfllletrations (Fire Rated) Mechanical '. .
Peoetrations (Fire Rated) Plllinbiilg .
Interior Lath .. HI )-10 }?1" '.
Exterior Lath . '.
.' GENERAL ITEMS I
~eriorPlaster (Brown Coat) . <J1Z//iIS
T -Bar EIl/elrical . v.
T -Bar Mechanical 0 o ..' .
.r ,sar Structural '. . .'.
Sewer . . . . I
Water Engineering Backflow . .0
Water Service. . .'
Date. InspeCtor
Meehanicallns~ections ~ . o~
11)'70 5" No I/lf If'. '? Nt
fA.p ~c&J? Mi, ,rP &to
{;
Plumb/na Inspections"
Electrical Inspections
BUilDING PERMIT NO. BlD2004-G1851
TYPE OF PERMIT (~
Tenantlmprovement(Limited) :-~ 1 OCITY
DATE: 8/3/2004
JOB ADDRESS: 1205 N LANCE LN
LEGAL DESCRIPTION: P BK 106 PG 16 PAR 1
ElM
~
BUILDING DIVISION ~.
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 140
i~
APPLICANT: GREG BOSWELL
OWNER INFORMATION:
GREG BOSWELL
1205 N. LANCE LANE
ANAHEIM, CA 92806
JOB DESCRIPTION,enant improvement, remodel 792s1 warehouse to retail seles and remodel 573s1 of office
VALUATION: 30,000.00 PROCESSED BY: DOR
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor':> License Law far the following reason {Sec. 7031.5 Business and
Professions Code: any dty or county which requires a permit to construct, alter, 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 lice,lsed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professic:ns 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 subfects the applicant to a dvil penalty of not more than five hundred dollars
($500).
o I, as owner of property, or my employees with wages as their sole com~jnsation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License L~w does not apply to an owner of property who builds or improves
thereon, and who does such work himself or hemelf or through his or her oviri employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one ye(~r 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 oontradors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's license Law does not apply to an owner of property 'vho builds or improves thereon, and who contracts for sum projects with
FLQontractor{s) licensed pursuant to the Contractor's license Law).
U I am exempt under Sec. ,8 & P.C. for this reason: _._
Date: OWner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o J have and will maintain a certificate of consent to self-insure for worker'l, compensation,
as provided for by Section 3700 of the Labor Code, for the performance ofth\i work for which
this permit is issued, I
o , have and will maintain worker's compensation insurance, as required by Section 3700 of 8/6/2004
the Labor Code, for the performance of the work for which this permit is iSSLIEd. Myworker's Date:
Compensation insurance carrier and policy are:
Carrier: Policy Number.
CONTRACTOR INFORMATION:
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION
I hereby a irm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing'
with Section 7000) of Divsion 3 of the Business and
Professions Code.
Contractor
NUMBER
EXPIRATION DATE
This section need not be completed il the pennit is for one hundred dollars ($100) or less.
o I certify that in the performance of the work for which this permifis issu~b. I shall not
employ any person in any manner so as to become subject to the worker's'C:cmpensation laws
of California, and agree that if I should become subject to the wofk.er's compensation
provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: 81612004 Applicant:
WARN ING: FAILURE TO SECURE WORKER'S COMPENSATION COVER>\GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED 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 agancyfor the
performance of the work for which this permit is issued (See. 3097 .Civ .C):
:"c~dc:-':::. !r,!or:i.n~or:: -.~-~- .
TYPE
Construcion Types:
VN, ,
Fire Sprinklered? NO
T.1. Area: 573
Date: 8/6/2004
it:
I certify that 1 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 authorize representives of this city to enter upon the above mentioned property for
inspection purposes.
1,534.56
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 Dermit is reauired to commence or continue work.
".
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