1395 N. Miller St. Verizon Millerloma
TYpE OF PERMIT
Tenant Improvement (Limited)
DATE: 4/21/2005
JOB ADDRESS:
BUILDING DIVISION
200.S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: . 437
QUARTER SECTION: 143
9--1(
BUILDING PERMIT NO_ BLD2005-00485
APPLICANT: JAM ES CULWELL
OWNER INFORMATION: CONTRAOTOR INFORMATION:
DBG ENTERPRISES METROC-ELL CONSTRUCTION INC
1399 N MILLER ST 1210 LEMON TREE DR I
ANAHEIM, CA 92806-1'412 LA HABRA, CA 90631 0000
JOS"DESGRIPTIONlnstall' equipment and masonry wall for verizon cell site. (OK to Issue elee. ped. permit and release emped as: 1695 N. Miller St);
VALUATION: (orla~8I\'6i85ued under1399 N Miller St.) I PROCESSED BY: JNJ
OWNER-BUILDE DECLARATION
ereby alrm un ef penalty 0 perjury t at I am exempt rom t e ontractor!s Icense aw for t e fa owing reason ec. 7031.5 BUSiness and
Professions Code: any city or county which requires a permit to construct, a~er, improve, demolish or repair any structure,- prior to its issuance,. also.
requires the applicant for ,such permit to tile a s'igned statement that he is'Jicei.hsed pursuant to the provisions of the Contractor's License Law-(Chapter
9)(commencing with Section 7000 o_f Di.vision 3 of the Business and Professiqns 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 sUb~ects the applicant to a civil penalty of not" nio re than-five hundred dollars
~OO)" .1.... .-
U I, as owner 01 property, or my employees,wlth.wages as their sole compensation, wi-ll.do ~he wor,k, and the structure i.s natilitended 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 fmpr.oves
thereon, and. who does.such work himselt or herself or through his or her owri employees, provided that such improvements are not intended or .
offered fot sale. If, however,_the building or improvement is sold with one ye~r of completion; the owner-builder will ,have the burden of proving that he
did not build or improve for the purpose of safe)~ r..' _
D I, as th~owner of the property, am 'exclusively contracting with licensed [eontractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner ot property Who buiJdsor improves thereon, and who contracts for such_ projects with
i3--!(ontractor(s) licensed pursuant tothe :Contractor's License Law). '
U '1 am exempt under Sec. ' , B & P.C. for this reason: -J.
Date: Owner: !
I
ARCHITECT/ENGINEER INFORMATION:
WORKER'S COMPENSATION DECLARATION I
I hereby affirm under penalty of perjury one of the following declarations: I,
. , ' , ~
o I have _and will maintain a certificate of. c6nsent to se.lt-insure for worker's:compensation, .
as provided for by Se,ction 3700 01 the Labor Code, for the performance of th~'work for which
this permit is issued. '. .. \
~I have and will maintain worker's compensation insurance, as required by Section 37000f
.the Labor Code, for the performance of the work for which this permit is issued. Myworker~s
Compensation insurance carrier and policy are:
Carrier: . - Policy Number. EXEMPT'
Contractor
NUMBE
829469
TYPE
EXPIRATION DATE
5/3112006
S.
Date: 5/16/2005 Applicant:
WARNING: FAILURE TO SECU E WO
UNLAWFUL, AND SHALL SUBJECT AN EM OYER TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVI DED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
. CONSTRUCTION LENDING AGENCY
I hereby affirm unper penalty of perjury that there is a construction fending agency for the
,perf_ormance of the work for w/:lich this permit is issued (See. 3097 .Civ.C): ,,- '- L
Lender'slnformation: ' . . . .
Construcion Types:
.v N, ,
Fire Sprinklered? NO
tate that the above information iseorrect. I
. ate lating to building construction, a.nd
he above mentioned property for
Date: 5/16/2005
Fees paid for Permit:
Total: 1,254.09
S' atur~ of Applicant or Agent
permit 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 issualce. A
new permit is required to commence or continue work.
INSPECTION RECORD
.. . INSPECTION DATE INSPECTOR
Temporary Power Polil
Plumbing (DraintWaste Pipe). ..
ElectriCal Ground Electrode/uter
SelbacklFormsfTrenches (Footings) . .. .
Do not install subtlooror p<!urfloorslab until the
fOllowing applicable items have b.een signed: .
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork)
. Electrical (Underground Condu it)
Pre-slab (Col1)pactionlMembrane.Rei nt. . I .
Underpinning (Floor Joist/Girders)
Do not cover or conceal the worK below until tne
following applicable items have been signed:
1st Floor Shear. . .
Firesprinkler (Rough)
2nd FI.oor Shear..
Roof (ShealhiI1!llDiaphragmlFrame)
Masonry (ReinfJBond Beam/Pre-Grout)
ROl!gh Plilmbing(Top Ol!t). . ..
ROl!gh Mechanical .
Rough ~ectrlCa/ (Dry wall) . n
ROl!gh Electrical r""~~
Framing (Only-after Plbg.. Elec.. Mech:. and Fire)
In.sulatlon (SoundlEnergy)
Do. not tape or plaster I!nlil the following applicable
items have been signed:' : . - .
Drywall .
Penetrations (Fire Rated) Electri.cal
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Pll!mblng
Interior Lath . .
Exterior Lath
. GENERAL ITEMS
exterior Plaster (Brown Coal)
T -Bar Electrical. .
T-Bar Mechanical .
T -.Bar Structural .
Sewer. . .
Water Engineering Backflow . .
Water Service . .
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanic,.. Final
Gas Test.
Engineering/Grading FinaI765-51~6
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-519 C, (0
Zoning 765~5139
Building Final (Last Inspection- Only
. . After Above Complete)
PARTIAL INSPECTIONS
BUil~!nSP~iO~ ..
~! ~,,;^ 1.(p~~-f-\I,V1
. . '\. .
lor
Mechanical Inspections .
Plumbina Inspections
w