5753 E. Santa Ana Canyon Rd. (2)
BUll,DING.flERMIT NO.
8L02004-03357
-'.- --"
~. }<~~*~.~:~~;~:\\
l/tI"."!/, _ '.;-10"'\
CITY gi'0f~N~HEIM
\~lJ-r~~Y . .
BU1LDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 5,5
QiJARTER SECTION: 185
TYPE OF PERMIT
Reroof
DATE: 9/1/2004
JOB ADDRESS: 5753E. SANTA ANA CANYON RD
LEGAL DESCRIPTION: DOMINGUEZ ESTATE LOT 4 POR OF lOT
. .
. .
OJ
CONTRACTOR INFORMATION:
SAN MARINO ROOF CO~'PANY INC
2187.N BATAVIA ;
ORAN GE, CA 92865 oooa :
BUSINESS PHONE: 71497.-3070
JOB DESCRIPTION: Tear off existing & reroof 135 sq with .3~ yr composition ~hjr:gtes for Strip Mi?ll. .
VALUATION: . . 32,000.00 . '11 . . . PROCESSED 8Y' MJF
! . . .' OWNER.BUILDERm:CL4RATIQtL-_.'
I hereby i;lffirm under penz!ty of perjury that I am exempt from the. Contractot'.s License Law for-the following rea3on(S€;c. 7031.5 Busi::ess and
Professions Code: any c:ty or county~hich requires iI permit tocor.struct, ~il?r, improve, demolish or repair any stnJ~turc-. prior to its issuance, also.
r!,,:qUires tha applicant for such pe,r:lit to file a signed statement that he jsl\c~hsed purs'uar;t.~u the ;:,co'.4sions oftt:e Contractor's License Law (Chapter
9){commencing with Section 7000 cf DiviSIon 3 of- the Bl!siness'<Jl"!d Profess-kins Codejur that he is exempt therefrom and the bas:s for the alleged
exemptiofl.. Any violation of Section7031.5 by any applicant fo. a ;:3rmH ~LJ~~!ects the dppfic.ant to a civ,if penar.Y,of not more than five hundn~d.dQlJars
($500). . ',>,'.., .' . .
'.0 I..as own~rof property, or nW'employees with wdges ~s their soh::: CC'r.l{'~;n::;,~tiC'\ will do the wb~j~,raj":c! .t~:e stru~ture is n(jt fntE:nded o:r offere~ fer
sale (Sec. 7044 Busrness_and Professions Code: The Cyntractor's Ucer;se\.:aw dcas not P..p~y 10 ap, c'f:,;'le~ of property who bui\ds or improves
thereon, and "Nho does,sl.ich work himself or h'erself or. through hi'} or her ow~)_er.lp~0;.'ees, provide,'~_ th?~ :.~uch improvements ~re'riot intended r.r
offered ~or sale. If, howev9r, th~ building or improvemel,t !s sc!d with one yr;,,~;'~ ,A completion; thcown~~-builde( wlll have the burden of proving that he
cia not build orimprovd tor the purpose of sale). . ~};,' ,: : .' "
,I. '. '
[J l as th~ QWnei cfthe pl()perty, am exdusively contracting WiUllicens~-ar.:Ol1trad(lrs to C0nstruct'tJ1e ;:orojer::t (See. 7044 BLisin8:3s and Professioros
Code: Th,e COritlaCt0r's Licence Law does nC't apr!y to nnownerof pr~"psrtYtW~10 blli!ds (ii" trnprGV~S thereon, and who ("..ontract~ for'such proi""cts wit!1
Montrayt0r{S) !iceQsed pursuant fe-the c.ontractar's .License L<lw), (I '
l-J,_tamexemptundt:rSc.c, '_ ..- ,B&P,C.rorthi3reason: -t--~-
Data: OWilS;: _.J.. ':'
1 WORKER'S COMPENSATiON DECL.o.BATION i "I r
I herehy affirm under penalty ot per;lJry one; of the following ce<:iarations: . 1~---':'_'" 1-
o I have and will maintain a certificate of oonsent 10 self-lnsura for wcr:\~i';.~ cCillpej.i;ati'~("I, i
3S provid~ for by Section 3700 of the Labor Gode~ fe,r the performance cf tr!f.-.; '\.'j(,;i, for which !
~. permit ~ Iss:..Jed. '. ~. . I
[ 'I have 8.nd will maintain worker's compensatiO;l. in$u~ance, ~s feqUi~d t:.~:. Sect;on 3~OO of. I '9/1.1200
t "'. bor Code, fo'r the performanC'.e of the work for which th!,s permrt is i5subd. Myworker's . Date:
C mpensaticn in~rance' ear.ier and, policy are: .' r
C rrier: l...UMBERMEN'S MUTUAL CASUAL TV CcPoiicy Number: 3BA154~',29-00
This section Moo_not be <:;ompteted if the peJTnit is for one. hundred doHars ($1 00' or ,less: I
o fcerf-ify that in the perlonyiance of the work for w'hichthi~ perriit;s i::.su~=1_,_1 shall not 'j
employ ;:my. person in'8;n~ m~r.ner so as to become.subjf!ct to the WOlker's c(),mpe~SC:ltidn law~ I
of Calif-emla, and agree tnat if I should be ome subJe. t.') th orY. 's. cOffi!">P.;lsatlon' ,
proVISions of Section 3700 of the Labor de, I h II art co '- , With th:~~e proVIsions I Construcion Types:
I VN, ,
Date: 9/1/2004 ApplIcant.. j Fire Sprinklered?
WARNING' FAILURE TO SECURE WORKER'S COMPENS 'rIO,~ COVER'GE IS' . ,
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIM~~AI" PENA~ TIES AND CIVIL
F!NESUPTO ONE HUNDRED TrlOUSAND DOLLARS ($100,000), IN ADDITION TO THE;
. COST OF COMPENSATION, DAMAGES AS PROVIDED FOkd{i>ECTlo,,, 3706 OF THE"
LABOR CODE, INTEREST MJD ATTORNEY'S FEES.. . ",
L CONSTRUCTION LENDiNG AGEN.CY'
.ll,eteby affirm ul\derp.enaity of perjury-that,there is a constructiqnlending :::g;~ncyfo; the' ., '.,_ '
j.J';; io, Il,ofl\.,;;:".0T-U'ie Y{orRlor;'liiic..'1 mrs-ptl-rniifTs-issOedTSec. ~1J;::l/-:CiV~C):-~ o--,,~_
Lender's ,Information:
APPLICANT: MARTHA RICHTERS
OWNER INFORMATION:
Imperial Properties
2424 SE Bristol SI #200
Newport Beach, CA 92660
ARCHITECT/ENGINEER INFORMATION:
J'
."
NUMBER
249559
TYPE
TYPE
EXPIRAT!ON DATE
7131120ns
C39
HIC
II
NO
-,--~.~--:j'
I certify that I have read this application and state that the' above information is correct. I
'agree to rom ply ,With all city o'rdinan d state laws relating to building construction, and
hereby.author repre. es is ci~ enter upon the above mentione<l property for
inspe pu 5
Dato: 9/1/2004
Fees_paid for Permit:
Total:
1.026.11
Signature of Appliean or Agent
The permit shall expire by limitation and become nuU and void if the building or
work has'notpassed finalinspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
INSPECTION RECORD
.. INSPECTION . .',DATE' INSPECTOR
Temporary power Pale .
Plumbing (DrainlWaste Pipe) . .
Electrical Ground Electrode/uter
Setbac:klFormsfTrenches (Footings). . .
.0() not install sub floor or pour floor slab until the .
.fOllowing applicable items have' been signed:
Plumbing (Water Pipe.Sprinkler Valves)
MeChanical (Groundwork) . ,
Electrical (Underground Conduit)
Pre-slab (CompactionfMembrane.Reinf. .u
Underpinning (Floor JoistJGirders) .
.0() not.cover or conceal the work below uhtil the
following applic",ble .items have been signed: ' .'
1 sl Floor Shear ' , .
Fill!Sprinkler (Rough) --c-. .
2nd Floor Shear '. ~
Roof (Sheathing/DianhragmlFr'aber,
Masonry.lReinfJBOnd BeamlPre-GfO\Jtl . .
Rough Plumbino(Top Out) , .
Rough Mechal)icai
I Rough electriCal IDrv Wall) .
Rounh Elecirical
Framing (Only after Plbg.. Elec,~ Mech and Fire)
Insulation (SoundlEnergy) .
00 not tape or plaster until the following applicable
items have been signed:. " .
DryWall '.' --c-,
Penetrations (Fill! Rated) EleCtrical .
Penetrations (File Rated) Mechanical u,
Penetrations (Fill! Rated) Plumbing .'
. Interior Lath '. ,
. Exterior Lath -- 'C- . , .
. G.ENERAL ITEMS .c-..
Ellterior Plaster (B.-n Coat)
T-Bar Electrical --c- .
T-Bar M.echanical .'. .
T -Bar ,Structural .
Se1Ner
Water Engineering Backflow
Water Service . ' .
FINAL INSPECTIONS Date Inspector
Electrical Final. . . . .
Plumbing Final . .
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 . / I .-
'Iluilding Final *ast Inspection- Only , 'ff~/hs JA.I,\l>~j
fter Above 'Complete)
PARTIAL INSPECTIONS . .'
. .
. B. Uild.~_.n. S7i. e.~..;~. '. ~. ~.. .... ....... .."
ffj~~- s &o-?"'" ... ...
MechahicallnsDections
. Plumbinq InSDections .
ElectricallnSDections,
~
BUILDING PERMIT NO. BLD2004-02424
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TYPE OF PERMIT"
Tenant Improvement (limited)
DATE: 3/1 Q/2004
JOB ADDRESS:. 5753 ESANTA ANA CANYON RD 0
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LEGAL DESCRIPTION: DOMINGUEZ ESTAT!: LOT 4 POR OF LOT
APPLICANT:
OWNER INFORMATION:
ImperialPropertie,s
2424 SE Bristol St #200
'NewportBeach, CA 92660
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CONTRACTOR INFORMATION:
J D ALLEN DESIGN & BULD CO INC
1101 W LAS'PALMAS . ':
FULLERTON, CA 928350000
BUSINESS PHONE: '71438(;-0403
ARCHITECT/ENGINEER INFORMATION:
. KENNNETH A PARSONS'
305 N HARBOR BLVD #215
FULLERTON, CA 92632
JOB bESCRIPTION'feriant Improvement
. VALUATION: 60,000.00 I. PROCESSED BY: DUC
I . .. OWNER-BUILDEftOECLARATION. ..
: I hereby affirm unde,r penalty of perjury. that lam exempt from the Contracto;'f;. License Law for the following, reason (Sec. 7031.5 Busin~s'and -.',' .
Professions Ga?e: any city or county which requires a,:permit to construct, ~:d~r,";mprove: den'lOlis6'or repair any st"'l!cture~ priOr to its issuance, als'o-,' "."
'requires th~ appliea.nt for such permit to ,file a signed statement that he is Hcclpsectpuisuant to, the provisiofl,S of the' Cantractor's'Licen~,eL:~iw (c~apter
9)(commeocing with Section 7000 of Division 30f the Business andPlofes$i~ns Code) cr that heis exempt therefrom and fhe_~asis;forthe alleged .
exemption. Any violation of Section 7031.5 by any applicantfor a perrnitsu:::.f~ts th;e applicant to a dvil pemilty of not more than fjvehundred doUars
($500). . . . , . . '. ~ . . . ..' . .' . . .. . .
D. I, as owner qf ~rop~r:ty, o~,my employees with wi3ges .as their SOlecomp~nsatjon, willdo:the~or!<, and the structure i~ no.n[lte~d~~ or ?ffered fo~__.
sa~e, {Sec. 7044 ~usiness and Professions Code: The Contr~ctor's License I'fw .c:.~,s not.applytQan owner of property-wh,? btJ;Id~,dr improves .
~h$feon, and who does such work hl~elf or herself or through his or her OVJ\,:;,;emPloyees" provided that suchimprovemer:tts are "('It :i1;tendedor
. ,"offered for sale., If, hOWever, the building or improvement is sold with one yo';,'r of completion, the owner-b.uilder will have the bUrden 9f proving that he .
: did not build or improve forthe'purpo~e ofsale). . &: ' .'. - ' . : : , ., "".'
!Z1 .1, as the owner of .the property, am exdusively_contrecling with licim!';ed.:'f.6ntractorsto construct the project {Sec. 7044 8usinE)~.s and Professions
COd'e; TheGOr'ltractol;"s License law does not apply to an OWner of pr("~:IJr>~~'~"/h0 b_l..lilrls or improves theredn, and who contracts for suCh' ProjectS with
tlOritractor.(s) i.ice~s:p pursuantto'the Contra?tor's, Uce~se law). ' ? .
. I. am exempt- under Sec.'. , ... , B & P.C. for this reason: ..___J__
Date: Owner: I. .
I WORKER'S COMPENSATION DECLARATION T- 'I. .
.I.hereby affirm und.er peflalty, of perjury one of the ,followi'ng declarations:. l '
0' I ha~ean~ will mainfaln a certificate of OOhser'!t to self-insurefo'r~)orkE'~1- ;::::lInpEmsation,
as provided for by Section'3700 of the Labor Code; for the performance of th,"iWOI'K for which
- this permit is issued. .. ' . . 1. .
0, t have a'nd willmslntairiworker's compensation insurance. as required b~:'Sectfon 3700 of
the Labor Code,'for .~he performance:?t the work fer which this permit isissc;id; My worker's '
Compensation insurance Garrier and policy are: ' .' .. ,;
Carrier:. .' ' Policy N~mber:: EXEMPl1.
This section need riO! be complet~d if the penni! i. for one hundred\lOHars($.1 Or.)'"r les..
o .,'certifythat in th~ performance of the ~ork for Which this' peF~it is iS~UB~.,:_Shall.hpt _ . . '
employ any person in any manner' so as to_become subject to theVlcrkers c(l(npensatlon '~ws
_of California, and agree that if I should become subjedto thewol:l5er's c'omp~nsatic;>n ....
provisions o~ Seetio,: 3700- of the Labor Code, I shall forthwith '- ty wit.' !h-~ . rovisions.
B!,iIL:J!NG DlVISIOl'J
'200S, ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 437.
QUARTER SECTION: 185
I'.
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.LICENSED CONTRACTORS DECLARATION
I f:1er~byaffirm under,penally 0 'perjllry that) am
iiC:clns~d u-rider proVIsions of chapter 9 {commenc.ing'
with_SectiO'l:f7000) of. Divslon 03 of the Business d
Profession Code.
NUMBER.
783484
TYPE
Construcion Types:
VN" .
Fire Sprinklered?
T.I.Area:
Date: 6/10/2004 Appllcan . . .".
. WARNING: FAII..URE TO SECU. ERKER'S COMPENSATiON COVER!\SE IS . .
UNLAWFUL, ANDSHAI..I.. SUBJ . AN. . EMPLOYER TOCRIMWAL. PENAI,T. IES AN. 0 9..IVIL
.FINES UP TO ONE HUNDRED 1HOUSAND DOLI..ARS ($10!J,!IQOl, IN ADD,.nON TOTHE
COST OF COMPENSATION, DAMAGES AS PROVIDED FQR:1N SECTION 3706 OF THE
LABOR CODE; INTEREST AND ATTORNEY'S FEES, . .
I CONSTRUCTiON LENDING AGENCY _
I hereby affirm u~d~r penalty of, pe~j~ry t~t ~~~r~"is ~ ?9n~tr~:t~<:~_!~~~~~ ag"nGYJor~~.,.,_"
-~~~:~;--r;--.;:;;-;-~.:l-~'-;--;,- ..y~:':~. ~0:;.;l>;0h ~h;.:. 'jJ<:.i',-j"U< i;> I~$i.it.l... .\St;;:.~.c.:JI.""IV~\J[.
Lender's Information:
I certify that I have read this application and state that the above information is correct.- I'
iqgree to oomplywith all city ordinan.cSs and state laws r~atlng to building coriStruction, and
hereby authoriZe representiVes of this dty to enter upon the above' mentioned property,for
inspection purpqses.
EXPIRATION DATE
8/31/2004
8
NO
1,452
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------- -----~-~,-,--
"",,"
Date: 6110/2004
Signature 0 licant or Agent
permit shall expire by limitation and become null and void if the building Or .
work has not passed final inspectiorl 365 days from the date of permit issuance, A
. new permit is required to commence or continue work. .
Fees .paid for'Peonit:
Total:
1.342,17
. .
INSPECTION RECORD'
.'. . INSPECtiON. . . . DATE INSPECTOR
Temporary Power 'Pole .
.
Plumbirt9 (DrainlWaste Pipe) . .
Electrical ~ound Electrode/Ufe'r. . '.
.' S.elbacklForl'll$lTrencheS (Footings)
1)0 hot install ~ublloor;or pour floor slab un!itthe
following applicable items have oeen signed: .' .. .
Plumbing (Water Pipe.Sprinkler Valves)
Mei:hanical (GrotindWork) . .
Electrical (Underground Conduit) .
Pre-Slab (Compaction/Membrane.Rein!. . .
Underpinning (Floor JoisllGirders) .1
Do not cover.or co'1cealthe work below untilt/1e
follOWing applicable Items have been SIgned:' :
1st.,Floor Shear .:
Fhesprinl<ler (Rough) . . .
'2nd Floor,Shear ", '. . ., .
Roof (Sheathing/Diaphragm/Frame) . . .'
Masonry; (ReinfJBondBeamlPre-Groul) .... .
Rough Plumbing (Top Out)
Rough Mechanical. .'. . .
Rough f1ectrocal (Dry Wall) . .... .
Rough Electrical . . .. . ." .
.- .Framing . . (Only after Pibg., Elec.: t.1ech._ and Fire) ?'4-oA. 11_
. ..
Insulation (SoundlEnergy)
00 not.tape or plaster' until thelol/owing applicable
item~ havebeen signed: . ". . I.
Drvwall. .... ~4- .
. Penetrations (Fire Rated) ,Electrical .' '. . ".'
Penetrations (Fire Rated) Mecl1anlcal .'. .
Penetrations (Fire Rated) Plumbing .
. tnterior Lat!:> . . . . . .
Elrterior Lath, . . .
GENERAL ITEMS
Exterior Plaster (Brown Coat) ,
T 'Bar Electrical
T-Bar Mechanical' . . ~..
T .Sar Structural . . ~.q--6:1j -'
Sewer. , .' . .' i . .
.Waier EJ)gineering Backflow
Water .Service . . .
- ,
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical. Final
Gas' Test
Engineering/Grading Final 765-5126 .
Fire ,Depi. Final 765-4040 " ..
\iVater Engineering 765'5268'
Sub ListlBusines.sLicense 165-51.9
Zoning165-S139' .
Building Final fLastlnspection. Only
. . .' After Above Complete
'.' pARTIAL INSPeCTIONS '. .
. .
. Buildinalnspections . .
,
Meehanicallrisl>ections
. Plurribinalnspections
EJectricallnspections .' .