1041 N. Pacific Center Dr.
BUILDING PERM!:r NO. BLD2003-04511
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,
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BUILDING DIVISiON
200 S. ANAHEIM BLVD.'
. (714) 765. 5153
INSPECTION REQi)ESTl.INE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 150
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TYPE OF PERMIT
Tenant Improvement (Limiied) CITY
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DATE:'11/19/2003
JOB ADDRESS: 1041 N P~CIFICENTER DR
LEGAL DESCRIPTION: P BK 263 PG 26 PAR 2
APPLICANT: RICHARD CURRIER
OWNER INFORMATION: CONTRACTOR INFORMAi'ION:
CateUus Development Corp %Bank Of C C S ENTERPRISES' \~
201 MissionSt#2 2271 N BATAVIA
San Francisco, CA 94105 ORANGE, CA 92855.(10001)-
. . .' BUSINESS PHONE: 714 63i:~242
'. JOB DESCRIPTION Add door into reception/seatingroom on first floor.
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VALUATION: 1,500.00 .... ,t '. . PROCESSEDBY: AEM', . . : ". ','
I .... .' .OWNER-BUILDER:J;1ECLARATION......:::=J
Il1ereby ~ffirm u~der penalty of perjury that I am -exempt from the Contract.oi;1~.Ucense Law for the followil1g reason' (Seq. 7031.5 Business ar:d <<"~.:" ,-'
Professi(lns Code: any .00/ or county which-requires a permit to constn:ct, r:l:~4--;_ itr.prove..demeJlish, or repair any structure,. prior to its isslla~ce, also_. .
requircc;....the. applica.n~for surn ~rmit to file a sig"ned statement that he isl:L~~~~,i.~,~.pur;3uant to the p!'Ovisions oftha,Contractor's License Law (Chapter'
9)(commencing with Section 7000 of Division 3 of the Business and Profess;::'j:1s Code) or that he is e~empt.therefrom and,the basis for the alleged
exemption. Any violation of ,Section 7031.5 by anyapplicantfor a permit sutAbc~~ tnp. ap"licant to a dvn ;:>e'nalt}'of not more than five hundred dollars
($500). . - '.' . .~ '. . . .... . ". . . . . . .
o I, as owner of property, or my empt:Jyees with wages as their sol~ ccm~',lt:s~tion, wi~. doJhe work, and the: ~~~uctur(; b not intended or offered for
sale.(~ec. 7044.Business and Protessions Code: The Contractc:ir'<J Licer.se':..~k.Y d'~-es net .:!.pplyto an owner ~fp~qperiy who builds or improves
thereon, and who does such work himsetf.o'r herself or through his or hor c.....J1 ~mr;.:c-vees. provided th<::.t such in~;'Irovements are not intended or
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offered forsale. ,If, however, the building or improvement is sold wi::' (;ne Yt"";}.('of \::fJ11:pI0i.;on. ll1e owner-buildl9r will have the burden of proving that hl3
didnot buUd or improveJorthe purpose of sale). , . .1' ,.:...~..,-. ',--'~-":"L" ".',",' ,',-
'0 .1" as the owner of the property, am{exc,;luslvely contracting with IicP'(lsed:it.;ntraeforsto construct the p~ojeGt (~ec., 104-1 'Business and Professions
Code: TheContractor'sLicense LawduE'S not',apply to an owne( Of.propc,ty"w,r.() builds or inlproves the(eon. andwhc contracts for such projects witl1
~ontractor(s} IIcerysed pursu'antto the Con,r~Btor~s'Li~n::;e Law}. .). ' "','
U I am exem~~under See,' ~~-:......._ ,B & P,C. fOI' this reason: --'"'--J__.__~_______.._ . .
Date: Owner: __.'!:-- . ,\, .
I.. WORKER'S COMPENSATION DECLA~T~,)N-=~J . ~ LICENSED CONTRACTORS DECLARATION I
l hereby affirm under penalty of perjuryolle utthe following declalations:. ',"c. . .' 1I1ereby.aii,irm lJ(lder penaity of perjury that. I <:iJ!l
o I have and w. ill rOO,intain. a certificaten.t' con.sen. t to self-insure f.:lr v~orke.;~" :co.rnpensati6n, Ii~ense,d ~nderpr6vi.Sio~~?f. ch.~pter 9 (co~msn.cing
.aspro vided for by Sect.ion 3700 of the Lahar Coc!P-., for t.heperfOrn lance of ti".- wOrX fOr..Whictl w It.h Se?tlO~7000) Of~'~n,3 ot. the Busr roes..> and
~thiS rmit is issued, .. . '. .... - . ProfeSSIOns Code. .. ~,
J have and will maintain worker's compens'ation irsurance, a$'requ-1~d tJ Section 3700 of .11/19/2003 __. C-. ~.
Labor C~de~ for the performance 'of the work fe:rwhich this permit is.ISSlJ?~. Myv/orker'Cj Date: . COl1tractor '
Compensa.tion insurance carrier and policy are: i' .
Carrier:. STATE COMP Policy Numb.,r. 046~0r.(;',';':a NUMBER EXPIRATION DATE
: . . , . ',615325 3/31/2005
This section z:aeOO: n~~, ~pleted if the pennit is for')M hundred dOIl~rs:($1C'!.,~'"t',!.~$~ . ..' TYPE 8
o I ,certlfy that in the performance of the work for which tnis permit is iSSU~l~~~ r ,~.~~U.r.ot TYPE C9
employ any person in any m~nl"!er,so as to become subject to the worke-,,'~ CA'l';P~f'I$8tiQn'laws
of California, and. agree that if I should. become su bje:ct to the worker's conl!Jii'1':;3't(G~'",
provisions of Section 3700 9fthe Labor C~. . forthwith comPI~w~th..t;.,;,.t.;;~ov. ision. s.
Date: 11/19/2003 . Applicant: L _ ~_ ,."f-.--",
WARNING: FAILURE TO SECUREWORKE'R'S COMPENSATION COVEP...GEIS ... '.
uNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN"I.ClE:!;ANO ClVIL
FINES UP TO. ONE HUNDRED THOUSAND DOLLARS ($100,000), INADn: ~~~NTO 1f1e
COST OF. COMPENSATION, DAMAGES AS PROVIDED FOR .IN SECTlb~l 2.iQ6 OF THE
'i LABORCODE, INTEREST AND ATTORNEY'S FEES. .'ii,.. .
I... . - CONSTRUCTION L:;NDING AGENCY,: ..' -:",-'\..,;;
_,I.,~~:,,~~l;)' ?~Jrr:"!~!!=!c1"'(,~"!~,,,,~:; ;::,fMd~-fl:.tb:,; !b-c~i- >; ,~~:;t;~:-i'~~:'~';;':'!-'":'~;;:; ""':~".r'",,'f~?_-~::~.;._-':"~i:
perfor~nce of the workforwhid"thi;.permit is iSSlJed (See.3097..Civ.C): '.'
.Lender's Infoonation:
ARCHITECT-/ENGINEER.INFORMATION:
Con$trucion Types:
VN, , .
Fire. $piinklered?
NO
,
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-~:_.~~__...;....::--....::._ _....i-E~ ~..::.::;~., *- '-'-
I.certify that' I have read this ~pplication a~ state' that the above informationii) cbrrect. I
agree to comply with all city ordinances and state laws relating to building coru..truction, and -
hereby authorize r presentiv~ of this City to enter-upo,n the above mentioned property for
iri~.~n ~r ~
". .Date: 11/19/2003
Signature of Applicant or Agent
TIle permit shall expire by limitation and become null and VOid if the building or
work has not passed final inspection 365 days from the date ofpermilissuance. A
new permit Is required.to commence or continue work.
Fee$. paid fQr Permit:
Total:
106.53
INSPECTION RECORD
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INSPECTION DATE INspeCTOR
Temporary Power Pole . .
Plumbing (DrainlWaste Pipe) .
Electrical Ground Electrode/Ufer
SetbacklFormsfTrenches (Footings) .
Do not iru.;tall subfloor or'pour floor slab .until the .
following applicable Items have been signed: . '.
Plumbing (Water Plpe.Sprinkler ValvllS)
Mechanical (Groundwork) . . . .
Electrical (Un~rground Conduit) .
'. Pre-slab (!;;ompactionlMembrane.Reinr.
Underpinning (Floor JoistlGirtlers). .'
. Do not cover or conceal the work below until the . . .
following applicable items have been signed: ' . .
1 st Floor Shel!r
Firesprinkler. (ROugh) . .' .
2nd Floor. Shear . .
Roof (Sheathing/DiaphragmlFramll)
Masonry (ReinfJBond Bl!amlPrll-Grout)
Rough Plumbing (Top Out) .
Rough Mechanical. .
. . HOugh ~ectrical (Dry, Wall) .
RoughElectricl!1 /i ..,"" /
Framing, -(Only after Plbg., Etec., Mech.. and Fire) 'I. 7r //"TI
Insulation (SoundlEnergy) . / \
Do not.tl!p.... or plaster until the following l!pplicl!ble G:J -
items have been sign~d:'- . ; ,.
Dr"ywall '. . 'J- .1_<> '.7/".71"'-.
Penetrations (Fire Ratlld) E.lectrical / /
Penlllrations (Fire Ratlld) Mllchanical '
Penetrations (Fire Ratlld) Plumbing
Interior Lath . . ' .
Exterior Lath' . '.
GENERAL ITEMS
Exterior Plaster (Brown Coat)
To.Bar Electrical
T-Bl!' Mechl!nicl!1 . -c-
ToBar Structural.
Sewer . .'. .'
Water Engineering Backflow c-
Water Service .
FINAL INSPECTIONS .Daie" r-'!nspector
Electrical Final '.
Plumbing Final' .
Mechanical Final . .' . '.
.Gas Test '.' ...
Engineering/Grading Final 765-5126 ,
.
Fire Dept. Final 7654040 '.' .
Water Engineering 765-5268 . .'
Sub List/Business License 765-519
Zoning 76505139 . . .
Building Final ~ast 'Inspection. Only. 2 -.:)"-q; ~~/ AiM
fter Above Complete) ~/ "
PARTIAL iNSPECTIONS
. Buildina Inspections
/
Mechanical Inspections
Plumbina Inspections
Electrical Inspections