1180 N. Miller St.
CONTRACTOR INFORMATION:
2 H CONSTRUCTION INC>
4101 LONG BEACH BLVD
LONG BEACH, CA 90807 Oi100
BUSINESS PHONE: 562424',5567
JOB DESCRIPTIONfenant Improvement. Computer training room at Sid. 235. t
VALUATION: 143,000.00 J
I OWNER-BUILDER j,ECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor'1:' License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any dty or cO\,lnty-which requ\res.a permit. tp construct, a:tt. improve, demolish or repair any structure, prior to its issuance,also
requires the applicant for such permit to file a signed statement th?t he is Jice'Csed pursuant t9 the provisi.ons of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and PrcfessiChs Cude) 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 suoj;~~ts the appl:ca~lt tea dvil penalty of not more than five hundred dollars
.~ . ; .
o I, as'owner of property, or my employees with wages a!3 their soie comDC~lzatjon, will-dc the work, and the st,uch..ire !s nol. intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's Uce~s~ U,wdoes.not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through hls or her O'."'n:~mployees,'provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with m.e Ye'~! of oompletior., the owner:.builderwill have the burden of prov:ng that he
did not build or improve for the purpose of sale). . '\ .
o I, as the owne.r of the property, am exdusively COt1trading wjth lic_-";!lsed ..:bntractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's "License Law does not apply to "an owner of pcopetty\i.rl0 bui!as or improves thereon, Clnd who oontracts for such proje.cts with
Montractor(s) licensed pursuant to the Contractor'sLicense taw). I;'
'-' I am exempt under Sec. ., B & P~C. for this reason: __;j .
Date: Owner: i" .
I WORKER'S COMPENSATION DECLARATION _J ~ I LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury one of the. folloWing declarations: r- I hereby affIrm undec penalty of perjury that I am
o I have and will maintaJn a certificate of oonsent to self-insure for WCis.er's. ompensation. i, licensed under provIsions of chapter 9 (commencing
as provided for by Section 3700 of the Labor Code, for the pelformance of th 811WO It, for which I with Section 7000) of OIVSlOn 3 of the BusJnes~ and
."fI~s permit is issued. Professions e)od~ " .~
~ I have a nd will maintain worker's compensation insurance, as required by~Section 3700 of 9/17/2004 ~ 1
the Labor.Code, for the perforrryance of the work for which this permit !s iss!.:~'_:. ~1yworker's Date: - _ '.contrac or
Compensation insurance carrier and policy are: I
Carrier: STATE FUND Policy Number: 1638186.;.002
BUILDING PERMIT NO. BLD2004-02328
TYPE eF PERMIT
Tenanllmprovement (Limited) C I TV
DATE: 911712004
JOB ADDRESS: 1180 N MILLER ST
LEGAL DESCRIPTION: KRAEMER TR LOT 17 BLK K POR OF LOT
APPLICANT: SEAN KELLY
OWNER INFORMATiON:
Rockwell International Corp
2201 Seal Beach Blvd
Seal Beach, CA 907'40
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 51'53
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 144
ARCHITECT/ENGINEER INFORMATION:
WAYNE TWEDELL
11 GOLDEN SHORE DR
LONG BEACH, CA 90802
PROCESSED BY: KBT
This section need not be completed if the pennit is for one hundred dollars ($10C) ;:.rless.
;0. I certify thann the petionnance of the work for which this permit is issue~~ I sha II not
employ any per~on ir) any manner so as to become subject to the worker's yOippe:nsation laws
of California, and agree that if I should become subject to the worke.r's compe:'J:~;ation
provisions of~ectjon 3700 ofthe Labor Go~e, I shall forthwith comply with til'fe prcvis.ions.
Date: 9/17/2004 Applicant: -1 ~ ~~. i..
WARNING: FAILURE TO SECURE WORKER'S COMPENS TION COVER"GE IS .'
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES !\ND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), INADor;lON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION ">706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY ii'. '..
I hereby affirm under penalty of perjury that there is a construction lending ag~nyy.J9r tre
;:.-~~r~:-n:.:.:,~~,zc!-~h;;; .....cr!.:+..;,-;-...~:;d1:{h;-~-p<=..-;i,;-t ,':;';~;;:i.i.:.-": (0.:;-=:<:;;JG7~C;vo-'::}: ----.:..-......'-^-'
Lender's lnfor~ation: .
NUMBER
741856
TYPE
TYPE
TYPE
EXPIRATION DATE
9/30/2004
A
B
HIC
Construcion Types:
II! N, ,
Occupancy Groups:
B, , , ,.
Fire Sprinklered?
T.J.Area:
I certify that I have read this application and state that the above information is correct. I
agree to romply with all city ordinances' and state laws relating to building construction, and
her.9"hyauthoriz~ representives of this city to enter upon the above mentioned property for
in ect:ion urposes.
I Date: 9/1712004
Signa ure of plicant or Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commen6e or continue work:
YES
2,500
1.523.29
Fees paid for Permit:
Total:
C,.,c}O - /;t ~ - 2<>$<:. - fvmf:;l/1l G
. '. INSPECTION . . DATE INSPECTOR .
Temporary Power Pole
Plumbing (DrainIWaste Pipe) . .
Electrical Ground Electrode/Ufer
SetbacklForrnsrrrenches (Footings) . .
Do not install sUbflqarorpour floor slab until the
following applicable items have been signed: .
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork) . . . .
Electrical (Underground Conduit)
Pre'-Slab (Compactlon/Membrane.Reinl.
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below ul)til the
following applic"ble items have been signed:'
1 st Floor Shear . . 1
Firesprjnkler (Rough) .
I,
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame) .
Masoi1ry (ReinfJBond BeamJPre-GlO\Jt) . .
Rough Plumbing (TOp Out)
Rllugh Mechanical. 'I .
ROugh ElectriCal (ury Wall)
Rough Electrical . ....-:.
Framing (Only after Plbg. Elec,. r.-lech and Firel ~ -I7-t> '/.
Insulation (SoundlEnergy) .
Do not tape or plaster. until the following applicable
items have been signed:' _ '
Drywall . .
Penetrations (Fire Rated) Electrical
Pl!fIetratiol'l$ (Fire Rated) Mechanical
Penetrati4ns (Fire Rated) P/unibi'!9
Interior Lath . . .. .
Exterior Lath P
GENERAL ITEMS
Exterior Plaster (Bl'lM/h Coat)
T -Bar Electrical
T .Bar Mechanical '.
T.BarStructural .
Sewer . .
Water Engineering Backflow E
Water Service '.
INSPECTION RECORD
FINAL INSPECTIONS .
Electrical Final
Plumbing 'Final
Mechanical Final
Gas test
Engineering/Grading Final 765.5126
Fire Dept. Final 765'4040
WaterE,ngineering 765.5268
Sub List/Business License 765.519
Zoning '765-5139
Building ,Final ILastlnspection. Only ,
, . ' After Above Complete)
, PARTIAL INSPECTIONS
Daie. Inspector
-/~
."
~~-d{
P~IE,
, '
Buildinq Ih:jction.s, '. '. ,.~/
412-f!PS{VI ~+~ ~ /)b;~
Mechanical Inspections' ,
lumbina Inspections
Jectricallnspections