3100 E. Miraloma 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: _ 437
QUARTER SECTION: 139
BUILplNG PERMIT NO, BLD2004-00678
DATE: ,6/1/2004
JOB ADDRESS: 3100 E MIRALOMA AVE
LEGAL DESCRIPTION: GOLDEN STAlETR LOT 8 BLK4 E1/2
APPLlCANT:HE'NRY SOLORIO ",,',
OWNER INFORMATION: ' CONTRACTOR INFORW:fiON:
C9unty WOrange AL SHANKLE CONSTf{LJc('(ION CO
, PO Box 8300 4214 E LA PALMA AVE it
Fountain Valley, CA 92728 ANAHEIM, CA 92807 (lOOV'~ '
.. -. . BUSJNESS PHONE: 714 ~~g!:f~8.960
JOB- DESCRIPj-IONJenr::lIit Improvement. First time built put New "tea shop" .} Suite 110,
, , ,',' " , , r
VALUATION: ' 55,000,00' , J PROCESSED BY:, MJF
I ',"" " ,,' ,', , , OWNER'BUlL.DER:?ECLARATION " . ,:. " ,'"
. l-her~by affirm under penalty of perjury that I am ex~mpt from the Contractc{t-Ucense~aw__for the' fo!lo~ing reas;<;m {Sec. r031.5:Business' and
ProfessiClns:Cooe: any city or countywhlch"requires a" permit to construc.t, a;l}ir,impro'le,-demolish or repair any struCture, prior to its issuance,also
requ'i~es'the applicant fOr'suo'1"permit to-fiie a signed sl~tement that he is licd.:i,sed pursuant to the prpvisiol)_S ofthe,Contrac;tor's UcemseLaw (Chapter
. 9)(commencing with Section 7000" oJ Divi~ion 3 of the Business and Professj~~h~ Code) or that he is exempt therefrom and the basis for the alleged, .
, exemption; ,~y v~olation. of Sectio!1 7031.5 by any applicant for a permitsut;~'~cts the,appUcant to a civ~ pen_alty of not moTe tha n five hundre~ doli~rs
~~~, , t ' ," , "
o 'I, as owner of prop~rty, or my employees with wages as theirsolecornp~Yilsatioh, wm'do the work,'and the strl!cture isnQt intended,or offered for
: sale (Sec, 7'044 'Business and Prl)fessions Code: The Cont'ractor's License L:Wi dces root apply,to an owner of property who'buildsor'lr,nprove~"
thereon, and who does such work hin1setf or herself_or-through his or her o'.JI~;-amp\oyees, provid'ed that stich improve'ment$ are 'pot intended or" .'
offered fo~ sale.' If, however, the building or, improvement is sold wIth one Y~:_47 of oompletion" the, owne'r~bu:lder,will have the ~urden'of provir:g tha't he
O;d notbl,lild; or imp'rove for the purp-oseof sale). , . '. ,:L .~. . ' "., " " _ . '- '.
o I, as the cII'me:- of the property,am exd~!siv~:y '~~nt;~.l.dir,:.:- ,,;[tJ~'iGenCedkcntra9tors to construct the project {Sec.,7044 -Business'and-Professions
Cod.a: The Coptradcr':::; l:c'3nse laW do~ 1"0: 2p;->:Y t:.. an ~,\;.,r.e( ~'r =,ropertY:ft'ho build'":> or improvcl:> thereon. aou who contracts for such projeots with
tjontractor(s) lit;en:':iea pursuant to the C~;mi':::~..tc:"'~ Licen,:'5: LaW). .~j .
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I am ex mp un.le, ec. __' ~. ,_', ,cr uil::' reason, ----J'
Oate-: Owner: ,JL
C ".WORKER's COMPENsAlION DECLARATION c_~,
I her'7byafffrm under penalty-of perjury, one of the following declarations: " .~
0: I have ~nd will ma intain a certificate _of ~nsentto setf-insure fcrr viorke~::1c0mpens,ation,
as pro;.Jided for by Section ,3700 of the labor COde, for the performance _":\f.t!V,,"/vork for y.l1ich
~is~~U~issti~, -, 1 .'
~'I-;'ave-;3nd'.Viltmainh:dnwoi1<er'~compensation insurance, as required t-J$ecticn 3700 of
,the Labor c;ode! fodne performance of tne work for which this permit ,js issl.:~)" Myworker's
C(Jrnpensatioll' in'surance ,carrier and policy are: . .-' i:( ;'c:
Carrier: STATE,FUND' Policy _Number. -1663~3:;::F~,'
if"
this section need not 'be complete~ifthe pennit is for. one hundred dollars ($1oc:l;~r'css;
o .1 ce!iify that in' the performance ,of the work forwhicb this pBml!1 is tSSu~l:t,I'~hall not ....,'
employ any person in a nymanner so as, to ,bDcome subject to the worker'sc{,:':i,pEmsation laws
,of California, and agree that if I should become: subject to the worker's comp.S':~~5ation
provisions of Section 3700 of the. Labor Cod.e, shari forthwith mply with fh~Jse' provisions.
, - . 'I
Date: 611'120.04 Applicant: I'X.-.J ,
W,o.RNING: FAILURE TO SECUREWORKI;R'S C ENSATION COVER'.',E IS
UNLAWFUL, AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENA;TIES AND CIVIL
, FINES UPTO ONE HUNDRED' 1H OU SAND DOLLARS ($100.,000), IN ADDi"IONTO THE
COST OFCOMPENSATION, DAMAGES AS PROVI.DED FOR IN S,ECTION:3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES,
___:""_1
I "., ", ,,',' CONSTRUCTION LEN~!NGAGENCY, '. " ., ,,' ,
, <(h'e;eSy,'8-ffi~r.l-uri~erialty 'of perJu~ thattiiere'''i5-~'-co'nst~''u-cifo;:;:Ie~ld~i~'ag;;n~;y-for'the'~--,-'~~ ,
performan_ceofthe work for whidl this p'ermit is issued (Sec.30g? .Civ.C): '
Lender~s Information: .
ARCHITECT/ENGINEER INFORMATION:
!=JdCENseD-~ONTRACTORs DECLARATION' J
, .1 hereby affirm under pe:naJtyof perJury that I.B/Tl
licensed under p,rovisior\s of chapter g.(commenr:lng
\vJth Section ,7000). of.D!vsipn 3 of,the.Basir.ess and
p,rofessionSC,odtt' ", ''<:)~
6/1/2004 ~. <? naq; I.. '
Date: .. ,. oiitractor
NUMBER
412074
TYPE,
TYPE
EXPIRATION DATE
10/31/2005 '
A
B
CoOStrucion Tvpes_:
VN, .
.Fire $prinklered?
T.t Area:
YES,
1,657'
,'!v,:-,~., )
I certify that I have- read this application' and state that the-above information ~::; correc,!. '1
agree tooomply wUh all city 'ordinances and state laws relating to buUding corlst:,uction, and
'hereby authorize representives of this dty to enter upon the above mentione<.:' property for
inspecti urposes'.:g ,'" Dah!': 6~1/2004
. n re of Applicant or Agent
The'permit shall xpire by limitation and become null and void if the buildin90r
work has not passed final i,nspection 365 days from the date of permit issu3llCe. A
new permit is required to commence or c()ntillUe work.,
,Fees paid for Permit:_
, ToIaJ: '
1,293.48
INSPECTION RECORD,
INSPECTION " " , ,DATE : ,INSPECTOR :
' ,
Temporary Pow," Pole , '"
PJumbillg(Diain/Waste Pipe), " ' ' '"
EleciticalGrciund ElectrodelUfer " ,
SetbackfFor/Tll;fT'renChes (footings) , ': '
Do noliostall subfloor or pour floor slab until the "
following )3pplicable ilems have been signed,' ' ". , '
',' Plumblllg (Warer Pipe.SprinklerValves) , '
M~haniCal (GrOundwork) " " '" " " " "
, ,I:!ectr'ical (UndergrOjJnd Conduit) "
,
Pte-s1a6 (CompactiOn/Membrane.Reint. "
"-
Underpinning (Floor Joist/Ginlers) ," , , " ,
,oonol cover orconceall!1e ,work below unllllhe, ,,'
"followIng applicable jt~ms have' been 'slgn~d: ,
'151 Floor Shear .. ' ' , , , , , , ,
FiresprinltJer (Rough) , " , ,
2nd Floor Shear' . " ,
, ROof ISheathinQ/Diaphragm'F,arne) H, , ,
,
Masonry (ReinfJSollO BeamlPre,<;routr , "
, ROjJghPlumbing (Top Out) , , , "
Rough ,Mechariical " , '" ,
Rough BectrlCaI tLll'V walll " . ,
.ectrical '" " , -
'" " . 12 _ (OnlyafterPlbg.: Elec:" Mech:, a.nd Fire) fJ.101'l/fJ '~.J
In$U'l!tion(Sou~nergy) " ' m -- " ,
" Do not tape orplasler until the tollowiAg'lapt!i/icabler " '
, item,S have been signed: ' , "', ," . '",' ~
, Drywall ",'.-,:', ," /I\I:~
, f'<<letrl!tions (Fire Ratetj) Electrical ' " '1 -r
Perlelrations (f'l1I Rated),Mechanical ' , ,
, f'<<letrations (File Rated) Plul1Jbillg " , , I,
Interior,lath ",'
" Exterior Lath "
" , GENERAL ITEMS , "
,
, Exterior Plaster (Brown Coal) " " ,
T -Bar Electric;1I ',' I ,
T-Bar Mechanical " ~ " .
T -Bar Structural I or. IF
Sewer " , , / '
Water Engineering Backflow " ,
Water Service',
I,
FINAL INSPECTIONS' '
Electrical Final
Plumbing ,final
Mechanical Final
Gas Test
Erigineeril'lQlGrading F,inaI765-5126
Fi..; D\lpt.FinaI7654040
W..terEngirieering 765_5268
Sub 'List/lIusin..ss License 765-5,19
Zoning 765.5139
Building Final fLast lnspection; Only ,
,. .. "A,fter,Abov:eCompl'ete).
, . PARTIAL INSPECTIONS '.
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lnsp!!cto( ,
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"
MectlanicallnsPections '.
c--
Plumbinq In.SDections
Electrical Inspections'