5701 E. Santa Ana Canyon... (4)
TYPE OF PERMIT .
Tenantlmprovemeht (Limited) CITY,
DATE: 4/21/2005
~OB ADDRESS: 5701E SANTA ANA CANYON RD D
LEGAL DESCRIPTION: DOMINGUEZ ESTATE LOT 3 POR OF LOT
i
ElM
El'UILDING DIVISION
200 S. ANAHEIM BLVD.
.(714) 765- 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 185
BUILDING PERMIT NO. BLD2004-04359
.." . ,~~~
APPLlCANT:'CHUCK MARVICK
owNER INFORMATION:
Canyon Plaza Shopping Center
2424 SE Bristol St #200
Newport Beach, CA 92660 '
CONTRACTOR INFORMATJON:
C E SNODGRASS CONSTRpCTION, INC
3961 N WILLIAMS AVE I
PORTLAND, OR 97227 oooo!
,
BUSINESS PHONE: 503282'7255
JOB DESCRIPTION,enant improvement- bank' :1
-. "
75,000:00 . . ;)'"
ARCHITECT/ENGINEER INFORMATION:
JOHN C MARVICK
- 3199 A-3 AIRPORT LOOP DRIVE
COSTA MESA, CA 92626
VALUATION:
PROCESSED, BY: KBT'
OWNER-BUILDER DECLARATION "
I hereby affi~m under penalty of perjury that I arn.exempt from the Contractor's pcense Law for the folrowing reason (8ec..7031.5 Business and
Professions Code: any city orcountywhich requires a" permit to construct, alte~ iliipro~e, demolish or repair any structure, prior to its issuance, al59 -
requires the applicant for such permit to file a signed statement that he is licenkd p'ursuant to the provisions of the Contractor's License Law (Chapter
9)(col"flmencing with Section 7000'of Division 3 of the Business and Profession~ Code)' or that he is exempt therefrom and the basis fortheatleged
exemption. Any violation of Section 7031.5 by any applicant for a permit Subj~ts the applicant to a civil penalty of not more than five hundred dollars
($!;OO). .. . 1,,'. .
o I, as owner of property.. or my employees with wages as their sole comperisation, will do the work, and the structure is not intended oLQffered for
'sale (Sec. 7044 Business and Professions Code: The Contractor's License La* does not apply to an Owner of property who builds or improves' '
thereofl,and who does such work himself -or herself or through hisor her own employees, provided that such improvements are not intended or~:-
offered for sale. If, however, the building or improvement is sold-with one yearbf completion, the owner-builder will have the burden of proving that. he
did not build or improve for the purpose of sale). . '. ,t., . -'
o ..I, _as the-owner of the property, amexclu5:ively cont~ctjng with licensed e<:fltractors to construct the project (Sec. 7044 Business and Professions
COde: The Contractor's License Law does. not apply to an owner of property who builds or improves thereon, and who contracts for such projects with
~ontractor(s) licensed pursuant to the Contractor's License Law). .' I- . .
U lam exempt under Sec. _ _ , B & P .C. for this reason: _
Date: ' Owner: .
WORKER'S COMPENSATION DECLARATION
I 'hereby affirm under penalty of pe~ury one of the following declarations: }
I
o I have and will maintain a'certificate of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance ot the Work for which
i ~ r ' is issued. 1
ave.and will maintain worker's compensatIon insurance, as required by Section 3700 6f
t or Code, for the performance of the work for which this permit is issued.l'. Mywo~ker's
ompensation insurance carlier and policy are: f
arrier: L1BERTYNORTH'{I'EST Policy Number. WC4-1NC-<J10281'
, , ' i
This section need not be completed ~f thepennit is for'one hun~red dollars ($1 00) 0!' less.
o I certify that in the Perfprmance of the work for which this pe,rmit is issued. f shall nof .
employ any person in a'ny manner so as to become subject to the worker's compensation laws'
of.Catifomia, .'and agree that if I should beCome subject to the worker's compensation
provisio'ns of Section :3'('00 of the Labor Co e, I shalf forthwith comply with thos~'provisiOi1S,
I I
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 30f-the Busine and
Professions C
4/21/2005
Oate:
NUMBER
622933
TYPE B
EXPIRATiON PATE,
7/31/2005
Date: 4/21/2005 Applicant. "
WARNING: FAILURE TO SES R ER'S COMPENSATION COVERAGE is
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES Up:r,O;ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDlllON 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--I:lerebyaffirm-under penalty of per1ury that there isa construction leliding agerll....yfor the
performance of the work for which this permit is issued (Sec. 3097.Civ.C):
Lender's Information:
Construcion Types:
V N, ,
Occupancy Groups:
B, , . ,
Fire Sprinklered?
T.I.Area:
NO
3,564
I certify that I have read this application and state that the above information is correct. I
agree to compiy with all city ordinances and state laws relating to building construction, and
hereby authorize representives of this city to e on the above mentioned property for
insp . urpose
" Dale:4/21/2005
! Signature of p Iieant o~ Agent
The ' "t shall expire by Iimnation 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 commence or continue work.
Fees paid for Permit:
Total:
1.657.61
..,. -........c
'. INSPECTION RECORD
INSPECTION . DATE INSPECTOR
Temporary power Po.le ~
Plumbi ng (DrainlWaste Pipe) . -'il> <>.
EleCtrical Ground Electrode/Uter ./ .
SelbacklFormsfTrenches (Footings)
00 not install subflooror pour floor slab until the
following applicable items have been signed: . '.
Plumbing (WaterPlpe.Sprinkler Valves) .
Mechanical (GroundwOrk) . .
Elel;trical (Underground Conduit) .
Pre-slab (Compaction/Membrane.Rei nf. . . .
Underpinning (Roar Joist/Girders) .
00 not cover or conceal the work below until the .
following applicable items Iiave been signed: .
1 st Floor Shear.
Rresprinkler (Rough) . . . .
2nd Floor Shear . '.
ROof (Sheathing/DiaphraomlFrame) .
Masonry (ReinfJBond BeamlPre-Graut) " -
Rough Plumbing. (Top Out) . . <;"'i}..,r. ~'/(
Rough Mechanical' .' , ~f
ROugn t:lectrlC;II. all) r' ,c,. 'I-O&, '. ..n,,~ /1
Rough EllIctrical . Ie"",...,'. C ."
. .Framing (Only after Plbg., EJ.ec.~ t\11eOh.. and Fire1' ~~-u<
Insulatian (SoundlEnergy)
Do not tape or plaster until the following applicable I
items. have- been signed: ... . - . .
Drywall " . .
P....etrations (Fire Rated) Electrical I . .
PlIoetratfons (Fire Rated) Mechanical . -c-.
Penetrations (Fire Rated) Plumbing
interior Lath . . .' .
Exterior Lath .
GENERAL ITEMS I
Exterior Plaster (Brawn Coai) . I
T .Bar Electrical . y. ~-~
T-Bar Mechanical . . f._ /' .
T -Bar Structural . . . ~- ~ --- ,p.
Sewer. . '. . :
Water En\lineering Backflow.
Water Service
FINAL INSPECTIONS.
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engi.-ring/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268'
Sub List/Business Licen'se .765-519
Zoning 765.5139
Building Final ILast Inspection. Only , I. r;,I\.;.
'.. . After Above Complete) ~1V'jV
PARTIAL INSPE9TIONS
Buildina Inspections
~~~~;~c~~st06;
C!/~1~t14:-'1~"4~ ./
_.Date
Inspector
Mechanical'lnspections
Plumbina Inspections
ElectricallnsrctionSr . II
. .,- '3 -oS- f' ~ '.j!. if/cJI.
S'Q~$z rd,4