8010 E. Santa Ana Canyon Rd.
Nhv!(, 0'1lf- /ClC; "'77.~/
BUILDING P MIT NO. BLD2005-00487'
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APPLICANT: RANDY JONES -;,j
OWNER INFORMATION: CONTRACTOR INFORMArI,oN: :
Olr Nominee;S!ate Teachers Relireme JOHM.M FRANK CONSTRUCTION INC
8010 E Santa Ana Canyon Rd 913E 4TH ST . :!
Anaheim, CA 92808 '. SANTA ANA CA 92701 oooef
, . BUSINESS PHONE: 714 210'~600 "
JOB DESCRIPTION,enanl improvament; pavilions. '.:, r .
VALUATION: 250,000.00 .~ .
TYPE OF PERMIT
Tenanllmprovement (Limited)
DATE: 5i9/2005
JOB ADDRESS: 8010 E SANTA ANA CANYON RD
LEGAL DESCRIPTION: P BK 255 PG 1 PAR 16
ElM
BUILDING DIVISION'
200 S. ANAHEiM BLVD..
. (714) 765. 5153
INSPECTION REQUESrLINE:
(714) 765.4626
CENSUS CODE: 437
QUARTER SECTION: 207
ARCHITECTiENGINEER INFORMATION:
PROCESSED BY: FAN
OWNER-BUILDER 0 CLARATION
I hereby a irm under penalty .of perjury that! am exempt rom the Contractor'~\pce.nse Law for the following reasoh ec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, altel~iimprove. demo.lish or repair any structure, prior to its issuance,B_lso
requires the applicant forsuch permit to file;i signed statem, ant that he is li9~n,~,dptJ'tsuant totheprovtsionsof the Contractor's.t..icense l~ (,Chapter
9)(commencing With Section 7000 of DiVision 3 of the Business and Professjo;.t'Code) or that he is exempt therefrom and the- basis for the alleged '.
exemption, Any violation of Section 7031.5 by any applicant for a permit Subj~ts ~eapplicant to 'a civirpenalty of not more than ,five hundred dollars
ffi(}?)~s owner of property, or my employees with wages as lheir sole comp:~"ti~n,'will do the work, and the structure Is not inlend~d or offered for.
s?tle (Sec:. 7044 Business and Professions Code:, The Contracto~s License L~jidOes.;~ot applyt~ an owner of pro~rty who builds or improves_ " ,.
thereon, and ,who does such work himself or herself. or through his or her own ~mployees, provided that such improvelJlehtsare not intended or .,
offered,far sale. If, how,ever, the buHdihg or improvelJ'lent is sold with one yea~of completion~ the Qwn.er-builderwill have the burden of proving thathe_,'
did not buUd or improve Jor the pucpose of sale). I~) .'. .'-
D I, as the owner of the pl'dperty; am exclusively contracting with licensed 'qhm:{ctors to,construct the project (See: 7044. Business and Professions
Code: T,he Contractor's Ucense Law does not ap., ply to an owner of property ~o, b, ullds or improves thereon, and who oontracts for such projects with.
,aQontra~or(s) licensed pursuant to the Contractor's Ucense La'."')., Ir:., .- .., ". '. _
W I am exempt under Sec. , B & P .C. for this reason: . . f'~ .... ' - ,.- .'
Date: Owner: ,L
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of per~ury one of the following declarations: r. _ .,
o I h'ave and will maintain a certificate of consent to self-insure tor worker'st:pmpensation,
as provided for by Section 3700 of the Labor Code, for the performance of theiMork,for.which
this permit is issued.. '.' , . ',:g.:. .
~.I have and will maintain worker's compensation insurance, as required ,bY,'!.", ,~tion 3700'of
the' LaDor Code, for the pertormance of the work for which this permit is issue~) My worker's
Compensation insurance carrier. and policy are: " ,H,~' :'..
Carrier: STATE FUND Policy Number. 0006465-:;0p4
Thi~ section need not be com~leted if the pennitis for one hundred dollars ($~'O<9Mi~s.
o I cl?rtify that in th~ perfonnance of the ork for which this permit is issue(!jJ:shaU not
employ any person inany manner so as 'ecoma su 'e 0 the workers com'pensation laws
of Califomia, and, agree that if I should b c me subje 0 th worker's compehJ,at~on
provisions of. Section 3700' of the Labor e, I shall f rth i comply with thc#e' provisions,'
I:'.
Date: 5/9/2005 APplicant:~ ' . '1' '
WARNING: FAILURE TO SECURE WORKER'S CO
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER T CRIMINAL PENALTIES AND CiVIL
FINES UP TO ONE HUNDFlED THOUSAND DOLLARS ($100,000), IN ADDI'jJON TOTHE
COST OF COMPENSATiON, DAMAGES AS PROVIDED FOR iN. SECTION 3706 OF THE
LABOR CODE, iNTEREST AND ATTORNEY'S FEES.'
CONSTRUCTION LENDING AGENCY
,'.'y
",Lh_9r-eb}!-affirm' ~ r-pena-lty-of-perjurythat-"there-iswC'Onstruciion ientillig-agency l()nhe-'~~--
performance of the work for whic;h this permit is issued (Sec.3097.Civ>,C).:.
Lender's Information:
Date: 5/912005
Signaturel plicant or Agent
The permit shall expire by ,milationand become null and void if the building or
work has n(lt passed final.nspec:tion 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
LICENSED CO
NUMBER
589230
TYPE
TYPE'
TYPE
EXPiRATION DATE
,2I;!812006
B
C36
C54
Construcion Tvpes':
VN, " .
Occupa.n"ci{ ,Groups':
M" "
Fii's Sorinklered?
YES
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Fees paid for Permit:
Tolal:
3.357.87
INSPECTION RECORD
, ,
INSPECTION DATE INSPECTOR '
Temporary Power Pole ,
Plumbing (DrainlWastll Pipe) , ,
EklctriCalGround ElectrodelUfer ,
SetbacklFormsrrrenches' (Footing$)
Do not install subfloor or,pourfloor slab until the
following applicable items have been signed:
, Pl\1I1lbing (Water Plpe.Sprinkler Valves) ,
MechaniCal (Groundwork) , , ' , ,
EklctriCaI (Underground Conduit)
Pre-slab (CompactionlMembrane.Reinf.
Underpinning (Roor Joist/Girders) I
~ not cover or conceal the work below until the
following appli,c,!ble ilems have been signed: ,
1st Floor Shear '
Firesprinkler (Rough) ,
2nd Floor Shear,
Roof (SlteathinglDiaphragm'Frane) , ,
Masonry (ReinfJBond BeamlPre-Grout) , ;,
Rough Plumbing (Top Out) ,
Rough Mechanical ; ,
I ROughl:lectrlCaI (Dry wal>> , ,
Rouoh Electrical (Dv",,") ,
Framlng'''!6nly aher Plbg.. EI~, MeCh.. and Fire} , , "
Insulation (Soul!dlEnerQYl , , ,
00 not tape or plaster until the following applicable
Items have been signed:' , " . ,
Drywall " ,
,Penetrations (fil'!l Rated) I;lectrical
Penetrations (Fil'!l Rated) Mecltamcal ,
Peftetrations (Fire Rated) Plumbing' ',' ,
Interior Lath ' "
Exterior Lath ' , "
GENERAL ITEMS
Exterior Plaster (Brown CQal)
T -Bar Electrical
r-Bar Mechanical
T -Bar .structural ' {,. ~rJ.f1!. ~A
Sewer '-I- I~. J., I<:,.,q.o =- .~(,.":
Water Engin~ring B'ckflow / "
Water Service ;, . ,
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
!'ngineeringlGrllding Finai 765-5126
Fire Oep!. Final 7654040
Water Engineering 765-5268
Sub List/Business License 765-51
Zoning 765-5139
Btiiiding FinallLast Inspection. Only
,. Aller AboveComplete)
, Inspector