1625 S. Lewis St.
BUILDING PERMIT NO. BLD2004-02407
TYPEOF PERMIT
Tenant Improvement (Limited) CITY .
DATE: 1012912004
JOB ADDRESS: 1625 S LEWIS ST
LEGAL DESCRIPTION: T 4 R 10 SEe 23 POR SW1/4
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BUILDING DIVISION
200 S, ANAHEiM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE: .
(114) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 97
CONTRACTOR INFORM!'.rJON:
ARCO BEVERAGE GROi.)P .
1750 S BRENTWOOD BI.VDi!$OO
ST LOUIS, MO 631440000.,
BUSINESS PHONE: 31496:;..5003
JOB DESCRIPTION,enant Improvement. New Canopy over existing dock.
VALUATION: 50,000.00 ,> PROCESSED BY: JJJ
I . . OWNER-BUILDER DECLARATION . .
I hereby affirm under penalty of perjury'that I am exempt from the Contractor'{or.er-.se La.w for the following reason (Sec; 7031.5 Business and
Professions'Code: any city or county which !'"~ujres a permit" to construct; alt01, !iTlorove. demolish or repair any structure, prior to its issuance. also
requires the applicant for suCh permit to file a signed statement that he Islicet\sed pursuant to the provisions of the Contractor's License law (Chapter
9)(commencing with Section 1000 of Division 3 of the Busil'less and Professio.:.iS Code) or that he is exempt therefrom and the basis far the alleged
exernpkio". Any violation of SectiQ!17031.5by anyapplieant for a permit subfi~ts the 3ppric~nt to a civil penalty of not more th;:m five hundred dollars
($600). :
o I, as owner of property, or myemployees with wages as their. sole C':;mPi~[i#;at!O!1, viill do the work, imd the structure is notinter.ded or offered fC'! .
sale (Sec. 7044 Business and Professions Code: The Contractor's License Lv:".....does not apply to an owner of property who builds or improves .
thereon. ~nci \'cho dces such work himself or helSelf or through his or herowri~mpl()yees, provided that such improvement~ are not intended 0: . .
cffefed for sile. n, however, the buildingorimprovement is sold with on~ yeJ"of rompletion, the oWner-builder will have the burden of proving thot he
~di ot build or .imIJrove for 1he pu.Tpose of sale). f:"., . . .
. ' -, as the .owner of the property, am ex'dtlsiveiy contracting with iicens.ed ~.0ntrs::1ot.s to construct the project (See. 7044 Business an<j Professions
".;odc: TheContractor's t icense Law does not apply to an owner. of prope{~y\/!h,1 ouilds or irllproves thereon, and who contracts for SIj(:t1 proJects with
F-~ontractor(s) licensed pUI'suant to the Contr.a.cto,r's License l.aw).
I J I U4;;~"f'~\Jd.r Sec. , B ,C. for this reason. ."--~~
Date: ~ - Owner: . . . ._=-.~
WORKER'S COMPENSATlO CION \. _:=J I
I hereby affirm under penalty of perjury one of the follow decl atjG, :. . \., I
[J . I have. and will maintain a certificate of consent to salf~insurl:::' or ...vurk,;:r'.:..~'~';mper;sati~n,
as provided tor by _Section 3700 of the Labor Code, forthe perfor:nance of'th~.wo1"k for which.
this permlt is issued. : '.;, ~ - I
o I have andwill main~inworker's compensation insiJrance. as requireu:JJ, ~edivrl37nO l')f 10129/2004
the Labof Code, for the performance of the- worl':. for which th:s permit !s ;,tt'WC;;, My'..,:erKer's Date:
CompenSation Insurance carrier and policy are:
Cerrier: ZURiCH AMERICAN INS. CO
. APPLICANT: JORGE MARQUEZ
OWNER INFORMATION:
HARBOR D1ST. LLC
1625 S Lewis SI
Ana~eim, CA 92605
ARCHITECT/ENGINEER INFORMATION:
l
LICENSED CONTRACTORS DECLARAT-;;;--'
I hereby affirm under penalty of perjury thatl ar"
licensed under provisiorl$of chapter 9 (comrnencir.g
with SeCtion 7000) of Divsion 3 of the Business and
Professions Code: .
Conlractor
Poiicy Number. WC~3lt:1i)l..QO
. NUMBER
810386
TYPE
EXPIRATION DATE
7/31/2005
. 'fhis soction neect not be co~pleted ifthe.permit is for One hundied d~Ila:'51$1CO) ",r'l~; .
'1V(-1 certify that in the performance "of the work fOf'wh:ch this permit is is:~~l&';';: i .$hall not
~~ioy Clny person in any manner so as to become subject to the workers_ccr:'ipensatiGr~ laws
of Califoml8, and agree that if l'should become subject to the worker's co;mpa{~ation
provisi?ns of Section 3700 of the labor C e, hall forthwith ompi)tWith-ir.O,ie provisions.
B
Oate: 10/29/2004 Applicant
WARNING: FAILURE TO SC-cURE ORKER'S cm
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER RIM AL ENAL";!ES AND CIVIL
FINES UP TO. . ONE HUND RED 11-1 OUSAND DO.LL.'.ARS. ($100,00 "AD.Di'lleN .TOTHE '.1
COST OF COMPENSAiION, DAMAGES AS PR9YiQip) FOR IN SECTION :;706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES:' .' '. .
. ! CONSTRUCTION LENDI~G AGE;NCY '5,-' . . ~-.:_j
; h~reb'J affirm u:1;1e.. p<3nalh' of perjury' that there ~- <'l. con$kuci.ic:: !end:ng 'a;:~~,-:.y fnr-the _ I..
periormance of (he work for which this permit is issued (See. 3097 .Civ.C);
Lender's Information:
ConstruciOlllypes:
III N, ,
Fire Sprjnkler~d?
NO
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I certify that I have read this application and state that the above information is correct.. I
agree to comply' with all-City ordinances and .sta1e laws relating to building con:;trLJction. and
hereby uthorize representiVes of thiS" city to enter upon the above mentioned property for
~spec\lon rposes. '
'.
Date: 19/2.9/2.004
Fees paid for Permit:
Total:
1.080,22
,
~
Ign ture A licant or Agent .
, by Ii itation and become null and void if the building or
work has not pas n' section 365 days from the date of permit issuance, A
new permit is required to commence or continue work.
INSPECTION RECORD
. . INSPECTION. . . . DATE' INSPECTOR
Temporary Power Pole 0 . . . 0
Plumbing (DrainlWaste pipe) . I
Electrical Ground ElectrodeJUfer . ""',,-rvml:1--N
SetbacklFormslTrenches (Footings) -
00 not install subfloororpour floor slab .until the ..
following applicable items have been signed: .'
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork) .' . .-
Electrical (UndelUround Conduit)
Pre-slab {Compaction/Membrane.Reinf. . .
Underpinning (Floor Joist/Gilders) .
Do not cover or conceal the work below until the
folliJwingapp'li.c,~qleitems have.been sig.ned:'".
1 st Floor Shear .' . . .... .
Firesprinkler(Rough} '. .
2nd Floor Shear . . .' .
Roof (SheathinglDiaplllagm/Frane) . .' .'.
Masonry (ReinfJBOnd BeamlPre-GlO\Jt) .
Rough Plumbing . (Top Out) .' . . . .
Rouglr Mechanical.
Rough f1ectrical (Dry wall) . .
Rough EleciRcal . . '.
Framing,._'; tOo1y after Plbg. , Elec.,. t".'iech and Fire\ .
InSlllation'(SOIl nd/Energy)
Do not.tape or plaster until the following applicable . .
items. have been signed: ':' . '.
Drywall . . . '. .
Pen_rations (Fire Rated) Electrical
Pen.etrations (Fire Rated) Mechanical ,
Penetrations (Fire Rated) Phnnbing . . .
Interior Lath. '.,
Exterior latlr
. . GENERAL ITEMS . '
Exterior Plaster (Brown Coat) . '.
T -Bar Electrical '..
,. -Bar Meclranical . . ". '.
T -Bar 'Structural ..' . . .
Sewer . 0
Water Engineering Backflow .
Water Service .
,FINAL INSPECTIONS Date' Inspector,
Ele'ctrical final .
Plumbing Final ,
Mechanical Final
Gas Test .
Engineering/Grading Final 765-5126 . .'
. .
Fire Depl. Final 7654040 .
Waler Engineering 765-5268 . . .
Sub ListlBusinesl; License7f;5-519
Zoriing765-5139 '.
Building Final *0.1 Inspection- Only [:2..-?4 /bI, , .P'
"Z .
fter Al)oye Complete) ,,/ ,
PA~TIAL INSPECTIONS
Buildina'lhspections
Mechanical Inspections '
Plumbina Inspections
Electrical Inspections