441 N. Lakeview (4)
TYPE OF PERMIT
Tenant 'Improvement (Limited)
CITY
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 167
BUILDING PERMIT NO. BLD2004-02628
DATE: 91712004 .
JOB ADDRESS: 441 N LAKEVIEW AVE NON-HOSP
LEGAL DESCRIPTION: RANCHO SANTIAGO DE SANTA ANA LOT'.
APPLICANT: JAMES MC COLLUM
OWNER INFORMATION:
Foundation H Ka iser
393 E Walnut St
Pasadena, CA 91188
CONTRACTOR INFORM.\TION:
KAISER FOUNDATIONf'EAL Tl-i PLAN
3355 E 26TH ST .
. LOS ANGELES, CA 90023 0000 .
BUSINESS PHONE: 21326,-4310
In~tallatiol"l of a'rne~ica! v3cuurn p~:-np.'
ARCHITECT/ENGINEER INFORMATION:
JOB DESCRIPTION,en.ant Improvement.
VALUATION: 40,000.00 PROCESSED BY: DOR
I.' . . . OWNER-BUILDE~PECi.ARATION.' ..' .~
I hereby affirm IJi1(ler penalty oJ perlury that I am exempt from the.Contr;;!ctQtIs LICen&e l.aw for the'following reason (Sec. 7031.5 Business and
Professions Code: any dty or county which requiles a per~TI~ to const:-uct, .3i!er, lll1prove, demolish or repair anystructure,. prior to its issuance, also.
requir.es the appliC3nt for such :permit to file a sighed stritf.lmellt that he is Ibin~ed ;..>ursuant to the provisions of the Contractor's license~aw (Chapter
'9)(commencini;iwith Section 7000 of DivisionS of the Bllsiness and P~ofes.s~nsCode)or that he is exempt therefrom and the basi.s fer the alleged
exemption._ Any.violation of Section 1031-.5 by any applicant for ~ permit s;:;tjects the applicant to 2 dvil penalty of not mcrethnn five hundred dollars
($500).. .'. . i '. .
D I, as ~wl1cr of p~operty. or ~y employees with wages as their s,,-::le com::ensction, wil! do"the work, al1d the s.tructure is not.intended or offered for
sale (Sec. 7044 Business and Professions Cod~: Thf! Contractor's license.,;:::....... does not apply to an owner of property who builds or improves
thereon, and who does '::Udl 'work !llmSclr"br he~elf or through his' c.r her o....ll employees, provided that Stich improvements are not intended or
offere;:i far sale. !f, however, the.bL:i!d,ing,or improvement k~ !;;c:d w!th one'1'.:":;~rof completian. the owner-builder wiil ha~ the: burden of proving tha.t he
did not build or improve for'the pur~ose of sale). , . '-,; .
[J ,I, as the owner of the pmpeliy, l::m exdusi,,;ely' contmcting witlll!cense:~\:ontractNs'to construct the project (See. 7044 Business?ild P;-ofes.c:;ions
Code: The. Contractor's License Law does notappiy to an owr.erof propd~~y;.\'ro builds or imp!"Ove::;'thereo~, and,who contracts for sudl prolec,ts \!ViIh.
F!--QOlltrad.nr(~) licensed .pursuant to the Contractor's Llrense 1-2W). - -: :
LJ l am exempt under Sec. -----..:-_ ,8 & ? C. for this rea3Cr.:
Date: . . Owner: ' . ,
~ WO","" """"""""" ",C","",g, 7_-=-:=J roo'" co~~w" 0''''''''''"' I
I hereby affirm under penalty of perjUl)' one of the follewing declarations:. I nereny affirm Linder penalty of perjury that jam
o I have ar:d will maintain a certIficate ot oon::ent to se:f-!nsure for wc~j~en3 LOf!'pej1~HJ.~IOr:. li~erTSed ~nd:r provlsions?f chartBr 9 (commencing
as provlde~ for by Section 3700 of the L?bor Cooe, fo- the perforrn3i'C;8 o~.~ ~ vI'Qrr( for .Nh:ch w,th Sechen 1000 IYSlOn 3 of tne Bus ~ 55 c:n
this oeffi1it IS Issued. f I ProfeSSIons
[3"1 'have Clnd will maintain worker's compe'1s3ti()11 Insurc:nce.:::s required. l; Section 3700 of 9/712004
the Labor Code, for the performance of the work for wnlch this pe:-mit IS lsst:.:d. MywO!ker's Date'
Compensation insurance carrier and policy are:
Carrier: SELF INSURED
Policy Number: 10:33
EXPIRATION DATE
3/31/2005
. . ,
~This section 'need not be completed if tiie,pennit is for one hundred dollars ($10~} or less.
o I certify that in the ,performance of the \vork for which this permft is iSSUl~'d, I. shan not
employ any person i.n any manner so as to become subject to the worker's c6mpens8tion laws
of Califomia, and agree:that if I should become subject to the worker's corr.p'.:::nsz.tion
provisions of Section 3700 of the Labo . d I lal! fort riith ~om Iywith n~s ... 7isions.
NUMBER
370871
TYJ:'E
B
Date: 9/7-12004. Applicant:
WARNING: FAILURE TO SECUR O. ER'S COMPENSATION COVE., GE!S
UNLAWFUL, AND SHALL SUBJ .T AN EMPLOYER TO CRIMINAL PEN' 311'3 AND CIVIL
FINES UPTO ONE HUNDRED Tl-iOUSAND DOLLARS ($100,000), INAQDlTION TO THE
COST OF COMPENSATION,. DAMAGES AS PROVIDED FOR IN SECT!O~: 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY .
I hereby affirm under penalty of perjury.that there is a construction lending~!):J~Jncy'for the
perf~nce of t~_e ~ork for whi,ch this per~it is issued (Se('~ 3097 Civ -'?t:::.
Lender... .nfarrr.?tl,:n. ' .
?-d1
Construcion Types:
1I1HR. ,
Fire Sprlnklered?
YES
I. certify that'l have read this.app.lication and state that the above information is correct. I
agree to romply.with all city ordinances aDd state laws relating to building cOl1struction, and
hereby au . erepresentives orthis city to en rupon the above, mentioned property for
inspe n pu s.
Date: 9/7/2004
Fees paid f,?r Permit:
Total:
664.66
Signature of pplieant or
T per it shall expire by Iimitatio nd become null and void if the building or
work h s not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
INSPECTION RECORD
. INS'PECTION DATE INSPECTOR
Temporary Power Pole'
Plumbing (DrainlWaste Pipe) .
Electrica"Ground ElectrodlllUfer r I
SetbacklForrnsfTrenches (Footings). 7/.nil o ~/!1/jfl 2-,
Do not install sUbflQor or pour floor slabJlnti l{the
following-applicable .items have been signed:
Plumbing (Water Plpe.Sprinkler Valves) .
Mechanical (GrQ\ind.work) ,
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane.Rei nt. . '
Underpi/'lning (Floor Joist/Girders)
Do not cover or conceal the work below until the .
following applicable. items have been signed:'
1st Floor Shear . . . .
FireSprinkler (Rough) . . , .
2nd Floor Shear . " . .
Roof (Sheathing/DiaphragI11lFrame) .
Masonry (ReinfJBond BeamIPre-GlO\Jt) . . .
Rough Plumbing (Top.Out)
Rough.Mechanical, . ' '.
Rough Electrical (Dry Wall)
Rough Electrical ,
Framing (Orily after Plbg'.. ElK. t...:ee:h . and Fire)
In5l!lation (SoundlEnergy)
Do not tape or plaster until the following applicable
items have bee.n signed: . . . '
Drywall' . . "
.Penetrations (Fire Rated) EleCtrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rl\Iled) Plumbil1!l
Int.erior Lath .' .
Exterior Lath, .' , . ,
GENERAL ITEMS
, .,:xteriorPlaster (Bl'QWn Coat) .
T.Bar Electrical
T-Bar Mechanical
T -Bar Structural . I,
Sewer ' . .
. Water Engineering Backflow . '
Water Service
FINAL INSPECTIONS
Electrical F.inal
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 7654040
Water E.ngineeting 765-5268
Sub list/BlisinessLicense 765-519
Zoning 765-5139
Building Final' (Last Inspection- Only ,
." ,After Above. Completel
Date
Inspector
.~
. ':'ARTIAL1NSPECTIONS", . ~ L6
Buildina Inspections 4-1t_ (JrR .
Mechanical Inspections
Plumbina Inspections
'. ElectricallnsDectlons