2376 W. Lincoln
CONTRACTOR INFORMA;fION:
MIAN CONSTRUCTION .1 .
6257 N ROSEMEAD BLVD i"
TEMPLE CITY, CA 91780 (000
BUSINESS PHONE: 626236,.2223
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I OWNER-BUILDERtIECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractof;~ License Law for the following reason (Sec. 7031..5 Business and
Professions Code: apy dty or county whlch'requfres a permit to construct, aJt~i:, improve, demolish or repair any structure, prior to its issuance,.also
[equires the applicantfor such permit t9 file a sign~ statement t~at he is Ijc~l~sed 'purSllant to the provisions oIthe Contractor's license Law (Chapter
9)(commencing :wit!1Section 70.00 of DiVision 3 of the Business and Professiqns Code) or that he is exempt therefrom and tlie basis for the alleged
exemption. Any v~lation of Se~tion 7031.5 by"any applicant for a permit s!Jbjects the applic~nt to.a ?vil penalty of not 1110~e than five hundred dollars
($500).. . ..' . .. . .
o I, as owner of property, or my employees with wages as their sole comt::"fnsation, will do the work, and the structure 'i~ not intended oro~ered for
sale (Sec; 7044 Busil1essand Professions Code:- The Contractor's License 4:'1; does not apply to a!1 owner of pro;::>erty who builds or improves
thereon, and who does such work hi msetf or h,erselfor through his 0: har oWl'~em!JloyeeS, provided that such improvements are not'intended or
offered for sale. If, hOW.,ever,.the building Or improvement is sold with one Y~~.r d cornpJeti~n, tr.e o'......ner-:builder w,jl have ..the burden of proving .that he
'did not build br improve for the purpose of sale). y.. '.
o I, as theowneroftne property" am exdusively contra,ding with licensed _l~""(ltra"ctors to construct.the project (See. 7044 Business ana Professions
Code: The Contractor's License Law does not apply to an owner of property:r:ho huilas or 1mproves _thereon, and who contracts for sUetl projects with
. [jontractor(s) Iicens~ pursu-ant to the Contracto(s UCe~S6 Law). -!) ..... ,
,I am'exempt under Sec., " ,B & P.C. for'thls reason: -'r--' - , ' '. .
Date: Owner: .. . .
I . WORKER'S COMPENSATION DECLARATION ~ _ ~ LICENSED CONTRACTORS DECLARATION
. I hereby ~ffir~u~der'penaltyof perjury one 9f the following declarations: T i hereby affirm under penalty of _perjury that I am
~ I have:flnd Vlill maintain a certificate, of consent to self-insure for. worker'~ cvmpensation, licensed under provisions of chapter 9 (commencing
as provided for by Section 3700 of the Labor Code, for the performance ofthfwork fcrw:-'ich withSe tion 7000) of DT::JPir' .n.30ftne B iness and
this permit is issued. . " .~ P'rofessi. s C e. ..V1' .. . ;... .
m I have arid will maintain worker's compensation insurance, as required b?Section 3700 of 12/22/2004 ~ .
the Labor Code" for the performance of the work for which this permit is issun,;. Myworker's Date: Contractor
CompenSation insurance carrier and. policy are:. . 'I'
Carrier: EXEMPT Policy Number. 677495 !
. ;1
This section need not be completed if the pennit is for one hundred dollars ($1~~~,!)f less. .
. rxr-I certify that in the perfonnance of the work for which this permit is issue:;, I shall not
~Ioy any person .in any manner so as to become subject to the worker's ~i11pensation laws
of Caljfomia, and agree that-if I hould ecome bjed to the worker's compensation
provisions of S~ction 37QO of the a rode, ~mPIY with th<_,j~e provisio~S.
Date: 12/22/2004 Applicant:. .
WARNING: FAILURE TO SECUR WOR R'S COMPENSATION COVER;\GE IS
UNLAWFUL, AND SHALL SUBJE T AN EMPLOYER TO CRIMINAL PENAI:TIES AND CIVIL
. FINESUPTO ONE HUNDRED OUSAND DOLLARS ($100,000), IN .ADomON TO THE
COST OF COMPENSATION, D ,AGES AS PROVIDED FOR IN SECTION ~706 OF THE.
LABOR CODE, INTEREST AND IjrrORNEY'S FEES. ~,
I CONSTRUCTION LENDING AGENCY _.
Lbereby..af!irm-undeLpenatty-OfperJury thrlt thece.is:3 COl')struction lend;~9 2'::,:::r:.CV for t.'"le: _
performance of the work for which this permit is issued (See. 3097 .Civ .C): .
Lender's Information:
BUILDING PERMIT NO. . BLD2004-04118
TYPE OF PERMIT
Tenant Improvement (Limited) CITY
DATE: 12/22/2004
JOB ADDRESS: 2376 W LINCOLN AVE
LEGAL DESCRIPTION: T 4 R 10 SEC 18 POR NE1/4
APPLICANT: MAZHAR MIAN
. OWNER INFORMATION:
Ralston Donald Tr For Elizabeth A R
2010 Main SI #890.
Irvine, CA "92614
BuiLDING DIVISION
200 S. ANAHEIM BLVD.
.. (714) 765 - 5153
INSPECTION REQUEST LINE:
(714)765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 33
ARCHITECT/ENGINEER INFORMATION:
JONATHAN S MATSON
13271 SOUTH STREET
CERRITOS, CA 90703
JOB. DESCRIPTION'l"enant improvement
VALUATION:
10,000.00
PROCESSED BY: KBT
NUMBER.
677495
tyPE
EXPIRATION DATE
9/30/2005
B
Construcion Types:
VN, ,
Occupancy Groups:
B" , ,
Fire Sprinklered?
T.!. Area:
Date: 12/22/2004
Signature of Applicant or Agent
rmit shall expire by limitation and become null and void if the building or
work s not passed final inspection 365 days from the date of permit issuance. A
new. p mit is required to commence or conti~ue work.
NO
1,313
Fees paid for Permit:
Total:
1,014.13
INSPECTION RECORD
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INSPECTION DATE INSPECTOR
T empora,.y Power Pole I. ..
Plumbi ng (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SelbacklFormsrrrenches (Footings)
00 not install subfloor or pour floor.slab until the .
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves) IJ_-IIK /!^
Mechanical (Groundwork)
Electrical (Undelllround Conduit) .
Pre-slab (Compaction/Membrane.Rei nf.
Underpinning (Floor Joist/Girders) . .. .
00 not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear .
Fimsprinkler (Rough) .
2nd Floor Shear.
Roof (Sheathin!llDiaphragmlFrame) .
Masonry (ReinfJBond Beam/Pre-Grout)
Rough Plumbing ('Top Out) t-".aJ;' r:....&
Rough Mechanical
Rough Electrical I Dry Wal1l . z.I1J6IH-
Rough Elec1rical ' ,
Framing (Only afterPlbg" Elee.. Mech.. and Fire) rr~ 1..- ct'/'Y\
Insulation (SoundlEnergy) I
Do. not tape or plaster until the following applicable
items have been signed: . . ~
Drywall . . 1/'\/..) \.....--
Penetrations (Fire Rated) Electrical
Penetrations (File Rated) .Mechanical . .
Penetrations (Fire Rated) Plumbing.
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T -Bar Elecirtcal .. . .
T ~Bar Mechanical . .
T -Bar Struc1ural .
Sewer
Water Engineering Backflow
Water Service . .C-
FINAL INSPECTIONS
Electrica.1 Final
I. Date . l!J!1pector
i"21'1Ii6 '-7 ......."?
IU'lV5 ~...
tiCj/oS 7-'
...
Plumbing Final
.
MeChanical Final
Gas Test
.. .
EI19ineeringlGradingFinaI765-5126 .
Fire Dept Final 765-4040
Water Engineering 765-5268 . .
Sub List/Business License 765-519 . .
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Zoning 765-51~9
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.Jq vs- ~
Building Final (Last Inspection. Only
After Above Complete)
PARTIAL INSpECTIONS
Bliildina Inspections
Mechanicallns~ections
Plumbina Inspections
Electrical Inspections