5130 E. La Palma Ave.
. TYPE OF PERMIT
Tenant Improvement (Limited)
CITY
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765, 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: .434
QUARTER SECTION: 172
BUILDING PERMIT NO. BLD2004-00644
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DATE: 8/23/2004
JOB ADDRESS: 5130 E LA PALMA AVE .107
LEGAL DESCRIPTION: P BK 204 PG 45 PAR 2
APPLICANT: MARC .RAOINSKI
OWNER INFORMAYION: CONTRACTOR INFORM/,TION:
AKAL BUILDERS
15855. E EDNA PL #11.B
IRWINDALE, CA. 9170600')0
BUSINESS PHONE: 62696?-.1332
JOB DESCRIPTIONfenant improvemen~, remodEH.office and restrooms
VALUATION: 30,000.00 :
I OWNER-BUILDER:Dl:CLARATION .
J hereby affir.m underpeilaJty of perJury that I am ex.enipt from the Contrac..1ct:::; L:cense Law for the folJo'.Ning reason (Sec. 7031.5 Business ~nd
Professions Code: any dty or countywhici) requiresa permit to construct, ~lt.~r" improve, 'demolish or repair anystructure, prior to. it$ issuance, also
requ ires the applicantfor such permit to, file a signed statement that he' is ]jcirlse~ pursuant to the provisions of the Contrador's'Llcen~~Law (Chapter
9)(comm.encing with Section 70000f Division 3 of the Business and PrcfesSi?nsCode) or that he is exempt therefrom andthe;baSisforth~.alleged
exemption,.. Any vio:lation of ~ectioi'l7031.5 byanyapplicant for a permi~ s'Jb}ects th'e applJ<?~nt to a' dvil penalty of not more than five' hundred dollars
($500)." '.' -. .! . . '" .'. . . '.
o I,",as owner of property, or my employees with wages as th~ir soJe comR~nsatjon,>' wiJJ do the work, and the structure Is not'intended oroffereej for
sale {Sec. 7044 Business and Professions Code: The Contractor's Licens~ taw does n.ot'apply to an owner,of property who builds or improves' .
ther~fI, and who does~such work himself or helSelf or through his Of her o~~!) employees, provided that such in"1pl'Ovements are nofintended or
oTferedfor sale._ .If, however, the building or improvement is sold with one ye:u' of rompletion. the 'owner~builder will have_ the burden of proving that he
did, not buil-d orimprove far the pUIp.cse of sare), . . ,:~:" . .' .. . :'..' .' .
o J, as the awner of the property, am exclusiv~ly contracting with licens~:::H:oritractors to. canstrlictthe project (Sec:, 7044Business'and Profe~ions'~ .
Code: The Contractor's License Law daes not apply to an owner _of propert..; _who-buMs Of improves thereon, and who contracts for such P:-OJectswith
P-Qontractor($)licenSed pl!.rsuant to t~e l.?antract~r's Ucen.se Law), ' '. .. . ,.
U I am exempt under'Sec" ., ,B & P.C. for tl1is reason:'
Date:" Owner:
I"
ARCHITECT/ENGINEER INFORMATION: .
PROCESSED BY: OOR
WORKER'S COMPENSATION DECLARATION ,i
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,/ hereby affi.rm under penalty~ qf perjury one. of the following de,clarations:.1 ;
o I have and will maintain a c.ertillcate 6f consent to setf~j"nsure for w0rke:"~ c~mpensatjo~,
as provided for by Section 3700 of the labor Code, for'the'.performance 'of tfl-'} work for which
this' permit is issued. .. ;; . . .
o I have and will maintain worker's compensatian insurance, as required L:'~' Section :3700 of
the Labor Code, for the perforl1!ance of the work far which this" permit IS tss\.~:c,I. Myworker's
Compensation i~sufance carrier and_poliCy are: ~
Carrier-;' . Poli.cy, t'-:'umber.' EXEMPf
NTRACTORS DECLARATION
I,Jnder penalty .of perjCi:ry that 18111
'sians of chapter 9 (commencio'g
Divs(on 3 'of the Business and
""
Thi's section need not ~completed if th Pe
01 certify~hat in the performance 0 e
emplayany person in any manner so a
of Califomia, and agree thaUf I should b
provision$ of Section 37QO of the Labor C
for-one hundred dollars ($10C~ orles.s. ,
~ 'r-which this permit is i$Slj~.j. I shall n'6t),
subject to the worke.r's c.cmpensat(6P~-I_aws
'ect to the wOrKer~ cO~flsatlon ,;;-. .
a forthwith' comply wlthth6sepr~visr6D~.
NUMBER.
589540 .
TYPE.
Contractor
EXPIRATION DATE
3131/2006
B
Date: 8/23/2004 Applicant:
WARNING: FAILURE TO SECURE RKER'
UNLAWFLJL, AND SHALL SUBJECT AN EMPL ER CRIMINAl.PENAcT/ES AND CiVIL
FINES UPTO ONE; HUNDRED THOUSAND DOLLARS ($100,000), IN ADGITIONTO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN 'SECTIO/', 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .
I CONSTRUCTION LENDING AGENCY. .
I hereby affirm under penalty af perjury that there is a,construction lending a[:ancyfor the
pe-rformanceojthe,wcrk for ll/hic:t; thi~ Pli!rm!t "~_!:;<::.;,,,.1 (Se-:.t!":97.C;::.C;: _~-o-_---'------c
Lende(s Inforrnation;
\-
COhstriJCion Types:
VN, , :.
Occupancy Groups:
B" " .
. Fire Sprinklered?
T.I.Area:
YES
457
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read this application- and state that the above information is correct. I
e" city ardina,nces ~nd state laws relating to building construction, and
sentives of this city to enter upon the above mention~ property for
Fees paid for Permit:
Total:
837.30
Date: 8/23/2004
Sig ure f Applicant or Agent
The permit shall exp e by limitlltion and become null ;md void if the building or
Work has not passed tinal inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
INSPECTfONRECORD.
FINAL INSPECTIONS
Temporary Power Pole
Plumbing (Drain/Wa~e Pipe) .
Electrical GroUnd Electrode/lifer
SetbacklFor~rtrenches (Footings I .
Do not install sub.floor or pourfloor'slab until the
lollo\\ling. applicable items have been signed: .
, Plumbing (Water Pipe,SprinklerValves) .
Mechanical (Grollndwork) , .. .
Electrical (Underground Condu it) . .
tore-slab (CompaetionlMembr;u:te.Reinf.
Underpinning (Floor JolstlGirders) , ". .'
. DO not cover or conceal the worl< below 'until the
lollowing applicallle. items have been signed:
1st Floor Shear.
Firesprinkler (Rough),
,2nd Floor Shear .... . .
Roof (Sl1eathing/Diaphla9m'Fra1)e) . .
". Masonry (ReinfJBOnd BeamlPre-Grout) . .
. Rough plumbing' (Top Out)
Rough Mechanical
. Rough l:Iectrical ItlI'YVVall)
Rough Electrical' '. '. .....U.
Framing . (Only afterPlbg., Elec.. Mech'.andFirel. .~.
lnsulation(soundlEnergy) . ..!.. II
po not tap.e or pla~ter ,until the following .applicable'. .',
.', ,temshavebeen signed:, . '. ,/1
Drywall . . . /I rf'1J/'tJ'I' ^
Per\etrations IFire Rated) Electrical .
.. Penetr.ations (Fire RatEld) Mechanical
Penetrations (Fire Rated) Plumbing
Interi.or 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
DATE
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INSPECTOR
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Electrical Final
Plumbing Final '.
Mechanical Final
Gas Test.
Engineering/Grading Final 765-$126'
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!,ire Dept. Final 765-4040.
Wat..r Engirieering76.5-5268 ,
SlIb l:ist/BusinessLicens'17f15:519< '.
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Zoning 765-5139 .' I', ( .('
Building Final (last 'nsp.e<;tion' Only if, lJi~ t:::-II'I ,. AIT,. ..
. . After Above Complete) ",. """ I ' 'I ,,,":' .
. .. PARTIALlNSPECTIONS '., .."
Bliilding Inspections
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. Mechanical Inspections
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Plumbing Inspections
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Electrical Inspections . .' . .
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