8132 E. Santa Ana Canyon Rd.
TYPE OF PERMIT
Tenant Improvement (Limited) CITY
DATE: 4/19/2005
JOB ADDRESS: 8132 E SANTA ANA CANYON RD
LEGAL DESCRIPTION: PM 255-1 PAR 11 POR OF PAR
ElM
BUILDING DIVISION
200 S. AN,gJEIMJlL VD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 213
BUILDING PERMIT NO, BLD2005-00710
APPLICANT: KEITH. MARTIN
OWNER INFORMATION: CONTRACTOR INFORMATioN:
Otr DEB CONSTRUCTION
18818 Teller Ave 1210 N JEFFERSON ST #0
Irvine, CA 92612 ANAHEIM, CA 928070000
JOB DESCRIPTION'renant improvement, remodel of exist. space inlo bank (Ba~k of America)
,
106,000.00 I
OWNER-BUILDER DECLARATION
. h"ere ya irm un eT pena ope~ury t at am exempt rom t e ontractor's. 'cense Law for t e allOWing reason ee.7031.5 usiness and
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 ~pplica.nt for such permit to file a signed statemenrthat he is Iicent;ed pursuant ,to the provisions of.the Contractor's License Law (Chapter
9)(commencing.~ith Section 7000 of Division "30t the Business and Professionh_Cade) ar that he is exempt therefrom and the basis far the alleged
ex~mptian. Any,,!,iolatian of Section 7031.5 by any applicant for a permit subje4ts the applicant to a civil penalty of nat more than five 'hundred dollars
~0.. .
o . I, as a~ner of praperty: ar my emplayees with \:Vagas as their sole campertsation, will do ttie work,and the structure .is not intended or offered for'
sale (Sec. 7044 Business and Professions Code: The C,ontractor's License Law does nat apply to an Owner of property who. builds or improves
therean, and wha-does such wark himself ar herself, ar through his archer awn ~mployees, pravided that suCh improvements are not intended or
affered far sale. If, hawever, the building ar impravement is said with one year~Df completia~,the awner-builder will have th,€! burden af praving that ~e
did nat build ar improve far the pu rpase of sale).: J' . ' ' ," '
o I;' as the awner' af the praperty, am exclusively cantracting with licensed ntractars to. canstruct the praject (Sec. 7044 Business and ProfeSsia~
C.ode: The Contractor's U~nse La. W. daes not apply to. an awn. er af'prope rty w.r b.uilds or improves thereon, and who contracts for such projects wnh
fl.J1antractar(s) lice~sed pursuant to. the Cantractor's[ice~se Law). . " . ':
U J am exempt under Sec. , B & P.C. far thIS reasan: "
Date: Owner:.... ., .
I WORKER'S COMPENSATION DECLARATION \
I hereby affinn under penalty af perjury one' af the following declarations: f,
D ,I haVe and will maintain ,8 certificate af consent to self-insure,far_worker'sc~ampensation,
as provided for by. section 3700 of the Labor Code, for the pertormanoe of the\vork for which
this permit is issued. ' I . .
FAI have and'will m,ainta'ln worker's compensation insurance, as required by ~ectian 3700'a!
tt1e Labor Cade, far the performance af the work far which this permit is issued,; Mywarker's
Campensatian insurance carrier and palicy are: I
Carrier: STATE FUND Policy Number. 12606-20~
.' I .
This section need not be completed-if th.e pen1\it is fOr one hundred dollars ($100) olless.
Q- I certify that in the 'perfarmance ofthe wark for which this permit'iS issued,"1 shall not
~Ioy'any pe~son in any manner sa as to become subjec to. the worker" l?mpensation laws
of Califomia, and agree that l.should became subje he warker' peMatian
provisions af Section 37.00 af t ~b )J al 0
ARCHITECT/ENGINEER INFORMA,ION:
DAVID J FRIDLUND
4675 MACARTHUR BLVD.
NEWPORT BEACH, CA 92660
VALUATION:
PROCESSED BY: JPD
Cantractar
EXPIRATION DATE
3/3112007
B
Date: 4/19/2005 Applicant.
WARNING: FAILURE TO SEC ERKER'S COMPENSATION COVERAGE IS
UNUIWFUL, AND SHALL SUB CT AN P OYER TO CRIMINAL PENALTiES AND CIVIL
FINES UPTOONE HUNDRE THOUSAND DOLLARS ($1 00,000); IN ADDiTiON TO THE
COST 'OF COMPENSATION, AMAGES AS. PROVIDED FOR INSECTION 3706 OF THE
LABOR CODE, INTEREST AN ATTORNEY'S FEES.
CONSTRUCTION LENDING A~ENCY
I hereby affirm' unde r pena Jty -of perj ury that there is a canstruction lend ing agency far the
p~r.f9rlTIaJ1CE!,:.QfthE3c)~!9.rk f9Lwhi_~_1Jits~IL~JIlitjsJssued ($ec.3097 .Civ.C):_ ,Jt~
Lender's Infarmation:
s.
Construcian Types:
VN, ,
Occupancy Groups:
B, , , ,
Fire Sprinklered?
T.I.Area:
YES
4,426
. Date: 4/19/2005
~ees paid for ,Permit:
Total:
.1.862.41
Signafl,lre af pplicant or A-gent
The ermit shall expire by Iim~ation and become null and void if the building or
work has not passed final inSpection 365.days from the date of permit issumce, A
new nit is required to commence or continue work. .
INSPECTION ' ' DATE INSPECTOR
Temporary Power Pole ' ./ -
PlUmbing (DrainIWaste Pipe) If--:z-iC'o) ~
Electrical ~d Electrode/Ufer ;/
SetbackIFormslFl'encheS (Footings) <{.2-i...." -..?L "
Do not install subfloor or pour floor slab until the "',
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves) ,
Mechanical (Grouriclwork)
Electrical (Underground Conduit) <(-0
Pre-slab (Compaction/Membrane.Reinf. J
Uriderpinning (Floot"oist/Girders) ,
,Do not ,cover or conceal the work below until the
following applicable i,tems hav<iJ)",eri signed:' ,
1 st Floor Shear '" (/;11-0/) , , I
Aresprinkler, (Rough) " \ "
2nd Floor Shear " ' ' "
Roof (Sheathlng/Diaphragm'Frame) ,
Masonry (ReinfJBQI1d BeamlPre-Grout)
Rough Plumbing (T9P Out) ~ .,-10. ..~ ~ '" -' ' i
Rough Mechanicall ~"" ) , -)'J-0iJ' '-- I,' !
I RDugn t:Iectncallur:v' a ,,~ , :-'/l-o I
Rough i:leC1r1cal , )1
FramingJt' (Only afterPlbg...Elec:. f;rlech.. an.dFlre) , , ~'
Insillatlon (SoundlEnergy) , , I
00 not tape or plaster until the following applicable
items hav.e be:en signed:. ". " ."
Drywall " ., Io.-v6r'),""" " ;
Penetrations (Fire Rated) Electrical !
Penetrations (Fire Rated) Mechanical ,
Penetrations (Fire Rated) Plumbing i
Interior Lath ' , , '~ ,
,
Exterior Lath " C;;:17'O
, GENERAL ITEMS ' , ./ I
,
Exterior Plaster (Brown Coat) ,
T -Bar Electrical , . ,
T-Bar Mechanical' , ,
!
T-Bar StruC1ural, , ,
,
Sewer " , , I
Water Engineering,Backflow ,
. ,
Water Service' , I
.A!Se~TION RECORD
I
-
FINAL INSPECTIONS
Electrical Final
Plumbing Final '
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 7'65-4040
Water .Engineering 765-5268'
Sub List/Business License 765-51
Zoning 765-5139
Building Final 'ILast Inspection- Only'
, Alter Above Complete
PARTIAL INSPECTIONS
BUildina.ln~(:!iOnS ." " ' , ,,'
40,,,,, ,.,1 6""",,' ,d~ t4~
~ . m-' ,("..LL. ',;!.
q~'~3.~ jll:~~~~pd(
-r./ ..,~r fi..w,./ikj .J./IJk .{ ),;-y..;if/~, . . . .
<e<(c.'f.pr/1'r1l1 ~111' '''f- ~-<_ d-r",J.;;" "
Mechanicalln,!Q!ction!!_ /, ~Lr..yv'
C'.17-~J 1'6-!:?J ~,/",..pr<c-< ,d~r~~
~/.c;~or' ~4Jn111 '/~ ",c?",rI",Jov' ~~~.
fr~ b I-. ~ ~ ~..s: .
;;:::~~c~~;~/$;~)~
BwlJUl5 JIlY~nU ~-tAtU'c{)
(;-'8-~r l1r-/wJ e ~/
Cell., 6tc /1-02 .d:d ~4c.-
ElectricallnSDectioilS . . , '" ' .' '
~t?e()'- 14.. a;:;;ti../ G> ~r/i;y.~
..,.os- /Z. <0/ 6,7 ;f,.,d4d~,