555 N. State College Blvd. (2)
BUILDING PERMIT NO.
BLD2004-04264
BUILDING DIVISION
200 S.ANAHEIM BLliD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(7141765 - 4626
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CITY ~~~;}.)iEIM
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APPLICANT: PETE MA TRAFAILO I
OWNER INFORMATION: CONTRACT~R INFORM;;'nON: . . ARCHITECT/ENGINEER INFORMATION:
Maris E Vanags WESTERN TEL-COM DEVELOPMENT INC DANIEL M CONNELL
1510 N Slate College Blvd 41715 CHERRY ST . 'i 16 TECHNOLOGY DR.
Al'\9heim. CA 92806. MURRIETA, CA 9256200r,b IRVINE, CA 92618
JOB DESCRIPTIONAdd Clock tower /cell antenna tower and BTS cab. on root.!
VALUATION: 60,000.00 'I PROCESSED BY,. MJL .
I . '. ." OWNER-BUILDER.bECLARATION' . . .---,
. J hereby affirrTl under penalty of perjury that t am exempt from the Contracto(s License Law f9rthe following reason (8eo._7031:5 BIJsiness anq
. Professions ,Code: any city. or county which req uires a permit to construct, al!~r,- ,Improve, 'deinolish or repair any str.ucture, prior to its issuance, also
. requires theapplrcanUorsuch permit to file a signed statement that he-IS lic~f!'sed pursuant to the provisions of the Contrtlctor's License Law (Chapter
9)(commencing with Section 7000 of Oivision3 of the Business and Pr.ofess~ls Code) or that heis exempt therefrom arid the basis for the alleged
exemption. Any violatiOn of Section 703(5 by any applicant for a permit s..:;;[:ects the applicant to a dvU penalty of not more than five hundTed dollars
~~ '" . . . ~ '. ."
o J, "as owner of prop~rty, or my employees with \vages as their sole com~~fns~tlo~,:Will do the wo~k, and the sf.rllCture i..<; not intended_or offered fo~
sale (Sec. 7044 Business and Professions Code: The Go.ntractor's Llcer:1sel;.~,,!! does rot applyt..:> an owner.of propelty,who builds or imprcves
thereon, and who does such-work himsetf or herself or through his or herov~'i,!3mployees, provided that such tmplOvementsare not intenc!edor "
offered for sale. _ If, however, the building or improvement is sold with one y~r or completion; the ,own~r-builder will hS'Je th~ b~rdenof -proving that ~1e_
d!9notbuild()r'~mproveforthepulposeof~le). . _.-it '_ ,., _ "', -. , ,-..
o I,. 'as the_o~ner ofthe, property, am exclusively centra ding with lice!l~~ql(~r:ltra~o.rs to .construc,t the project (See. 7~4 Business _a~d Pr~feSSI?_r.'-s
Code: The Contractor's LH.:ense Law does net 8?ply.to an owner of property who bUllaS.or improves thereon, and who contracts for sum projects with
.f!Jf:lOtractor(s) licen~ed pursuant totheGontractor's License Law). }t, - . ':; ,'.' ,
u latnexemptunderSec. . ,B&,P.C.for.1hisreason: ~:,.<' '
,Date: ~ awner: ' . , ~,~ c ,
l WORKER'S COMPENSATION DECLARATION . y. ~ ':=]1
I hereby afWm under p3nalty of perjury 6ne- of the folloitJingdeclaratiolls:' S' I
CJ I, h_ave and "'YilI. :1,18intain a ce~ificate of ,consent to ,self-insure forwork~;;'~c. omoensation, ,
as pm.'lJ:dedtor by Section 3700 of the labor Code, fOi ihe perrormance of !~1~.wo;k f'Jr'which
!;hi permit is-issued. ' ' ., -'(j I
) have and will maintain worker's compensation insurance, as r<~quired tt.::sectkm.3700 of
t e aqor Code, for the performance of-the work fOl'which this permit is iSSll~~. My..."orker's
mpAnsation insurance carrier and policy are: ,.t-
Carrier: ACCORD ' Policy Number. 4503-02~_
Thi$ section need not be completed if the pennit is-for one hUndred dollars ($,1 Oaf Our less.
.0- -'certifY-that in the performance of the work for which this _permit is i~!-!E'~, J ::;hall not
_ employ any pers.on in any manner so as to 'beeo ubject to the worker's-ccrnpensc,tion law~
ofGalifomia, ,and agree that if I should become' ject to the woiker's Ccill1~ilSatil)n
proviSions'ofSe~tion 3700 ,~fthe Lab~r CO~?all forthwi . pI with .s~ 'isions.
Date: 31412005' AppliCant:' ~
WARNING: FAILURE TO.SECUR WORKER'S COMPENS .
UNLAWFUL, AND SHALL SUBJE T AN EMPLOYER TO INAL PENAITlrS AND CIVIL
FINES UP TO ONE HUNI1RED OUSAND DOLLARS 100,000), IN ADDiTION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY
I hereby affirm uncler penalty of perjury that there is a constrtlction lending a.g';:ncy for-the
performance of the work for which this permit is issued (See. 3097 .Civ.C): %
Lender's Information: -,
TYPE OF PERMIT
Tenant improvemenl(Limit!"d)
DATE: 3/4/2005
JOB ADDRESS: 555 N STArE COLLEGE BLVD
LEGAL DESCRIPTION: P BK 83 PG 34 PAR 2
CENSUS CODE' 437
QUARTER SECTION: 102
NUMBER
515503
TYPE
B
EXPI
8/3112005
Construcion Tvpes.
VN" .
fire Spnnklered?
YES
'.
. --"--, .-- - ----=
I certify that I have read t' application and state that the above information is correct. I
Dale: 31412005
Fees paid for Permit:
Total:
2,047.76
Signature of lcant or Agent
The permit shall expire 'limitation and become null and void if the building or
work has not passe mal inspection 365 days from the date of permit issuance, A
new permit is required to commence or continue work.
INSPECTION RECORD
.
. . INspeCTION DATI! INSPeCTOR
Temporary Power Pole . .' - .
Plumbing (DrainlWaste Pipe) , .
Electrical GrQUnd ElectrodelUfer
SetbacklFormsfTrenches (Footings)
Do not install subfloor or pour floor slab until the .
following applicable Item's have been signed: .
Plumbing (WaterPlpe.Sprinkler Valves) .
Mechanical (Groundwork) '.
Electrical (Underground Conduit) .
Pre-slab (Compaction/Membrane.Rei nf. . .
Underpinning (Aool' Joist/Girders)
Do not cover or conceal the worK below untirthe
following applicable items have been signed:
1st Floor Shear . ..,
Aresprinkler . (RoUgh) .
2nd Floor Shear . , .
Roof (Sheathing/Diaphragm/Frame) [/, &n
Masonry (RelnfJBond BeamlPre-Grout) [' I /i /l "-.
Rough Plumbil)g . (Top Out)
Rough Mechanical .
Rough aectrlC al\)
Rough Electrical A .
Framing (Only afterPlbg.;. Elec.. Mech.. and Fire) ~/ol>h:5' n
Insulation (SoundlEnergy) f'f/ --.:--
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 A . - "
Exterior Lath. '. ~s ~
. . GENERAL ITE
Exterior Plaster (BlOWn Coal) .
T-BarElectrical .' . .
T -Bar Mechanical' .
T-Bar Structural .
Sewer
Waler .Engineering Backflow . - .
Waler Service
t
-.
Date Inspector
FINAL INSPECTIONS
Electrical Final
,
plumbing Fi'1al
Mechanical Final
Gas Test
Engineering/Grading Final 76505126 .
F,ire Dept. Final 765-4040
V)/ater Engineering 765;5268
Sub List/Business License 76'5-519
Zoning 765-5139
Building Final' (Last Inspection- Only
, . After Above Complete)
.PARTiAL INSPECTIN
S.. ,.U.. i1di. na.lnSDeC. ~ion.s..... .... . .... . ". .' aDo~.o'
~t1-o/1),r ~~.~fi)f1..,~ f~h-tAAtJ~
, . - ......
I. " ".
Mechanical Inspections
PllImbina inspections
. Electrical Inspections
--.
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TYPE OF PERMIT
Tenant Improvement (Limited)
CITY
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'~N"':H ElM
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765-5153
Ii'lSPECTlON REQUEST LINE:
(714) 765 - 4626
BUILDING PERMIT NO. BLD2005-00553
DATE: 3/3/2005
JOB ADDRESS: 555 N STATE COLLEGE BLVD
LEGAL DESCRIPTION: P BK 8'3 PG 34 PAR 2
CENSUS CODE: 437
QUARTER SECTION: 102
APPLICANT: MARIS VANAGS
OWNER INFORMATION:
Maris E Vanags
1510 N State College Blvd
Anaheim, CA 92806 (
JOB DESCRIPTION;renant i~provement, Build out of unfinished offke space: 3t;te 207 &208)
VALUATION: 10,000.00 , f PROCESSED BY: MJL
I . .. '. . OWNER-BUILDER ciijGLl\l;ATION ."
I her.eby affirm under penalty of perjury that I am 'exempt from the Contrac!:ori1[.:e!:s.:e- Lel.'''! for the foHewing re;;.s,)j"l.,Sec. 1031.5 Business and
Professions Code: any city or ccuntywhich requires a per-mil to ccnsi.rllci., a!t~;;~r(;prove, demolish or repa;.- :-l.ny stnh.::;ture.. prio:- to its. issuancE::, al~t:
reqlljre~ the (3-ppliCl3.o1 for such permit to file a i3igncd s~at(;lment that heis !ic€'rl~Jd p~:rsuant t~ tt'!e provisions of the Contractor's License Law (Chapter
9)(commencing with Sec~icn 7000 of Division 3 of the Susiness and P;ote~$~):.i"iGud.;) or-thst he is exempt tht'!iefrom ancl the basis for the alleged
;.8XE:mptioll. Any vip!3tion of Section 7031.5 by any app:icant for a permit si...i!~l~:j-:~:"(hG dj.;~iicG'{lt to a clv!l penalty o~ net l,nor'J tnan,fivE" nundred dollars.'
'WfO.)~)as owner Of. prope";, or my. employees with wag~. os their ';'!eCG'n;~r)iq1iC",.W;1i 00 the work. ."~ the struc~;rc ;, not '"i.nded or o'!ered tor
'~S~c. 7()44 .Busir:essand Professicn3Code: The Cuntractor'::; license '-:a\ldr..c~ not .3iJp!ytoan cw:;er of r<roperty who !?e!!dsor impro....e':; .
. t~ereoi'l, and who does such work himsf11f or herself or thr(;)i.Jg~ tJis ~.r)ler (jw,!-i;~Tir,loye(~s_ ~:"ov!dw !rl3t sucr: ;rnpJo'vsn"';:5!lts arc not jntG~d~~:or,,_ '
offered for &lIe. If. however, the buildir~y,or improvement L~ sold \A..'!th onGY€-,~!:4r;:_cor;;t:1letic;;.:hP. awner-tiuildel v,;ii! h3',ieihe-burd~n_~fPr()y!n~_t,hat he.
dij not, hui1d,orimprove for the p'Jrposc of sale). ':,' ,::~:":,;,~:_ '_" " . . ,." '-:,:,-':>~; ::_:. .
LJ ,_I,asthe:~'Nr;er cf the property, am ejCcil.ls,iv~ly ':.cntr,:;ct1r1::;"~;th J;cml$€-t:~;;1~p'qc~'s to~onstrL.::.t th~pr;Jjec~_(8~l;. 7a~'Bi;SI~:~SS c:nd P:'ufee3i0ns.
. Code:.. TheGontractoi's License:: Lc:w dues net apply to an,OW!lsr of ;):0PJ.~yyj(k; b:.!!1d::; or 1!TI:JfC"-cS ihemon, ?.ild'w~o GOlllr~.:ts lor :;uch 'iJr~jo;'!cts'':''''itil
F-)ontractcr(s)Uccnsed pun::uc;_l1i tothd Ccht~9ctur'& Uccr.:",e La'~J).. :::/}_:; . .
_;~lel=~nder se~wne" ~~~~=~;~~",",__::;JI.;~~:---_-~:-.::-- ________'__~===-
L H, ':""'_' ."-"<{ '_' VtJORKER~~~OM ~i;__A rICNJ:)E~!-AK!i.TI.oN-. ..___:"t-.,,__._J L. L=CENSEO CvNTit4.CTOR~_ OECL"\~TJC:-.J _ J
I hereby affirm !inder.penalty'ofpe:-jl!IY "l1e of the foliowlng deciai",l.iC!1::: . ..t-,. . I i hereby .:.ffirrn u:1der.p('.n~ity'~f perjurv ~tla! 10:l!!"l
LJ.':i'have -an:dwilJ f'Tlaintain a certff/Cat~ of ~'(:nser:t io seli-insure f('t \,~~ori{~;:;:J,-:~fl:peI1S~ticn. I licenstld :~nder prov:sior.~ of ~:'ap!t'!~:) (e,jrr:mencirlf.J
. 'as piOvidot..dfo~ (.y S~ctjon 3701) of the l.abor Coce, furY1\? ~erf(lrm;:.r:,;e C!ui;-y,h.~~}:; rUI whiCh i ,with'Section 700m of Divs~.}(l3 oithe Busine~s and
this permit IS issued. _.it .: ~rofe$~jn"s Code.
. [] I h~ve'i:lnd wi!1 m::lir.tain wo!",{er's'compensation !ni~lrar.(':c, F:l.;.ie:<rdIBd t:~;,'S._';(;t;L'!1 j?OO of I 3/:~i2C05 _____
th~ L~b;'r Cade.for the p'3rformaJ'"lce o. f th3 wGrk for '.viil~h tnis DE::r~lii: 13 is:~Ul;:':'':~.''r-' 1\.'~'.' ";V'Q(k~r's I L\::ite:
Compensation insura(lce can~er znd oolicy ar6: .' . !
C"rrfer: _' . '. POIICt NLirnber:,.':_ I :.JUjI./ISi::R EX~"';RATION DATE
This section need not be completed if the pe;mitis tor one hundred tiollars {$1(;ajf~l:' !~IS_ . TYPE
r\.Y1certifj that in the performance of the wor!< fCi( '-vhich ,his pe:'"mitis'l-S:S~e!.i;~,~!1aH not
~y any Peison in any manner so as'to become subject to tns worker'scc,klper.s-~tiqn lal!oJs
-of CalifGmia" and agree that if I shouid become $u.bjecl to the wo'rl<e(s com~~lsC:ition
provisions of Section 3700.ofthe Labor Code, I shall forthwith comply V!ithth8:se provisicms'.
Date: 313/2005. APPlican;, X 11M ~ ~ ~ J'~
WARNING: FAILURE TO S~S COMPENSATION COV=P,;("E IS
UNLAWFUL, ANt) SHALL SUBJECT AN EMPLOYER TO CRIMINAl. PENAi_kIFShl";;O CIVIL
FINE~ UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), 1N ,..OlJi;:ON 10 THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECflQ^! ~706 OF Hit,
LABOR'CODE, INTEREST AND ATTORNEY'S fEES. . .
I CONSTRUCTION LENDIN~ AGENCY --:-::='-'-~~
iflereby .3ffirm under penalty of perjury that thf.(e is:3 cOrlstructic'1 !~i1rt:nr :~C3r.cyfor the.
:;y:l:rf :':'"m;::'l,'1~: _of .tt!JsV,lo";<_foJ:_wb.;d::,--thj.<:.-r,er...!~ i,~ ;_"-~~;~? ct (S",'r; ,30(;rl.,.G~'_~,C}:.:-__~-'.,..' -'~--=--':__'"
Lende'r's-lnlormation: . .' .
CONTRACTOR INFORMATiOJ:
ARCHITECT/ENGINEER INFORMATION:
I
.'
Contracto:'"
Construcicn Ty~es:
VN. ,
OccuPCln.:;y GroU~~5:
S, , , ,
Fire Sorif)kier3c!?
NO
I certify that I have read this application and state that the above information;s correct. I
agree to oomply with all city ordinances and state laws.relating to buDding COfistruction, and
.liereby authorize representives of this city to enter updn the above mentioned property for
i...hSPe. ction p.~~s. ", . .
X //I?/~ r _ Date: 3/3/2005
. , ' . Signature of AP~nt or Agent
The permit shall expire by limitation 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:
535.98
.
INSPECTION DATE INSPECTOR. Electrical Final \\1 \~I(~ ~I
Temporary Power Pole . - Plumbing .Final , r.
Plumbing (Drain,waste Pipe) , - III ,d~
., Electricai Ground ElectrOdetUfer . Mechanical Final
. SelbacklFormsrrrenches (Footings) Gas Test . I
Do not install.subflOQr or !,ourtloor slab until the , Engineering/Grading Final 765.s126
following applicable items have been signed:
Fire Dept. Final.765-4040 .. .', .
Plumbing (Water Pipe.Sprinkler Valves) ,
Mechanical (Groundwork) , Water Engineering 765-5268 . .
Electrical (Underground Conduit)
Pre-slab (l,;ompactioillMembrane.Reinf. Sub List/Business License 765-519 .,
Underpinning (Floor Joist/Girders) Zoning 765-5139 f)
Do not cover or conceal the work below until the Building Final lt~st Inspection- Only ,'" ~k {1/n-X1 /b{
following applicable ijems have been signed: fier Above Complete) , lfY",,~,c;'
1st Floor,Shear , . . PARTIALJNSPECTI NS
Firesprinkler(Rough) .
2nd Floor Shear . YL-os- ., Buildinq Inspections
Roof, (Sheathing/Diaphragm/Frame) II.IlVl4.t:"7T
Masonry (ReinfJBond BeaI'n/Pre-Grout) . . . '
.
Rough Plumbing (Top Out) , ," . /"J' . . '
Rough Mechanical, I A~ -
Rough Bectric.a1 ,""y nail) . ' .
Rough electrical I{ , .
Framing (Only after Plbg:, Etec... Mech.. and Fire) 1 1'1\ , ,
In$Ulatlon (SoundlEnergy) , , ,
DO not tape or plaster until the following applicable Mechanical Inspections
items have been signed: . ' ,. , . ,,' .: . "
,.,....
Drywall, , ._, ' , ,.', ':':':~';1~~;~it-,:\:-:,~..'-~
Penetrations (Fire Rated) Electrical ' ' '
" '>
Penetrations (Fire Rated) Mechanical , , , '" :;.^' "
Penetrations (Fire Raled) Plumbing , . ....'..
. ....;.._-~
Interior Lath
Exterior Lath , . Plumbina Inspections ',<. ,
, GENERAL ITEMS
Exterior Plaster (Brown Coat) ~ /' ./ , . .
T.Bar Electrical ' , ~I\ ./ . ., " ,
T .Bar Mechanical ,
T .Bar Structural ' I '
Sewer
Water Engineering Backflow ElectricallnsD .
. ctions
Water Service
INSPECTION RECORD
FINAL INSPECTIONS
or
tfnlf1, ~ZOY