3470 E. Miraloma Ave.
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BUILDIN~ PER~'IT NO,
. . '":9)i...~1:;-.
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DjPE QF PER;.-1IT
Tenant Improvement (Limited),
BLD2004.02843
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CITY GI5j;i[N~H EI M
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BUILDING DIVISION
2GC>S ANAHEIM l3lVD,
(714) 765: 8153
INSPECTION REQUEST LINE:
(714) 765.4626
CENSUS CODE: 437
QUARTER SECTION: 149
VA TE: 9/24/2004
JOB ADDRESS: 3470 E MIRALOMA AVE
LEGAL DESCRIPTION: KRAEMER TR LOT 18,BLK K POR OF LOT
APPLICANT: GABE HERNANDEZ
OWNER INFORMATION: CONTRACTOR INFOR~,'A,TION:
North American Aid ICE BUILDERS INC . ~
2201 Seal Beach Blvd 421 E CERRITOS AV~ ,I'
Seal Beach, C,A 90740 ANAHEIM, CA 92805-000(\
, BUSINESS PHONE. 71449;! ':3'17 ,
JOB DESCRIPTiONCommercial Addition and Tenant Improvement. Enc!os'e 'Z1.:~sting open entry and Tlat main Ic:Jby and surroun-di!1g offices at BLD 290. .
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VALUATION: 110,000,00 PROCESSED BY: MJL
I OWNER-6lJILnEi'~DEcLARATION
I hereby affirm under penalty of perjury that I am exempt from the> ContrZ7.:t""';..)~;s Uc~nse Law-for the fo:lowing rcae;:)n (SGC. 103i.5'Business.'aQd.
Professions Code: anydty-.or cow1:rYwhich requires a permit tOGOnstrud,ali,~r, im;:.rove, c!e:Tlolish or repair ~ny structure, p:-ior to its -isst.:ance. also
requires the applicant for such perr~1it to file a signed 5:tstBment thatt~c is i!c~hsed pilrsuant to the provisions of the Contr::ldor's License Law (Chapter
r3)(ccm~'l'lencing with Seetio:! 7000 of Division Z,of the Business and Fr.Jfe$:::;1~n~ Cede) or that he is exempt thF;refrom ~md the ba~is for tiie a::eged
exemption, Any violation of,SectloI17031.5 by arlY applicant fer 3. pet'rrlll s1~~~fl2:cts the appiicant ,ti) a dvi! penalty of r,ot mQre than five hundred dolian.
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o I: as owner of property, or my employees with wi;lg~S asthe;( soie (;Otn~~nsatjon, ~il! ,do th~ work. and the stiuctUfA is not ;~terided OJ offered for
saie_ (Sac, 7044 8lJ~ir,ess.and Professions Code: The Contractor's Ur.ens~ :/;.~w do'~s not apply tQ an cwne.r -:)f prcpcrtywho buHds or iinprove~'
thereon, and who does such wor-k himself Oi herseif or through his ,~r i,efG~Ii~ employe~s, pr<.;vided thatsu:h irnprOVerqet1t$ Glrc~ not ir.t;?m:h9d or'
o!feredfor sa!e,. If,:however, the building ur impi"Ovement is sold .with 0r;e,:,~";~~ Gf qorr:p!f')tion, the owner-buikier-wiil have th'3 burder;'of provir,g that he
did not bl!;id or improve for the purpose of sale), . ~ . . " ' " .
[J .!, 33 the owner oftha' property, am eXdu::>ively contractin'g wl~h li::,:ns~,~:It:)flt(actnr~ tn,constru.:;t tt'H~ V'.ljeci' (3ec, '7044, 8\Js!~'€ls.'S al1d Profes.~illn:::;
Code: Tt":e Cer:tractors LiCBnse La....... doe~ not apply to an CI.w:,:;:r cf i':-c~.:;rtY:""J.!;o bU:::1::>cr impioves thB:'(;:Cr., and whccontr~cts for SUdl project:;;: wlrh
<3 ~Clnt;<.::lrt.:1r(e~ licet"!Sed pursuant ~othe Contmctor's LiC8(,Se La......), j1''; . '- ' .
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~--',-13m exemot under Sec;, ,8& P.C. fnr thisI€2Son: . __'. ~__,~__~_~__"';"'_-'--______~___.-:-_'
D.9l(~: Owner:.... . ,:i . . .- . .'
L__ - WOFKER'S cOMPE=NSATIONDECl,P>Bt:flQ.i:c::.:J= _-=--:---=:r ILiCENS~D CO-;:~TRA~~TORS DECLARA -::iON'~J
j h&rehY affirm under penalty Of perjurv ana of the follo'.....ir.g cieclr:tt"a!t(:ns::l I hereby affipTi u,Kler penalty of pe:juiy-tha.i I ~n:
[] I have '"md ..viii rnai.1tain a certificate of (.Cn-sent to self-insum f>:'f'.vorv'.;.:rb Go;r~:~n::;,a~;on, licensed ur,C:~r previsions of.0hapter $I (ccmil!em"ing
GlS iJrov, idedfor ty Sectio, n, 3700 of the L;;'.bor Code, tor th,e peifc:-mvr)ce or ih~,~',\'\'Ork'f0t which, With. SB?!iOn 70.GO).0f Dlv~ioi"'" ,)f t, "':r2_.USine._ '1d
.thi'" p(~rm1t ;!:) iSSlJE;d,. r, I p:-oresslor.'/f-.. ( od , . .' .
jlf ! nave and ~NiiJ ,rrtaintflin worker's l.::ompensation :nGurance, 3."; requ:r13d hI'- Section 37"00 of I 9/24/20e4 . . ... ~__
~ L<.:lbor Code, for the peiformance of the "...._crk t0r wtlicl1 this p~I'mil is iS5l)~~~:. rlilV W,v'rkf;~r'S I Date: ' 'Contrz:ctor. .
Compensation insurance carrier an9 potiey core: . J;-, .
Carrier: AMERICAN ZURICH INSUR' . . Polio; N~mt:('!r. WC-S00,5?,.,:,tS..oo I NUMBER
775547
This section need not be completed if the petmit is for one htindred Ijoll€-.lrS ($13fJj ory?e.,_,_ I TYPE A
D l.::ertify that in' the performance of the workfcrwhicn thi$ permit ~5 _i~l.l~:~;! rf.alL ~()t I .iYPE B
employ any person in a ny manner so as to become, subject to the' worke;':; c.-:knpensation lawsj TYPE C21 CRAN
Of California, and agree that if 1 should-become wbject to th~ wor'r<:er's com;;gr.. ~ '.n' \I~ C?~
previsions of Section 3700 of the Labor Code shall It. .th,cot1ply Wit;l m 30 pro loicos. 'I ~cr:l:t'~CiO" Type,:
Dete: 9/24/2004 Appli.cant: - W I.~ . Occupanl.."/ Groups:
WARNING: 'FAILURE TO SECUR WORKER'S COMPENSATiON r:O\/Er~\GE IS _ S, , , ,
UNLAWFUL, AND SHALL SUBJECT 'AN Ef-l'PLOYER TO CRIMINAl PENA~~TiES AND CIVIL j Fire Sp,rink!~red?
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,OOG), It.J ADG;T~ON TO -fliE New/Additional !\rea:
COST OF COMPENSATIQN, DAMAGES AS PROViDED FOR IN SF::CT!ON, 3706 (::F THE T.r. Area:
LABOR CODE; INTEREST AND. ATTORNEY'S FEES.
! CONSTRUCTiON LENI}!NG AGENCY
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perforrnance of th~ w~r.k fa (whid,- thi; per~it is i~sued (Sec:3097 ,CiV','C): - - .
Lender's Information:
ARCHITECT/ENGINEER INFORMATION:
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=:XP:RATiON DATE
3131/.2006
YJ::S
191
2,950
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I certify that I have read this application and state that the above information is correct. I
agree to oompl-y with all city ordinances 'an<;J state laws relating to building construction, and
~,ere by;auth,orize represe.hYJ;~e of this city to~e r upon the above'mentionec! property for
Ins~P 10~PO~ /I . L.) , . .
l ~ ' . Date: 9/24/2004
. Signature of Applicant or Agent .
The permit shall expire by limitation and become nuH 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.
Fees paid for Permit:
'rola!:
2,145.18
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o -""'1I?-HAI";;(J,fU..../ biAl7ca
INSPECTilllN RECORD ' , , FINAL INSPECTIONS ,. Dit~.c , Ins~ector '
.. , . ' , I 77/1 15' 1il 71
Electrical F;nal , ..>.'
I INSPECTION ' DATE' INSPECTOR .'
Temporary Power Pole , " Phimbing Final 1711. :" ;, ~'
,Plumbing (DrainlllVaste Pipe) I,' Mechanical Final ~H 'fj d a /, ~-
Electrical Ground Electrode/lifer ,,/ ' '
Gas Test , ,
SetbacklFormslTrenches (Footings), , -c,rC"J' - ! ' "
'00 not install sUbflQoror pour floor slab until the Engineering/Grading Final 765-5126
following applicable items have beet"'! signed: ' , , :'
Plumbing (Water Pipe.Sprinkler Valves) Fire Dept. Final 7654040
Mechanical (Groundwork) Watllr Engineering 765-,5268
Electrical (Underground Conduit) ,,' j
~ltstiBusinessLicense 765-519
Pre-slab (CompactionlMembrane.Reinf. ~Z;I.-{j( At!. ..A' ,
Underpinning (Floor Joist/Girders) , " , , Zoning 765-5139 , ,f j ,
00 not cover or conceal the work below until the j , ~ast Inspection. Only , O/I1t!t1 ()lifl '
'fonowingappli,table items have been'signed:' Building Final fter Above Complete) ,
1 st Floor Shear, , ',' 1". /1../ .. ,
Firesprinkler (Rough) ..( II' " PARTIAL INSPECTIONS
2nd Floor Shear ' , , , Bui/dina l~eCtiOns ' ~,,"
Roof (Sheathing/Diaphragm/Frame) ,
/ tJ "I'f'~ ' tV.4Z6 .JJV41#" ,.. -
Masonry (ReinfJBOnd Bl!am/prll-Gl'O\It) , , , ' " ,
Rough Plumbing (Top Dut) , ' , ,
Rough Mechanical ' ,
Rough Bectrical (Dry Wall) , , , ' ..----'
Rough Electric:al ' ' [/QA J. ....
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Framing . (Only after Plbg:.. Eiec...Mech and Fire) , '" '
Insulation (SoundlEll'l'rgy) " , , ,
" MechanicallnSDllctions
00 not tape or plaster until the followif:19 applicable
items have been Signed: . -', - . ' " " ,
Drywall " ' " , 'ti~~/-& , . "
,Penetrations (Fil!! Rated) Electrical ' , ,
Penetrations (Fire Rated) MeChanical " , ' ,
Penetrations (Fire Rated) Plumbil1ll
Interior Lath ' , " ,
Exterior Lath ' , ' ,Plumbina Inspections' "
, " GENERAL ITEMS ' ",' ' '
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Exterior Plaster (Brw/O Coat) , "
T -Bar Electrical " , ,
T -Bar Mechanical ,. . Ul , " ,
T -Bar 'Structural , HI'll :-V"" ,
Sewer , " , ,
Water Engineering Backflow " ," Electrical Inspections
Water Service , ",
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