3991 E. Miraloma
APPlICANT:.EARL SULLIVAN
OWNER INFORMATION: CONTRACTOR INFORMATioN:
Richard J Paul MONDRAGON SPRAY S~'STEMS & FIRE
639 Vista VaHnda 219 3RD AVE #5
San Clemente, CA 926720000 LA PUENTE, CA 91746 OOGO
. . . . BUSINESS PHONE: 62636" b090
JOB DESCRIPTION;ena,;t Improvement. Spray booth.
VALUATION: 75,000.00 '.,
I OWNER-BUILDE~~ECLARAl'ION
i herebY affirm uncjer penatty of perjury that I am. exempt froni the Contracto(l'-Uc~nse' Law for the following reason -(Sec. 7031.5 Business and
Professif)n~' Code: ,any dty,'or coun~ywtJich requires a: permit to construct. an:f;~ iniprove,'demoJish or repair any structure, piio~ to its issuance, :JJso
requires the applicant for SUm P:e:rmit to file a s19ned statement that he is Jict/ls..':!(; pursuant to the provisions of the Contractor's Ucense Law (Chapter
9)(commencing with Section 7000 of Divi5ion 3 of the Busfnes~andRrofessic~SCode) qnhat he is exempt thel"e'"from and ~he basis.for. the alleged
exemption. Anyviolationof Section 7031.5 ,by any_ applicant for a permits\Jbj~'cts the applIcant to a d....i\ penaityot :lot mOle than five hundred doliars
($500)..' .' '. . i' .'. .' .
o I; as owner of property, or my employee.'=: with wages asdheir'sdle com~+:Ci:ttion, wil(do the work, and th,e structure is: ncifil1tenc:ted Of offere'd fuf
sale (Sec. 7044 Business and ProfesslonsCode: The Contractor's Gcerse L:~v... doe's :'lot apply to an. owner of property who builds or improves .
t11ereon, ~l;d,who does such workhirnseltol herself o'r thro:.:gt)h!s',~r hp.r cwi:j;;mploye/3s; provided that sUch improvements Are not iritendedor
offered f~r sale. 'If, however, the building or Improvement is soldVo?rth oneye;; of corni>l'etion, the owner-I::ullcer will have thE' bl.lrden of prQv:ng tht:t he
c!dnotbuiidorimproveforthepurposecfsal~) "1_,, '_,_', . .
o I,as the OWl",er of the pro~rw, an'. exdusively contracting w~hl!cens~j ,',o:"\traclcrs to constructthe project (St)c' 7044 Buslnesa ::!nd Profe~j;)r:s'
Cod e: TM e Contr~Ctor's L_icense .LaW does not apply to an owner ofproperiy '_:!IO bt,silds or improves thereon, 'ind v:ho 'oontracts for sum proJect$ with'
. ~olltrador(s) licensed pursuant tc>-th'e eontra:ctor's licenSe Law). . ,
U 1 am exe~pt under,Sec.. ' . , B & P.C. for. th~s reasor:: .__..._
Date: Owner. . !
I WORKER'S COMPENSATION DECId'RATION - t___--.J
I hereby affirm under p'enalty Of perjury one of thafo!lcwing declarations: ,
o I have. and will maintain a certificate of ronsent to self..:j'nsure fer work.:;:;:-'~~ ";::mpel)satlon,
as provided for. by Sedion 3700 ,of the Labor Code, fer ~he perlorma~cp. ofth;j .,\'OrK for which
thisl'mit is issued.
;> I have and Will maintain worker's: compensaticninsuranc~, al::l required t'l.~ei::tk.'m .37()O of, 03/1/2004
t e Labor Code,fodhe perfor~ance of the work tor whichthi~ permit is i5SU~j Mywr.)rker's Date:
Compen'sation insurance,carrier and poliOf are: to-
Carrier: STATE Co.MPEI'<SATION FUND Policy.Number. 1634;55
lt1is ~tionneed not" be completed if the pennit is for one hundred doliars ($100j .)( lp.ss.
~ Q.V"I c~rtify that in the ~rformance of the work for wt)ich thiS permit is issuer:,,: sr-:?II not
e~ploy any person in any ~anner s,o?s to become subject to the worKer's ccbpe:.Qsation laws
. .of California, and agree that if I should become ect to the worker's cQmpe~.$ntion
provisions of Section 3700. ofthe ~bor Code al ~ h com ~ ith t i\e provisions.
BUILDING PERMIT NO, BLD2004.00156
TYPE OF PERMIT
Tenant Improvement (Limited) CITY
DATE: 31112004
JOB ADDRESS: 3991 E MlRALOMA AVE
LEGAL DESCRIPTION: P BK 224 PG 17 PAR 12
BUILDING DIVISlo.N
200 S. ANAHEIM BLVD.
. (714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765; 4626
CENSUS CODE: 437
QUARTER SECTION: 153
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JJJ.
1
...!:!f.ENSE!? Co.NTRACTORS DECLARATIq;~J
I hel'ebyaffi!'.n u;oder-penalty of per;ury that lam-
licensed under provision ofch9pter 9 (commencing
with Sectio" 7QOO} -' ivs' .1, fthe sin' ;~Rnd
Professions C
NUMBER
499372
TYPE
TYPE
Construcion Tvpes"
III N, ,
Fire Sprinklered?
Dale: 3/1/2004 Applicant:
WARNING: FAILURE TO SECURE WORKER'S Co.MPENSATION C
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO. CRIM IN ENAL-'!",S AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000 , IN ACDr:.,ON TO THE'
COST OF COMPENSATION, DAMAGES AS PRo.VIDED FOR IN SECTION ::!.t}~OFTHE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .
I CONSTRUCTION LENDING AGENCY _.
I hereby affirm under penalty of perjury that there is a construction 1l~!1dil1~ 3~H'::';(;'ffdrthe
_ D.erf.~r,'X'-ai'l('..r.~.of~hp_ V'~ork fur wf!irh thi~ o"'rmit !<:,: iC:C'I-'~d (S'?'~. 30c;.7..,r.;:;\1.0~. ;. ~,_ ',. i. i. -
Le-nd~r's Information: . . - ....
-
, . .
J certify that J have read this application and state that the above information'i.scorrect. J
agree to rom ply with aU ciW' ordinances and- state taws relating to bu ~ding con:. truction. and
herebyauthoriZe'repre tives of t is ci 0 ent run the above mentioned rJroperty for
inspedion purpo
Date: 3/1/2004
ignature of I ot or Agent
The permit shall expire by limitation and bec null and void if the Iluildingor
work has not passed final inSpection 365 ys from the date of permit issuance. A
new permit is required to commence or continue work..
EXPIP.Anm,
. 5/31/2005
B
C16 FIRP
YES
~-.'--
-"~~---"---.-
Fees paid for Permit:
Total:
1.411.00
, INSPECTION RECORD
, , ,INSPECTION' , DATE INSPECTOR
Temporary Power Pole '. . ' ,
Plurttbing (OrainlWaste Pipe) , ,
Electrical Grmlnd EI,ectrodelUfer , ,
SelbacklFQI"ms/Trenc;/t.... (Footings) , ,
Do not install subfloor or pour floor slab until the
following applicable items, have been signed: '
Plumbing (Water Pipe.Sprinkler Valves) " ,
. Mechanical (Groundwork) ,
Electrical, (Underground COndu it) , ,
Pre-slab (Compactionl,.,embrane:Rei Of. :3 ur/otl /.
UnderPinning (Floor Joist/Girders) , ' /'
Do nolcover Or conceal the WOrk below until the
following applicable items have been sigried:
1st Floor Shear " , , " ,
Firesprinkler (Rough)
2nd Floor Shoar
, RoOf (Sheathing/OiaphragrnlFrame)
Masonry (ReinfJBOnd BelJil/Pre-G!'QUn ' ,
Rough Plumbing' (Top Out) , ,
Rough Mechanical' . " ,
Rougn t:Iectrical (Dry Wall) , ,
Rough Electrical ,
Framing '(Only after Plbg" Eie'c_; Mech" and'Fire)
Insulation (SoundiEnergy) " , ,
DO not tape Or plaster' until the fOllowing applicable
items have been signed: " . . ,
Drywall ,', , "
Penetrations (Fire Rated) Elect!ical ' , ' ' ,
Penetrations (Fire Rated) Mec;/tal1ical " '
Penetrations (Fire Rated) Plumbing ,
Interior Lath
Exterior Lath ' ' ,
GENERAL ITEMS " ,
Exterior Plaster (Brown COal)
T-Bar Electrical , ,
T-Bar Mechanical , ,
T-Bar Structural " ,
Sewer '
Water Engineering B,ackflow ,
Water Servic" '. ,
FINAL. INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire .Dept. Final 76,54040
Water Engineering 765-5268
Sub List/Business License 765-519
Zoning 765:5139
Building Final (Last Inspection-Only
After Above Complele)
. PARTIAL INSPECTIONS
BUildina Inspections.
Dale 'Inspector
Mechani'cal Inspections
Plurribina Inspections
Electricallnsoections