5761 E. Santa Ana Canyon Rd.
TYPE OF PERMIT C
Tenant Improvement (Limited) ITY
DATE: 8/17/2005
JOB ADDRESS: 5761 E SANTA ANA CANYON RD
LEGAL DESCRIPTION: DOMINGUEZ ESTATE LOT 4 POR OF LOT
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 185
BUILDING PERMIT NO. BLD2005-02118
APPLICANT: HELENA GARROVILLAS
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
IMPERIAL PROPERTIES R L CLOlWORTHY CONSTRUCTION INC CALVIN COATSWORTH
2424 SE BRISTOL ST #200 27637 COMMERCE CENTER DR 2458 DUPONT DR.
NEWPORT BEACH, CA 926600000 TEMECULA, CA 925900000 IRVINE, CA 926120000
JOB DESCRIPTION,enant Improvement, 115051 retail space (Friar Tux shop)
25,000.00 PROCESSED BY: MJL
OWNER-BUILDER DECLARATION
I hereby a Irm under penalty 0 perjury t at I am exempt rom the on tractor's. lcense wort e 01 oWing reason ee. 7031.5 BUSiness a
Professions Code: any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, 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)(commencing with Section 7000 of Division 3 of the Business and Profession"s Code) 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 subjects the applicant to a civil penalty of not more than 1ive 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 or offered for
sale (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 does such work himself or herself or through his or her own employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale).
D I, as the owner of the property, am exclusively contracting with licensed contractors 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 oontracts 10r such projects with
fU{ontractor(s) licensed pursuant to the Contractor's License Law).
U I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
D r 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 of the work for which
~s permit is issued.
)8='1 have and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the performance of the work for which this permit is issued Myworker's
Compensation insurance carlier and policy are:
Carrier: STATE FUND PoHcy Number. 1713094-2003
LICENSED CONTRACTORS DECLARATION
ere ya Irm un er pena ty 0 perjury t at am
licensed under provisions of chapter 9 (commencing
with Section 7000) of D. f the Business and
Professions Code.
8/17/2005
Oat.
Contractor
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
o I certify that in the perionnance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the workets compensation laws
of Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I forthwith comply with those provisions.
Date: 8/17/2005 Applicant: ~
WARNING: FAILURE TO SECUREW RKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED 11-IOUSAND DOLLARS ($100,000), IN ADDI1l0N 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 hereby affirm under penalty of perjury that there is a construction lending agency for the
periormance of the work for which this permit is issued (Sec.3Cl97;Civ.C):
Lender's Information:
NUMBER
803626
TYPE
EXPI RATION DATE
113112006
B
Construcion Types:
VN, ,
Occupancy Groups:
B, , , ,
Fire Sprinklered?
T.I.Area:
NO
1,150
'certiiy that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby authorize re resentives o!_ this city to enter upon the above mentioned property for
in ection purpo .-----.
Date: 8/17/2005
Fees paid for Permit:
Total:
979.99
Signature of Applicant or Agent
The per it shall expire by limitation and become null and void i1 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.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION
DATE
INSPECTOR
Temporary Power Pole
Plumbing (DrainJWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklForms/Trenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (ReinfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall) "f".etLY
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire) '1'"'lluI
Insulation (Sound/Energy) f
Do not tape or plaster until the following applicable
items have been signell: I
_I / ~A,", \.~1/_1
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
I I
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T-Bar Electrical
T-Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
,
IQMf
I D( /J~
I
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub ListlBusiness License 765-5t94
Zoning 765-5139
Building Final (Last Inspection - Only ItJo(
After Above Complete) C/
.~
PARTIAL INSPECTIONS
Building Inspections
Mechanical Insoections
Plumbina Inspections
Electricallnsoections
APPLICANT: MARTHA RICHTERS
OWNER INFORMATION: CONTRACTOR INFORMATION:
impenal Properties SAN MARINO ROOF COMPANY INC
~424SE Brislol',SI#200 2187 N BATAVIA "
Newport Beach, CA 92660 ORANGE, CA 928650000,
, 'BUSINESS PHONE: 714974-3070
JOB DESCRIPTION: Tear off existing & reroof 165 sq with 30 yr Composition :thingles for Strip Mall.'''5761-5769''
jVALUATION: 50,000,OOJ__~ PROCESSED BY: MJF
OWNER-BUILDER,DECLARATION
\ hereby affirm under penalty of perjury that I am exempt from the Contractoi"';S License Law for the following reason (Sec. 7031~5 Business and
Professions code: any dty or countywhich"requlres.a perm!t to construct. <3\t*r. improve, demolish or repair al.1Y structure, prior to its iss'uance, also
requires theapplicantfor such permit to tHe.a signed statement that he is Jjc~;1sed pursuant to the provisions of the Contractor';; License Law (Chapter
1 9)(comrr:encing,w\th Section 7000 of Division 3 of the Business and Professidns .code) or that he is exempt therefrom and the basis.jor the alleged
exem-ption. Any vioJationof Section 7031.5 by any applic.ant for a permit sut'[ects the applicant to a civil penalty of not-more than fiYe hundred dollars
~~ '~. "
o I, as owner of p:,oPcrty, or my "3mployp.es with wages as their sole cDmr:~nsatic(l, .will do the '."lorK, and the structure L<ii not .intended or6ffered:for
sale (Sec,?044 Busir,ess <'I.no Professions COde: The ContraciOl's License L:ilw does noi <::ppryto a.n owner.of,property who builds or improves
thereon, and who does such wor:, himseif or herself or through his or her OW;7 emplpyees, provided that such im!JioVement~ are not intended or'
offered for sale. Jf,however, the building or.irr'provement is sold wfth one v:::h. of ~mpletiQf\, the owner.builder wili haye the burdenof preYing that he
didnotbuiidorimproveforthepurposeofsaJe).. .~ ..
. r--] I, es the owner of the property, amexc\usive~ contracting with lIeensed}Jntractois to construct the projec.t (~ec. 7044 Busirless and Professions
.Code: The.~ontractor's ~jGense Caw does not apply to Z:1 owner of p,cpert:/.:vi10 builds or improves thereo'n, and who contracts for such projects-with
~0~tractor{s) licen$~ pursuant to tne Contractor'$Ucen.se Law). .
L.J !,ameyernpt under Sec. ~__ ,B&'P.C,foithisfl2!:Json: _~~.
Date: .own~r: !.___.--"-""
I "., ' , WORKER'S COMPENSATION DECLARA1JQJL_~~= ~
I hereby affirm \lOder penalty of perjury one of the fOl!cwing dp.c1arations: ~:
o I h-~lVe and will ma intain a ceitificate of ccmse,-;t tc self-:nsure for \'J\'rker';';.f;c~lpen5ation,
as prcv:d ,(f for by Section 3700 of f~e i...abor Code, for the perfo.rmanc"~ of th'<.:; work for which
this p it is i&sued.
have and will maintain worke;"scOrTl;Jensatior. in~arance~ 035 required !)~~I S"Odloo 3100 01'
t e Labor ~ode, for the periorfTiance Of.the, work for which this permit is i$SuJd. Myworke:,,'s
Compensation insurance C:3rrier and ooliey are: l
Carrier: LUMBERMEN'S MUTUAL CASUALTYCcPo1icy Number: 38A164~:L9-00
This setti~n need not be CO~Plete.d if.the pe~it is for one hundr~ dollars ($.1r.(I~ cr iess.
O. I certify that in the peifonnance6f.th~ work for which this permit is. issuc~1, ! shall nc.t
employ any person in any man~er so'as to becomE;: s'ubject to t orkers c~':II?ensation laws
of Califomia", and agree that if I should b orne subject to the erker' ccrnp.{nsation
provisions of Section 3700 of the lab d s 1 rt ith th',se :?rovisiims..
BUILDING PERMIT NO.
BLD2004-03359
lf~~i;;;{~~~~~\, .
CITY €)' '~',.'N~H ElM
." ",0.., ~ .
. '\ ,~:..tL(;"t /
. \~'/.':>';'~ \,-!,-0../I .
".~Zt,~?n:~t.f"\}'/
TYPE OF PERMIT
Reroof ,'" "
DATE: 9/112004
JOB ADDRESS;
5761 E SANTA ANA CANYON RD
LEGAL DESCRIPTION: DOMINGUEZ ESTATE LOT 4 POR OF LOT
BUILDING DIVISION
200 S, ANAHEIM BLVD
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE; 555
QUARTER SECTION: 185
ARCl-llTECTfENGINEER INFORMATION;
LICENSED CONrRACTORS DECLARATIO.~
I hereby'affirmui1der pe:'!alty 01' ~er.jl:ry that I GIlT)
license<:l under provi3lons:..o! CII pter 9 {cornmencing
withSection70 )of iitln. ofitheBusinessano
Profsssions C
91112004
Date:
NUMBER,
2490;59
TYPE
TYPE
Construcion Types:
VN, ,
Date; 91112004 Applica t: , _
WARN ING: FAILURE TO SECU W RKER'S COMPENSATION COVER\GE is
,UNLJ\WFUL, AND SI,ALL SUBJECT AN EMPLOYER TO CRIMINAL PENAcTJESl\ND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADD:T.iON50,THE
COST OF COMPE;NSATION, DAMAGES AS PROVIDED FOR IN SECTION '3706. OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES, '
,I ' , , CONSTRUCTION LENDING AGENCY . _:__'~
I her~by affirm under pena_!ty of perjury that there i~ '3 constrilctionlending <~gt;,'j,SyJ~r .th~,
~--pz~f.::7o'l:iUi~G1't:.Z ......c-I;,itTv....i-lici~- ti-i;~-pefll;;~-b-i6~t:;:d {Sec. :::;('.Gi.Clv.C/~ .._. ,- ~
lende(s Information:
I certify that I have (ead this application and s.tate that the above information is correct. I
agree.to comply with all city . Inan sand state. raws relating to buil.ding construction, and
hereby authorize presenti es of thl cit to ente~ upon the above mentionoo property for
inspection purpo s. .
Date: 91112004
Signatur of A licant 0 Agent
The permit shall expire by limitation and become, null and void ifthe bUilding or
work has not passed final inspection 365 days from the date of permit iSsuance. A
new permit is required to co,"mence or continue work.
Co.,traci.or
EXPIRATION DATE
7/3112006
C39
HIC
Fees paid for Permit:
Total:
1,254,05
INSPECTION RECORD
. INSPECTION DATl;' INSPECTOR
Temporary Power Pole
Plumbing (DrainiWaste Pipe)
Electrical Ground Electrode/Ufer .
Setback/FcirmsTTrenches (Footings). .
Do not install subfloor.or pour floor slab until the
following applicable items -have been signed; .
Pluml)ing (Water Plpe.Sprinkler Valves)
. Mechanical (Groundwork)
Electrical (Underground Conduit) .'
Pre-slab(CompactionlMernbrane.Reinf. .'
Underpinning (Floor Joist/Girders) .
. !Xl not cover or conceallhe work beloW' unl,'the .
following app.licab1e items have been signed: .
1 sl Floor Shear . . . .
Firesponlder (Rough) '.' . .
2nd Floor Shear . .
RQd (SheathiIl9'Dlaphra!lmlFrame)
Masonry (ReinfJBl)rld Beam/Pre-GrQ\It)
Rough Plumbing (Top Out) . .
Rough Mechanical .
Rougheectrlcat (Drywall) '. .
ROUgh Electrical
Framing. (Only after Plbg. EJec.. t;~ech and Fire! .
Insulation (SouncllEnergy)
00. nollape or plaster unt" the following applicable
items have been signed:. . .' .. . . .
Drywall
.Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical .
Penetrations (Fire Rated) PlumbillQ .
Interior Lath
Exterior Lath . .
. . GENERAL ITEMS .
Exterior Plaster (Brown Coat)
T -Bar Electrical .
T -Bar Mechanical.
T -Bar Structural .
Sewer . .
Water'Engineering Backflow .' . .
Water Service
PERMIT EXPIRED
. U~SPE ell 0 N
NOif COMPLETED
. DATE: Id-dq- os
0"
'-,
FINAL INSPECTIONS. Date . Inspector
Electrical Final . .'
Plumbing Final r---; "-.
.' ' ;'
Mechanical Final .
Gas Test . .
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040 . '.
Water Engineering 765-5268 -
Sub ListlBusinessLicense 765-519
Zoning 765-5139 ..,
Building Final ~astJnspei;tion. Only' . .
fie, Above Complelel . .
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections
. .Plumbina Inspections
Electrical Inspections