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30 SANAHEM BLVDCITY HEIM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 755 - 5153 INSPECTION REQUEST LINE: (714) 765 5161 CENSUS CODE: 437 QUARTER SECTION: 83 CONTRACTOR INFORMF :SION: ARCHITECT /ENGINEER INFORMATION: BUiLDING.PERMIT NO BLD2000 - 03985 TYPE CF PERMIT Reroof DATE: 12/13/2000 JOB .ADDRESS: 30 S ANAHEIM BLVD LEGAL DESCRIPTION_ . P BK 178 PG 22 PAR 1 APPLICANT: JOSEPH SILVA OWNER INFORMATION: ANAHEIM HOLUALOA 100 S ANAHEIM BLVD ANAHEIM, CA 92805 310 - 45t - 56b9 JOB DESCRIPTION :' Tear off existing BUR &'reroof 24 sq w /BUR - VALUATION: -.3,000.00 - - } PROCESSED BY MJF OWNER BUILDER tJ CLARATION I hereby affirm under penalty of perjury that I am exempt from the Cogtracto s - License Law for the following reason (Sec. 7031.5 Business and Professions Code: any city or county which requires perm. "to construct, a't-'r, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9)(cornmencing with Section 7000 of Division 3 of the Business and Professions 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 more tha n five hundred dollars ($500). -.( L []. I, as owner of property, or rny . employers with wages as their sole comp rsation, will do the work, and the structure is nbt intended or offered for sale (Sec. 7044 Business and Professions Code. The Cortractor's License L w does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her oat employees, provided that such improvements are not intended or offered for sale. 'If, however, the building or improvement is sold with one yflr of completion, the.owne r= builder will have the burden of proving that he did not build or improve for the purpose of sale) • - 1111 1, as the owner of the property, am exclusively contra ding with licensed contradars to construct the project (Sea 7044 Business and Professions Code: The Contractors License Law does not apply to an owner o r ropedy who budds or imprbves tnereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Con _ or's L cen Law am exempt under Sec. _ B & • .C. for ryas - Date:2,Z-IL ZGUU. ' Owner: WORKER'S COMPE TION DECLARATION I hereby affirm under penalty of perjury one of the follpwing declaraticns: • Fire Sprinklered? E. I have and will maintain' a certificate of censent to self - insure fbr worker' ',compensation. as provided for by Section 3700 of the. L. abor Code, for the pe rforrnance of time we for which this permit is issued 11] ' I have and will maintain worker's compensation insurance, as regwied b•/ Section 3700 of the Labor Code; for the performance of the work for which this permit is 'sew. J. My worker's . Compensation insurance ca mer and policy are: Carrier: • - Polley Number, This section need not be completed if the pemtit is for one hundred dollars ($1 poi or less: n I certify-that in The performance of the work for which this permits issued "I shall not employ any in any manner so to become subject to the workers compensation laws of California and agree that if l should become subject to the worker's compensation provisions of Section 3700.. of the Labor Code, I. shall forthwith comply with those provisions. Date:. 12/13/2000 Applicant: WARNING: FAILURE. TO SECURE WORKER'S COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL -PENH! TIES AND CIVIL FINES IJP TO ONE. HUNDRED THOUSAND 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 FEESj.` CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of penury that is a construction lending agency for the performance of the work for which this permit is issued- (Sea 3097,Civ.C): .I certify that I have read this application and state that the above information is correct. .I. agree to comply with all city gcd • lances and state laws relating to building construction, and hereby r e represent' es of this o)«Jt0 enter upon the above mentioned property for inapt • poses � —' ° Date: 12/13 /2000 Signature of Applicant or Agent The p e mit 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 LICENSED CONTRACTORS DECLARATION 1 I hereby affirm under penalty of perjury that I am licensed under pro 1sibna of chapter 9 (commencing with Section 7000) of Divsion 3 of the Business and Professions Code. 12/13/2000 - - Date: Contractor NUMBER - • EXPIRATION DATE. • TYPE Fees paid for Permit: Total: ' 102.88 FINAL INSPECTIONS Date inspector Electrical Final Plumbing Final Mechanical Final .Gas Test Engineering/Grading Final 765-5126 Plumbing (Water Pipe.Sprinkler Valves) . Fire Dept. Final 765-4040 Mechanical (Groundwork) Water Engineering 7655268 Electrical (Underground Conduit) Sub List/Business License 765.519E Pre -slab (Conlpaction/Membrane.Reinf.Y Zoning 765.5139 Underpinning (Floor Joist/Girders) Building Final ((Last Inspection gi After Above Complete) Do not cover or the work below until the following applicable items have been signed: 1st Floor Shear INSPECTION : - - DATE INSPECTOR. Temporary Power Pole Plumbing (DrainMaste Pipe) Electrical Ground Electrode/ufer Setback/Forms/Trenches (Footings) Do not install subfloor or pour floor slab until the following applicable items have been signed: _ Plumbing (Water Pipe.Sprinkler Valves) . Mechanical (Groundwork) Electrical (Underground Conduit) Pre -slab (Conlpaction/Membrane.Reinf.Y Underpinning (Floor Joist/Girders) Do not cover or the work below until the following applicable items have been signed: 1st Floor Shear Firesprinkler (Rough) 2nd Floor Shear Roof (Sheathing/Diaphragm/Frame) Masonry (Reinf./Bond Beam/Pre -Grout) Rough Plumbing (Top Out) Rough Mechanical ,Rough Electrical (Dry Wall) Rough Electrical • Framing (Only atter Plbg., Elec., h 'lech., and Fire) _ Insulation (Sound/Energy) 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 Exterior Lath'. . GENERAL ITEMS Exterior Plaster (Brown Coat) T -Bar Electrical' T -Bar Mechanical T -Bar. Structural Sewer Water Engineering Backflow Water Service INSPECTION RECORD PARTIAL INSPECTIONS Building Inspections Mechanical Inspections Plumbing Inspections Electrical Inspections "L IPTION LEGAL A 1P /79 -4•Z SEC MAP 3a C8 / - 2S Z7 -3343 CITY LIC. NO. 2/3 O — 8 MAILING ADDRESS iOQ . nit +)9Y /nag4 CE USCODE FIRE ZONE PANC A a CONST. F /V�.Sf A PA* �7 ENGINEERING OFF SITE IMPROVEMENTS: DEDICATION STREET IMPROVEMENT PLAN: BOND: REVIEWED BY SEWER ASSESSMENT: BY PUB. SERVICE PLAN CHECK FEE ft g a do FIRE PERMIT FEE /4J// 00 / HEALTH STATE TAX Z 71 SANITATION MICROFILM FEE 4 o' WITH PLAN ❑ WITH PLAN ❑ WIOUT FLAN ❑ ��A ppWpp / Y // TOTAL FEE A 2 u '7, _APPLICATION FOR A EtlfLDIN PERMIT PLANNING DEPT BUILDING DIVISIO N (714) 254 -5161 ANAHEIM, CALIF. TIT coc�4n -ras o a ai c. sTES31 -3343 CITY LIC. NO. 2/3 O — 8 MAILING ADDRESS iOQ . nit +)9Y /nag4 P. a. enS r&p 62it P/ // MA A frE - a rep Op STATE cr N zi / M/ O WNER_ l-` TEL. t 73b V i I C r 30 s /y8Hs /A/ ,81va MAILIf1GADDRE Arlo/1E1/ airy BUESENT I / R BUILDING USE G` J PROPOSED j J BUILDING USE NEW ❑ AWN ❑ ALTER. ❑ REPAIR ❑ DEMOLISH ❑ GARAGE AREA FLOOR ❑ INCREASE AREA ❑ DECREASE DESCRIBE WORK TO BE DONE BLDG9 JOB ADDRESS DESCRIPTION OF WORK NO. OF I NO. OF DWELLING SO FT STORIES UNITS 2 50 Fr awnfooS, PA-41 co.t'.iis Fence's VALUATION y"el°rl aInclude , Nast, Etc. Mn r T Th he issua this permit Ai of author zestoervI constitutes of a ny s lave. k described u nL 56859s Dime carefully read and examined the above application and Mow the same to be true and correct. All provisions of LAWS 31V1 Ordinances COV this type Of COnitrr of M be complied OIi with whether specified herein or rot. No per- in OWNER OR AUTHORED AGENT $ /3, non 22 $244.314 - FINAL EL '" McALTI, PET. REG„IREMEN *E FINAL PLUMBING SUB CCM. RAC'!'ORS UST FNAI AC. - STREET. LIGhTS ZON■NG REQUIREMENTS FNGINEF NG RECU!REMEN :S MEd P Oth OUIHFMENTS R RE DEPT. 4WUREMERTS INSPECTOR FOUNDATON FRAMING PLASTER DATE BACKS 9i06 R SDE REAP SC. INSPECTION BY DATE LEA072pe: / Real. 1 4 - / 74 - 4 2 SEC MAP en- 25 2 0 MAILING ADDRESS I cid 1 < +fr-p-ifria CENSUS CODE FIRE RANGY ZONE CCCU- 4 3 gasT.7 413 ENGINEERING OFF SITE IMPROVEMENTS: DEDICATION I STREET IMPROVEMENT PLAN: BOND: REVIEWED SEWER ASSESSMENT: BY I PUB. SERVICE PLAN CHECK FEE FIRE PERMIT FEE 814,S0 HEALTH STATE TAX 1 t ,SC SANITATION MICROFILM FEE I. 7. o0 PERM. RAN 0 WITH PLAN 0 MOUT PLAN 0 ( "Ei ( , TOTAL FEE BC APPLItATION FOR A BUILDING PERMIT. PLANNING DEPT ANAHEIM. Ddl/MON (714) 254-5101 17Areow e..ns i4c. 1 n Ai TEL NO. .S A MAILING ADDRESS I cid 1 < +fr-p-ifria jffisjell) 8.4, p ' W43-3,3")) MA KING AD HESS i5 A Ar 4 4 STATE LIG. NO. NBit i leffhp i‘ 44 ) Act c Ito LA, A-ce 111- 19 -- q7q1) go g. gA/A /ism/ ez v..2) I )` a so..; r .• . • JUB ADDRESS MAILING ADDRESS A Ai 41.1 n1 4 , tricr PRESENT I BUILDING USE R intT /3-14 tAatrr PROPOSED BUILDING USE - SA- ekt !IC DESCRIPTION OF WORK NEW 0 Aoo.N 0 ALTER Er" REPAIR 0 DEMOLISH 0 GARAGE NO. OF AREA SO ET I STORIES FLOOR. 0 INCREASE AREA l 0 DECRonao I NO. OF DWELLING UNITS 59.33 DESCRIBE WORK TO BE DONE t o en, i s Aj . Ar a n S int r I NOTE: MAWS Lam, MM., lifting, Plumb., Neat Etc. $ PCs, et,e9e, When properly validated in au space anjjaid for this lorm constitutes a Permit 1 0 do tfw wiN/L described hereon The issuance of this permit does authorize the vidabon cit any state or WON law. I haw carefully reed and Laws and Ordinances Lon shall be eznPloYed SLOGS X sO FT same to be Irue and cot ed with whether speed ate of Calilornia. U1NOV91. TOTAL PEPtIIT TR. kiSACT ION SIGNATURE OF OWNER OR AUTHORIZED AGENT AM Royston al eln or not. No Deo / — 7- 2e- -571 4W4-4.7 REkieva- nO t-n -5't- zA:, / ye. 7s---L? SUB CONTRA TO u 1 EST • ENAL iC/(it■- / -4 / al-Ffog ZONING REQUIRENIENTS ENGINEERING rmourRSNIENISLI4 , W SANITATION REQUIREMENTS _ N FIRE DEPT / REQUIREMENTS 4 FRONT FOLJNDATON FRAMING P LA SleR • ■ PE - MISC. INSPECTION _ -134/.4e/ cazdr rt L-rta, taw tiwt el "CD ber-Ar-r gr14,0 e SIDE DATE /7> W S. 4A (%,//' ir°) o r • J St APPLICATION FOR A MECHANICAL PERMIT (HEATING AIR CONDITIONING OR REFRIGERATION) (714) 9995161 BUILDING DIVISION - ANAHEIM, CALIF. CITY LIC. Rf0 30 RESIDENTIAL AIR C0RGULATING OUTLETS HEATING OR COOLING - - ,/ ( ' COMMERCIAL AIR DISTRIBUTION SYSTEM HEATING COOLING OR VENTILATION ' OGOR T t fo rewAJre Al r Srs hint" J V �/ COMMERCIAL HOOD OR EXHAUST TO<OOPEFM .. MAILING ADDRESS 3yoo ( "re/ r /ant W 4Ar4 4e(-t • COMMERCIAL HOOD OR EXHAUST OVER 4000 EFM OWN ' //1 // • TTELLNO. /tart nun N ITEM HEATING APPLIANCES INSTALLED. REPLACED OR RELOCATED LS r • J St F EE RESIDENTIAL AIR C0RGULATING OUTLETS HEATING OR COOLING - - ,/ ( ' COMMERCIAL AIR DISTRIBUTION SYSTEM HEATING COOLING OR VENTILATION 11, ♦ EXHAUST SYSTEM Q —{ L _ iO OpQ'GFM' ON SINGLE DUCT J' !Yt Atp J V �/ COMMERCIAL HOOD OR EXHAUST TO<OOPEFM .. • COMMERCIAL HOOD OR EXHAUST OVER 4000 EFM COMBUSTION PRODUCTS VENT (OTHER THAN CHIMNEY) FACTORY BUILT OR METAL CHIMNEY F APPLIANCE REGULATED BY THIS CODE BUT NOT SPECIFICALLY LISTED IN THIS SCHEDULE 20 HP ABSORP UN R T T 500000 BTU COMPRESSOR OR BOILER - 21 TO 50 HP ABSORP. UNIT 500.001 TO 1 0100.000 BTU COMPRESSOR OR BOILER OVER 50 HP ABSORP. UNIT OVER 1.000000 BTU HEATING OR COOLING COIL (DIRECT EXPANSION OR HOT OR GOLD WATER. COOLING TOWER, EVAPORATIVE OR AIR COOLED CONDENSER I 0l 1 10THE % THAN PORT ' �,{ LYA �\ 4 .Sf 1V WINDOW TYPE AIR CONDITIONER (BURT IN MAXIMUM 10 HP GAS SYSTEM - 1 TO 5 OUTLETS ea carefully read kntl a .he above application and know the Inn same to be rue and Correct. All provisions Of f Lo is »s and Ordinances Covering this type of con sc he n o t .ied with 1 bee pern or r not. person :odnell be employed herein i n violation of f S p the Labor Code the State 0 California. PERMIT F EE /��T lL ld ' 1 1 ISSUING FEE �p�., VV TOTAL FEE OD of J. '2 33 MAILING ADDRESS q V1 ( 1/ i 0 itD 4N4le,., DESCRIPTION OF INSTALLATION NEW ❑ ADD'N ❑ ALTER. 0 REPLACE ❑ When properly validated in this space and paid for this form constitutes a permit to do the work described hereon. The issuance of this permit does not authorize the violation of any state or local law. - ')G 13 JOB ADDRESS ir < TO) 1L TiN $47 CON SIGNATURE OF OWNER OR AUTHORIZED AGENT gif INSPECTION RECORD CORRECTION AW a'aftif r MGM Du M' tt Clete ?YPE2 4 r'etm i Cv Dear � slitnt PARTIAL INSPECTIONS DATE 1-4. -V tNSPE CTC}t DATE "dO HID YI(tRK_ i __ R ^UGH HFATIN BQUGk 9EPAiG. LV2 AIR CCNDr -. FINAL HEATIN FINAL REFRiC. CF AIR �CNb INSPECTION RECORD CORRECTION AW a'aftif r MGM Du M' tt Clete ?YPE2 4 r'etm i Cv Dear � slitnt PARTIAL INSPECTIONS DATE 1-4. -V APPLICATION FOR A MECHANICAL PERMIT (HEATING AIR CONDITIONING OR REFRIGERATION) (714) 999.5161 BUILDING DIVISION - ANAHEIM, CALIF. CITY Lii N�} 6 N � , � T W-, L 6 J� STATF L C.4� 3 J tt TRACTOR r _ • l/ "pNl MILLING 'E „ z- •v , , - vs TEL. NO. nun N ITEM HEATING APPLIANCES INSTALLED, REPLACED OR RELOCATED FEE RESIDENTIAL AIR CIRCULATING OUTLETS HEATING OR COOLING COMMERCIAL AIR DISTRIBUTION SYSTEM HEATING COOLING OR VENTILATION EXHAUST SYSTEM ON SINGLE DUCT TO 300 CFM I TO COMMERCIAL H000 OR EXHAUST 4000 EFM 17.00 ` COMMERCIAL HOOD OR EXHAUST OVER 4000 EFM COMBUSTION PRODUCTS VENT (OTHER THAN CHIMNEY) FACTORY BUILT OR METAL CHIMNEY APPLIANCE REGULATED BY THIS CODE BUT NOT SPECIFICALLY LISTED IN THIS SCHEDULE COMPRESSOR OR BOILER TO 20 HP ABSORP. UNIT TO 500.000 BTU COMPRESSOR OR BOILER - 21 TO 50 HP AOSORP. UNIT 500.001 TO 1.000.000 BTU COMPRESSOR OR BOILER OVER 50 HP ABSORP. UNIT OVER 1.000,000 BTU HEATING OR COOLING COIL 0DIRECT EXPANSION OR HOT OR COLD WATER. COOLING TOWER, EVAPORATIVE OR AIR COOLED CONDENSER �, EVAPORATIVE COOLER (OTHER THAN PORTABLE) WINDOW TYPE AIR CONDITIONER (BUILT IN) MAXIMUM 11/2 HP GAS SYSTEM - 1 TO 5 OUTLETS I have carefully read and examined the above application and know the sane to be rue and correct. All proviSiOrs 01 I aw5 and Ordinances covering INS type of Con- structior. wili be complied with whether specified herein or not. No person shall be employed in violation of the Labor Code of the State of California. APPR BY PERMIT f /. A'1'J) V(f �/ � / I� ISSUING FEE /' l / TOTAL FEE •• DC 40- S . a'nhotri4 5 h , arts • SOB ADDPFSS Q rt�h¢ Cm DESCRIPTION OF INSTALLATION NEW ADD'N ❑ ALTER, ❑ REPLACE ❑ When properly validated in this space and paid fo this form constitutes a permit to do the work described hereon. The issuance of this perm t does not authorize the violation of any state or local law. BLDG 13 iu^: $3.2.41ON S TORE OF OWNER OR AUTHORIZED AGENT PINAL HEATING______ _____ ....... �.__ K1 NAL ft£FRiG. OR A A CCND CORRECTIONS & PARTIAL 9NSPECT €0 EFRIG. BR A(R "ON❑ NSPECTION RE ITEP�i - - !NNVErgvR bATF OUAN ITEM AMT. QUAN ITEM AMT. WATER CLOSET 1 GAS SYSTEM 15 OUTLETS /St BATH TUB 6 OR MORE OUTLETS-PER SHOWER WATER HEATER OR VENT LAVATORY WATER SOFTNER KITCHEN SINKS WATER GIST. SYSTEM EXISTING BLDG. ONLY GARBAGE DISPOSAL WATER MAIN 1st 100 CLOTHESWASHER WASTE gpp•L. 100 SLOP SINK LAWN SPRINKLER VALVES FLOOR SINK ADDITIONAL VALVES EA. FLOOR DRAIN SEPTIC TANK AND SEEP PIT DISHWASHER SEWER CLOSED LAUNDRY TRAY SEWER 1st 100 DRINK FOUNTAIN AOD L 100 URINAL BACKFLOW PREVENTER GREASE INTERCEPTOR RAINWATER DRAINS SANG INTERCEPTOR SOLAR PANELS BAR SINK SOLAR TANK 1 n ave carefully read and examined the above a pEoation and know me same io be Lore and e oL All provisions of Laws and Ord nanoes vedng this type of constrocHon aOl e pl eowar. 11 b erspeced in or not. oho 0 rson shall be employed In vlolati0 of the Labor Code of the State of Califon ARRR By ���••• ��� TOTAL ABOVE ISSUING FEE 4, Sf� TOTAL FEE - BUILDING DIVISION • ANAHEIM, CALIF. CONTRACTOR Spar Plumbing and Heating MAILING ADDRESS 15641$ Sparata Street Cm Garden Grove, CA. 92643 -5353 OWNER Lawrence Niezgodzki MAILING ADDRESS same PROPOSED -. ❑ NEW. - REMODELED ❑ RELOCATED USE:' - BLDG. tgi BLDG. BLDG. DESCRIPTION OF WORK: Resturant - When properly validated in this space and paid for this form constitutes a permit to do the work described hereon. The issuance of this permit does not authorize th feolation aey state or local law. S r °i�75 SIGNATURE OF OWN OR AUTHORIZED AGEN BLDG 12 JOB ADDRESS 30 South Anaheim Blvd. APPLICATION FOR A PLUMBING PERMIT (714) 999.5161 CITY L . NO 0 -19154 TELEPHONE 839 -7727 STATE LIC. NO 342576 TEL. NO 839 -7737 PERMANENT a.a ■BINC- Ct GROUND WORK ;WASTE) GROUND WORK (VVATERRGAS ROUGH. GAS & PRR B•G SEWER, SEPTIC TANK SEEPAGE PiT, ORAN Fl =ID RINALGAS NSIDED-TiON. RECORD BASC: NSPECOON OUAN ITEM AMT. OUAN ITEM AMT. 3 WATER CLOSET la �/ -/: - GAS SYSTEM 15 OUTLETS 3 ( IS BATH TUB 6 OR MORE OUTLETS-PER SHOWER / WATER HEATER OR VENT 3 LAVATORY WATER SOFTNER 2 KITCHEN SINKS WATER LIST. SYSTEM' EXISTING BLDG. ONLY Z GARBAGE GAR OBAL 1W WATER MAIN 1st CLOTHESWASHER WASTE ADD 100 / SOP SINK L&WNN SPRINKLER 14 VAES / FLOOR SINK 3 ADDITIONAL VALVES EA. 6 ELOOR DRAIN t{$ SEPTIC TANK AND SEEP PIT / DISHWASHER 3 SEWER CLOSED / LAUNDRY TRAY 3 SEWER 1x1100 DRINK FOUNTAIN ADOL 100 / URINAL BACKFLOW PREVENTER GREASE INTERCEPTOR RAINWATER DRAINS SAND INTERCEPTOR SOLAR TANK / SAP SINK `$ SOLAR TANK I have carefully read and examined th above a phcation and know the same t0 be rue and correct. All provisions Of Laws and Or nance8 cOverinp this type Of construction will be com- plied with whether specified herein or not. No person shall he m w olatio of the employed Labor Code of the State of CaMornia. APPR BY TOTAL ABOVE Y� �j 5`.. � aJ ISSUE NG FEE q `t ft V TOTAL FEE //7 V JOB ADDRESS DESCRIPTION OF WORK: BLDG 12 APPLICZATION FOR A PLUM:SING PERMIT IMILORDO DMMON ANAHEIM. CALIF MA 5 NOU 9 i TA PROPOSED NEW - ` REMO DELED RELOCATED USE: Lj BLDG. M %: :LDG. ByDG. r / cm uc. N g l54 . (714) 9993181 E PHONE TOR b OWNE� WO CUP r , - ,I TE NO LING ADDRESS iUY TATS UC. N0 s When properly validated in this space and paid for this form constitutes a permit to do the work described hereon. The issuance of this permit does not authorize the violation of any state or local law. $117. A 44-77,4_17 SIGNATURE OF OWNER OR AUTHORIZED AGENT PECTION RECORL'S LC IN R`MISC:IN$PECTION • BY _ DATE `4` ¢ SS L7 i ./ F.NA.. a RS iii&vo; PECTION RECORL'S LC IN R`MISC:IN$PECTION • BY _ DATE `4` L£ 1/ _ IPTID _ _/ v e 0774-x1 _ SEC. MAP 1 -Ztt' eV MAILING ADDFIF 14,0D .'SCa i tt S,¢ CENSUS (((����DE FIRE OCGU- TYPE ZONE PANCY CONST. TEL. NG ENGINEERING OFF SITE I IMPROVEMENTS'. DEDICATION' � STREET IMPROVEMENT PLAN: BOND: REVIEWED SEWER ASSESSMENT 5 I PUB. SERVICE PLAN CHECK FEE 4 FIRE PERMIT FEE 2 F OE gw 4. / �/ 7 VEALTH STATE TAX SANITATION / �� i MICROFILM FEE " PERM. PLAN WITH PLAN ❑ WFOUT PLAN ❑ APP. BY t % • TOTAL FEE r' 2 51.11 APPLICATION FOR A BUILDING PERMIT PLANNING DEPT BUILDING EM, CAL IF. .( o j R - A Tv,A4. TELN JJ6 ZJNP�Lt MAILING ADDFIF 14,0D .'SCa i tt S,¢ C ITY LIC. N0. o izi ❑ ARCH. - ❑ ENGR. TEL. NG IMA IUUNNGG A STATE LI NO. (` ?� OYI IM rCiwitiACC �\ L�� l 1W\ �j^/ TEI. c) L' IYILING ADDRESS t Y PROPOSED BUILDING USE I have carefully La ws and Ordin hall be ern BLDG9 JOB ADDRESS C ^�� • S, AgoAss 24. ft. &Le., PRESENT N —ACIA— slr— BUILDING USE NEW IfCt ADD'N ❑ ALTER. ❑ REPAIR ❑ DEMOLISH ❑ GARAGE NO. OF I NO OF DWELLING AREA SO. FT I STORIES UNITS FLOOR ❑ INCREASE AREA ❑ DECREASE DESCRIPTION OF WORK DESCRIBE WORK t TO BE DONE 1 c`Dff FE' $'W"? N. VALUATION more Plumb- ` ,EK ° When properly validated in 0i space and paid for this fa m constitutes a permit to do the work desoribed hereon. The Issuance of permit does not authorize th violation of any slate or low law. leoso 45 $ coo $254.44N d and examined the above Imaficn a ces covering this type of cons uction wil oyes in vialeliptycme Labor of IN nd correct All provisions W ified herein or 505. P40 per- SIGNA - EOF OWN EI PERMANENT SO. FT FOUNDATiO FRAM NCR' PLASTER F? AiiI DE =T RMIT. E4AENTS REC IRFN "N'$ lON SET SACKS MISC. INSPECTION APPLICATION FOR A SIGN PERMIT l PLAN CHECK FEE 40. (`4)778 -0999 'e St. AnaheiM 928 - BLDG. FEE 63.90 ENGINEERING STATE UC NO. Yve Masauefa ELEC. FEE / S & 0 • TRAFFIC SUB TOTAL ' ' B . (1 S ZONING STATE TAX . 3 4- OTHER MICROFILM FEE PERM PLAN o WITH PLAN O WITHOUT PLAN 0 BY TOTAL FEE f %. 7q APPLICATION FOR A SIGN PERMIT l J PL INING DEPT. %L IM M CM S'ON 1714)999-S161 °xpr ti essions Advertising (`4)778 -0999 'e St. AnaheiM 928 !"V D ARCH o ENCR TEE NO MA UNG ADDRESS STATE UC NO. Yve Masauefa 714)999 -2440 r S oREB Anah eim Blvd., Anaheim, CaT32805 ON SITE OFF SITE BLDG 25 30 S. Anaheim Blvd. JOB ADDRESS DESCRIPTION OF WORK NEW ADDN ❑ ALiER ❑ REMJR ❑ DEMOUSH❑ TYPE OF SIGN WALL ❑ ROOF ❑ POLE ❑ Mynuflt abf BILLBOARD ❑ 4' -0" SIGN SIGN HEIGHT WIDTH OVERALL 4' -Olt IEIGHT BOND REO. ❑ AMOUNT $ TEMP TRACT ❑ DIMENSIONS 4'5" 18 SQ. Ft HEIGHT ABOVE ROOF LOT FRONTAGE PA92 GL< c_ / !9-F / .40 /74 _ rfri/ -2 (1/ -arz) VALUATION I ,Pl u mb.. , , a HatEt c $ 4,000 00 BOND NUMBER When properly validated in the space and to this Ipm c nalitutes a pe mit to do the work desai N hereo The issuance of this permit does not authorize the vimaton of any state or local law 17APR92 TOTAL PERMIT 0 TRANSACTION 62459 1 had carefully read and examined the above application and knew the same t0 be true and correct. All provisions Of Laws and Ordinances covering this type a construction will M complied with whether specified herein cr not Na person yep be employed in vdakon of the Labor Code of the State M California. $119.79 INSPECTIONS FOUNDATION: P.'ELGING ZONING CLEARANCE FINAL ELECTRICAL LOCATION DISTANCE FROM PROPERTY LIN FINAL F T� ,y #! N DATE PERMIT APPLICATION JOB ADDRESS 1 > S /V✓ FCC (N`2 .' /; &V NUMBER. q STREET PERMIT - (7 ' Z xx ' 1 OF 3 sr N NUMBER ERN PANT 2 To obtain this permit. the undersigned hereby files this application and agrees, certifies and declares: That notice has been given me that this permit may be used only in compliance with the Anaheim Municipal Code, and all other applicable oVinances and laws- - That this permit does not allow occupancy, Ind that no occupancy is permitted, of the construcffon for which this permit is issued until it has been approved in writing by this office for occupancy after final inspection. That this permit does not allow. and separate permits are required for, any plumbing,electrical,heat- ing and air conditioning work. That a double fee will be paid for any permit issued after any work thereby allowed has been com- menced. I agree Martha City may enter upon the job premises at any reasonable time to inspect any work installed under this permit, and to otherwise act as and when required by the Anaheim Municipal Cdde. LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class C -45 Lie Number 5 Exp Date 5/92 Contractor Expressions Advertising OWNER - BUILDING DECLARATION 1 hereby affirm that Iam exempt from the Contractors License Law for the following reason (Sec.7031.5 Business and Professions Code: any city or county which requires a permit to construct, alter, improve, demolish or repair arty structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors Ucense law (Chapter 9) (commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt and the basis for the alleged exemption. Any violation of Section 7031.5 by any appli- cam fot a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property. or my employees with wages as their sole compensator, will do the work, and the structure is not intended or offered for sate (Sec. 7044 Business and Professions Cade: The Contrition's Ucense Law does not apply to an owner of property whg]milds or improves thereon, and who s suCdryry work himself or through his own employees, provided that such improvements are not inte rld or offeled for sale. d, however. the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or improve for the purpose of sale). 1, as the diVner of the property, arri exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions Code: The Contratars License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such Projects with a comrac- tor(s) ficensed pursuant to the Contractors License Law); ❑ I am exempt under Sec 8 & PC for this reason Date Owner WRKERS COMPENSATION DECLARATION l hereby affirm that l have a certificate of consent to self - insure, or a pectificatepf,W2 r� nation -, Insurance, ora certified copy thereof (Sec. 3800 Lab_ C) Policy No. J - / Certified copy furnished Exp. Date 'Applicant T- ` dvtgInde[Lnity CERTIFICATE OF EXEMPTIONKROM WORKERS' COMPENSATION INSURANCE (This section need not be com if the permit is for one hundred dollars ($100) or less). I certify that in the performance of the work for which this permit is issued, i shall not ethploy any person in any manner so as to become subject to the Worker5TGOmpensalion taws of California. Date Applicant NOTICE TO APPLICANT: 'I making this Certificate of Exenptiore,you should become subject to the Workete Compensationprovisions of the Labor Code. you must forthwith comply with such provi- sions or this permit shall be deemed revoked,' CONSTRUCTION LENDING AGENCY , . -_ +- I hereldyatitrt4hat Siena is a consgu Lion lending agency for the performance of the work for which this permit issued(See. 3097. Civ. c1: Lenders Name - r Lenders Address I certify that I have read this application and statdihat the above information is correct. I agree to comply with all city ordinances and state laws relating to building construction, and hereby authorise represen- tatives of this city to enter upon the above mentioned property for inspection purposes. THE PERMIT SHALL EXPIRE BY LIMITATION AND BECOME NULL AND VOID IF THIS,WORK IS NOT COMMENCED OR COMMENCED AND SUSPENDED AFTER A PERIOD OF 480`DAYS. NEW PERMIT IS REQUIRED TO COMMENCE WORK ) /( &,/ � I \ `�'s�' `/ DATE I � / C P RINT NAME aF APPLICANT CLC\. 1 Mt. rcn1YO1 BUILDING DIVISION . ANAHEIM, CALIF. CITYLIC. NO O-43 lZ ) CONTRA O ,aS TQ Cr ( 6>rJ TEL. NO. 65a-t)41.0 (v MAILING Or 1O i err-004.24 "re i0 / STATELIC. NO 6-3 6's 2-ss' T TEL NO. EL NO. 6 CITY 94 ,44/.4, 04 Qanc t, G 1 Y t� ��. GWN [1 & } ].t Kp) rJrc.lQ MAILING ADDRESS RESS A � � � ` , S ., "/VR U.&44 *Zoo 44 j. (-Itf A.-T- o NEW Mt EXIST 1-1 NO SERV. ❑ RECONNECT BLDG. VW BLDG. CHARGE OR RESEAL NOTE! TOTALS SHOWN BELOW MUST BE SUBMITTED IN DIAGRAM ON SEPARATE WORK SHEET. - NO. 39 OUTLETS:AND � SWITCHES 2Z- LIGHTING FIXTURES When properly validated in this space and pai or this orm constitutes a permit to do the work described hereon. The issuance of this rmit does not authorize the violation of any state or local law. BLDG 10 JOB ADDRESS �F1 � r j ew APPLICATION FOR AN (714) 999 - 5161 TEMPORARY POWER POLES ( GENERATORS, MOTORS, TRANSFORMERS OTHER) O1AUG85 TOTAL RMIT �. C 5A URE EACH HORIZED AGENT $39. 204 PERMANE , Q EA. FG EA. ® EA. SUB TO ■••■.- NO. ITEM EACH SELF-CONTAINED FACTORY WIREDAPPROVED UNIT SERVICE NO. TRANSFORMERS # SIGNS NO. LAMPS # RESIDENTIAL Square Feet GARAGE Square Feet MI f n q �l eA6 4 ©c F�fr I have arefully read and examined the above application and know the same to be true and correct All provisions of Laws and Ordin- ances overing this type of construction will be complied with whether specified herein or not. No person shall be employed in violation of the Labor Code of the State of California. APPR. BY TOTAL ABOVE 7 ©` 2 I L ISSUING PEE L 0,0( TOTAL FEE 3 vN _ 24 MAILING ADDRESS RESS A � � � ` , S ., "/VR U.&44 *Zoo 44 j. (-Itf A.-T- o NEW Mt EXIST 1-1 NO SERV. ❑ RECONNECT BLDG. VW BLDG. CHARGE OR RESEAL NOTE! TOTALS SHOWN BELOW MUST BE SUBMITTED IN DIAGRAM ON SEPARATE WORK SHEET. - NO. 39 OUTLETS:AND � SWITCHES 2Z- LIGHTING FIXTURES When properly validated in this space and pai or this orm constitutes a permit to do the work described hereon. The issuance of this rmit does not authorize the violation of any state or local law. BLDG 10 JOB ADDRESS �F1 � r j ew APPLICATION FOR AN (714) 999 - 5161 TEMPORARY POWER POLES ( GENERATORS, MOTORS, TRANSFORMERS OTHER) O1AUG85 TOTAL RMIT �. C 5A URE EACH HORIZED AGENT $39. 204 PERMANE , IEEC.I ER GROUN D CONDUIT GH ELECTRICAL XTURES E£ItORD - `'f INSPE ITEM j TEMPORARY POLE ELECTRI CEILING HEAT AT CTIONS OR P ARTLAL INSPECTIONS e APPLICATION FOR A MECHANICAL PERMIT (HEATING AIR CONDITIONING OR REFRIGERATION) (714) 9995161 BUILDING DIVISION ANAHEIM, CALIF. ITEM F CITY LICE NO. /' . 3 ' T Eyyy .5 3 ) 66 ``PP STATE �N� /, ✓L `,' TOR / , C ; s H ^ _ / NG ADD".. lv as A ./ 4 � C ? 0 N.H '/ y /(J t COMMERCIAL H000 OR EXHAUST TO 4000 EFM TEL. NO nun I ITEM F FEE RESIDENTIAL AIR CIRCULATING OUTLETS HEATING OR COOLING ^ _ s H ^ _ `a O" EXHAUST SYSTEM ON SINGLE DUCT O COMMERCIAL H000 OR EXHAUST TO 4000 EFM COMMERCIAL HOOD OR EXHAUST OVER 4000 EFM COMBUSTION PRODUCTS VENT (OTHER THAN CHIMNEY) FACTORY BUILT OR METAL CHIMNEY APPLIANCE REGULATED BY THIS CODE BUT NOT SPECIFICALLY LISTED IN THIS SCHEDULE COMPRESSOR OR BOILER TO 20 HP ABSORP. UNIT TO 500,000 BTU COMPRESSOR OP BOILER -21 TO 50 HP ABSORP. UNIT 500,001 TO 1,000,000 BTU COMPRE550R 08 BOILER OVER 50 HP ABSORP. UNIT OVER 1,000,000 BTU HEATING OR COOLING COW (DIRECT EXPANSION OR HOT OR COLD WATER) OOOLING TOWEAOI AIR COOLED CONR, DEEVNSPRAT V OR ER EVAPORATIVE COOLER (OTHER THAN PORTABLE) WINDOW TYPE AIR CONDITIONER (BUILT IN) MAXIMUM 143 HP GAS SYSTEM -1 TO 5 OUTLETS I have carefully read and examined the A APPR P PERMIT JOB ADDRESS eta MAILING ADDRESS 6 DESCRIPTION OF INSTALLATION NEW ❑ ADD'N ❑ ALTER. • REPLACE ❑ When properly validated in this space and paid for this form constitutes a permit to do the work described hereon. The issuance of this permit does not authorize the violation of any state or local law. 08AUG85 TOTAL . $22.00N P^EERIIIT 0 TRANSACTION 60271N BLDG 13 SIGNATURE OF OWNER 0 PERMANENT SPECTIt3 RECORD t NPECT QUAN ITEM AMT. QUAN ITEM AMT. WATER CLOSET I 1 GAS SYSTEM 1-5 OUTLETS � ? BATH TUB 60R MOPE OUTLETS-PER SHOWER WATER HEATER OR VENT LAVATORY WATERSOFTNER `KITCHEN SINKS - - WATER DIST. SYSTEM EXISTING BLDG. ONLY GARBAGE DISPOSgt F WATER MAIN ]st ]00 CLOTHESWASHER WASTE AUDI. — SLOP SINk - - - - LAWN SPRINKLER 1d VALVES FLOOR SINK ADDITIONAL VALVES Eq. FLOOR DRAIN SEPTIC TANK SEEP PIT DISHWASHER SEWER CLOSED LAUNDRY TRAY SEWER 151 100 - DRINK FOUNTAIN ADO'L 100 URINAL BACKELOW PREVENTER GREASE INTERCEPTOR RAINWATER DRAINS SAND INTERCEPTOR SOLAR PANELS BAR SINK / SOLAR TANK 1 a hav carefully read and examined the ab pcauon and Mow a to i na c nce e� f correc. All provisions o of Lawws s antl ri n i g this type of construction II ll b be e plea will whether specified herein or me No p rsoo shall be employed In violation of the Labor Code of the State of California. ' k• PPP TOTAL J ABOVE ABOVE I SSUING FEE v,.... ' I1 {i TOTAL FEE / 3 CI JOB ADDRESS 3 0 S. A fl hel Rtvc APPLICATION FOR A CITYLIC. NO. PLUMBING PERMIT 2�� T P 4-7 7? 7 STAT LIC. NO. 3 ge15710 (714)999.5161 A BUILDING DIVISIION - A ANAHEIM,, CALIF. � t J k R \ LW' / ` • • //� V / LI IS a c o E g s SPt c sr — A?-Oe N Gktl UE OWN r �) - �[s iiG'ER G1 Ega�g 7etG '� - 101 TEL.NO. �l 11 14— "rf ��ti 3.69 rth)b4 `lc e/Yt /� //GE L), re .2, PROPOSED a NEW G. BLDG REMODELED ❑ BLDG. USE DESCRIPTION OF WORK: When properly validated in this space and paid for this form constitutes a permit to do the work described hereon. The issuance of this permit does not authorize the violation of any state or local law. L• _ _ K` ,1.311.E $13.00IN — PERMIT /WY SIGNATU BLDG 12 TRANS AC 0 NE• OR 2C PERMANENT GROUND WOAK(WASTE) GROUND WORK (WATER -GAS) S3)JC(H GAS BPL R.G SEEPAGE P(T_ DRAINF€ AL GAS INSPECTION RECORD BASIC INSPECTION:' PARTIAL OR ISC, INSPECTION OUAN ITEM AMT. OUAN ITEM AMT. 2 WATER CLOSET _ lJ4 A1. 1' {/ GAS SYSTEM 15 OUTLETS BATHTUB -. 6 OR MORE OUTLETS -PER SHOWER 1 WATERHEATER0 N C, `3 3 LAVATORY A WATER SOFTNER 1 KITCHEN SINKS 3n/VYIF'f "` EXIST IN BLDG ONLY 1 GARBAGE DISPOSAL WATER MAIN 1st 100 CLOTHESWASHER WASTE ApD'L. 100 1 SLOP SINK Q J L SPRINKLER VALVES 2 FLOOR SINK 4 ADDITIONAL VALVES EA. FLOOR DRAIN SEPTIC TANK AND SEEP PIT DISHWASHER SEWER CLOSED LAUNDRY TRAY SEWER 1st 100 DRINK FOUNTAIN ADD'L 100 URINAL BACKFLOW PREVENTER GREASE INTERCEPTOR RAINWATER DRAINS SANG INTERCEPTOR SOLAR PANELS BAR SINK SOLAR TANK pli carefully read the sa ID m eeand correct All and know of same m Or true and correct. All provisions of Laws and Ord dances unit this type of construction will e p lied wile whether secmei herein or not no p boon snail be employed in iolafm of the Labor Code of the Slate of California. APFF BM TOTAL ABOVE 33 ^, 3/ a ISSUING FEE / 0 TOTAL FEE 4 3t JOB ADDRESS 30 S. Anaheim Blvd. Anaheim 714) 999.5161 CONTRACTOR Spar Plumbing and Heating (LING APPLICATION FOR A PLUMBING PE IM, BUILDING DIVISION � ANAHEIM, CALI 15641 Spar Street CITY Garden Grove, Ca. 92643 OWNER Wood Bridge Village Ltd. MAILING ADDRESS 50 S. Anaheim Blvd. Suite #200 PROPOSED n NEW ❑ REMODELED ❑ RELOCATED USE: L�J BLDG. BLDG. BLDG. DESCRIPTION OF WORK: CITY LIC. NO. 0- 042099 1111 S A4E / tJ TEL. NO 520 -9730 When properly validated in this space and paid for this form constitute a permit to do the - work described hereon. The issuance of this permit does not authorize the violation of any state or local law. oo8A0Ga5 TOTAL $43 U(3N PERMIT TRANSACTI N SPEC ION RECORD BASIC INSPECTION � k -- 4GF. SPEC ION RECORD BASIC INSPECTION APPLICATION FOR A SIGN PERMIT PLAN CHECK FEE „26,a5 ' t 7T4) 778 -0999 MAIUNG ADDRESS ZIP CODE 556 S Rosa St Anaheim 92805 BLDG. FEE -so/ 0c 9 ENGINEERING MAILING ADDRESS - STATE I IC An ELEC. FEE 5 / /v o TRAFFIC T 014)999 -2440 SUB TOTAL L elL , T 45 ZONING STATE TAX 50 OTHER MICROFILM FEE / w PERM. PLAN O Y1THOL PUN 0 T OTAL FEE A te ' APPLICATION FOR A SIGN PERMIT PLANNING DEPT. v BUILDING DIVISION 1714) 999 -5181 ANAHEIM, DA CONTRACTOR Advertising ' t 7T4) 778 -0999 MAIUNG ADDRESS ZIP CODE 556 S Rosa St Anaheim 92805 CITY UC NO. T- 00R196 D ARCH. O ENGR TEL NO ,,,...■tr MAILING ADDRESS - STATE I IC An OWNER Masquefa T 014)999 -2440 ADDRESS 30 S. Anaheim Blvd. mA Tt A R : GS Anaheim Blvd., Anaheim ca`v2805 ON SITE OFF SITE VALUATION BOND BLDG 25 DESCRIPTION OF WORK NEW Lp ADD'N�] ALTER REPAIR 0 DEMmJSH❑ TYPE OF SIGN YPLL POLE ❑ BILLBOARD ❑ TEMP TRACT ❑ NOTE' Include Labor. MN.. Wimp. Plumb.. Hear. Etc. DIMENSIONS 10APR92 TOTAL 584.75 PERMIT 0 SIGN TRANSACTION 62053 SON 11 SIGN HEIGHT 36 WIDTH 12' AREA "i6 sq. Ft OVERALL 14' HEIGHT HEIGHT ABOVE ROOF > raJL 1 c- 7 /2 ft $ 1,800.00 $ BOND REQ. ❑ AMOUNT $ NUMBER When properly vaibated in this pace and pap for This form c nslitutes a ward to M the work described hereon . The issuance of this permit does not aMprire he violation of any staled local law I have carefully read and examined the above application and know the same to be true and correct All provisions of Lams and Ordinances covering this type of construction will be complied with whether specified herein or ml. No person MRII be mpbyed in violation of the Labor ../ - e of California. INSPECTIONS FOUNCAi!ONS INC OCATJON _ ' CSTANCE FROM PROPERTY LIN r:?OT/I SETBACK ZONING CLEARANCE FINAL ELECTRICAL b v,! POINT TA APPLICA R OB DD. ESS ?- nti - NUMBER / n PERMIT - / /l:-J TYPE OF NUMBER IIIXXX VVVii' PERMIT BY STREET s PART 2 To obtain this permit. the undersigned hereby files this application and agrees, certifies and declares: - That notice has been given me that this permit may be used only in compliance with the Anaheim Municipal Code, and all other applicable ordinances and taws. That this permit does not allow occupancy, and that no occupancy is permitted, of the construction . for which this permit is issued until it has been approved in writing by this office for occupancy after final inspection. That this permit does not allow, and separate permits are required for. any plumbing,electrical,heat- ing and air conditioning work. That a double fee will be paidlir any permit issued after any work thereby allowed has been com- menced. I agree that the City may enter upon the job premises at any reasonable time to inspect any work installed under this permit, and to otherwise act as and when required by the Anaheim Municipal Code. LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my licens is in full force and effect. License Class ✓ Lic Number 2 " IEx Date 4 47> Contractor �yf C, OWNER- BUILDING DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason (Sec.7031.5 Business 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 applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9) (commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any appli- cant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I. as owner of the property, or my employees with wages as their sole compensation, will do The work, and the structure is not intended or Offered for sale (Sec. 7006 Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and •who does such work himself or through his own employees, provided that such improvements are not intendeddr offered for sale. If, however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or improve for the purpose of sale). ❑ I, as the owner of the properly, an exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions Cade: The Contrators License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a contrac- tor(s) licensed pursuant to the Contractors License Law). • I am exempt under Sec. B & PC for this reason Date Owner WORKERS DECLARATION hereby affirm that I have a certificate of consent to self - insure, or a ceryficate of Compensation ranee, or a certified copy thereof (Sec. 3800 Lab. C) Policy Nofq 1 V b9 o 11 � pany (7, /a, •tied copy furnished Exp Date t z Applicant , // �'r� )oN ! .!.O M • CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSA INSURANCE c tion need not be completed if the permit is for one hundred dollars (5100) or less). I cerlify th a • e performance of the work for which this permit is issued. I shall not employ any person in any manner so9s to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provi- ons or this permit shall be deemed revoked_ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Sec. 3097. Civ. C): Lenders Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city ordinances and state laws relating to building construction, and hereby authorize represen- tatives of this city to enter upon the above mentioned properly for inspection purposes. THE PERMIT SHALL EXPIRE BY LIMITATION AND BECOME NULL AND VOID IF THIS WORK IS NOT COMMENCED OR COMMENCED AND SUSPENDED AFTER A PERIOD OF 180 DAYS. NEW PERMIT 15 REQUIRED TO COMMENCE WORK. E/J T,NAM OF APPLICANT - OWWMER -AGEN LDER- OFFICER 41 -/t - DATE mil/ BLDG - 18 Rev. 6/88 • -1.o Ai-27 IZz / 01__- . 4 so s, G DATE: Q"�Z� IL APPROVED BY DRAWN BY ADVERTISING FAX (714) 77B -1978 (7•4) 778 -0999 1 556 5. Rose St_ Anaheim CA 92805 CSL 0530949 DRAWING NUMBER 5 0 ES OpF IHE C N E HpL pp� �1 ERMIT PROLE OS AT HIS WII RIS APR 1 7 1992 BUILDING DIVISION OF AHEM APPROVED 6 't ck� RY I 749 iN 1�r �� — ulj / 17 so s. H1=I H, A.NkHWI M,oA DATE: .4"/2- APPROVED BY DRAWN BY } I FAX (714) 77 8-1676 (714) 776-0999 .556 S. Rose SL Anaheim. CA 92805 CSL 0530949 DRAWING NUMBER � 00 • ODES OF ariNla THNEHo pp�F'p` ERMIT PROCEEDS AT HI N RISK, APR 1 7 1992, BUILDING DIVISION OF AHEtM APPROVED 6L�kY'T AY 3,(c„ 000 200,x0 0 1 106, 000 o00 80, 000 ?Z, 000 64,0oo 4 40, boo 2 000 i , 2 88,c04 MAx 1St STAN Cc 34¢oo 3100 Yz" 2 , . 9 74 ,1 74. 41 Sri I YZ • o asoo 44d; •. 3Z' 5 4 6 Z ,00 Q7t3 Nrie-n Epp_ e�N 12 0 �. ('` 11' 1- 44- ec� A- eft_ ._ WOO c■ p�UM 1 _ It_ Q BUILDING ROV�D ECT�� f — t - -AP wsp - 138351 ‘ �p 1 ss 1 ELD Z �' 1,s- nzte rL 1(0 Z` I - 4 7$ 1 � T l�e S 150 X 0 00 72, 60C IX," 3 /4 SO re OD tu , =<1001 Sk f 2A 4 8 3( 3 • S(05, z Gas 4*3set dM J t " Is' (tilt) CFt> 3" Aso ;-S S YS Tam'{ use N . 1 3 Totsi TC h ,o ta5ut,r4UE OF Tni3 rERMIT Doi NOT APPROVE VIOLATION OF ANY C THE BUILDING CODES OF THE CIT TiFE HOLDER OF THIS PERIM PRO, CEEDS AT HIS OYIH R4BK. APR]. 01992 301-DING D }VISION OF Mann Et".1 APPROVE O < < Zi,,, BY CERTIFICATE OF USE AND OCCUPANCY GRANTED BY PLANNING DEPT. CITY OF ANAHEIM No a- 1 2 - 2- - DATE / ) LOT No Block SUBDIVISION No. and St /Fa USE: CONSTRUCTION' ZONE CLASSIFICATION:IL / i +I S ird4 ,d%'r1.d P " 11+5✓ This structure has been inspected and is in compliance with the applicable provisions and ordinances of The City of Anaheim, Any change of occupancy group requires renewal of this Certificate. Classification ;., Group Type ''��'" No of Stories Use Zone Permit No ` Building Owner: riccd Bridge vllLa_;e, Ltd. . Anaheim Blvd. Classific Lion rim:. Tenant 'improvement_ 3,938 sq. ft. Group Type v_d /SprNo of Stories t Use Zone Perr Building Owner: Woodbridge Village Building Address 30 S, Anaheim lvd. CERTIFICATE OF OCCUPANCY This structure has been inspected and is in compliance with the applicable provisions and ordinances of The City of Anaheim. Any change of occupancy group requires renewal of this Certificate. ELECTRICAL PERMIT NO.. ELE2000- 01984 TYPE OF PERMIT Alteration or Addition to Existing DATE: 10/23/2000 JOB ADDRESS: 30 S ANAHEIM BLVD LEGAL DESCRIPTION:: P BK 178 PG 22 PAR 1 APPLICANT: H JOE SADRI OWNER INFORMATION. CONTRACTOR INFORMATION: ARCHITECT /ENGINEER INFORMATION: H JOE SADRI'S HOME IMPROVEMENT 20802 ELY AVE LAKEWOOD, 90715 0000 CA' JOB DESCRIPTION:. Relocate Recepticles - Ref PLM2000 -01805 • OWNER UB� ILDER DECLARATION ere g affirm under penalty of perjury . that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Business 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 applicant for such permit to file a signed statement that he s licensed pursuant to the provisions of the Contractor's License Law (Chapter 9)(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the exemption. Any violation. of Section 7031.5 by arty applicant for permit subjects the applicant to a civil penalty of not more than five hundred dolls rs_($500). I, as owner of property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered fo sale (Sec. 7044 Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that Such improvements are not intended or . • offered for sale If, however, the buikfing or improvements sold with one year of completion, the . owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). I, as the owner of the property', am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law). - • I . I am exempt under Sec. , B & P.C. for this reason: Date: . Owner; - - WORKER'S COMPENSATION DECLARATION . . I hereby affirm under penalty of perjury one of the following. declarations: • El I' nave and will maintain a celtifitate of consent to self- insure for worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. • 0 I have and will maintain worker's compensation insurance, as required by Section 3700 . of the Labor Code, for the performance of the work for which this permit is issued. My workers Compensation insurance darner and policy are Carrier - Policy Number: 'EXEMPT This section need not be completed if the permit is for one hundred dolais (WO) or less. '0 I certify that in the pe:rfermance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the worker's compensation laws of California, and agree that if I should become subject to the workers compensator provisions of Section 3700 of the Labor Code, p 1 shall. forthwith comply with those. provisions. • Date ' 10/23/2000 Applicant: /, i I _4 A WARNING: FAILURE TO SECURE:VbORKE R'S OMPENSATION COVERAGE IS ' UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND - CIVIL FINES UP TO ONE HUNDRED THOUSAND 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. hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued - (Sec.3097.Civ. C);. Lender's Information; I certify that I have read this application and state that the above information is correct I agree to comply with all city ordinances and state laws relating to building construction, and hereby. authorize representivesof this city to enter upon the above mentioned property for inspection purposes. " IAj� . 4 Signature Ic or Agent QUARTER SECTION: 83 CONSTRUCTION LENDING AGENCY • Date: 10/23/2000 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. new permit is required to commence or continue work PROCESSED BY: RLC Date: 10/23/2000 NUMBER: 100193 TYPE: BUILDING DIVISION - - .200 S. ANAHEIM BLVD. (714) - 765 - 5153 INSPECTION REQUEST LINE: (714) 765 -5161 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000) of Divsion 3 of the Business and Professions Code in Receptacles, switches, lights Contractor , EXPIRATION DATE: 12/31/2000 . tees paid. tor. Permit: - Total: 40.00 .INSPECTION- DATE. -- INSPECTOR Temporary Power Pole Plumbing (Drain/Waste Pipe) Electrical GroundElectrode/Lifer . Setback/Forms/Trenches (Footings) Do not install subfloor or pourfloor slab until the following applicable items have been signed: Plumbing (Water PI Valves) Fire Dept Final 765-4040 Mechanical (Groundwork) Water Engineering 765 -5266 Electrical (Underground Conduit) Sub List/Business License 765 -5191 Pre- slab (Compaction/Membrane.Reinf.) Zoning 765 -5139 Underpinning (Floor Joist/Girders) Building Final tL astInspection - Only -After Above Complete) Do not cover or conceal the:wark below until the following appiicable items have been signed: 1st Floor Shear Firesprinkler (Rough) 2nd Floor Shear Roof (Sheathing/Diaphragm/Frame) Masonry (Reinf./Bond Bean/Pre-Grout) Rough Plumbing .'(Top Out) Rough Mechanical Rough Electrical (Dry Wall) Rough Electrical Framing • ' (Only after Ping., Elea .i PAech., and Fire) Insulation (Sound/Energy) Do not tape or plaster until the following applicable items have been signed: Drywali Penetrations (Fire Rated) Electrical Penetrations (Fire Rated) Mechanical Penetrations (Fire Rated) Plumbing Interior Lath Exterior Lath GENERAL ITEMS Exterior Plaster (Brown Coat) -T-Bar Electrical T -Bar Mechanical 1 Structural Sewer Water Engineering Backflow Water Service FINAL INSPECTIONS Date, Inspector Electrical Final Plumbing Final Mechanical Final - Gas Test Engineering/Grading Final 765°6126 Fire Dept Final 765-4040 Water Engineering 765 -5266 Sub List/Business License 765 -5191 Zoning 765 -5139 Building Final tL astInspection - Only -After Above Complete) ,.. INSPECTION, RECORD - PARTIAL INSPECTIONS Building Inspections Mechanical Inspections Plumbing inspections Electrical Inspections PLUMBING PERMIT Na PLM2000 -01805 TYPE OF PERMIT DATE 10/23/2000' JOB ADDRESS: 30 "S ANAHEIM BLVD LEGAL DESCRIPTION:, P BK 178 PG 22 PAR 1 • APPLICANT: H. JOE, SADRI: OWNER INFORMATION: ANAHEIM H OL UALOA 100 3 ANAHEIM BLVD CITY OF ANAHEIM CONTRACTOR INFORMATION: H JOE SADRI'S HOME IMPROVEMENT 20802 ELY AVE ANAHEIM, CA. 92805 LAKEWOOD, 90715 0000 CA • JOB DESCRIPTION: Replace Plumbing Fixtures OWNER BUILDER DECLARATION I hereby affirm "under penalty of penury that I -am exempt from the Contractor's License Law for the following reason (Sec. 7031 5 Business 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 applicant for such,permrt to file a signed statement that he is Foensed pursuant to the provisions of the Contractors License law (Chapter 9)(commencing with Section 7000 of Division 3 of the Business and. Professions Code) or that he is exempt therefrom and the basis for the alleged exemp{ ion:. Any violation of Section 7031:5 by any applicant for a permit subjects the. applicant to a Civil penalty of not more than five hundred dollars ($500). - , WOR'KER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: . .❑ 1 have and will maintain a certificate of consent to sell- insure for worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance•of the work for which • this permit is issued. - - 9� I have and will maintain workers compensation insurance, as required by Section 3700 ofthe Labor Code,. for the perform ance of the work for which this permit is issued. My worker's Compensation insurance- carrier and policy are:' Carrier. - - _ Policy Number EXEMPT - _ This section need not be completed if the permit is for one hundred do tars. ($100) or less. 0 i certify that in the performance of the work for which this permit is issued, .1 shall not employ any person in any manner so as to become subject to the worker's icompensation laws of California , and agree that if I should become subject to the workers compensation provisions of Section 3700 of the LaborCode, I shall forthwith comply with those. provisions. , • Date: 10/23/2000 Applicant: WARNING: FAILURE TO SECURE wv{.�RKER'S C•MPENSATI ON COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,006), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEYS FEES. I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered fo (Sec: 7044 Business and Professions Code The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who does such work himself pr herself or through his or her own employees, provided that such improvements are not intended or offered fqr sale. tf, however, the building or improvement is sold with one +ear of completion,; the owner - builder will have the burden of proving that he did not build or improve for the purpose of sale). • - 1, as_the owner of the property, am exclusively contracting with Iicensed contractors to construct the project (Sec. 7044 Business and Professions Code: The Contractors L icense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law),` I am exempt under Sec_ , B & P.C. for this reason: Date: " Owner: CONSTRUCTION LENDING AGENCY I hereby; affirm under of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097.Civ.C) - Lender s Information: I certify that I have read this application and state that the above information: is correct. I agree to comply with all city ordinances and state laws relating to building construction, and hereby authorize representives of this city to enter upon the above mentioned property for inspection purfo / /I 1 Date 10/23/2000 ". Sign ore " of Applicant The permit shall expire by limitation and become null and void if the building or work has net passed final inspection 365 days from the date of permit issuance. A new permit is required to commence or continue work. ARCHITECT /ENGINEER INFORMATION: PROCESSED BY: RLC LICENSED CONTRACTORS DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000) of Divsion 3 of the Business and Professions Code. j Date. 10/23/2000 • NUMBER: 700193 TYPE: E ITEMS Lavatory 'Water Closet BUILDING DIVISION 200 S. ANAHEIM: BLVD. (714) - INSPECTION REQUEST LINE: {714) 765 -5161 ` QUARTER SEC 83 -TA ;4, Contractor EXPIRATION DATE: 12/31/2000 tees paid tor Permit: Total: - 68.50 INSPECTION, DATE INSPECTOR Temporary Power Pole, Plumbing (Drain)Wastepipe) Electrical Ground:Electrode/Ufer - Setback/Forms/Trenches (Footings) ' Do not install subfloor or pour floor slab until the following applicable items have been signed: Plumbing (Water P'ipe.Sprinkler Valves) Fire Dept. Final 765 -4040 Mechanical (Groundwork) -. Water Engineering 765 -5265 Electrical (Underground Conduit) Sub List/Business License 765 -5194 Pre-slab (CompactionlMembrane.Reinf:) Zoning 765 -5139 Underpinning (FloorJoist/Girders) Building Final After AbovetC mp ete) Do not cover or. conceal the work below until the following applicable items have been signed: .. 1 st Floor Shear Firesprinkler. (Rough) 2nd Floor Shear _ Roof (Sheathing/Diaphragm/Frame) Masonry (ReinfJBend Beam/Pre -Grout) Rough Plumbing (Top Out) -' Rough Mechanical Rough Electrical (Dry Wall) Rough Electrical Framing , (Only after Plbg., Elec., Mech., and Fire) Insulation (Sound/Energy) 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 - - ExteriorLath. - GENERAL ITEMS Exterior Plaster (Brown Coat) T -Bar Electrical T -Bar Mechanical - T -Bar Structural Sewer ` , Water Engineering Backflow dVeter 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 -5265 Sub List/Business License 765 -5194 Zoning 765 -5139 Building Final After AbovetC mp ete) INSPECTION RECORD PARTIAL INSPECTIONS Building Inspections Mechanical Inspections Plumbing inspections Electrical Inspections sl. t r o 2 / 516 iN WIELEINSEPOST 18A13-011 —11 x 17 6!IN FABRICATED ALUMINUM CABINET WITH EXPOSED NEON GREEN CABINET, WHITE NEON 0 «II Th6 I 1I BACK ELEVATION =1 -0 ti EOM s i nc wjuAr.uE. OF'i' 3 FERIai1 Out. THE BUILDING CODESCOF T HEEGIT THE HOLDER OF THIS FERMI' PROCEEDS Al HIS OWN RISK. A PR101992 3VILDITIO DIVISION OF ANAHEIM APPROVE SCALE: DATE: 3 ZONING DIVISION SIGN APPR OVAL BY IC* DAIT FAX [714) 778 -1878 556 S. Rose SC. Anaheim CA 92805 DRAWN SY 7 [714) 778 -0999 C% 0530949 DRAWING NUMBER inflwNEP06T 1SAB-011 —113117 LA 5494 Pe 6 J»$ -:=I M s8 I c \ N s 15 X APR ' UILDING DIVI 15 16 - sc, 30_5. A -J AHw1M 431 m. IM scALE:NLt i L o DATE: A. --Z -1 nt Ib3uAivvE OF MOT APPROVE fi THE BUILDING :t THE HOLDER PROCEEDS AT Ni FERM w:Cnil I T C4- LATION OF ANY C DES CF THE CJT F THIS PERMI OWN RV.. OVER APPROVED BY ADVERTISING 3 01992 ZONING D'VISION ONOF ANAt ' LSIGN APPROVAL f BY ____/ DRAWN BY FAX j714) 77B -1678 _ [714) 778-0998 556 S Rue Sc. ft WWTh CA H2005 - CSI. •530948 DRAWING NUMBER EoG:, ., ■ X 14, 11 , 'I II 1 N a.JJg .. IL_ r stn 2 I� 1 II I I II II rssE ti II -34x7 64 12-FF-1 fJEct-1 rotzmR 017-N- G44,44-21.k L L iZ, ^ rr b G-1 DA 1 f T \MJ ��I✓ Dfr HokiLIH ILLUmtNcrE ns. S s e._, c_ 's 4J To V.L, L--1 ' ZONING- DIVIION SIGN APPR OVAL BY k.40 Q 2. C`ovA }ie� t' 0 r. r Gw KKK 1 ).r0 0 4 G. I.tr. NEbN DATE 4 -Z • ADVERTISING so 6. I � ANkHI rifr- seam - of I APPROVED BY r i ;�aN'.t 'M' • HE CITY. HE HOLOE a Ht •NI PROCEEDS ATiOIS OWN RIS APR 1 7 1992 BUILDING DIVISION OE A AH EIM o A 1 PPROVED G 2t(- -% AY ■ DRAWN BY 1 FAX (714) 778 -1678 (714) 778 -0999 556 5. Rose Sc. MMSn. CA 92805 C31.0530949 DRAWING NUMBER boo WitECVNEPOST 19AB-09 —11 ■ 17 ,L 9 desrc a c1- Cware Z1 )c `/ 1 - ST�et G La izat l' E n__4.b --- ` ts o LA M , y I RO oEW 7H Al KS O RMIT PROCEEDS APR 1 1 1992' BUILDING DIVISION O HEIM APPRO ALD s a/+ 96 6 - RAS S 30 5. ANAH IM $ ' )M,4i& SCALE: L!ti 0 1 APPROVED 8? I DRAWN or Vat. DATE: -2 -9 2_ . HE CI i T IH T I r� t HI IT PROCEEDS AT 1 S WN RIS APR 1 7 1992 BUILDING I O OF ANAHEIM 24- ° l RY FAX (714) 77B -1678 (714) 778-0989 . 896 S. Ras St Anthem G 92805 091 0530949 ^ - I DRAWING NUMBER wr —11 x 11 SIGN PERMIT NO. TYPE OF PERMIT New Attached to Structure Sign DATE: 3/31/2003 JOB ADDRESS: 30 S ANAHEIM BLVD APPLICANT DEEN BAKSHI OWNER INFORMATION: Holualoa Anaheim 100 S Anaheim Blvd Anaheim, CA 92805 JOB DESCRIPTION: VALUATION: 9,000.00 SGN2003 - 00047 LEGAL DESCRIPTION: P BK 178 PG 22 PAR 1 CONTRACTOR INFORMATION. MEGABRIGHT SIGNS, INC 736 W KATELLA AVE ORANGE, 92867 0000 CA Install 2 wall signs. " PHO Republic " OWNER BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Business 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 applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9)(commencing with Section 7000 of Division 3 of the Business and Professions 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 subjects the applicant to a dvil penalty of not more than five hundred dollars ($500) I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended 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 improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold with one year of completion, the owner - builder will have the burden of proving that he did not build or improve for the purpose of sale) [] I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law) [—I I am exempt under Sec. , B & P C for this reason: Date. Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following dedarations ❑ I have and will maintain a certificate of consent to self- insure for worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this it is issued. have and will maintain worker's compensation insurance, as required by Section 3700 of bor Code, for the performance of the work for which this permit is issued. My worker's Compensation insurance carrier and policy are: Carrier STATE FUND Policy Number 1663645 -2002 This section need not be completed if t he permit is for one hundred dollars ($100) or Tess. El I certify that in the performance of the work for which this permit is issued, I'shall not employ any person in any manner so as to become subject to the worker's compensation laws of Califomia, and agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor C I shall fort� %!co with those provis Date: 3/31/2003 Applica WARNING FAILURE TO S ' URE WORKER'S COMPENSATION COVE GE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND 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. CONSTRUCTION LENDING AGENCY CITY��OFAN `��nr2o Vii' I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec.3097.Civ C) Lender's Information: I certify that I have read this application and state that the above information is correct. I agree to comply with all city ordinances and state laws relating to building construction, and hereby authorize representives of this cit to enter upon the above mentioned propert for d /// D inspection purposes. / 4 Signature of Applicant or Agen The permit shall expire by limitation and become null and void if the building or work has not passed final inspectoin 365 days from the date of permit issunace. A new permit is required to commence or continue work ARCHITECT /ENGINEER INFORMATION: PROCESSED BY. CAL LICENSED CONTRACTORS DECLARATION I I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000) of Divsign 3 of the Business an Professio, Code. i '41f % $p/f Uate: 3/31/2003 Contractor BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 QUARTER SECTION: 83 NUMBER: BUS2003 -01334 8/31/2004 TYPE. C45 TYPE. BUS le�ctric ign (Y /N): Y EXPIRATION DATE: 2 Fees paid for Permit: Total: 334.01