2840 E. Miraloma Ave.
BUILDING PERMIT NO.' BLD200.4-02557
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TYPE OF PERMIT
Tenant Improvement (Limited) CITY
DATE: :8/9/2004
JOB ADDRESS: 2840 E MIRALOMA AVE
LEGAL DESCRiPTION: EUCALYPTUS FOREST TR LOT 10 AND LO!
APPLICANT: CHARLES MCLAIN
OWNER INFORMATION:
William F Cozad
2840 E Miraloma Ave
Anaheim, CA 92806
BUILDING DIVISION
200S, ANAHEIM BLVD,
(714) 765 - 5153
INSPECTION REQUESTUNE:
(714) 765 - 4626
CENSUS <;:ODE: 437
QUARTER SECTION: 132
CONTRACTOR INFORMAflON: ARCHITECT/ENGINEER INFORMATION:
HOMEOWNER CONSTRUCTION SERVICE
5342 REDWOOD ST
YORBA LINDA, CA 92886C,)00
, BUSINESS PHONE: 71457').0566 ' , "
JOB DESCRIPTION;fenantJmprovement Remade! existing office space and l'J..vert 10051 of warehouse to office. (Express-PIC)
VALUATION: 45,000,00
[-..,.. , , ' OWNER-BUILDERiJECLARATION
I hereby affirm under penalty of perjury that I am exemp.t from the Contr3.c.tor:~ License Law for the following. reason (Sec. 7031.5 Business and - .
Professions Code: any citY or c6unt"ywhich requires a pt::rmit to construct, 8!t~{r, Improve, demolish or repair any structure. prio'r to, ~ts issuance, also
requires: the applicant for such. permitJofile a signed state;nentthat he i:::lic::,\,sed pursuant to the provisions of the Contractor's License Law.(Chapter
9)({;ommencing with Section 7000 of Division 3 of 'the Business and P:ofcSS'~~;lS Code) or that he is exempt ,therefrom and the',basis for the alleged
exemption. Any violation of SeCtion 703,1.5 by any apDlicam for apetmit s(.;i"':-~cts th~ applicalit to a civil pen'a"lty'of not more than five hundred dol)ars
($500)" ' " ,; ,- ,,' "
D-I,as oWr1erof property, or my employees with wages as their sole cnmf"lr-'nsatioll, yviHdo the work, and the structure 'is not lh~endect or offered for
sale,{S~c;..7044, BlIsiness and Professions Code: The: Contractor's License :~,ilW dqes not apply to an ownerof property who builds or improves
there.or., and who does such work'himself or helSelf or thrqugh his or her o'.'~' employees, provided that such imp-rqvements are-not intended or '
offa~i?cI for sale. If, however, the.bui!ding' or improvement is sold with Qnp. y'~'irof w\Tlpletion, the owner-builder will have the burden of proving tha~ ~e
did not build or,improve for the pUlp<?seof Sale). . .' _ -V . _ . .' , . ' " .'. ,','
o _ I, as the 9wrier of the propet!Y, .am exdusivel~1 cor.tracting wit~, lict;:ps€d{-:-.:;ntrado~s to ccnstruct the project (See. 7044- Blls:ness -and'Profe.ssions
Code: The Contractor's License law doesnot}).pply to .an owner cf P!Op€rtYr:hobu~ds or improves thereon, and who contra~ts jor such projects with
~ontracto~(s) licensed pursuant to the Contractor's Uce~se Law}. ..
LJ j'amexemptun"derSec. '. ,8 &P.C. for this reason: ~._____.
Date: Owner:' - ,
I WORKER'S COMPENSA TI9N'DECLARA T~--'
I hereby affirm under penalty, of perjury ohe of the tclIowing 'declarations: .
q . I have and will maintain..~ certificate of OOll8ent to.- self~insure fer wor!{I;-,r:,~ ',;ompemsation,
as provi9ed for by Section 3100qf the labor Code, for tjle perforrnance of !t.:. '..VorkJor which
this permit is'issued. , . . . ., .': . .
.~ 'I have and will maintain worker's compensation insurance, as requimd::y Section 3700 .of
)he'tabor Code; for the-performance of the work for which this permit iSiSSl:'h. fJ1yworker's
Compensat:on insura.nce carrier andpoUcy are: . .
Carrier: VIRGINIA SURETY COMPANY Policy Number:; 00500(~1~1n1
PROCESSED BY: DOR
'Date: ,8/9/2004 ' Applicant.
WARNING: FAILURE TOSi;C ,RE WORKER'S COMP: ,N COVER."GEIS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE~.!.k,T:cS AND CIVIL
FINES UPTO ONE HUNDRED THOUSANDDOLLMS ($100,000), IN ACr'TION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED~OR IN SECTIOt' 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I, \' CONSTRUCTION LENDING AGENCY ,_
I. hereby~ffirm under penalty of perj'ury.t.hat,there ie a construction lending;l~:cncy for the
PElrfor!!lan.ce gf.~l)e v,'tlirk for wt}i0Jhi:? pe_!"IT'!itis !S~1.'e~ (See. ~097 .C~v_,G~: :~ 1 _
LenGer:; Information: . .
his.application and state that the above information is correct. I
II 'tyordiqances and state laws relating to building cc-nstruction, and
se tives 0 this ,city to enter u pon,the above mentionE',,1 property for
Oat,,, 8/9/2004
Signat Applicant or Agent
The permit shall ex ire b Iiinitation andbecome null and void if the building or
work has not passed mal inspection 36,S days from the date of permit issuance. A
, new permit is required to commence or continue work.
8/9/2004
Date:
NUMBER
543192 .
TYPE
~'
EXPIRATION DATEO
10/31/2004
B'
Construcion Types:
)IN,
Fire Sprinklered?,
NO
..
Fees paid for Permit:
Total:
1.358.51
INSPECTION RECORD
INSPECTION . . , . DATE INSPECTOR
. .
Temporary Power Pole . . . .' ,.,"
Plumbi ng (DrainIWaste Pipe) , , tl ffiiQ!
!,lectrical Ground Electrode/Ufer . /
SelbacklFotrilsfTrenches (Footings)
Do not install subfloor or pour floor slab until the .
following applicable items have been signed: .'
Plumbing (Water Pipe~SprinklerValves) .
MeChanical (Groundwork) . .
EIe.ctrical (Underground Condu it)
Pre-slab (Compacti(lf1/Membrane.Reinf. . .
Underpinning (Floor.J!>ist/Girders)
Donot cover or conce.al. the work below unt.1 lhe. ,
following ap'plicabie items have been signed,' . '.
1st Floor Shear . . .
Firespririkler (Rough) . . . .
2nd Floor She'ar '. . . .
Roof (Sheathing/Diaphragm/Frame) .: ~
Masonry (ReinfJBond BeamlPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical 11JlE!
Rough l:Iectricat(Dry lNaU)
Rough Electrical . '. "
Framing (Only after Plbg., EJec" ,r",lecl1.,: and Fire) ~
Insulation (SoundlEnergy) . ~
.00 not tape or plaster u.nlil the following applicabl~ (\)
items have been signed, ". . .~.... .
Drywall" ..,. . . .... ~
PenlitrationS(Fire R~ed) Elec:trical' '. . ~ . i.
Penetrations (Fire Rated) Mechanical'
Penetralions(Fire Rated) Plumbing'
Interior Lath .... :
Exterior Lath ., '. .' ..
. :.' , GENERAL ITEMS
Exterior Plaster (Bl'O\Nn Coat) . . .
. T .Bar Electrical , . ., . I . I
T .Bar Mechanical I 7/24/ rr-' /J/1I;f7C.
. T.Bar Structural . . . . '-' . 'v
Sewer .'
Water.Engineering BackfJow
Water Service . . .' -
- '
FINAL INSPECTIONS
Electrical Final
plumbing Final
Mechanical Final
Gas Test
EngineeriniliGrading Final 765-6126
Fire Cept. Final 765-4040.
lNl!ter EngineerIng .765.-5268 .
'Sub List/Business License 765.519 .
Zoning 765-5.139'.'
Building Final (Lasllnspeclion- Only
. After AboyeComplele)
PARTIAL INSPECTioNS
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, MechanicallnSDections
Plumbina InSDections
Electricar InSDections
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