3703 E. Melville Way.
BUILDING PERMIT NO. BLD2005-00556 ~4-,
TYPE OF PERMIT C
New Commercial Construction . . ITY
DATE: 5/5/2005
JOB ADDRESS: 3703E MELVILLE W.AY
LEGAL DESCRIPTION: PBK 58 PG 42 PAR 5
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST UNE:'
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 149
APPUCANT: ELIZABETH ORR
OWNER INFORMATION: CONTRACTOR INFORMATiON: ARCHITECTiENGINEER INFORMATION:
Jerome R Bown R L CLOlWORTHY CONSTRUCTION INC CECIL R CARNEY C11980
3703 E Melville Way 27637 COMMERCE CENTER OR 12641 NEINPT (714) 665-9500
Anaheim, CA 92806 TEMECULA, CA 925900000 TUSll N. CA 92780
JO~ DESCR1PTIONi=xpansion of exis~lng foundation and ins~arr new 230s1 equipment shelter for Nextel Cell Site.
VALUATION:
.55,000.00
PROCESSED BY: MJL
OWNER'BUILDER DECLARATION
I h,ereby a lrrn under pena 0 perjury t at ! am exempt rom the on tractor's License Law or the 0 owing reason ec. 7031 ~5 Business and
Professions Code: any city or county which requires a permit to construct; after" improve, demolish or repair any structure, prior to its issu,anc13, also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter
9)(c'ommencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the arleged
exemption., 'Any violation of' Section 7031.5 by any'applicant fo(a permit.subjects the applicant to a civil penalty of not more than five -hundred dollars
($500). ' .' ". . .
o I, 'as owner of property, or,my employees with wages as their sole compenSation, will do the work, and the structure is not intended Qf ofte'red for
sale (Sec. 7044 Business and Professions Code: The Contractor's L.icense law does not apply to an owner ,of property who builds or improves
thereon, and who does_such work,himself or herself o~ through his or her own employees, provided ttiat such improvements are not intended or .
offered for sale. If, however, the building or improvement is sotd with one year. Of comple~ion, the owner-builder will have the burden-of provingthat:'he~-.-
did not build or improve for the purpose of sale). " ' '.
D I, as the owner of the property, am exclusively contracting with Iic;:ensed contractors to construct the project (Sec. 7044 Business and 'Professions
Code: The ContraCtor's License Law does not apply-to an owner of,propertywho builds or improves thereon, and who contracts for such projects with
F1-Jfontractor(s) I_icensed pursuant to the 9ontractor's License_Law). '
U I am e~empt under Sec. '. , B & P.C. for this reason:
Date: . Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe~ury one of the following declarations:
D' 'j have and will maintain a certificate of- consent to setf-iri;:n,ire for worker's compensation,
as provided fQr by Section 3700 of the labor Code, for the performance of the VlOrk for which
this ermit is issued.
I have B:nd wUI maintain worker's compensation insurance,'as required by Section 3700 9f 5/5/2005
t e bar Code; for the performance of the work for which this permit is issued.~ My"worker's Date:
ompensatiCin insurance carrier' ahd policy are: . '
arrier: STATE FUNq Policy Number. 1713094-2003
This-section need',n,ot be completed if the pennit is for one hundred dollars ($100) or less.
o 'I certify that in the performance of the work for which this permit is, issued, I shalt not
employ any person in any manner so as to:become subject to the worker's compensation laws
of Califomia, and agree that it I should become subject t9 the worker's compensation '
provisions of Section 3700 of the lab9r Code, I shall forthv~Hh comply with those provisions.
LICENSED CONTRACTORS DECLARATION .
ere ya Irm un. ef pena ty 0 perjury t at am
licensed_ under provisions of chapter 9 (cor:nmencing
WIth See 'on 7000) of . 3 of the Business and
P rofessio s Co
Construcion Types:
VN, ,
Occupancy Groups:
S2; , , ,
Fire Sprinklered?
New { Additional Area:
. NUMBER
803626.
TYPE
Date: 5/5/2005 Appli<?ailt: ~ '"--
WARNING: FAILURE TO S RKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100.000), IN ADDlllON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR COD E, I NTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I.hereby affirm under penalty of perjury that there is a construction lend.ing agency for thE!
-performance_of the work for which-this permitis issued (Sec.3091..civ.C): - .
lender's Information:
I certify that I have read this application 'and state that the above information is correct. I
agree to comply withal! city ordinances and state laws relating to building construction; and
hereby authorize re ntives of this city to enter upon the above mentioned property for
inspection pur s.
Dale: 5/5/2005
Signature of App lea Agent
The ermit shall expire by limitatiQn and become null and void if the building or
work has not passed linal inspection 365 days Irom the date 01 permit issuance. A
new permitis required to commence or continue work.
~
Contractor
EXPIRATioN DATE
1/31/2006
B
NO
220
Fees 'paid for Permit:
Total:
1,311.75
INSPECTION RECORD
-c-
INSPECTlON DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainIWaste Pipe) ..
Electrical Ground Electrode/Uter - .
SelbacklFormslTrenches (Footings) . . . .
Do not install subfloor or pour floor slab until the
following appiicabie items have been signed:
Plumbing (Water Pipe,Sprinkler Valves)
Mechanical (Groundwork) . . , .
Electrical (Underground Condu it)
Pre-slab (CompactiontMembrane.Reinf.
Underpinning (Floor ,Joist/Girders) .
Do not cover or eonoeal the work below until the
following applicable items have been' signed:
1 st Floor' Shear . .
Firesprinkler (Rough) . . .
2nd Floor Shear
Roof (SheathlnOlDlaphragrn'Fram81
Masonry (ReinfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out) . . --c-
Rough Mechanical
rROught:fectrlCld(Drv Wallf
Rough EleCtrical
Framing . (Only after Ptbg.. Etec.. Mec~. and Fire) . . . . . I.
Insulation (SoundlEnergy) .
Do not tape or. plaster until the following applicable
items have been signed: .
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS ..
Exterior Plaster (Brown C!)at) -c-
r~Bar Electrical .
T-Bar Mechanical
T -Bar Structural . -:-
Sewer .
Water Engineering Backflow
Water Service I
FINAL INSPECTIONS .. Date Inspector .
Electrical Final . gf,z;Jo .lJ7Avf6,
Plumbing Filial. . . .
Mechanical Final .
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040 .
Water Engineering 765-5268 .
..
Sub UsUBusiness License 765-519 .
Zoning 765-5139
. Building Final ~asllnspeclio;" Only ghJ~J !f1jj Ih .
fter Above Complete}
PARTIAL INSPECTIONS
. Buildina InSDections. . . .. ..
. t.ZI.6r--~~~.D~
. <;ef~ . .--.... It ilQ<...c.
Mechanicallnsbections
Plumbina InsDections .
ElectricallnSDections