3130-3150 E. Miraloma Ave. (2)
CONTRACTOR INFORMP,tION:
T K SYSTEMS INC .
369 CLlFFWOOD PARK Sr#(;.
BREA, CA 92821 0000
BUSINESSPHONE: 714 5.2['-4664
JOB DESCRIPTIONStorage Racks, Maximum height of 12 ft. ..
VALUATION: . 32,000.00 .0".
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty. of perjury that I am exempt from the Contractors license"Law for the following reasbn (Sec. 7031.5 Business-and
Professions C0ge: any.city or county which requires a permit "to construct..aft(}r~"improve,.demolish orrepair any structure, prior to its issuance,also-
requires the applicant for such permit to file a sign~ statement that he is liCf";;~ pursuant to the provisions of the Contrador's License Law (Chapter.
9)(bommencingwith Section 7000 of Division 3 of the Business and ProfE*;sk1h's Code) or that he i$ exempt therefro,m and the basis for,the alleged
. exemptioh.. Any yiolation of Section 7031.5 by any applicant for a permit sUbjects the applicant to-a civilpeilaltyof not more than five hundred dollars
($500)... . ..' .... <'::". . ... '. . .
o J, as oWne'r of property',or my employees V(ith wages as their sole comp'~'nsation, will do the work, and the structure is not intended or offered (or
sale'(Sec. 7044 Business and Professions Code: ,The Contractor's licens,e,-Liw does not apply to an owner of property who builds or improves '
thereon; and who does such work himself or herself or throug 1:1 his or her.c\vr,employees., provided. that such improvements are not intended or .
offered for sale.. If, however, the building or improvement is sold with_one ye~.t of completion"the owner.t>u ilder will have' the burden of proving that he
'-didnotbuildorimproveforthe:purposeofs.;lIe). '. "27 \ _ , _. .' ,'_
D k as the owner ()f the Property, amexdusivety contracting with licensed "1Jntractors to constnictthe project (Sec. 7044 Business and Professiqns
Code: The Contractor's License Law does not apply to an owner of property ,.Jhe builds or improves thereon, and who'contracts for such projects w~h
~ntractor(s) licensed pursuant tot.he Contractor's license Law). ' i{ ,
U I am exempt under Sec.. " ,B & P.C. for this reason:
. Date: .owner:
i" WORKER'S COMPENSATION DECLARATION
.I.hereby affirm under penalty of pe~ury one of the folloWing declarations: .:
o I have_and will ma,intain a certificate of eon sent to self-i'nsure for ~orker'!. ;ompensation,
as provided for by Sect.ion.-3700 of the Labor Code, for the performance qftht'.'~york for which
~hjS permit is issued. .' . .0;,
I have a'nd will rriafntain worker's c,?mpensation insurance, as req.Uired by Section 3700 of
t 'e abor Code, for the performance of the work for which this permit is jssue:l. Myworker's.
Compensation insurance carrier and policy are:
Carrier: STATE FUND. .
. ' ..' ',~\---I.: , __ '
BUIL,~!~;~,!,ERMIT NO,.;BLD2003:03976
"J'
,'r.,
. ~ _....~':." ""
TYPE ()~PEORMIT C y
Slorage;Rack.iC' .IT
DA TE:10/31/2003
JOB ADDRESS: 3130 E MIRALOMAAVE
LEOGAL DESCRIPTION: P BK 284 PG 44 PAR 1
'1;'"
,
APPLICANT: ELAINE MOTTO
OWNER INFORMATION:
. Kilroy Realty Lp
3130 E Miraloma Ave
Anaheim, CA 92806
=
ElM
BUILDING DIVISi.oN
200 S. ANAHEIM BLVD.
(714) 765 - 5153 -~,
INSPECTION REQUEST LINE'
(714) 765.' 4626
CENSUS CODE: 431
QUARTER SECTION: 139
ARCHITECT/ENGINEER INFORMATION:
NARESH J PALKHIWALA
1725 S. DOUGLAS RD.
ANAHEIM. CA 92806.
PROCESSED BY: KBT
Policy Numbe.r. 1643791 .,.
. . .','
This section need not be.completed .ifthe pennit is for one hundred dollars ($100) c~.tess.
o I certify that in the perfo~ance 'of the work for wh!ch th'is permit is issuetf,'lshall not
employ any persori in any' manner soas to become subject to the workels ,90'llpen~ation laws
of California, and agree that if I shou'ld become subject to the wQrker's compe',sation .
provisions' ofSectlon 3700 ofthe Labor Code, I shall forthwith c~ withth<)5:~~provisions.
, ,~ -" '~":' .
Date: 10/3112003 Applicant: ~. j :~.
WARNING:" FAILURE TO SECU ORKER'S COMPENS N COVER'.GEO IS
UNLAWFUL. AND SHAll SUBJECT AN EMPLOYER TO CRIM INAL PENALTIES AND CIVil
. FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100.000), IN AOCrnON T.o THE
COST OFCOMPENSATI.oN, DAMAGES AS PROVIDED FOR IN SECTI.oN n060F THE
LABOR CODE, INTEREST AND ATTORN.EY'S FEES. . ..
I -CONSTRUCTION LENDING AGENCY .
I hereby affirm und~rpenaJty cjf perjury that there isa construc~ion-lend'ipg!il~';Q9Yf.Qr:~he
performance of the work for which thisperrnit is issued {Sec;3097.;C~C)::;~~-~..' :.2,;:,,",,::;',:,{i..i...
Lender"s fnformation: --. ,-- - -
, ' . ,.
I ,certify that I, have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to bUilding-construction,.and
hereby authorize representives of thi.s~ to enter upon the above mentioned property for
. inspect. ion ~se..v..:..4.... .
~ f ;7 - Date: 1.0)31/2003
Signature of Appli n or Agent
The permit shall expire l>y Iimna ion and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
L1CENSEDCO.NTRACTORS DEC.LARATION
I hereby, affirm under penalty of perjury that I am
licensect under provisions of chapter 9 (commencing
with section.7000~Of Divsion 30ft e.Business an. d.
Professions f:od . /. .. 'S r
10/31/2003 X .,
~ . .
Date: Contracto .. . .
NUMBER
800845
TYPE.
TYPE
EXPIRATION DATE
11/30/2003
C61 AWN
D24
'~;.' :::
COrlstrucion Types:
VN" .
Occupancy Groups:
51, , , ,
Fire Sprinkle red? .
NO
><,!:,''''-
Fees paid for Pennit:
Tolal:
805.91
INSPECTION RECORD.
DATE. . .
INSPECTION . ..INSPECTOR
Temporary Power Pole '" .' . .' . .' . .
Plumbing (Dl3inLWastePipe) '. .
Electrical Ground ElectrodeJUfer . . .
SetbacklFormsfTrenches (Footings)
Do not install subfloor Or pour floor slab unlilthe :.
following applicable items have been signed: . "
Plumbing (Water Pipe.Sprinkler Valves) .... . '.
Mechanical. (Groundwork) . .
Electrical (Underground Condl!it) . ..
Pre,slab (Compaction/Membrane.Rei nt. . .
Underpinning (Floor Joist/Girders)
Do'not cover or conceal the work below until the
. following applicable items have been signed: . . . .
1 st Floor Shear . '. . '
Firesprinkler (Rough) ... . . '.'
2nd F.loor'Shear . . . .'
Roof (Sheath ing/Diaphl3gmtFrame) '. .
M;lsonry(ReinfJBond BeamlPre-Grout) '. .
Rough Plumbing (Top Out)
Rough Mechanical . . .
KOugn .t:Iectrical (Dry wall)
Rough .Electrlcal , . '.
Framing (Only a'ftE~r Plbg:. Elec..Mech.,.and Fire} .
Insulation (SoundlEnergy) . . . . '.
po-not tape or pla~ter, until the following applicable ." .'
.tems have beens.gned: . .....
DryWall '.' . . '.' .
Penetrations (Fire Rated) Electrical . . ..'
Peneirations (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 Strl!ctural . .' '"
Sewer .
Water.Engineering Backflow .
Water Service " . .
F.INAL INSPECTIONS .Date . Inspector'.
Electric.al Final . . . .., .
Plumbing Final. .
Mechanical Final .
. . , .
Gas Test . '.
Engineering/Grading Final 765'5126 '. '.
. .
Fire Dept. Final 765-4040 . .... . .'
Water Engineering 765-5268 . . .'
", . . .'
Sub List/Business License 765-519 '.
. .
Zoning 765-5139 . .
'. .
Building Final ~astlnspection. Only . .
fter Above Complete) . . . . !
PARTIAL IN.SPECTIONS
Buildina Inspections
MechanicallnsDections
Plumbina Inspections
Electrical Inspections
PERMIT .EXPIRED
I NSPEGT10N
NOT COMPLETED
. OAT E:JJ . -Ia--D cJ