3301 E. La Palma Ave. (13)
TYPE OF PERMIT C
Miscellaneous ITY
DATE: 12/2212004
JOB ADDRESS: 3301 E LA PALMA AVE 13 203
LEGAL DESCRIPTION: KRAEMER TRACT BLKK LOT 16 POR OF
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765-5110-3
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE:
QUARTER SECTION: 144
B'UILDING PERMIT NO. .BLD2004-04483
I.
APPLICANT: KEITH MARTIN
OWNER INFORMATION: CONTRACTOR INFORMATION:
Rod<welllnlemalional Corp DEB CONSTRUCTION :
.2201 Seal Beach Blvd . 1210 N JEFFERSON ST #D !
Seal Beach. CA 90740. ANAHEIM, CA 928070000 I
JOB DESCRIPTION:Foundalion and slab only for security slation. (Phase 1) ,
'. . I
VALUATION: 5.000.00. \ PROCESSED BY: ENO
I . '.' OWNER.BUILOF.~_bECLARATION . .' I
I her~by affirm under penalty of perjury that., am ~xempt from the Contracto"fLicense Law for the following reason (Sec; 7031.5 Business and-. .
. Professions COde:_a'oy city or county WhiCh requires a perm~ to construct, a!i~r. improve, demolish 'or repair any structure. prior to its issuance, .also , .
requires the appUcar)t for such permit ,to file a sIgned statement that he is Iice:~Sed pursuant to the provisions of the Contractor's license Law (Chapter'
9)(commencing With Section 7000 oJ Division 3 of the BusinessanQ Profes&lchs Code) or that he is exempt therefrom and the basis for the aUeged
. ~;::oi~jon. Any. violation of Section07?31.5 ~y any' applic,ant for a perrrlit S~_b~tcts the applicant.to 'a civil pe~atty ~f ~t ~re than fi~ehundred dO!la~s
[1 I, as owner of property, or my employees_ with wages. as their sole com!)~hsation, will do the work, and the structure is not intended or offered fur
" sale" (Sec. 7044 Business and.professions Code~ Th. e Contractor's License'dw aoes not apply to an owner of-property who builds or improves ..'
there':m. .and who doe.s sum work himself or helSelf or through his' or he-r QwJemplo)'ces, provided that such improvements a re not intended or ,
offered for sale. If,',however,'the builct'ing,or improvement is sold w!thcneYe~f[Of~:::omPletion, the owner-builder ~Ul haVE:: the burden of proving that r.e
did not build or improve for the purpose Of sal€).
o I, as the owner of the property, am exdusively contractit'g with Ucel"\sf'jo '..,tractor~ to construct the project (Sec. 7044 Business and Professions
Corle: The Contractor's license Law does not apply to an owner of pro(Je;t~ ~';>IO builds or improves thereon, and who contracts for such projects with
~..Qo!1tractor(s) licensed pursuant to the Contractor's License Law)
L~ j am exempt under Sec. ,B & P.C. for this reason: ___
Lot'" - WOR~;;~ COMPENSATION DECLARATION __~- I -
I hereby affirm under penalty of pel1U.ry one of thEl! following declarations: ~t
o , I have and will maintain a certificate of consent to self.msure for worl<,erj4pcmpensation,
as provided for by Section 3700 of the Labor Code, for the performanre cf tfn.i{....:ork .fer which
this_oermit is issued~ , . - . 11
. Kl o'-have and will mainJain worker's compensation insurance, as required L~>$,!3e(.ticn 3700 of
ffie labor Coc1e, .for the performance otthe._wor!rfor which this permlt IS issvepo, 'My worker's
Compen~t!on insurance carri~i and policy are.: : f.
Carrier: STATE FUND Policy Number. 12606-20W.
. . ;f
This section need not be compl ed if-the pennit ie- for one hundred dollars ($tO!)]};r Jess.
~ I certi~ that in the perfonn ce ofthe.'wor. {which this perrr\lt.~-'iSS.J~~l _l sh~ll not
(~IOY any person in any manne so as to come subject to the worke,ts;~9Jnpen~ation laWs
'of California, and agree that jf Ish Id be' me subje to the worker's Omp6h~9.tion
provisions of Section 3700 of the La or o~e, J sh rth 'i With thg:3e provisions.
. ,
ARCHITECT/ENGINEER INFORMATION:
''Contractor
NUMBER
372419
TYPE.
. XPlRATIb'NDATE
3/31/2i:fo5
B
Date: 12/22/2004 Applicant
WARNING: FAILURE TO SECUR
UNLAWFUL. AND SHALL SUBJE TAN PLOYER TO CRIMINALPENAL'nEs AND'CIVIL
FINES UP TO ONE HUNDRED l!:OUSAND DOLLARS ($100.000). IN ADDI)1ON TO THE
COST OF COMPENSATION. MlAGESAS PROVIDED FOR IN SECTION ~706 OF THE
LABOR CODE. INTEREST A ATIORNEY'S FEES. .
C NSTRUCTION LENDING AGENCY
Coristrucion Times:
.VN. .
Fire Sprinklered?
NO
I hereby affirm underpena. of perjury that the~e is a cOl1structionlendii1g agi.ncy fOf the
_~~r"f(""!'T1::!n~ nfthe1<..,orkfdrwhid11hispe~it:sisS~IIJ;:!!SI3c.:30q7"Cjll,C)' ~ '.._ _
Lenaer!s Information: /
l"oo'., ..
Date: '12/22/2004
Fees paid for Permit:
Total:
250.85
ignature'of licantor gen
perml I expire by limitation and become mill and void if the bUilding or
k has not passed fimil inspection 365 days from the date of permit issuance. A
w permit is required to commence or continue work.
l. . . '.
INSPECTION RECORD
- .' .:.
. INsPEcnON..
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electl'li<lelliter.,Mri : .,.,- khfeV<:. .
SetbacklFormslTrenches (Footings). It -"J<).o<
Do not install subfloor. or paur flaar slab until the
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler ValveS)
Mechanical (Groundwork)
Electrical (Underground Canduit) .
. pre-slab (\;ompactionlMembrane.Reinf. i 11--) '" d-
. Underpinning (Floor Joist/Girders)
. Do (Jot cover.or conceal the .Y'ork belOW until the
follOWing applicable Items have been signed.: .
1st Floor Shear .
Firesprinkler . (Rough)
2nd Floor Shear . .
Roof (SheathinwOiaphragmlFrame\
Masonry (ReinfJBoncl !leamlPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical .
KOugn l:Iec:trlCallury vvalt~
Roullh Electrical . .
Framing (Only.atter Plbg.. Elee" Mech.. and Fire)
Insulation (SoundJEnergy)
00 not tape or plaster until the following applicable
items have been signed: ..
Drywall .. ..
Penetrati.ons (Fire Rated' Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
. .. . . GENERAL ITEMS
Exterior Plaster (BlO\Nn Coat)
T .Bar Electrical
T,Bar Mechanical
T -Bar Structural
Sewer.
Water Engineering Backflow
Water Service
DATE I. INSPECTOR
.
..
.
.
.
I
.
./1,1"
I
.
.
FINAL INSPECTIONS
Electrical Final
PiumbingFinal
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business Licens1l765-519
Zoning 765-5139
Building Final ILas! Inspection- Only
After Above Complete)
.
Date
Inspector.
PARTIAL INSPECTIONS
Buildina Inspections
f~t.o- oS GlLdJ"${P F<.cI}
.~
Mechanical hlspections
Plumbina Inspections
.
Electrical Inspections
APPLICANT: KEITH, MARTIN
OWNER INFORMATION: CONTRACTOR INFORMf.TION:
Rockwelllntemational Corp DEB CONSTRUCTION
2201 Seal Beach Bivd 1210 N JEFFERSON ST I'D
Seal Beach,CA 90740 ANAHEiM, CA 928070000'.
JOB. DESCRIPTIONNew security station: 20'x 20' (Plan approval number: 50;:,1301)
. VALUATION: 15,000.00 i. PROCESSED BY: MSM
I OWNER-BUILDEI~ DECLARATION_
I hereby affirm under penalty of perjury that' I am, exempt from the Contractol'i's License Law for the following reason (Sec. 7031.5 Business'and
.Professipns CQde: any city or county which requires a permitto construct, z~fir, improve, demolish or repair any structure-, prior to its issuance, also
req"uires the applicant for such permit to file a signed statement th.at he is licJi";-.::;p.d pursuant to the pcovis!ons of the Cvntractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business; and Profess.:bns Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for aoermit su;1jdcts'the applicant. to a dvil penaJtyof not more than five hundred dollars
($500).. . , l' .
o I, as owner of property, or my employees with wages as their sole cOlTip!msation, wiii do the work, and the structLlre is not intended or offered for
sale (Sec. 7044 Bus'iness and Professions Code: The Contractor's-Uc~n~e _iklW doe~,nQt ::lp.p\yto an owner 01 property who builds or improves
thereon, and who does such work himself or herself or through- hiS or her 6w~'.em;:::loyees, provided that such improvements are not intended or
" ,f', , "
off.ered-for sale. If, however, the buildingbr improvement is sold with Ol'le."ierr of comolei;on, the owner-bullder will have the burden of proving that he
did not build or improve for.the purpose of. sale), . . '_, , ' ',',' . "
o 1, as the owner of the property, amexdusiveJy contracting with Hcenseu ~':(jntrE'ctor5 to construct the ptoject (See. 7044 Business and Professions
Code: The Cont~actor's License, law does not apply to an owner of propf!rt/~;'no t:u~ds or improves thereon, cmd who contracts for such r;'rojects with
~pntr~ctor(s) licensed pursuant to the Contractor's Licens,e Law). 1'.~'
L.J ,I am-exempt under Sec. , . " ,B&'P.C.forthisreason: ,
Date: Owner:l. .
I
BUILDING DIVISION
2OOS. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714)765 - 4626
CENSUS CODE:
QUARTER SECTION: 144
ARCHITECT/ENGINEER INFORMATION:
-1
LICENSED CONTRACTORS DECLARATION
I hereby:af irm underpenC'llty 0 perjury that I am
licensed'under provisions of chapter 9 {commencing
with Section 7.o00)-of Divsio of the Business
Professions ~~
12/23/2004 C...::::2-
Date: .
WORKER'S COMPENSATION DECLARAT!ON J
! here:by affirm under penalty of perjury one of the fQllowing declarations: .i .
o I have and wili maintain' a certificate of consent to ~If-insure for worker';: :compensation,
as provided for bySedion ~700 of the labor Code, for the performanoe oft'1i,;cWCIK fOl which I
~h' ermit is issued. ,"
I have and will maintain worker's compensation insurance, as reqlJired b~ Sec~ion3700 of
the labor Code, for the performance of the.work ter which this permit is iSSL1ed. Myworker's
Compensation insurance carner and policy are: ,
Carrier: STATE FUND Policy Number: 126oe~2C,;)4
This section need not be completed if the pennit is for one hundred doilars ($1n~ or Ie$s. I'
o I certify that in the penonTIqnce of the work 'for which this permit is i::;sue;:(l ~haU not
employ any 'person in any manner s9 as to become subject to the worke ,;cmpell_satioil !awsl
of Califomia, and l;Jgree that if I should become subject e. rker' rr:p~r~<;aUon, ~' '
provisions of S~ction 3700 of the labor Code, J shall' It . 1 0 I ith ~r.;jse pro\f1*T9ns. Construcion Types:
" '" . VN" .
Date: 12/23/2004 Applicant: Occupancy-Groups:
WARNING: FAILURE TOSECU EWORKER'SCOMPENSATIONCOVEP,\GE'IS B" ", ?
UNLAWFUL, AND SHALL SUB ClAN EMPLOYER TO CRIMINAL PENA'X:ES AND CIVIL Fire Spnnklered,
FINES UP TO ONE HUNDRE' THOUSAND DOLLARS ($100,000), iN ,4,ODrno.'l TO THE
COST OF COMPENSATION, DAMAGES AS PROViDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. '
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lendir:g :::'';<!I~CY f('lr tne
::-cri:'irY>3nC!? or_ t~e \N0.rJ.- ~(\r w!1idl'_ thi~!).p.;mitjs i~t:'Jed (S.c:c..3C9l;Ci!!.G): ~ - -!
lender's" Inforrnation: '
. NUMBER
372419
TYPE
. Contractor
EXPIRATION DATE
313112005
B
NO.
Date: 12/23/2004
601.98
ignature of Applicant or Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed final inspection' 365 days from the date of permit issuance, A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
, INSPECTION RECORD
,INSPECTION' DATE ,INSPECTOR,
l'emp<>ra,y Power Pole,
Plumbing (Drain/Wasle Pipe)
Electrical Ground Electrode/uter
SetbacklFormsrrrenches (Footings)
00 not install subfloor or pour floor slab until the
following applicable items have been'signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechimical (Groundwork) "
Electrical (Underground Conduit) , '
Pre-slab (Compaction/Membrane.Rainf. "
Underpinning (Floor JoistlGirdl!fs)
I 00 not cover or conceal the work below until the
, following applicable items have been signed:
1 st Floor'Shear '
Fhesprinkll!f (Rough)
2nd Floor SIlear
Roof (SheathlnaJDiaphragmlFrane)
Masonry (ReinfJBond BeanlPre-Grout)
Rough Plumbing (Top Out)
Rough, Mechanical , .. . .
wough t:lectricalt....y,..aU)
Rough Electrical
Framing, (Qnly.after Plbg." 'Elee.. Mech. and Fire)
In,$Olation (SoundlEnergy) .
Do not tape or plaster until the following applicable
items have been s~gned: ,'.
Drywall .
Penetrations (Fire Rated) Electrical . I
Penetrations (Fire Rated) MeChanical
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 Backllow .
Water Service .
FINAL INSPECTIONS .
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
, Inspector
Engineering/Grading Final 765-5126
Fire Dept. Final 7654040
Water Engineering 765-5268
Sub List/Business License 765-519
Zoning 765-5139
Bulidihg Final (Last Inspection- Only
After Above Completel
....
(I
Mechanical'lnspections
PlumbinQ Inspections
EI,ectricallnspections