1515 E. Winston Rd. (2)
TYPE OF PERMIT
Repair
CITY
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BUILDING DIVISION
200 S, ANAHEIM BLVD,
(714) 765 - 5153
INSPECTION REQuEST LINE:
(714) 765 - 46~ '
, CENSUS CODE: 437 '
QUARTER SECTION: 106
BUILDING PERMIT NO',BLD2005.00726
}p . ~ Il"
DATE: 3/1512005
JOB ADDRESS: 1515 E WINSTON RD '
LEGAL DESCRIPTION: P BK 167 PG 1 PAR 2
1
,
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CONTRACTOR INFORMATiON:
BEVEN HERRON, INC
14511 INDUSTRYCIR :
LA MIRADA, CA 90638 OOQO
BUSINESS PHONE: 714 5~3-5870
JOB DESCRIPTION:lnstall post tensioning of 1900 purtins in existing root stru~ture, (1515 E, Winston'& 1715 E,Winston),
I
VALUATION: 560,000,00 ' ',1 PROCESSED BY: MSM
I OWNER.BUILDER:DECI.ARATIOIIi
I hereby' a.ffirm under penalty of perjury that I am exempt from the ContradOf;s license Law for the following reason (Sec. 7031.5 Business and
Professions Code: ~i1Y_city or county which requiresa. permtt to construct,-alter,"-improve, demolish-or repC1lir anY-structure. 'priorto its isSuance, alse
requires the applicant for'such permit,to fil~ a signed s'tatement that he is Iii';,fsed pLrrsuant to the prqvisions of the COI;"tract, or's license law (Chapter -
9)(commencing with Section 7000 of Oivisjon 3 of the Business andPrQfeSs~n$Code) or tt:.at he is exempt therefrom and the basis for the all,eged
exemption." A,y /lolat10" of Section 7031.5 by any applic~n! for a permit sutt'ects thG a,pplicant'to a dvil penaftyof :101 mor~ than five hundred dollars
,($500), , ' , " ' ." ",' "
o I, as owner of property, or my employees with wages8s their sole com~ensatiOl1. .will,oo the work, arid the structure is not _intended or offered for
5&le (8eo;7044 Business,and Professions Code: The Contractor'sUcer.se1J~w does no~ apply to an owner of property wh~ ,biJilds or improves
thereon, and who does such work himself or hers_elf o'r through his or her ow~ employees, provided that such improvements are not intended or, .
. offered forsaie. If, how~r,th~ building -or improvement is sold with one yeirr<?f oompletion,'the crwner..builderwill have the burden 'of proving that he
didno~bundori~proveforthepurposeofsale). . _ ' ;1 ~ .' . . : . , _
o I, a~.the owner oftl)e property, am exdusively contractjngwith.)j':iense~_'p:mtr8ctor$'mconstruct the project (See. 7044 Susines~an9 F'rofessjo(ls
Code: The Contractor's license, law does not~pply to an owner of propelty~\-vhc builds or improves thereon, and who contracts for sudl projects with
~ont(actor(s)licensed pursuant t.o the Contr,actor's License law).. - ~1' .
U lamex~rnptunder8~c. . _ ,B&P.C.for.this_reason: '-l
Date: Owner:
L WORKER'S COMPENSATION DECLARATiON ._;-
,I nersby affirm under penalty of.perjury one of the following deClaTEtjOns:\'[ .
o I h.ave and. w!l/ maintain a _certifICate of consent to self-insure tor worker;$. ccmpensation,
. as providect fer by Section 3700 of the Labor Code, for the performance, Oft!1;3.work rorwhich
j{h. - permit-is issued. .' , ,', ',ji '
. J have and will maintain worKer's compensation insurance, as requjrodbi,Section3100 of
. he Laber Coci~. for the performance I:?f the work for which this pe~011t is i:>s~<\d, My worker's. I
Compensation insurance carrier _and policy are: ._'>
Carrier: SEA BRIGHT INSURANCE CO, ' Policy NUmber BB105()Z12
i
This seCtion need nOt be completed if the pe~t is for one hundred dollars ($10(i~ at Jess.
D- I certify that in the performance ofthe work for which thIS perma isissue'tJ, I shall,not -
. 'employ any' person in any manner so as to become-subject to the worker's cc\mpensation laws
of CaHfomia, and agree that if I should become subject to the worker's compensatiun
provisions of Section 3700 of the Lab Code" I shall forthwith comply with trrq:~e provisior:s.
'j"
APPLICANT: BRENT BERGLUND
OWNER INFORMATION:,
Winston Road Realty HoIdjng Co Ine
1515 E Winston Rd
, Anaheim, CA 92805
ARCHITECT/ENGINEER INFORMATION:,
,
I
LICENSED CONTRACTORS DECLARATION~
I hereby affirm under penalty of perjurj that I am
'licensed i,lIlderprovisionsof chapter,9 (coMmencit'"lg
with Se-ction 7 00) of Oi\lSion 3,ofthe Business and
~/7:~0~~ 'a 0- ^
Date:,cont~ -
NUMBER EXPIRATION DATE'
184071 3/31/2005
TYPE HIC
TYPE B
Date: 3/1512005, Applicant:
WARNING: FAILURE TO SECUR, .
UNLAWFUL,AND SHALL SUBJE AN EMPLOYER T RIMINAL PENALTIES AND CiviL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDi'80N TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FE(OS: , j'
I CONSTRUCTION LENDING AGENCY
I hereby_affirm under p~natty' of perjury that there is a construction lending a~"ency for the
performance of the work for which this permit is issued (8ec.3097.Civ.C):' ; f.
Lende;'s.lnfcrmation: \ ~. .
--------- -"---- '--- -- --.--_..------,'-, . --~;".~'_.'~'
'Construcion Types:
VN, ,
Fire Sprinklered?
NO
I
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, ~nd
. hereby' authorize representives of this city to enter upon the above mentioned'property for-
ins. ctrl,U u~r~ ses. ' .
U~ Date:3/15/2005.
Signat
The permit shall expi limitation and .become null and void if the building or
work has not passed final inspecti<>!1 365 days from the date of permit issuance, A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
767,04 '
, INSPECTION RECORD
, , INSPECTION' , , DATE, ',NSPECTOR
Temporary Power Pole ,
Plumbing (Drain /Waste Pipe) " , -
ElectriCal Grou,nd Electrode/uter
SetbacklForrnsfTrenches (Footings) ,
00 not install subflqqror pour floor slab until the'
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves) ,
Mechanical (Groondwork) ,
Electrical (Underground Conduit)
Pre-slab (compactionlMembrane.Rel nt. " "
Underpinning (Floor Joist/Girders)
00 not cover or conceal the work below ul)til the
following apRli.c",ble items have been signed: ' , ,
1st Floor Shear '
FireSprinkler (Rough) ", "
2nd Floor Shear
Roof (Sheathing/DiaphragmtFrame)
Masonry (ReinfJBOnd BearnlPre-Gl'O\lt)
Rough Plumbing (Top Out)
Rough Mech,allical ,
KOugh t:lectrical (Dry Wall) ,
Rough Elecirical
Framing (Only after Plbg_. Elec.. MeCh and Fire)
Illsulation (Souml'Energy) " ,
PO not tape or pla~ter until the following applicable
rtems have been" signed:, .
Drywall' "
,Penetrations (Fire Rated) Electrical
Penetratio,ns (Fire Rated) Mechanical "
Penetrations (Fire Rated) Plumbil1!l'
Interior !.lith ,
Exterior Lath ,
" ' ,GENERAL ITEMS
Exterior Plaster (Brown Coat)
T -Bar Electrical
T-Bar Mechanical
T .BarStructura' '
Sewer "
Water Engineering Backflow '.
Water Service .. ' ,
FINAL INSPECTIONS Y, 0, Qale Inspector
Electrical F,inal
Plumbing Final ,
Mllchanical Final ,
Gas Test ,
Enginee'ringlGrading Final 765-5126 "
Fire Dep!. Final 765'4040 , -c
,
Water Enginee,ring 765;5268 ,
Sub listlBusinessLicense 7ii5-S19
Zoning 765-5139 , ' ~,'
Building Fi~Jast Inspection. Only 1/~n-o ~R.;;.~"
, fte' Above Complete)
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PARTIAL INSPECTIONS
BUildinQlnSpectiO..!!!, /. fl J~ '~~\.
' !r If-/); or /2 r.,...--r 0 It t-r I...... <::::;:iF L *;,
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Mechanical Inspections
, Plumbinq Inspections
Electrical Inspections