5735 E. La Palma Ave.
TYPE OF PERMIT
Foundation Only CITY
DATE: 1/20/2005
JOB ADDRESS: 5735 E LA PALMA AVE
L.EGAL DESCRIPTION: pM 85-20 PAR 1 POR OF PAR
BUILDING DIVISION
200 S. ANAHEIM BLVD.
. (714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434 .
QUARTER SECTION: 184
BUILDING PERMIT NO. BLD2005.00170
. CONTRACTOR INFORMA1 iON:
ARTIC MECHANICAL INC
160 VANDER ST #B
CORONA, CA 928800000 ;
.. BUSINESS PHONE: 888340::4822'
JOB DESCRIPTION:Buildpra~orm for condenser coil change out.
VALUATION: 21,000.00 "PROCESSED BY: ENO
I. . . OWNER-BUILDER,bECLARATION .
I hereby:affirm under penalty of perjury that I am exempt from the Contractor\~ Ucense Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or countywhich.requires a permtt to construct. alt~tr, improve, demolish or repair: ohy structure, prior toUs issuance. ':lls.o
requires the applica nt for such permit to file a signed statement that heis licf;:!'~sed 'pursuant!o the provisions of the Contractor's' License, L~w (Chapter
9)(commencing with Section 7000 of-Division 3 of the Business and Professichs Code) or that he is exempt therefrom and the basis fer the alleged
.. exemption. 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
~~ . .1.. ...
01, as 'owner of property, or my employees with' wages as their' sole i:::om~::tl~'lS3ti~n, will do the work, anQ the strllcture i.s n01 intended or offered for
sale (8ec..7044 Business and Professions Code: The Contractor's License L~w does not apply to an owner of property who buildsoi improves .
thereon, and wh.o does such work himself or herself or through his or her owr;amrlloyees, prOVided that such improvements are not intended or
offered for sale. If, however, the build ing or improvement is sold. with one 'i?,zlr of ,.::;umpletioll, the owner-:-buitder will have the. burden. of proving that 'he..
didnotbuildo~.improveforthepurposeofsale). .. J ... ... .
o I, as the owner. of the property, am exdusively contractif\9 with lic:ensed ;ilont~Gtors to constru.ct 1he project (See. 7044 Business and Profe.ssions
CC?de: The:Contractor's license Law doe's not apply to an owner of property\~h.O uuiids 'or impfoves thereon, and who contracts fo:- such projects with
~L' . ontractor{s) licensed pursuant to. the Contractor'~ License Law). j'
LJ I am exempt under Sec., . ' , B & P .C. tor this reaso,n: _~,~_
Date: Owner: J
I.. . WORKER'S COMPENSATION DECLARATION J ~
I hereby affirm under penalty of perjury one of the following detlarations: "J .
o I have and will maintain acertiftcate ~f oonsentto self-insure fot wQ;Ker;;: CO~i"10ensatlon:
as provided for by Section 3700 of the labor Code, for the performance ofthAwork fotwhi~
this ~rmit is.issued.' '. . . ,. .\
~ I have and will maintain worker's compensation insurance, as required b.;.j ~ect:On 3700 oJ
the Labor Code, for. the performance of the work for which this permit is issu€;i:l. My worker's
Compensation iAsurance carrier and policY are:
Carrier: REDlANDS INS
APPLlCANT:!-AIKE MAY6ERRY
OWNER INFORMATION:
Raymond Spehar
6937 E Avenida De Santiago
Anahein:', CA 92807
ARCHITECT/ENGINEER INFORMATION:
Policy Nu mber. RPSI-1.1 :\ko-oo
i
'rhissection need not be completed if the pennit is for one hundred dollars ($10IJftr less. ,
. . '. . 1
rid, I certify thatin the perfo~ance of the work for.which this permit is issue~, I shall not
~loy any person in any manner sO,as to become subject to the workers cqJhpensatJon laws
of Califomia, and agree that if I should become subject to the wo'rker's c mpe'l$ation
provisions of Section 3700 of the abo od, shall fo h .t comply th~.se prOy'ision's.
NUMBER
806737
TYPE
EXPiRATION DATE
4/30/2006
C20 HT AC
Date: 1/20/2005 Applicant:
WARNING: FAILURE TO SECUR RKER'S COMPENSATI N OVER,\G IS
UNLAWFUL, AND SHALL SUBJ TAN MPLOYER TO CRIMIN PENAL. S AND CIVIL
FINES UP TO ONE HUNDRED OUSAND DOLLARS. ($100,000), IN AOD11l0N TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION :J706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I .CONSTRUCT!ON LENDING AGENCY
,-,..1 hereby_affirm !.mdec.pena/ty_of perjtlryJMUhpre.Js ~ const.'"ueticn !erldin:, ;'C:?"(~.y for the __
performance of the work for whidi this permit is issued (See. 3097 .Civ.C):
Lender's Information:
Cbnstruciorf Types:
VN, ,
Fire Sprinklered?
NO
Date: 1/2012005 .
Fees paid for Permit:
Total:
343.48
~ignature of Applica or Agent
permit shall expire by Iimilatio and bec me null and void if the building or
w has not passed final inspection 365 days from the date Of permit issuance. A
new permit is required to commence or continue work.
INSPECTION RECORD FINAL INSPECTIONS , Date ' Inspector
INSPECTION' , DATE I INSPECTOR Electrical Final Ic\\Mo~ ~.,
I Plumbing Final "
Temporary Power Pole , ,
Plumbing (DrainIWaste Pipe) , Mechanical Final ""\~(l,,\ -..-: I ..f
EledriCal GroundElectrode/Ufer ' Gas Test
SetbacklForrnsfTrenches (Footings) , , I'
Do not installsubfloor or, pour floor slab until the , Engineering/Grading Final 765-5126 , "
following applicablE;> items haVE;> been signE;>d: ,
Plumbing (Water Pipe.Sprinkler Valves) Fire Dept. Final 765-4040 ,
MechaniCal (Groundwork) , , Water Engineering 765-5268 , ' '
Eledric,al (Underground Conduit) ,sUb ListlBusineSs License 765-519
Pre-slab (CompactionlMembraneReint.; , I J, ~ ' '
Underpinning (Floor JoistlGirders) ~\f:l~ f/I 11\ ...- ,.. Zoning 165.513~ "
Do not cover or conceal the work below unt!1 me Building Final~ast lnspection~Only , M\4{o~ ~...i
following applicablE;> ilE;>ms have bE;>E;>n signE;>d: ' , fter Above Complete) ~I,
1 st Floor Shear , , PARTIAL INSPECTIONS ' , '~~
Fhesprinkler (Rough) , Buildina InSDections ,
2nd Floor Shear' I
RoOf (Sheathing/Diaphragm/Frame) ,
Masonry (ReinfJBond BeamlPre-Grout) , ,
Rough Plumbing (Top Out) ,
Rough Mechanical
Rough aectr ,II) , , , ,
ROUllh Eledrical ,: " " ,
Framing . "(OnlyafterPlbg.; Elec.. Mech.. and Fire) , ' ,
-
Insulation (SoundlEnergy) , MechanicallnSDections
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
Interio, Lath Plumbina InSDections ,
Exterior Lath ,
GENERAL ITEMS , ,
exterior Plaster (Brown Coal) " ' ' '
"
T -Bar Electrical '
T-Bar Mechanical " ' "
T -Bar Strudural " "
Sewer " -
Water Engineering Bacl<flow Eiectricallnsoections "
Water Service ,
.