2585 W. La Palma Ave.
, TYPE OF PERMIT
Tenant Improvement (Limited) CITY
DATE: 3/16/2005
JOB ADDRESS: 2585 W LA PALMA AVE
LEGAL DESCRIPTION:' P BK 45 PG 6 PAR 2
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BUILDING DNISION
200 S, ANAHEIM BLVD,,'
(714) 765 05153
INSPECTION RE;QUEST LINE:
(714) 765 0 4626
BUILDING PERMIT NO. BLD2002-03223
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CENSUS CODE: 437
QUARTER SECTION: '24
APPLICANT: All DOGMETCHI
OWNER INFORMATION:
"_ Tosdo Corp
'02585 W La Palma Ave
ANAHEIM, CA 92801 0000 , , ' ",
JOB DESCRIPTION: Tenant Improvement. Convert existing service station ir:lc a food mart and "install new parapet. (Separate permit required fOI" light
VALUATION:' sta~HliH:&~enew permit for sixmonths to expire 9/15/2~05) PROCESSED BY: ,SAM
I OWNER-BUILOciLDECLARATION
I hereby affirm under: penalty of perjury that I_am exempt from the Cbntlactc:i'~ License Law, for the following reason (Sec. 7031.5 Business and
Professions:_Code: anydty or .county which requires a permit ~o-eonstruct.'flf;,$-J,,:irYji)rcve, d~rtlolish or,repair any !Structure, prior to its issuanc~, 'alSo
requireS the applirontfor such permitto file asigr:red statement that he iSnl':,~,lsed p'ursL!ant to the provisions ofihe COlitractor's License Law (Chapter
9)(commencing with Section-70aOof DiVision 3 of the Business a nct Prof8ss!~>ns,Gode) or that he is e;~empt therefrOm and the basis for the all.eged
exemption. Any violation of Section 7031,.5.by any spplicant 1ar a pe:-mit sub\ctts the applicC'lnt to a civil ,penaftyof not more than five hundred dollars
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, .. I, as oweer of property, or ~lY ~mpioyees Wiih wagos a, thei;- sole cumi!,~:,-18.StiOn, wilt d? the work, and the str~j9tur(:: is not intend, ed:oroff~red for
. a. (Sec: 7044 Sl'!';:dness and P~of~ss!0!1S Code: TheContra(".i.o!"'s:~:(,€jJ.::;e,i!~~.'1 c!ee,f) not apply to an owner of propertY' who builds 01' improves
hereon, and whodc?5. sudl work hirnsl':lif or herself orthrql.gh hj~ or j'l<:'r O'f"jl;'~l11p!oye(;s; provided that such improve!t1entsare uot intended or . .
offered for sale:, U; howaver, thebui!tling or lmpruyement-is Gold witncnc- ~.;;)~ of -:ompletivr;, the owner-builder will have the 'burden of proving that he
did not'build or improve fertile pl;tposeQf ~ie}. I';
o I! a8the O\</ller cfthe prop~rty.a: ex~~\vely cont . y ith'!ie;ensed ~~)nt~'aci:(;rs lOi::Oiist(llctth~~ project,(S9c. 7044'SLI.ein~ss aDd. Profess~ons
Code:,_ The Gontr~ctor's ,License: ~..olir ~~., -~ne1. a,pp. , al1.owne:-of P(O~rtY!Nho bu~d~ m improves ih!'lf€lOI1, an::!: W:'IO ~.o~tracts iar such projects with
fL~ontractor(s) Hc?r.sed, purSiJam ~ . ';3 '7'< tr'lq. ;' uce~~f: La~/).' , \" ". .' . , .
LJ .13m'i:>ver"pt 'inde,' S~~ " ,.... "'or ",'< r"''"'.;'''r.' "
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~_o MP 1 ,-:..nON DgCL,\R~TiON --::'-C===_--l r, l!CENSEU CCNTRACTORS DECLARATiON"'l
i hereby affirm ufld.r;r pene:ity of perjur)' one of ihe following dec!aratjolls:' ,i' ... ~I' Chel'eby affirm Vnnel pen~~lt/of'periury that: arT', .
o I have arid .w'n:l m:Etintain a ce:iiflc.ate vcf consent to .ooiHnsu;:e for \.V(lrke,.'j ~cri:!')ens~t1,)n,' Il~ensed ~ncer P~6\'is:d(.\S?( chapter 9 {c~me:TCing
CiS :Jrovided f,or bf,$,ectiO!'l 3~'OO of tne Laber GOd,e, fOi tt",E' perforrn;;mo:; c,fYhp," ......f:)M~ fur Which, I' W:}h'S9~tIO!) 7000) of DI\'Slcn 3.cHi1e ~SltlesS and
this permifis lsSflec.L. .1 . P!"9fess1ons elide.
D ,I have a~ ~ijll::-)aintain worker's compensctlo:-: jr,s~r::!:f"I('e, ~s !"e'quired b} S~'(;ti!Jn 3700 of. 3/16/2005
th~ Laber Coee; fQ(the performar,ce ot the 'hc.rk for whjch'~h:$ pf,)rrnit is !~su<kl Myworker's I Date:
,Compensation jn~~j"ance carner and "po:!oj are: ,', ~ I
ca:rier: .:..-, , . Poli,cy i'~Umbt:r:t..' 1- NUMBER
jhiS S2Ction neetl root be- compl"lted if the permit i::. for one n...l:-ldred dollar~ (S~?~ ',::r 1<;:;5. 'TYPE
, i certiff that in the pE".rformance of the work fOlwhich this 'p3r:rllt!sissu~.~, ! 1;<~U!r(;(lt I
,_m, PIO,y any person,,~ in;:i qy rnanner so as to be.come subject to the "'\'orkell~'c6:r.,pe, i1BBt:C,n ld-WS ~ ','
ofCalifomia; anc'3gree that if I,should become su .ectl~~rker's com;:'€;...sa;i,~, --'--..M__
~rO,YisiOnS of Se"ii"n 3700 Ofth, eLab ~Code, I ,all fO/:Z~;' _,'.' :_' f':;<:; cro\!isio:"\<i. ,e~:],~,tT~cion Types:
'Date: 3/15/2005 " Appiicant:. ~-''''''.7f:9;{ . '/-".... "':'_--._~__J Fire Sprinkler~d?
WARNING: FAILURE TO SECUR W KE S OMPE A ON COVEP.f,GE IS 'I Number of Slaries '
UNLAWFUL, AND SHALL, SUBJECT AN EMP 'fER l' CRIMINAL PENMiTlES AND CIVIL U Araa:
FINES UP TO ONE HUNDRED THOUSAND DOLLAR ($100,000)" IN ADOil1ON 10 THE 'I '
COST OF COMPENSATION, DAMAGES AS PROVI ED FOR IN S~CTION:;706 OF THE'
LABOR CODE, INTEREST AND ATTORNEY'S FEES, I
I CONSTRUCTION LENDING AGENCY ,
I hereby affirm under !;>e!lalty of. perju,ry that ~h~re 15 a c~pstructiml ,~~;n$ af;~ncy for the l
r..~.."ri:"l.".'T'~I).(",;L2f_~b~vnry_._.fcc..I__''1!d"":...1IJ!S_;Jen!1:J is:t.F.UE\d tS_~c;30~7 .CIY :-~\L. i . '>._-_.,,,,:., -~--+.-,~t--__-,,';-.....
Lender's Information:
CONTRACTOR INFORMAc:ION:
, .
ARCHITECT/ENGINEER INFORMATION:)
Contracto'r
- :::XPIRAT:O~; DATE
'NO
1
1,004
Oat.,: 3/15/2005
. Fees paid for Permit:
Total:
1,039.36
INSPECTION RECORD
. INSPECTION . '.DATE' INSPECTOR.
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Temporary Power Pole
Plumbing (Dr.iinlWaste Pipe) . :
Electrical Ground Elec.trode/Ufer .
SetbacklFormslTrenches (Footings). . ....
Do not install slibflqor or pour floor slab until the . ..
following applicable items have been signed;
Plumbing (Water Pipe.SprinklerValves)
Mechanical (Groul)(lwork)
Electrical (Underground Conduit)
Pre-slab (Compactlon/Membrane.Reinf.
Underpinning (Floor Joist/Girders) :
. 00 not cover or conceal the work below until the ,
following applicable itemS have been signed: ,. . '
1 st Floor Shear . . . . ,
Fi.eSprinkler (Rough) .'
2nd Fioor Shear. .' ,
RQof (SheathinglDiaphragrn'FrlWlle) ,
Masonry (ReilifJBond BenlPr~l"O\It) '. .
Rough Plumbing (Top Out)
Rough Mechanical . ..
Rough Bectrlcal ,... y all) .
Rough Elec;ir'C31 . .'
Framing {Only afterPlbg.. Elec., Mech. and Fire)
Insulation (SoundlEnergy)
Donat tape or plaste.r until the following applicable
items have Ileen signed:. . . .
Drywall .' :....
Penetrations (Fire. Rated) Electrical . '.: .'
PeIletrations (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 Baekflow. .
Water Service'
Electrical Final
Plumbing Final
Mec.hanieal Final,
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765,4040
Water E.ngineeri"g 765-5268
sub'List/BusinessLieense 765-
Zoning 765-5139
Building Final ILastlnspection. Only.. '211t.fO
.' Mer Above Complete) ZIP!'
PARTIAL .INSPECTIONS
Bui/dina Inspections
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MechanicallnsDections .......&. . _~,,;.. '. ..
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Plumbhia Inspections
Electrical Inspections
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CERTIFICATE' .OF' '.' OCCUPANCY,
'. .; '.' City Of Analleim
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. This struciuJe ha$b8e~inspectedpursuimttothe .
.Jheeityot Ari?-~eim., '. .... '.' .,.. . .... "'~
Any chll.nge in the Character 01 oCClJpancie' ~.
:group'oIMcupancies requires a new Certi aPA
.'.;.' ..,',: .'. ~..
, DESCRIPTlON'OFOCCUPANCY:..
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IT: Bl02002-03223 .
. EA: 1,003'
".OCClJPANCYCLA,SSIFlCATIPN:M
. .. ..NOe Of STORIES: .' .'. 1 .
CONSTRUCTIONTYPE:,.V N
. .'BUILDINGOWNER:
. BUILi)ING A,DDRESS:
DATE OF ISSUANC7;
'. PR.. OCESSED. BY. : Mary Montgomery
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