1205 N. Miller St.
.....no..""'. ~ -.. - . .
RECEIVED FROM:
~~~.~~~!~ .
a ;'} cM~(S.
. . -~-
~
l' 2>> C ~ l LltOJ to
~-U:.~ ~~ ~
\(ofH(~ h'le11aYlill\C. ~~O'^ Gl"'ld~1"n~n"" IMF~nr
:Bl9 '2.~- oo~ \ .1-7 '"'5 W\ ,'.llr .z.o,?-4-. . '
. CHECK(S)
',QTY
'95J~ .-
CURRENCY:
lOO'sx
50's x
20's x
=
lO's x
5'sx
l'sx
o
P PARER'S NAME
r>
TOTAL
-.
- Date: 6/17/05 53 Recei;t~o;
HI mSCEllAtJEous 1
279~12F724 3817.
HI "ISC~llANEOUS I.
181~12f724 lal&
Total tende1'f!d
Tohl pa)'ilent.
Trans date: 6/17/115Tlae:
.
. . .)}JSTRIBUTION: winTE ~ACCOUNTING YELLOW - CUSTOMER PINK - RECONCILE COpy . GOLDENROD "-ORIGINATING DEPT.
. ,
.
.'
COR Rev. 6101
,f
.
CONTRACTOR INFORMATION:
. 2 H CONSTRUCTION INC
4101 LONG BEACH BL VO :'
LONG BEACH, CA 9080i 0000
. ,
BUSINESS PHONE: 562424-051;7
JOB DESCRIPTlONOfflce mezzanine expansion (31555f) and office tenant impr~[vemer1t'(Conversion of warehouse to office'4123sf) Applicant to bring
VALUATION: strH8~li'IJcf.~~stoday ., PROCESSED BY: KBT
OWNER-BUILDER DECLARATION
I.hereby affirm und~r penalty of perjury that I am exempt from the Contractor's Llcenss, law for the following reason Sec. 7031.5 Business and
Professions Code:'any city or county which. requires a permit to cOrJstruct, alter';' improve, demolish orrepairanystructure. prior to its issuance, a1so .
requires the appHcantfor such permit to file'a signed statement that he is Ijcen~d pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section.'70006fDivlsion 3 of the Business and Professjon~ Co.de) o'r that he is exempt therefrom and the basis for thealle'ged
exemption. Any violatiE>n 01 Section. 7031.5 by any applicant for a permit subjects-the applic~nt to a civM penalty of not more than. five hundred dollars
($500). .. .. . . . . ) . .
O. I, as owner of property; or'my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
sale (See, 7044 Business and Professions Code: The Contractor's License La\V does not apply to an owner of property who builds or-improves
thereon, and who does sum work himself or herself or through his or her a-wn 'employees, provided that such improve'mentsa're notintenCled or,'
oHered for,sale. If, howe~er, the bUil,ding or improvement is sold with one year"bf_completion, the owner.buildeJ will have the burden of proving that he
did not bujld or improve for the purpose of sale).. . ;1 ' . , . . .' ',-,
o I, as the OWner of the property, am exclusively contracting with licensed'ce.htractors to construct the project (Sec. 7044 Busrness and Professions
~od.e: TheCon:ractor:s License Law does not apply t? an owner of prope'{tyw\no bu>>ds or improves thereon, and who oontracts for such projects wrrh .
iUi. ontractor(s) licensed pursuant to the ~ontractor's License Law), . .
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 perjury one of the following declarations: 'a
o I have and_will mainUlin a certificate of consent to selHnsure for workers ciampensation,
as provided forby section 3700 of the Labor Code, far the performance of the ~ork for which
this permit is issued, -:j
~. , -I have and will. maintain worker's compensation insurance, as ~quired by :.psctIO. n 37QO of
s-Labor Code, for the. performance of the work for which this permit is issued!' My worker's
6mpensation insurance carrier and policy are:' , ,~ . .
ICarrier: STATE FUND Policy Number. 1638105-~OO2 .
(.- .
This section need not be completedlllhe penni!is lor one hundre<l dollars ($100) <it less. ,
OC"Lcertlfy that In' the perf~RTlarlce of t.he work for which t s p rmit. issued!, I shaU not - ,
".emplOy any person in any manner so as to becom subj 0 t w .ker's con,jpensation laws
of Califomia, and agree that if I should become su ect e rke 's comper,sation
provisions of Section 3700 of the . I sh II fo jth Iy with tho~e provisions.
BUILDING PERMIT NO. BLD200S-Q0631
TYPE OF PERMIT C
. Non Residenlial.Aj:ldition ITY
DATE: 6/16/2005
JOB ADDRESS: 120.5 N MILLER ST
LEGAL DESCRIPTION: KRAEMER TRACT BLK K LOT 17 POROF
APPLICANT: JEFF HEINSIUS
OWNER INFORMATION:
Kilroy Rea'lty L P
POBOx 131152
Carlsbad, CA 92013
Date: 6i1612005 Applicant:
WARNING: FAILURE TO SECU EWORKER'S
UNLAWFUL, AND SHALL SUB ECT AN EMPL
FINESUP TO ONE HUNDR THOUSAND D
COST OF COMPENSATIO ,DAMAGES ASP ViDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTERESl" AND ATTORNEY'S FEES. .
./ . CONSTRUCTION LENDING AGENCY
Jll_e!e~_~l!!!,__u!!~e!.p~_1]~~Y _QfJ?_~tlury _~~_~j:h~~e.J~a constru~jon lend ing agency for-tl;te
performance of the work for which this permit is issued (Sec.3097.Civ.C}:
Lender's,lnformation: .
Lhat the above information iscorr~t. I
ate laws relating to building construction: and
enter u'pon the above mentioned property for
Date: .6/16/2005
Sig
The permit shall
W()Fk has not p d final in ection 365 days from the date of permit issuMce_ A
. new permit is re uired to commence or continue work.
ElM
BUILDING DIVISION
200 S. ANAHEiM BLVD.
(714) 765' 5153.
iNSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 144
ARCHITECT/ENGINEER INFORMATION:
JON ZIMMERMAN
18002 COWAN
IRVINE, CA 92614
I'
I hereby affirm under p
licensed under provisio so
with Sec1iori 7000) Of vB;
.Prot". C
6/16/2005
Date:
NUMBE
741856
TYPE
TYPE
TYPE
COnstrueion Tvpes:
VN, ,
Occupancy Groups:
S, B, , ,
Fire Sprlnklered?
'New / Additional. Area:
T.I.Area:
. YES
3,155
7,278
Fees paid for Permit:
Total:
4,419,79
INSPECTION RECORD
INSPECTION DATE INSPECTOR
TemporarY Power Pole ,
PlUmbing (DrainlWaste Pip,e) "
Electrical Ground Elec,trode/Ufer ,
SelbacklFormsrrrenchl!$ (Footings) [l Ii<lM m,U tG
Do not install subfloor or pou(f1oorslab until the
following applicable items have been signed:
PlumbinglWater Pipe.Sprinkler Valves) "
MllllhanicaI (Groundwork) , , ,
Electrical (Underground Condu h)
Pre-slab (compactionlMembrane.Remf.
Underpinning (Floor JolstlGirders) ,
Do not cover or conceal the work below until the
following applicable items have been signed:
1st Floor Shear ' '
Firespill\lller (Rough) , ' , "
2nd Floor Shear . ,
Roof ISheathing/DiaohragmlFrane) "
Masonry (Re.infJBond BeamlPre-GlQUt)
Rough Plumbing (Too Out) . IV/A- t
Rough Mechanical : .' ''WAJ
I KOllgn t:IectrlCalllJI)' wall) I, 'I.. h"j)
Rough ElectriCal
Framing (On~ affer PIbg.. Elac.. Meen.. and Fire) .. I' : (TIll. ,lP,
Insulation (SoundlEnergy) a. .r . ffl1ill1P.
Do not tape orplasler until the following pplicable .
items have be.en signed: . " ,
Drywall IJfIVl/W
. Penetrations (Fire Rated) Electrical ,
Penetrations (Fire'Rated) Mechanical
Penetrations (Fire Rated) Plumbing " . . .
Interior Lath '. ' .
Exterior Lath . '. ,
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T .Bar Electrical ' ' " I ( )/) . 1..- ..
T.Bar Mechanical " ll>,I'1~ ,/ '1, 'fAAI lIV
,T.Bar StructUral.
Sewer
Water Engineering Backflow ' '
Water Service
.-
FINAL INSPECTIONS
Electrical Final . .
Plumbing Final No
Mechanical final
Gas Test
Engi.--ring/Grading Final 765-6126
Dateo
Inspector .
'rJc
Fire Dep!. Final .765-4040
Water Engineering 765:-5268'
Sub List/Business License 765-519
Zoning 765;5139
Building Final (Last Inspection- Only 'if) I ,{ < ji",'; 1#
. After Above Complete) IV' VV
'2,. ~ ~
. Mechanical Inspections
Plumbina Inspections
,
1acEntia-Yorba Linda
nifiEd School District
DEnnis M. Smith. Ed.D.
SUp<<!ntflndEnt
1 e. OrangEthorPE AVEnUE. PlacEntla. California 92870
EphonE (714) 996-2550 Fax (714) 524-3034
Board of Educatlon
Carol DownEY
Karin FrEEman
Judy Minor
Craig Olson. D.D.S.
Jan Wagner
DEVELOPER FEE RECEIPT
The Placentia-Y orba Linda Unified School District adopted Resolution No. 89 on March 10, 1998, imposing fees
pursuant to A.B. 1600, effective May I, 1998. The following project was reviewed on June 16, 2005
OWNER: KILROY REALTY
PROJECT NAME: ADDITIONAL COMMERCIAL CONSTRUCTION
PROJECT ADDRESS: '1265 N. MliiERST;
ANAHEIM, CA 92806
Sq ft: 3,155 SQ.FT.
TOTAL AMOUNT OF FEE: $1,135.80
HIGH SCHOOL ATTENDANCE AREA:
MIDDLE SCHOOL ATTENDANCE AREA:
VALENCIA
KRAEMER MIDDLE
ELEMENTARY SCHOOL ATTENDANCE AREA:
RIO VISTA
DISTRICT RECEIPT NUMBER:
146
: 869475 '
ACCOUNT NO.:
DATE: June 16, 2005
PLACENTIA.YORBA LINDA UNIFIED SCHOOL DISTRICT
Received By: ~~
*r::~~
Director, Facilities and Planning
NOTICE
DEVELOPER FEES
Assembly Bill 3081 (CHAP 549, STATS. 1996) requires each local agency to provide the applicant a statement in writing at the
time of imposition of fees or project approval of the amount of fees, description of dedications, reservations, or other exactions and
a notification that the 90.day approval period in which the applicant may protest such fees has begun.
This wlii serve to notify you that the 90-day approval period in which you
reservations or other exactions wlii begin to run from the approved ra
fees, description of dedications, reservations or other exactions.
ay' protest any imposed fees, description of dedications,
I ic ed on the building permit which describes the
~
Acknowledgment:
DATE: June 16, 2005
By:
op n nt/ p Icant
SErving studEnts in the communitiEs of R
orba Linda. AnahEim, BrEa and FullErton
tacentia-Yorba Linda
nified School District
DEnnis M. Smith. ecLD.
SUPErintEndEnt
I e. OrangEthorPE AVEnUE. PlacEntla. California 92870
IEphonE (714) 996-2550 Fax (714) 524-3034
Board of Education
Carol DownEY
KarIn FrEEman
Judy MinEr
Craig Olson. D.D.S.
Jan Wagner
DEVELOPER FEE CERTIFICATE OF COMPLIANCE
TO: City of Anaheim
The authorized representative of the PLACENTIA-YORBA LINDA UNIFIED SCHOOL DISTRICT (hereinafter "District") has
reviewed the building proposal for Additional Commercial Construction located at 1205 N. Miller, Anaheim, CA 92806,
consisting of 3,155 Sq. Ft and has collected fees of ONE THOUSAND ONE HUNDRED THIRTY FIVE DOLLARS AND SOl100
CENTS. The Project has been evaluated and has been determined that the fees imposed are necessary to meet the cost of
providing education for students resulting from the Project, and that the District faciiities cannot accommodate this new
enrollment of students without reconstruction or construction of new school facilities consistent with the
District's facilities plan.
This will certify that the above-named ProponenUApplicant has paid school facilities fees in compliance with Government Code
Sections 53080 and 65995, and that building permits for the square footage in this proposed development may now be issued by
your jurisdiction.
DATE: June 16, 2005
PLACENTIA-YORBA LINDA UNIFIED SCHOOL DISTRICT
By: ~
Mike Bailey r
Director, Facilities and Planning
The ProponenUAppiicant representations as to square footage are true. ProponenUApplicant agrees that if it is later determined
that such representations are not true, then this certificate shall auto ti ally termi ate and the appropriate City/County shall be
notified.
June 16, 2005
By:
ProponenUAp Ii
devcert.01/28/97
5eNing students In the communities of
rba Linda, Anaheim, Brea and Fullerton
~ ~, ~
PUBLIC WORKS DEPARTMENT FEES
BUILD # (I's::;cra~Jti;TRAFFI~,E~~~~~~~~G FEES-- TE # \ I 7
PROJECT SITE: "la..c sf-. /V. 1'1, / (.tJt.., S:.t-'
SIZE: S JS- S 0 ~~ / '"' If\ '2.::3 II\) iY ~ <' m"":'-
o TRAFFIC SIGNAL FEES: 4:- x., 2-<... 7 + (z.. 2...7- 8'?) k ~
279-412-F724-3017 .
RANSPORTATIONIMPACT AND IMPRO/VEMENT FEES:
278-412-F724-1818 ~ I't;" S " · c. sr.... 1..11 Z ~
o TRAFFIC SANTA ANA CANYON FEE:
278-412-F724-2001
o EASTERN TRANSPORTATION CORRIDOR FEE:
101-412-F724-6704 .
COMMENT:
REVIEWED BY: ALFRED Y ALDA (714)765-5183 A~
--DEVELOPMENT SERVICES FEES~-
RIGHT OF WAY REVIEWED BY DATE:
o OLD ZONING CODE (i.e. in plan check or entitlement prior to July 8, 2004)
o NEW ZONING CODE
DATE: 3 (,-s1.
DEDICATION
CREDIT
STREETIMPROVEMENTffiEPAIR
.
SEWER CONNECTION FEE.
CITY SEWER ASSESSMENT
ACCT #
ACCT #
DRAINAGE ASSESSMENT FEE
ACCT #
GRADING:
WATER QUALITY MANAGEMENT PLAN (WQMP)
LAND SUBDIVISION:
REVIEWED BY: