8712 E. Santa Ana Canyon Rd.
).;
it
I
" ~,
cr.
OWNER.BUILDEH'PECLARATION
I heceb; a irm under penalty 0 .perjury that I am exempt" ro'tn)l~::PQm~actc~,.Uce~e !.:aw for the following reason {Sec. 7031.5 ~usiness and
Pro.fessions Code: any city or countywhi<::h requires a permit to const'r'Uctan,lr, improv~., demolish or repair any structure, prior'to its i~u'ance, also
r~qliires t~e. ~pplicant for such permit to file a signed stateme~ thi;lt ~~ !S-lic;.:'~!l:sed pursuant to the provisions of the Contractor's License'Law (Chapter
9){commencing with Section 7000 of Oi,vision 3 of the BUsinessa~d Prcfessi-rs'Code) or that he is exempt the ref tom and the ba~is for the alleged ,':
r;~~i~ion. .Any violation of Section g031.5 by any applicant for t1,~.~~~it ~I}~fcts the_t~~_icant- to a civil p~nalty of not more than five', hu~dred dollars
fl: I~ as owner of property, o~ my em,PIOyeeS with w, ages as their,~i~:CI)~~;-,~,"\, .,sati'?I1;,:,:.~i'ldO the work, and the struCture is nqt intended or, C>.~ere, d for
"s<;'11e (Sec. 7044 Business and Pr.<?fes~ions'Code: The Contractor's Uc~n~;e,,-i., W does.flot apply to'an owner.of property who builds or improves
.ttlf.:~eO:1, and who does such .work himself or herself or throu9.h his 0r~~E:.-r o,w. ;temploy_e~-, provid,ed that such improvements are not _intended or.
(1r1~1;red .for.sal~, If,. hoyvevE!.r. the building cr improvement is soJ1.&2'_:~iMne y~;"~: of completion, the owner-builder will have the burden of proving that he
':rid"no uil~0rj[l1prQveforthepurposeofsa~e). " ",.,'~-"\ ,--~~ -. _ f ',' . .~,
J ,I. as the QW, r;'erof the prop.erty, am e,~c;JuSjVel},:..r..c[~taGtinp-WithJj~r:Sed,fJ:o, n..ractors to construct the project (Sec. 7044 Business and ProfesSions-'
d':l: The Contractor's License Law does not appl" to an owner of pi,' ertyho bllads,c..r improves thereon, and who contracts for such projects with
p '" n~ractor(s) licensed pur$uant to the Contractor's Ucense Law)~~.~"., ,:l" . . .
l-j~'I.am exempt under_Sec. _ . f '.::;;:: _....1\
D3[e: ;''';;, Owner-:... ,? -';Jl
,.c' ." " WORKER'S CO; PENSATI N DECLARAT1()N"':-~:f: -:=J
I here~y-a!firm-"y,nd.er penalt(ofp'~rj.l:lory one of the. following dec1a~atiC'nsr 'I;!
[] ,'.- i haV~ and wilf 'ma intain a certjfjcate"of conse(ltt()_-,~eif-;nsIJre f6f work.erj. L'ompensation,;
, as provided for by Section 37000fthe Labot Code, faithe performance of UfJ work for which
this permit is issued. '\' ','
o -'have and will maintain worker's .compensation insurance, a.s required i-~i; ~ection 310p of
the:: Labor Code, for the performance of the work for which this permit ;s issllt~. Myworker's
Com'pensat!on insurance carrier and policy are:. h
Carner: .' Policy ~umber. F"
This section need not be 'COinpretedif~e p~rmjt Is for.o~,hlm~e<icloJlars {$1~t1lt;r l.es5. .
~ertify that in the perfonnance of the work forwhich-th!;>'perm[t"is issu.~~(J shaiL not
~oy 'any person in any "manner so as: to become subject to thev./orker's._c:b;'11)ensaiion laws
of California, and agree that if I should become sUbje to the worker's -con. t!)~ation.~,:> "
provisions of Section 3700 of the Labor e, sh 'fJ rth . 'co 'ly i i:se provisions.
-"" ~: .i .
Dat~: 7/1/2004, Applicant: " '
WARNING: FAILURE< TO SEC ERKER'S CO ENSATIO COYEFt\GE IS;:
UNLAWFUL, AND SHALl SUBJECT AN EMPLOYER TO CRIMINAL PENA:'TIES AND CIVIL
FINES UPTO ONE HUNDRED TIiOUSAND DOLLARS ($100,000.UN 'AqD,nON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR iN'SECTION',3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES, "
I " " , CONSTRUCTION LENDING AGENCY, " -f ' ..
I herl;)by affjrm under penalty of perjury that there is a cO["lstruction lenrliiig :?(t,~nty for the
perform,ance of.the work for whiCh this pArmit is; issued {Sec.3C97.CiY,Cl: ~L~
"::::;,~;::;:;;ts"iIY;(.ii-i'lid;:liJil:"~-'--~ -~'" - . -
BUILDING PERMIT NO. BLD,2004-00399
i
.
,'I"
~;,-~'",-~ :..r'~"".
/1{,<.-"'"t~~~;" .
'~ti;'-^{:NltH ElM
'\~~!~l~;/ '
- ,.
TYPE OF PERMIT
Non Residential Addition C I TV
[jA TE:7/1/2004 I
JOB ADDRESS: 8712 E SAN!.A ANA CANYON RD
LEGAL DESCRIPTION:
APPliCANT: PAUL MITCHELL,
OWNER INFORMATION:
\
I:'
,
CONTRACTOR INFORM)ftON:
"
"
,
"
JOB DESCRIPTION Commercial Addition, Addition to existing church,
\(AlUATION:
500,000,00
I certify that I have read this application and state that the above iriformatior'l'is correct 1
agree to oomply with all city ordinances and state laws relating to building construction, and
hereby authorize representives of this'ci 0 enter upon the above mentioned property for
insp 'on ~po
Date: 7/1/2004
Si ature 0 Apph n.t 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.
"
BUILDING DIVISION
200 S, ",NAHEIM BLVD,
(714) 765.5153 < .,.. -'
INSPECTiON REQUEST LINE:
(714) 765.4626
CENSUS CODE: 437
QUARTER SECTION: 225
ARCHITECT/ENGINEER iNFORMATiON:
PROCESSED BY: ODe
LICENSED CONTRACTORS DECLARATION,j,
: hereby affirm under penalty of perjury that lam
licensed under provisions of chapter 9 (commencing
:with Section 7000) of Divsion"S of the Business and
Professiohs Code.
7/1/2004
Date:
. Contractor
NUMBER
EXPIRATION DATE
TYPE
Construcion.Types:
VN, ,
Fire Sprinklered?
New I Additional Area:
T.I.Area:
YES
4,152
600
Fees paid for Permit:
Total:
6,135.01
.. INSPECTION RECORD FINAL .INSPECTIONS Date. . Inspector .
~" _ ,....., t> INSPECTOR j.. Electrical Flna( V'/ A,+ Pcde-.) 2/Z--f -0 -~'4.
. . INSPECTION DATE.
Temporary Powerpoie Plumbing Final'" . 2.l-tj'r 7'/
~
Plumbing (DraintWaste Pipe) Mechanical Final . . Z-l.:" S- ~. ";ZZ ,'L
.
Electrical Ground Electrode/uter . . . }.J;., . t:.
SetbacklFormslTrenches (Footings) . Gas'Test
00 not install subfloor or pourfloor slab until the Engineering/Grading Final 765-5126 . .
following applicable items have been signed:
" ~ :f7-u~ -Jk
Plumbing (Water Pipe.Sprinkler Valves) Fire Depl. Final 765-4040 1<. .
Mechanical (Groundwork) Water Engineering 765-5268 )0.
Electrical (Underground Conduit). .
Pre-slab (Compaction/Membrane.Reinf. Sub List/Business License 765-519 f/7:2-os l/J. .r.. .
Underpinning (Aoor Joist/Girders) . . Z"ning 765-5139 . <: ?/~~<' J..a. l~
00 nolcover or conceal the work below until the -~ BUilding Final' \tast Inspection. Onl~t rzq~ 'h,
following applicable items have been signed: ~ . fter Above Complete
1st Floor Shear' . ~. . PARTIAL INSPECTIONS /(j ~'Z-bt
Firesprinkler (Rough) .. . Buildina InSDections 7l!~/I ~h'bs.. ~ -
2nd floor Shear '.11 l
. Roof (Sheath ing/Dlaphragm/Frame) . ~2~ -M A.l 7-/:?'-P<b fi>t:PV7/'J7~ ';tJ..p--,::> . .
Masonry (ReinfJBond BeamlPre-Grout) . , &;. ,; 'L>X- r ",...-1//
Rough Plumbing (Top Out) . ~ -
.~/_ _"-- -hi/s L..L I?~ .A.
Rough MeChanical
Rough'E1ectrlCaI (Dry Wall) . -7-1i-pl//~- !J1fp;::P077NA4 5/'1,51 WI', \~
Rough Electrical 4!t/~13tZ!f'.f.f'eK,( /p ~7 je/.
Framing "(Only.afterPlbg., Elec.. MeCh_. and .'1. "
InSulation (SoundlEnergy) I t lWIeC;haniC;SI III~- ntie n5
00 not tape or plaster until the following applicable C;,/"
items have been signed: . '. . .7~1'o9'~aG'-54W?A:-S ~~
Drvwall rl.llll1t . --:f.I8f. . ~~v/2 /.?Mb/(,'~ _ . ..... ".
Penetrations (Fire Rated) Electrical
Penetrations. (Fire Rated) Mechanical 7--n-o/?-.?~yR4V.f(!J <;.,....~L qJ//'''t~AAf ....
Penetrations (Fire Rated) Plumbing : .' .. . .
Interior Lath A f . J?#~< ~. ... '.
, . .V - . . 1 JJ{
Exterior Lath 'I'NCe,! ov~_ "1L."7' cl ~) n.r09'J I "" .
. . GENERAL m,MS /. Q'"-?f)....,4-
Exterior Plaster (Brown Coat) .' JiMDlJIl-" I . -:r//19'6Y !Hf-;..J r;~/;'9 Q \h</~/o-r
T -Bar Electrical .' .
T-Bar Mechanical tJJ.kJ../ (~/cr/c-r d 1;;;<;) lJ1ci.i-r
T -Bar. Structural "t, .tFledt/* ~ ~ ~'/t j/(~<A' +..
Sewer.
Water E;ngineering-Backflciw . k/ .
-- -/[~
Water Service . ..... . '. . l(...~ ..... v..w,f.lW--
~
\\\'ltt{01\- ~ ~ uJa) :U~ ~
~-:t ~~LC lo~..r.~
~ //'30-01 P.vf,;/.r;~J(f2 cPeJ-l?-
('f~ y-e-( ')c P{!dls f;.Jt5)
.-fr 2.-z.cr ~. 4r ~5tc-
7C8.~7
/
TYPE OF PERMIT
Blockwall/Coiumns CITY
DATE: 12/10/2004
JOB ADDRESS: 8712 E SANTA ANA CANYON RD
LEGAL DESCRIPTION:
BUILDING DIVISION
200 S.. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTioN: 225
BUILDING PERMIT NO. BLD2004-04389
APPLICANT:. KINDRED COMMUNITY CHURCH
OWNER INFORMATION: CONTRACTOR INFORM';,TION:
ARCHITECT/ENGINEER INFORMATION:
JOB DESCRIPTION:Construct6' high equipment enclosure block wall per clt/~tandards.
VALUATION:
6,000.00
PROCESSED BY: ENO
WNER-BIJILDER'OECLARA TION
I hereby a irm Ll er pena 0 perjury that I am exempt from the ,Contracror/., license aw or t e, .0 lowing reason (Sec: 70 1-.5 Business and
Professions Code: a TY'I city or county which req wires a perm it to c;::onstruct, a fr.{: r, im"prov:e,:d ema Ush -or Tepa ir any structure, prior taits issuance,' also
requires the applicant for such permit to file a Signed statement that he i~ Iic~1ised ,'por~Vant to the prt:lylsionsoftheContrac:tor's License Law {Chapter
9)(coffimencing with Section 7000 of Division_ 3 of the Business and,Profes;;:kllis Codej:o~r ttlat he is exempt therefrom and the basi,s' for the alleged.
exemption. Any violation of Section 7031.5 by any applicant"for a permit sut:;ects th~:applicant to a dvil pen::llty of-r;0_t more than five hUndred dollars
($500). . .. \ .... . .. .. . .
l\dl I,' as owner of prope.rty, or my employees with wages as their sole ccm~t.l'sation~ will do the work. andthe;structui'~)s not intended oroffer~d for
~e (Sec. 7044 Business_ and Professions Code: The Contrac.tor's License t:-aw do,?s net apply to an owner of property who builds or improves
. thereon, andwtJo does such work himself or hefself or through his or her owh f.:mplcyees, ,provided that such improvements are not intended'or > ,:
offered for sale. If, however, the building or improvement is sold with one y~;ir of c.cmpletion, 'the owner-builderwill have the burden of proving.t~the. .
did n0t buildor improve for the pUl'Poseof sale)., ".-L, . " ,_' . "," ,';i~:."~Y"
0,' I,.as the ,owner of the property;. am exd,l.1sively contractinG 'l/ith licensed:'i:ontractors to construct the project(Sec. 7044 Busines,,:> and profess.i6ns
Code: Th~ Contractor's liCense Law does not apply to ar1 owne; of property:i'Jho buliJ:;; or improves thereon,-ar.d who contracts for such projects :with
Ron ctor(s) licensed pursuant to thee n ractor's Lire' Law). ' .. -
.) ~!1J ex mpt under. Sec. P. . J_: /
a . .~. Own . ., .
WOR ATleN DEClARATIQN; . .._.J L
I hereby affirm uncer penalty of perjury one of ~h€: followlfig declarations: I
o 1 tlave and wjll rnaintaln a certIficate cf consent to self-Ins~t(e for wor~E::( ~-:;crnpl?"l)s;:~:on,
as provid~~ i~r by Section 3700 of the Labor Code, fortr.e ~erforrr'Cl-r'te vf:f"~ VJork i(;r wh;C!), I
thIS permit ./S Issued. '. i I
o I have and will-maintain worker's ccmpimsation insurance,as reqwred tF SectL.Jn .3'100 of
the Labor COde, for the pe!formance of tt')e work for which this pern~it is jss:;f:d. My worker's
Compensation insurance carrier and policy are:
Carrier: Policy Number.
LICENSED ~.9NTP.ACTORS OECLARATlQiil
I hereby affirm under penclty of. perjury that"! 3i1)
licensed un<;ler provisions of chapter_9lcornmencing
-W'ith Section 700t))'of Di\,;sio:: 3 of the' Business and
Professions Code. '
12/10/2004
Date:
NUMBER
Contri3ctor
EXPIRATION DATE
Dale: 12/10/2004 Appi.icant:
. WARNING: FAILURE TO SECURE
UNLAWFUL, AND SHALL SOBJEC AN
FINES UP TO ONE HUNDRED 1H USAN OLLARS ($100,000), IN ADD:TrON TO THE
COST OF COMPENSATION, DAl AGES AS PROVIDED FOR IN SECnON'.3706 OF.THE
LABOR CODE, INTEREST AND f\TTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY _______
. I hereby affirm under penalty of perjury that there is a construction lendini):3',;.t1ncy for the
performance of the work fo:r which this permitis issued (See. 3097 .C:v.C):' "
L..~(]der.-S lnfonnatlon:-- ~- - -- - -
TYPE
Construcion Types:
VN, ,
Fire Sprinklered? NO
f certify that I have read this application and state that the above information is correct.' I
agree to y with all city ordinances' and state laws relating to bu iJding construction. and
febyaut orize representives hi~ city to te~ upon the above mentioned propertyfor
ectio
Date: 12/10/2004
Fees paid for Permit:
Total: 12S.80
ignat e of Appli nt or Agent
The er hall expire by limitation and become null and void if the building or
wor Lhas not passed final inspection 365 days from the date of permit issuance. A
new I'ermit is required to commence or continue work. . .
INSPECTION RECORD FINAL INSPECTIONS Date . Inspector
. INSPECTION DATE INSPECTOR Electrical Final . .
TemporarY Power Pole Plumbing Final
Plumbing (DrainlWaste Pipe) . Mechanical Final
'Electrical Ground ElectrodefUfer /1/
SetbacklFormsrrreriches (Footings) IJ_JL-6 '\'J. Gas Test .
Do not install subfloor or pour floor slab until the " Engineering/Gradirig Final 765-5126 .'
following 'applicableilems have been signed: . . .
Plumbing (Water Pipe.Sprinkler Valves) FIre Dept. Final 765-4040. I. -
Mechanical (GrOundwork) . Water Engineering 765.5268
Electrical (UnderlJround Conduit) .
Pre-slab (Compaction/Membrane.Reinf. .Sub List/Business License 765'519
Underpinning (Floor Joist/Girders) Zoning 765.5139 .,. .
,;
Do. not cover or conceal the war!< below until the Building Final ~ast Inspection- onlY)h ~n~ IlL... f'. j
following applicable items have been signed: .. fter Above Complete)
1st Floor Shear . PARTIAL INSPECTIONS
Firesprink/er (Rough) Buildina Inspections
2nd Floor Shear' .
Roof (Sheathing/Diaphragm' AJ . . .
Masonry (ReinfJBond BealillPre-Grout) 1)/7/1.. .Ql c--...-q.: t-::.", '. .
Rough PlUmbing (Top Out) . ". I
. ,Rough Mechanical .
Rougn l:IectrlCaI (Dry wall) '.
Rough Electrical . . .
.Framing {Only_after Plbg.. Elec.. r.,.1ech and Fire}
Insulation (SoundlEnergy) .
Do not tape or.p/aster until the following applicable Mechanical Inspections
items have been signed: . ..'
Drywall . . '. . .... .
Penetr.ltions (Fire Rated) Electrical .'
Penetrations (Fire Rated) Mechanical .
Penetrations (Fire Rated) Plumbing .' '. .'
Intllrior Lath. .
Extllrior Lath . Plumbing Inspections '.
GENERAL ITEMS
Exterior Pla$ler (Brown Coat) '. '.
T -Bar Electrical .
T.Bar Mechanical . .
T .Bar Structural .' .
Sewer .. . . . . .
Water Engineering BackfJow Eiectricallilspections . . .
'.
Water Service ,
BUILDING PERMIT NO, BLD2004-03798
ElM
BUILDING .DIVISION
200 S. ANAHEIM BLVD,
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 320
QUARTER SECTION:
TYPE OF PERMIT
New Commercial Construction . C I TV
. DATE: 11/9/2004
JOB ADDRESS: 8712 E SANTA ANA CANYON RD
LEGAL DESCRIPTION:
APPLICANT: PAUL MITCHELL
OWNER INFORMATION:
Church Garden'
E Santa "Ana Canyon Rd
Anaheim,CA 92808
JOB DESCRIPTION New 507 sq.ft, 9arage (maintenance building) and trash .Il?IOsUre,
VALUATION: 60,000,00 . ( . PROCESSED BY: JNJ .
I .. . . .. OWNER-BUILDER'QECLARATION
.1 hereby affirm under penalty of perjury that I am exempt from th~ Contractorl".,Ucense ,Law for the fcllowing reason (Sec. 7031.5 Business and
Professions Code: ar-lY dty or county which requires a permit to construct, att~'r;..,improve,demolish or repair any structure, pripr to its issuance, alc;o
requires the applicant for such permit to fiie a signed statement that he is Jice1&'Bd pur$:uant to the provisions of the Contrad:<?r'.$ License Law (Chapter
9)(commenCing with Section 7000 of Division 3 of the Business and ProfesSlO'.;1S Code) octhat he is exempt therefrom and the basis for the alleged .
e.xemption. Any violation of Section 7031.5 by any applicant f'Or aperrnit subj~\Cts the appl.fcant. to a civil penalty of oat more than five hundred dollars'
($500). . .: ..1.. .... ,.:!i. .
O. I. "as Qwn~r of property, ,or my employees with wages ast'fleir so\e~?:1)8t:sat!on, will do thewotk~ and the structure is not intended or o~eredfor
sale '(Bee: 7044 Business and Professions Code: The Contractor'~,Liceirse_':~_~Wdoes notapplyta anowner of property who build~o( improves .
thereon;. and W~lO does such worfS, himself or herself or thro,ugh his or her ow.N'~mplay~es, provided lh?t such improvements are_ not intended or _ , '_<,
bffered far sale;_ If. however, the buliding or improvement is sold wfth one ye~1[:of conipi:e:tion; the own~r-b.uilder wi!1 have the burd.er. of proving that lie- ",.
~irj n t.buiidor improve for the purpose of sale). . ,':::;'l,:. ,: _ . ). .. ./ ._;
.'._C...b th. e owner ofthepr<?peity, am excbsiyelY c. .cnti<lcti.f)9. Wit.h..'i~e,:'f>ed.:...'d~;'.'~.,..tract.:o rsIo cons..t..r lJct the proJe.,.ct (See. _7044 Business and Professio'l1~ ;
de: The Contractor's License Law does notapp!y to.an owner of property:' ,bo bUilds or imprf)ves thereon, and who contracts for such projects with -.
~. ontract_~r(s) lice.ns~ pl!rsuam to the COl1tractor~~ Ure~~ :awl..:::-'. .' ,.:~...:.':~: ... " . , .
I an:;t~9-'p~ IJnder See.--_ . .C .._ 1~""_+1! ~:-;-- ,.
ate: tI~ Owner. ~ " . _-~
I '... WORKER'S M ooNSATION DECLARA.TION'B:, I UCENSED CONTRACTORS DECLARATION ...\:
I hereby ~ffirrhynder p~nal,tyc:__perjuryolle cf the fdUowing deciar~ti~ns:___,,_. ,:.;.~:~:f, , I hefeby affirm under penalty of p~ijt!ry that I.am.:~,:.:
o f h~~~ and,WiU rna{0tain.8Ceitif:cate.Of consent tr)'seW-,~~sure fOi wO~k~<~-r,ompensati~n,. ~i~en.$ed ~nder provisior,s?.f c.;hap!er 9 .(c-o:nrncncin~
as prQ....'dedfor oy Section 3/00, of tne Labor Cede, .for~h,e periormance cfth:tl~...ork fo'r whlc"1 With Section 7000) of DlvslOn 3 0,_ the: BuslIless ana
. this permit is issued. 1 _~' -':J ...... '-:: c .,:-1:' Professions Code.
D ., have and will maintain worker's compensation !11.~urar.-ce, as required, b_ylSection 3700 of 1-1/9/2004 _____
. the Labor Code, fo'r the pe"lforrnance of the work for which this permit is iss:Je:{i. Myworker's Date: Contractor.
Compensation jnslirance carrier and polic.yare: .. . f
Carrier: ' Pelicy Number: l. NUMBER EXPtRATION DATE
~'-hi sectlonneednotbe.~omPlete.djfthe~errnitisforonehundreddO!lars{$!g~c;1~~J~S. ' .. ,;. TYPE
r- I certify that in the-performance of the work for which this pem)it is !ssu~~',i-snc:;ll not
.. by any person in.. anymanner so as to becom.e subject to the workersc'2,..,peilsati.ontaws
f Califamia. and agree that if 1_ should become subject to the worker's cor;'pe;;s~ti6n'.
provisio~s of ~c~ion3700 Of the La sha\ rthwith ply v.>ith tht~;-e;:provisions.
I
!
I
CONTRACTOR INFORMNnON:
ARCHITECT/ENGINEER INFORMATION:
TERRY 0 JACOBSON
Date: 11/9/2004 Applicant:
WARNING: FAILURE TO SECURE ORKER'S COMP SATlON COVI"R/S
UNLAWFUL, AND SHALL SUBJECT AN ,EMPLOYER TO CRIMINAL PEH1\L','![OS AND CIVIL
FINES UP TO ONE ,HUNDRED THOUSAND DOLLARS ($100,000), IN AODqON TO THE
COST OF COMPENSAT.ION, DAMAGES AS PROVIDED FOR IN SECTION :'?OB OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES, .
I CONST~UCTION LENDIN~ AGENCY .
I hereb~' affirm under penalty of perjury that there is a construction lending atl~~1cy fc:r the
_ p.~I1~,!,aJ).ce pf t~~.Y'!.~t~.1QIl[...t1l~__Qi!S Q~[l!\itis_ i.sgy~(i.(~_?c. ;?q~7 .Cl'{.Ct___ --L..
Ler:~er's Information: . .' '",. - - -, .-
Construcion Types:
VN, , .
Occupancy Groups:
U1, .."
Fire Sprinklered?
NO
~-,,:--,
. .',', ,'- ,...... >"~\,;l_:;~ _;
I certify that I have read this application and state that the above information i~ correct I
agree to comply with all city ordinances and state laws reJ;;lting to building cOl15tructian, and
her by authorize represe-ntives of t is city to enter upon the above mentioned property for
ips
. Date: 11/9/2004
Fees paid for Permit: , .
Total:
3.767,60
Signa~ure of Applicant or Agent c::./Ju~
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.
... . INSPECTION . . DATE. . INSPECTOR Electrical Final
T emporaiy Power Pole . Plumbing Final
..
Plumbing (DrainlWaste Pipe) .. Mechanical Final .
Electrical Ground Electrode/Ufer .
. SetbacklFormsrrrenches (Footings) Gas Test
Do nol install subflooror pour floor slab until the Engineering/Grading Final
"following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves) Fire. Dept. Final 7654040
r.le!:hanical (Grouildwork) . Water Enginee.ring 765-52
Electrical (Underground Conduit) Sub List/Business License
Pre-slab (Compaction/Membrane.Reinf.
. Underpinning (Floor Joist/Girders) Zoning 765,5139
. Do nolcover or conceal the work below. until the Building Final ~.ast Inspecti
following applic'lble items have been signed:: fler Above C
1st Floor Shear. . . PARTIAL.
FireSprinkler(Rough) .
2nd Floor Sheaf... . .. . . ~l ~ildina Inspections
RQQf1Sheat . aphragmlFran .\ ~ j l. -I {.e> <.( S"e.,..::.
Masonry (ReinfJBond Beanti't"'e-GfO\It) Iz -I'). / ~-4QV: .. ./b cKl- 7$L)O~
Rough Plumbing (Top Out) I .f1-'U.~<f 6t- If.c
Rough Mechal)ical .
ROugh Electrical (Dry wall) . ..,--;:) /I?<l.IIlf-. ~ {.
. Rough Elecirical .
. Framing . (Only atrer PIbg.. Sec.. Meeh, and Fire! ,(l'.Z7-Ac.I_"2d1. /
Insulation (SoundlEnergy) . '. "iC~~ilar.~rec'ti
Do not tape or plaster unlilthe following applicable
items have been signed: . . . .~ :S::'-(b ..
Drywall . . ..
.Penetralions (Fire Rated) Electrical . . .
Penetralions (Fire Rated) Mechanical
Pllf\elralions (Fire Rated) Plumbing .
Interior Lath . .. ,Plumbina Inspection
.Exterior Lath
. . . GENERAL ITEMS
Exterior Plaster (Brown Coal) . .
T -Bar Electrical
T ,Bar Mechanical , ..
. T .BarStructural .
Sewer I ..
Water Engineering Backflow ... . ' Electrical Inspection
Water Service . . . .. .
INSPECTION RECORD
FINAL INSPECTIONS
765-Q126
68
.765-519
s
s
BUiLDING PERMIT NO.
BLD2004.03800
-",~
<,..,. ..I.
CITY .:;l,~'t~HEIM
'\;~{:tJ~~0r~:i/ .
,
,
BUILDING DIVISION
200 S. ANAHEIM BLVD..
(714) 765.5153
INSPECTION. REQUEST.LiNE:
(714) 765. 4626 .
CENSUS CODE: 320
QUARTER SECTION:
TYPE OF PERMIT
New Commercial Construction
DATE: 11/9/2004
JOB ADDRESS: 8712 E SANTA ANA CANYON RD
LEGAL DESCRIPTION:
APPLICANT: PAUL MITCHELL
OWNER INFORMATION:.
Church Garden.. .
E Santa Ana Carlyon' Rd
Anaheim. CA 92808. .
JOB DESCRIPTIONNew 233 sq:ft. electric swich gear build\n~ and reta\:1ir:g Vti!l;\-,
. .' . . ... '0"
VALUATiON: . .40.000.00. . .... PROCESSED BY: DUC
L . . OWNER.BUILnE~,*U\!<AT!ON ......... .. -1
I here~yafffrm under-penatty of perjury that I am exempUrcmt~ Contr3<.:;t""rl_l,jce~e_'Law'forthe following reason (Sec. 7031._5 Business and '. ~
~rofessio;'s Code: any city or. county which requires a ;J9rm(t to construct, a:~IIIr._:_imp(Ove,.defl19!i$h or re:pair any structure, P.tior to its issuance, also, '
requ,i(=s :he appHrent for su9tl permit tiJ,file a signed,st~temen~ thal-he i51\c'~).lsod piJr:5lJantto' the provisions of the ,Cojjtractor's~Licens~ LaVII (Chapter
.9)(cumpencing, with Section 7000, of Division 3 of tnhBL''3iness ~nd Prof~s~~),,> Ctid'_efot"that he is exempt therefrom and the basis for the aHeged ':';
. exemption; Any-violation of Section 7031.5 by.a:1Y appticantf<;.if a" permit s\.t;1L'Cts thtj:41pp!icant to a ovn papally 61'not more than five hundred dollars
($500).:t ""'" ,> "" .' '" _ , ,"1\,' ':''',.~<.-' _ "", ..',.
[Jt;.as owJ:ter of prqperty, or"rTlY e.mployees with W2gSS as tl~dr'so!e c0m~~'nsaiicn>Ni!l cio tne wc:.irk, and the-st(ucture is notintandedor offered for
sa!e(Se.c~ 7044 Business a.nd P.rofe~sk>ns Gode: The Contra(,.tor's"UcenS0~_~w ooe'sDot -ap;.)lyto em own~r of property who builds or-improves
~~er~9n. and who does such work himse;[{.ar he,rse:tor through h!s c.f.,her o':'-',<f'em~!.o'J~e~', provided that suqh improvements are not intended qr
'oJf~red f(';.r ~!e. if. how~ver, thec_uilding'o,r !mpr:';'1/e!T,e~1t \5 :;;o~ with c>:1.':'} ye~&- ('.f C9f!::pletior." the oWI)er-buil~er will have the burden 'of proving that he
~'d ,otbuddor:mprcveforthe;';-lirposeofsalz). f . ~
I. as th,) ownc:- of ~!1e prope:iy, 3m exdustvety ~cntraC1ln!J With li~en~ec! ~oni.rZ1ct<.::-s to construct the project (Sec. 7044 BLlsiness and Professrun..>
- . The'"'Contractor's L:cense La.......do~ not a~ply to .~m o....,w.er Of propefty);:;rIO bUl!cs or l,t1f.rcves thereon. and who contla<.ts fer 3U~ proJect') with
f'J;onl,a~or(s)t;c?n.ed pursuanttOth~CO~~~ i " '. :::.....
L..-J i~i)~~(Undersec. ~ ~or ;::;'. --.,..:1l-':-- __' " __~:::i;..
D"t~k_.,l_~ Owner. , _ ._. _.Eff-;;!Ji.'!>'O~<>AJr7"::Kft,d"J/~ .,' ,":
r . ... '. WORKER'S CO, PENSATION DECf.ARAl'iOtL....J:J.__-1, [""LICENSEO CONlRACTORS D,"CLARATlmJ "l.
. I he~eby:a!fi:rm under penalty of perj~ry one of the follow1rig dec.l~(at;ons: . , -::f; ~:; ::. _::;.,~', _ ;',> , \ ;/-:~._'o:)h~~~Oy afin (l Ulyj(3 r penaliy of -p~rl~~Y- th~U, ~~,~:!;,-:::~?:: '
CJ!hC:,ve 'ai"d wi!l,rr>.ajr:~_~jrl a certificate of ;:x:m~.ent to self-i\lsur~forV"O~kb~tcolilP~-n?:~~j'C~;:^) :})~:e:~~~9y.r:_~erproVi;~~S?f c~apy;r,9 (::io,?",m~~Cjn~9_'('X
as provioedtor by Sectioh 3700 of the Labor Code. for the pe!fcrm~~,cc cf ~i~f~;c0rk)or\';fhi~~;~'~'" :.;~tt:l.:,ef~lOn ?,OOO) o. Dr~lOn --:,ort~e' Bu~,~~,~S$: ~_;~,..:.~::'
:his permit is iS$;ue<1.' , i" -~_': I ,Pro~~~.cf'!$ Co~e., ..:-' ',', '> '
o !.have <:fr;j \"Jjll ma,ir.!ain worlq~:r's compensation ins.uraf.b::l. as required bI.rS-0Ci:lon 3700-0f 11/9/20CA.'---'::-.;.
the LahorCode, fOfthe pertcan,;,nce of the warY. klf whkh'tn;s rerl'(lit is issu{:L MY'iv-orker's .Oate:'
Compensation insurance carrier and poliql are: (-
carrie::" F',oiicy i'~lJrnber. J;- , NUM~ER
Thi ~ octionneed not he qDmp!etedifthe permit is fer on~ hundred do:!,v.') ($'~;g=r'~f_'~s. .,' ',:TYPE :
J- ertit)~ thatin the performance of!he wOik forv"hiCh this perrdtis h:>s:DejL-Lshall not" L--
e. . ..,ro any person i.n a ny manner so.as to become subject tG t.'1e W0!"ker~:.,..ii~'rfOefle.?tion laws ". ' "" , .
of California. and agree th"d if I should become subject to the worl<:er's c'_':;rrft::fi::;,aticn~ .' .
. provisions of Section 3700 of the La C .e, . all IT ithc 'l'IYVJ"h";[;~;:; eOr7~t~cionTypes:
DC:1te: 11i9/2C04 Applicant: ~~ ':' " _' Occupancy Groups:
WARNING::FAILURETOSECUREW K R'SCOMPENSATIONCOVER.';G_,J" .. U1.'.., . .
UNlAWFUL, AND SHALL. SUBJECT AN EMPLOYER TO CRIMINAL PEN.~l'm:S AND CiVIL Fire Sprinklered?
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100.000)., IN ADIY:TiON TO THE
COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTlOrJ ~7Qo OF THE
LABOR CODE:mTEREST AND ATTORNEY'S FEES. I
I . CONSTRUCTION LENDING AGENCY. ;_-' ,__ I
I hereby affirm ur:lder penalty of perjury that there is a constn~cticn !encHnq ,o:;;;J!v:::'!for tho -~
.perfQqnance ()r the work for whi,d,l Jl1is p.ermitts J.s~LJ~d (S0G. 30~Q?,Civ..C!'_ d:." _._~_l
--l~j-1d9isinforrri~:itron:'- -. ---- --. --. -----
CONTRACTOR INFORMf~rtON:
ARCHITECT/ENGINEER INFORMATION:
TERRY 0 JACOBSON .
Contractor
EXPIRATION DATE
NO
"".H'_'I'."
".,'.'
I certify that' have read, this application and state that the 4lbove information i;; correct. I
agree to comply with all city ordinances and state laws relating to building cor.struction, and
l1ereby authorize rep'resentives of his oty to enter upon the above mentioned property .for
insg io ses
Fees paid for Permit:
Total:
1.447.1Q
'-.
Date: 111912004
Signature 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.
INSPECTION RECORD'
FINAL INSPECTIONS
Date
Inspector' ,
" INSPECTION,
Temporary Power Pole '
Plumbing (Drilin/WaSte Pipe)
Electrical Grounil ElecttOd I '
SetbacklFormsrrrencheS((FootinQs), \1'1/2.-3-"
Do hot installsubfloor or J~"w,:-"oor s,a, until the
foHowing appljcable items have' been signed: . ,
Plumbing (Water.Pipe.Sprinkler Valves)
MeChanical' (Groundwork)
ElectricallUnderground Conduit) ,
Pre'sIaP (Compaction/Membrane.Reinf. "
Underpinning (Floor JoisllGirders) ,
Do not cover or conceal the work below uhtil th!,
followin"g appl,i.Cqb1e: items have be~n signed: .
1st Floor Shear'
FileSprinkler (Rough) , '
'2nd Fioor Shear' ,/I
RQof (SheathinglOiaphra ~ /-6 ~ ~ ,f<.l..,..
M~onry(ReinfJBondBe;tnlPr...Grou1\i i>'-n.fo'l'Dr',/'- (, " ~~, /l-2.D ":lJeJ-q;.t.l ~ ,~~, S"y;_
RoU9hPlumbi~g(TopOut) /' " . (11,jM~Ure- krllJ..c)./,.--/'P f(:LLiJP.-~"-uh' "
Rough Mechan,,:al ' , . "'to/v'r r, ,',' IA:_ V- . ~
I ROugh 6ectnCal (Orywall) h-(V-,r.(. ft."". 5/'...:f is-,! {2.#;....J c,#~
Rough Electrical ' " '(/ , '
Framing lOnlyaherPJbg..''EJec.. Mech and Firei - ' .
Insulation (SaundlEnergy) , ' , , , ". .
Do not tape or plaster untillhe following applicable ' " ' , Mechamcallnspectlons
items have b!'en signed: ,. , '
DryWall'
PenetrationS (Fire Rated) Electrical
Penell'atlons (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbil1!l
Interior Lath
Exterior Lath
DATE'
INSPECTOR
Electrical F,ihal
,
Plumbing Final
,
,
/
Mechanical Final '
GasTe~t '.
Englll!'ering/Grading Final 765-5126
fire Dept. Fina17654040
Water E,ngi,:,eering 765-5268
,
,
..
, ,
/u .;-
_ (;_h
, ,
, Sub List/Business License 765-519 '
Zoning 765-5139 , ' '/1-,1 0< _
.
Building FinallLast Inspection- OnIY;J: --X:, :A/' 1Ll_'
. ,'" , ,After Above Complete" '"'Vil~"~
PARTIAL INSPECTIONS
, . ' Buildina InSDections ' ' " ' , '
-f-12-,.,.6'fF-oo!1I/C; +, a/<>r (b)6cvtd~
" '
IVt. ,. "
" 9l
' '~~
,
,
"
,
,
"
, ,
"
, "
"
PlumbinQ Inspections
"
GENERAL ITEMS
Exterior PIa~er(Brown CoatI
T -Bar Electrical
T;Bar Mechanical ' ,
T -Bar .Structural
Sewer
Water Engineering Backflow
Water Service
-', '
,
,
,
,
,
,
, "
ElectricallnSDections
, ,
,
, '
,
,
, "
TYPE OF?ERMIT
Light! Flag Pole C I TV
DATE: 11/5/2004
JOB ADDRESS: 8712 E SANTA ANA CANYON RD
LEGAL DESCRIPTION:
/<~\:~:';~};r:l/;\, , .
I",,:r$' ',1'-.'""[\.;,/....\
lie ,(7...... ,'"\.:""'s::q\O'\ .
Ii...?,;?]._'__ i:'\:i;'*,'P'lkI
~.eE;....'.....;:.(_.o'.'."....""\ .... ElM
,~ . ..",.\.~ " -\.
I'U ".~i.J: "~"'.' .;V); ; 'j
, ''--<;'"-'''''-''-''.!M:;-.u;J''' ,
~ "~-:;".;':~:::~~:'.~j'
~~B.,'::.o"::"{<' ',-~$:.
~v""<...,.y,,.;,,!:/?)...
"'ctI:;:- ,;~};;/.
BUILDING DIVISION
200 S. ANAHEIM BLVD.
. (714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 329
QUARTER SECTION: 225
I:lUILDING PERMIT NO. BLD2004~03779
APPLICANT: PAUL MITCHELL
OWNER INFORMATION:
\ .
CONTRACTOR INFomi,ATlON:
. ARCHITECT/ENGINEER INFORMATION:
.1 '
\
,
. JOB DESCRIPTION:lnSIaUatio.n of 65 light standards.. Maximum height of 18[1'0..:1
VALUATION: 75,000,00 . '. ., PROCESSED BY: .CDL
I ..' .' OWNER-BUILDS;foECLARATION, '
I ~ereby affirm under p.enalty of perjdry thatl am exemptfrom:the Contract0(;s.Lic~9seLaI;VJ~rthe fCillowing reas9" (Sec. 7031.S Business and .
Professions Code:_ any city or county which requires a permit to construct, ~l~~r~ improve,-.'demolish or repair any structure, priorto its issuance::, also
requires the applicantfor such' perinit to file ,a signed stat~~nt th:::!~ he is !~d};~sed~p'~;fsuant t9 the provisiorls of the Contractor's license Law (Chapt~r i
9)(comm_encfn~ wl~h Section 7000 ot"Division 3 of the Busin'ess and Pro;c:~~~1&>hs C:ode) or,that he is,exemptlherefrom and the ba~is for the alleged,
exemption. Any violat,ion of $ectlon,7031.5 ~y any applicant for a permit 5:"h~t'Cls' tHe appHcant to a civil penalty of not more than five hundrE'>..d dollars
~~}a.'s a.w. 'ner ~f property, or '1'Y" e~p1aY"i<SWi\n wageS as th.eir SOle. com:~'''''ltlan, wil! do the. work, dild fhe struc~.re is ~ot intended or o. tfeted fcJf
- -~ (Sec. 7044 Busr~eSsa!1d Ptofessiar:i:fCodt3: The Contractor'$Ucel"\~<::,j'0V/ doe3 notapply;o an QWl)er of property who builds or improves
i;l~{~OI", BncJ.who does such work himself or herself or through his or ~e( c,>;;ri~mpJcyees, provided Ul8t such improvements are oot Intender! or
off3nad for sale.: if, however, the building or improvement is sold It/ith one :}~Jjfbf corilp_l~t!ar.,thc owr.er~build~:r wi!l have _the burden of prevtng that he
didl~Gtbuildorimprovefort~iepu-rposeofsale)., .,t- -,:<:':.:, ..,' " '
0' 'C-~s th'3 owner of the prcperty, .am'exciusiveiY (;orrtrading V{ith'licens{;':~;]:~:1tr~,.;t(Jr~"tG.construct ~he ;:lr6ject (Sec- 7044. 8usi~ess and Prof~ssions
Cod_e: Th~ Contractor's License" Law does not apply to an owner _f../f pr9PE:r~.~t~'J h.o t/l;l.~d~-:6r'"improves thereon. and Wi10 corit~a~t.s for SUch. projects Vlit~
f.l..qontr~ctor(s) licensed pursuar;t ~o the qo ractor:~r U _:3 ,law)._:, t- , . '" . , "
LJ . " '," . .
! ~r;t"' e.~ x~. mp.t under sec. .. ' . f r I. 'r s.' __. ?,{~.. .....___~
. bote:;j~ownGr' . . f~f!:#J~~J"'> ,Z:.c': ..
r-:, .' '...,. WORKE~S COMPENSA'rICN m:cu>.RATiON-::J___.---1 L, LiC~EnCONTRACTciRS DECLARATIO~
I h€!fe~y ~ffirm_';.J~der p~qaliY o'f PEl!"jwyone of the followingae0iard,tions:' _1 ':. " ' ! hereby attrrni under penalty of perjur'(.Jhat Jam
O_'':-J:D<::lye and w:j1i119"intaln a" certifici3te ofwnsent to sejf~jnsi.lre; br' WOf:';':}r'~ C9r:lpe~S;)tjoll, licens~j unda previsions of chapter 9 (commencing .',
as pr~v'idt.-cfor by SE?Ctton 3700 of the Labor Code:, _for t.he performance 01 ,;'\:l~w(.ik fer whidl wi~i1 Sect:on 1000-, of Divsion 3 aftre Business ~nd
th!s'peri11iti~nssued;!'. <~:'t"' " Professions C'O'je.
U I 'lave a nd wi!~ maintain worker's compensation insurance, as requl!'f:d ~l'~ SectIon 3700 of ( 11/5/2004 _~
the Labor Code, fOl the perforrnanc::e of the work for wh;e:h this pe"mit IS 1$5'.'';;:'1. Myworker's I Gate:
CompensatIon insurance calner and pGlicy are: I I
Carrier: Pohc.'Y Number \ NUMBER
,
ihi ~ection need not be com~letedifthe pemlit.is f~r one "ur.~jed dollars ($1VC.~~lf_!esS. t TYPE
-, f I certIfy that in the performance of the work for which this permt ~<; ;ssu~t.~, shall rot I
lay any person in any manner $0 as to become subject to the workers 61'lpensation laws
of Califomia, and agree that if I should become SUbject to tne worker's CO!TI;:'f::~'satiQn '
provisions af Section 3700 of the Labor od II/to WIth com WIth" !h:.;~e provisions. Construcion Types'
! VN, ,
Date: 11/5/2004 Applican ~f. Fire Sprinkfered?
WARNING: FAILURE TO SECUR WORKER'S COMPENS TION COVER/'":;;,, IS
. UNLAWFUL, AND SHALL SUBJE T AN EMPLOYER TO CRIMINALPENAl'\tES'AND CIVIL
FINES UPTO ONE.HUNDRED THOUSAND DOLLARS ($100,000), IN ADGI'f,ONTO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION )706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES, . ';
I CONSTRUCTION LENDING AGENCY _
I hereby affirm unde~ penalty of perjury that there is a construction I,ending ag;~icyfor ~he
'peiiormance of the work for which' this permit is issued (Sec. 3097 ,CiV.C): ~;
_Len_dBL:!...!r.f:.~tmatic:::!:" ~------'--~~_'-----'____ -__ _~___-=,,-,-::.:c - ~~-______,__~_ ------__
Contractqr
EXP:RATlON DATE
NO
I certifY that i have read this application and state that th~ above informatiol1 is t:ot'rect. I
agree to oomply with all city ordinances and state laws rerating to buRding construction, and
hereby authorize representives of this- city to e r upon the a bove mentioned property for
inr.p peet . ~ ur se
"-b Date: 11/5/2004
Signatur of Applicant or Agent
The permit.Shall expire by Iimitatioil.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 requiredto commence or continue work.
Fees paid for Permit:
Total:
2,524.~9
INSPECTION RECORD
. INSPECTION .
.. DATE INSPECTOR
T empora.ry Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/'lIA. /> -)-.-'-
S,etbacklFormsfTrenches (foo~) . 'Z.~. j~\,./.
Do not install subflooror,pour or slab until the /
following applicable items have been signed:' .
Plumbing (Water Pipe.Sprinkler Valves) ,
Mechanical (Groundwork)
Electrical (Underground Conduit)
, PIll-slab (CompactionlMembrane.Reinf.
Underpinning (Floor Joist/Girders)
Do not coveror conceal the work belOW until the
follOWing applicable Items have been signed:
1 st Floor Shear ,
Filllsprinlder ,(Rough) ~
.
2nd Floor Shear
Roof (Shelllhing/DiaphraamlFrame) .
Masonry (RelnfJBooo Beamn>re-GlOIlt)
Rough Plumbing (Top Out) ,
Rough Mechanical
Rough 8ectrlcallLKY Wall) :
Rough Elec!rical
Framing (Only after Plbg., Elec.. Mech. and Fire)
Insulation (SoundlEnergy)
Do not tape or plaster until the following applicable
items have been signed: ,.
Drywall
Penetrations (Filll 'Rated) Electrical
Penetrations (FiIllRated) Mechanical ..
Penetrations (Fire Rated) Plumbing .
Interior Lath ' ' .
Exterior Lath
. GENERAL ITEMS
Exterior Plaster (BraNn Coal) .
T-Bar Electrical
T -Bar Mechanical
T -Bar Structural .
Sewer , " ,
Water Engineering Backflow , ,
Waler Service
FINAL INSPECTIONS
Electrical Final
Plumbing Fina,l
Mechanical Final
Gas Test
Enghieerlng/Grading Final 765-5126
Fire Dep!. Final 765-4040
Waler Engineering 765-5268
Sub List/Business License 765.519
Zoning 765-5139
Building Final (Last Inspection. Only
, After Ahove Complete)
Mechanical Inspections
Plumbina Inspections
Electrical Inspections
'"
CERTIFICATE OF COMPLIANCE
PAYMENT OF SCHOOL FACILITY FEES
ORANGE UNIFIED SCHOOL DISTRICT
726 W. Collins, Orange, CA 92867
(714) 628-4500
.'"
Developer/ Applicant Name:
Address:
Kindred Community Church
8712E. Santa Ana Canyon Rd
Anaheim, CA
Phone: 714-685-7950
Owner Name:
Address:
same
Phone:
Address/Location:
Type ot Project:
Lot #:
Tentative Tract #:
No. of Dwelling Units:
8712 E. Santa Ana Canyon Rd., Anaheim
church bldgs. APN#:
o Single Family
D Multi Family/Condos/Apt.
Total Square Footage:
Multiplied by Applicable Fee:
Other:
$3.89
Applicable Fee Level: D 1 [gJ 2 D 3 D 4
Total School Facility Fees: $
Total School Facility Fees:
Total Square Footage:
Multiplied by Applicable Fee:
$0.36
Total School Facility Fees;
D NO [gJ YES
REASON: For Sunday school class and restroom use only / Church
The above representations as to square footage are true and correct. Developer/Applicant agrees that if it is
later determined that such representations are not true, then this Ce tificate of Compliance shall automatically
terminate and the appropriate City/County s II be ified.
Developer/Applicant Signature:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with
Education Code Section 17620 et. seq. a Government Code Section 65995 et. seq.
Date: January 3, 2005 Name: j Title: Executive Secretary
NOTICE: The 90~day period in which you may protest the fee described herei will begin on the date this fee is paid. However, if the fee
was imposed by the City or County as a condition of approval for your project, and you have received the requisite notice, the 90-day
protest period began at the time your project was approved by the City or County.
certificate of compliance
Rev. 02-24-04
JAN-03-2005 16:25 FROM:
TO:714 997 6180
P.001/001
'/8
..
I
I
I ...."
. .... ..
............-.:.---'-........-........-.-..... ".- ".-. - ".-'~."'.
.,
. '''::
. ". di~
~r
'.'
..
.,
f
"., .' ! .. ~ '.
.~. ~. ,--......---., .... -..-.......--
KINDRED
COMMUNITY CHURCH
January 3.2005
Orange Unified School District
Attn: Sharon Schweitzer
Via Facsimile: 7149976180
Re: 8712 Santa Ana Canyon - Anaheim. CA 92808
The designated use for the existing and new modulars af the site address
mentioned above is for Sunday school class room and restroom use only,
lease contact me with any questions.
17B53 SANTIAGO B~VO.
SU ITE: 107-247
VIL-L-A PARK. CA 92861 .
RE:AOI-IING "r'HE WCRL..D WITH TH~ WORO
WWW,)(INCRe;cCOMMUNITYCHURCH.ORG
(!) 714.2B2.9941
@ 7'4.974.4335
,~
PUBLIC WORKS DEPARTMENT FEES
--TRAFFIC ENGINEERING FEES--
BUILD # c:l4 -04 \7<i( .
PROJECT SITE: '~i\7.. -€.,5 .,b;.C~< r. .
SIZE: 9'8 CI CI S r=
TRAFFIC SIGNAL FEES: ..s: >< 2..2.. '7
279-412-F724-3017
TE# G:, 7
-
21
-
E1EASTERN Tl,UNSPORTATION CORRIDOR FEE:
101-412-F724-6704 EX€" fV'Ipr
COMMENT:
REVIEWED BY: ALFRED YALDA (714) 765-5183
A'1
DATE: 12-ft:"O 1
--DEVELOPMENT SERVICES FEES--
RIGHT OF WAY . REVIEWED BY ~ DATE: tL_-ID-O
o OLD ZONING CODE (i.e. in plan check or entitlement prior to July 8, 2004)
yNEW ZONING CODE .
DEDICATION
CREDIT
NDl'-JE ?-~D
~I
,
STREET IMPROVEMENTIREPAIR~
SEWER CONNECTION FEE A( / /J...
CITY SEWER ASSESSMENT f'l11~
ACCT #
ACCT #
DRAINAGE ASSESSMENT FEE. IV I A- ACCT #
GRADING: .. "(L~ '2.0" c.. _ "U i~
WATER QUALITY MANAGEMENT PLAN (WQMP) 0'/..(1..001,_"""'- Oo16S-
LAND SUBDIVISION: .,. LL4-- 0000<,1'7-
REVIEWED BY: M.
l'LILol-j
12-yLtD
!
I
!
i
CONTRACTOR INFORM".!nON:
S J F CONSTRUCTION: II,C
,
361 S DEVON RD I
ORANGE, CA 926680000';
. . ,
.' '.' BUSINESS PHONE: 7149n1344 . . . . .
JOB DE.SCRIPTION:Remove.architectural componen.ts prior .to addition o~ ~!..'jl~~ITg a~s~ownunder Case No. BLD2004-00399
VALUATION: 18,500.00 . , . . .., PROCESSED BY: ODC
I . OWNER-BUILOERb'ECLMATION.
I hereby affirm under penalty of. perjury that I am ,exempt-from theC.~0tractorr 'Ucens~,C:aw for the following reason (Sec, 703.1.~ Business~~.d ,'"
.Profe.ss!ons Code: any dty or cowity'whichrequlres a permit to co~~truct, a~\',~.,'iTrtP~dY~, ~.er.no.n,sh or repair a~ystructure, prior tO,its iSSlianc~"arso
requ ir.e$ the applicant forsuch perf'l1it to tHe a signed stat-ement thathe _i~ nCA~~sed pursu~~t to the provisions of thl;}' G?l1tractor's Lic~nse Law~(Chhptet
9)(commenci~gwith.Sectlon 7000 of Division 3 of the Business a_nd Profess~Fs God~,),o~W1at'he i~'exempt,therefr6rT1and'thebasjs forttle_ alleged
exemption. Anyyiolation of Section 7031.5 by any applicant for a permitsU')__iects.the)~pp'HGanfto a dvilpenalty of not more than five. ,hundred dollars
($500). . '. . .' .':. < ... '. . .' . . . .' . ..' ". ..F
.0 'I, as" owner of p:o~rty',_or my e~~oyees with,w~ges as.thet~~_e cOJn~~s~tio~~}jtif.dO, the work, and the ~t(ucture ~~rot.i.nt~nd~ or"qffe:ed 'for.
53_Ie '(Sec. ]044,~Bu$mess anclProfesslons Code: The Contractor'S':~I.!~ense ~H_W 9oe.~'J)oti3pp\yto an owner of property who bUIId~ or JmprOV~s _,'-
thereon;' s~d who does such work hj~elf or herself Of through bi.s;~9r~E:f ow;j ~mpI6'Y~'9~;':.pr,?Vided that such imprtn;emehts are not intend'~.~r. :,t_
offerEW for-sale~' If, hoV:/ever, the, building or improvement is sold with oneye,-.y ('If cQ_mpf~~lon"thepwner-bui!de{ .will have th~ holden of p:rovi"rig thz:t he:
did not build or improve forthe purposeof.sale)" .,_~,,_ ','_' -, H~'(:O,>",,: .' ' .'
o . ,I, 'as-the Qwner of the -property, am- ~xdus~ely cont~dl'~~"~it'h"liCen-seu :fur:tri_J.6/~':t.O,-constructthe project (Sec. 7044 Business'and 'P;qfes::;iqhs.
Code: _Th~Gontractor'~ Ucense _Law does not apply to an owner of propeJtY:;'1j";o b'Sil~M',?r'j,nproves' trier-eon, and. who. oontracts for,such projectswitti,
~oi1tractor(s) llcens~ 'pursu~nt to the Contractor'~ ricense' Law). ~' '
U: I am exempt und~r S~c, " . '- , . B & P .C. for this-reason: '
Date: OWner: --lr
.~.:.
I .. WORKER'S COMPENSATION DECLARATION'\ ."..(1
J. hereby affirm under pe,nalty of perjuryo~e oflhe following declarat,ions: -, .J .... '- ....;:'. ,'.
D- j i1~ve' .and will maintain 'ac~rtiflcateof. oonsent to_ self:-i-nsu~e f~:rwork~r~~f Gomper:saii'on,.
as pro\(ided for by Section '3700 of the Labor- Code, for the pefformance of th.~ \')"0:1< fot.\-yhich
this permit is i~sued:' ' . . . I ~ . . -.
OJ h~ve and will maintain worker's 'compens?tion insurance, ~s required b"~ Sectiori_,~700 of
the Labor Code, for . eperforl1)ancE!' of the work for which: this permit. is iSSUEr' My wdrker's
. Compensatio . $Orance carrier and policy are: ' .'
Carrfer: -. . . '. ',' . policy ~U~ber._ EXEMP}'L, . .'_).<
',,:',. ',_',',.'. ,-,":-' :''F<',..-''-^" ._....r!",'___ '.- -:....,c';..':,.. "
ThiS__ tion need not be ~mp'leted jf th~ .pennit is tor-one hundred dollars ($1Q.~~,~r less~~',-, ':
I ,certify that in thSperformance of the work forwhich this permit is jssu~\JfJ, '$ha n.'Oq( ,
employ any- persOriin any manner so as "to become subject to the work~~S9~t:5pensa{~6n laws
of Califomia, and agree that jf I should beGome su . clto the wo ~er's'com~.:r~~atjon':'!- '
provisicjns of Section 3700 of~he la'bor Code, I Sh forth th c' plywith t~:~~e provisicins.
Date:. .6/1012004 . Applicant: ~ 1:-:
WARNING: FAILURE TO SECURE WORKER'S C PE SATION COVEEi.I,(;[3/S
UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAlTIES.ANO qlVIL
FINESlJP to ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADljITtoNTC;.tHE .
COST OF COMPENSATiON, DAMAGES AS PROVIDED FOR IN sECTIOi'! '37.06' o!,,'niE
LABOR CODE..INTEREST AND ATTORNEY'S FEES..' ..... .
.! . CONSTRUCTION. LENDING AGENCY;".;'
1 hereby affjrm."un~e~ pena Jty of perjury 'th<it th~r~ _~a ~~_n~tru?tj9n-I~nc.t,irJ~~g' ;\1r;YJ9CJb,~ "'''~~~''_:'''
...s-r':'Ii7.E'i"iCb-iJ~'l.j-...;'~""vlj.,; iu! wil;\:,.l\'-li\r~p'elti)Ii.'I:{r$suetff6ec.-.;U8i .ClV.(,;: - -~ -- . ..
Lender's Information:
-.1....
BUILDING PERMIT NO. BLD2004.02371
TYPE OF PE'RMIT .
Tenantlmprovement (Limited) CITY
DATE: 6/10/2004 .
JOB ADDRESS: '8.712E SANTA ANA CANYON.RD
LEGAL DESCRIPTION:
APPLlCANT:JIM FORD
OWNER INFORMATION:
BUILDINGDIVISfON .
200 S. ANAHEIM BLVD.
(714) 765- 5153 .
INSPECTION REQUEST LINE:
(714) 765: 4626
CENSUS CODE.: . 437.
OUARTER SECTION: 425
ARCHITECT/ENGINEI::R INFORMATION:
TERRY D JACOBSON
I
-'",-.'
"f'
~::--,,,
",;
LICENSED CONTRACTORS DECLARATiON. .....
JJ;Jer_eb:y.affir(l1, under penalty ofperjury.that_l:am ,.'.'
license,a under' proYisiqj1s of cnapter 9 (commE;loeil1g '.
with 'Section 7000) of Divsion 3 of BusineSs and
Professions Code.
6/10/200
Date:
NUMBER
',770061'
TYPE
Construcion Types:
VN,., .
':ire Sprinkler-ed?
J certify_-that I hay read this application and state that the above information is_correct. I
, agree to ~m with all ity ordinances a d state I;BWS relating to bunding .construction, and
hereby a rize repre tives oft!"t s ci to. enter upon the above mentioned property.for
inspe purposes. '
B
EXPIRATION DATE
..10131/2005
YES
Date: 6:1 0/2004
605.68
Signatur of
. rrn; permit shan expire. limitatiOn and become null and void if the building or
work has hot passed final inspection 365 days from the date of perinit issuance. A
new permit is required to 'co'!'mence or continue work.
FeeS! paid for Per~it:
Totai: '.
INSPECTION RECORD'
. . . .
....' . , . ','.
" .'INSI'ECTlQN ' OATE INSPECTOR.
.' TeRlporilrY Power Pole . . . '. ..',
. .
. PlUmbing (DrainlWaste Pipe) , .' '.
E.leetrical ~Ound EktCtJOdelUfer ., ..'
.' SetbacklFormSlTnmClies (Footings) .
Do not install s\Jbfloor or pour floors/ab until the
following 'applicable items have been signed, .
. Plumbing (Water PiPe.Sprinkler Valves) , ., ,
. Mechanical' (GrOundwork). ,,' '.. . .
!:lecttic;al (Underground CondUit) . '.
, r f'ie-slllb (C<:ompactiQnlMembfane;Reint. . ,
Underpinning (Floor JoiSt/Ginlers) .'.
"LD<> not cover.QT conceal the ",or\< below until the .
'following applicable items have been signeo: .' " ." .
. 1 stFloor' Shear "', , ".,'
Fire$Prinlder' (Rough) . .
2nd flo.or Shear' . '. .' .
. ROoflSheathinglOiaphragmlFrame)
'. '. .
Masj)nry (RlilnfJBolld Beam/Pre,Grout) ,. .
Rough Plumbing (Top Out) . .
Rough. Mechani.cal. ' . ' . .
I Rough. t:Iectricill ,II) . ' , .:.
.' Rough Electrical '.
f:rainlng .' (Only atter Ping.. Elee. Mech . and Fire) '. , ,
In....latlon(SoundlEnergy) ..' , '.' , .'
,. PO nottapeorpla~ter'until tl1efollowiAg applicable ,
Items have been SIgned: '.' ,', .' . . .
DrYwall. , ' ,
PenetrationS (Fire Rated) Electncal .' .
Penwations (Fire Rated) Mechanical . .
Penetrations (FiR! Rated' Plumbing .'
..
Interior Lath , . . .
, Exlerior Lath . , ,
"
. GENERAL ITEMS ' , .
Exterior Plaster (BrownCoat) '. . ',' . .
,T -Bar Electrical , .', .
T'Bar Mechanical .
T -Bar Structural .. .
, Sewer' ". . . . .
Water Engineering Backflow . , . .,
Water Service, .
,
FIIIIAL INSPECTIONS'
Ele"trical Final
Plumbing!;.inal
Mechanical Flnal
Gas Test
Enginl!eringlQracfingFinal 765-5126 '.
Date
In$pector ,
, ,
Fir$ Dept. Final 765-4040
Water engineering 765-5268
Sub List/B\lsiriesS License 765-5~9
Zoning 765-5139
Building Final . fla,Un'pectttin: Only _ ., ~. ~
'.Mer Abav,e Complete), -...
'. . PARTiAl INSPECTIONS
Buiidinalnspecti6ns
." " '.
. Me'chanicallnspections
Plurnbinalnspections
Electrical Inspections
.
TYPEOFPERMIT CITY
Retaining Walls . ..
DATE: 11/5/2004
JOB ADDRESS: 8712 E SANTA AN;>' CANYON RD
LEGAL DESCRIPTIQN:
/;(~W~/lj~~i~?!J\. . .. .
&fk~~~i:HEIM
:'::;C~~~t/ .1
BUILDIN(3 DiVISION
200 S. ANAHEIM BLVD.
(714) 765, 515a .
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: . 565
QUARTER SECTION:
BUILDiNG P!:ORMIT NO. BLD2004-03801
APPLICANT: PAUL MITCHELL
OWNER INFORMATION:
Church Garden
E Santa Ana.Canyon Rd w" . :\: '
Anaheim, CA 92806 '. ':
.108 DESCRIPTIONA<Jd 175 lineerfeet of retaining wall 7.5' high .:.!.... .
VALUATION: .39,000.00 '.' ti . . . . pROCESSED BY: DUC
C . .OWNER-BUIC-:::::r;EGLAR,;mON '. _.'. .______.J
I her.l:l'C~ .atfirm urider p::!~a,tty of perju. Y'f.' t~~11 am, exe. rnP~ fr.o~ the,'C?on.,}ra.~r~1,{.:~.':.L. ~!',~~~.e. Law for ~he fo!!owin.n reason, {Sec. 70~1.5.~US.il~E'.'SS .and
?rofessl.ons Code: ?ny City or cOun!:y'whlCn requl~S a permit to ?OnstnA(;.:t,:-'~''1r,.lf:;p~ove, demolish or ret-~~r any structl;lre, pnor to Its lssllance,'_a~o
. requ!~c~ the applicant for $uchpermlt to ~le asigned'$t3tern~,r.1lhath~ 1s IJ~;;~h,~edpUr$Uant, to the plOvlsi(,nS of the ContraCtor's Ucense Law (Chapter
9)(cornrnencing with S?ction 1000 cfDivision 3 of 1heBusiness aDd ,PJof~s~lris Cc,de) of-'1h~1 he b exe_mpi'there.from and toe basts_for ,the an~ged ~
exemption, Anyvloiatio(rot Section 703,1.5 by, ~my app!!cant for a"pa(intt ~uRA~p~s:theapp!jG9nt to a ~vjl pe~~llyc.f.not more than five'hU~dr.ed ~o!la,~
~?'>Os. o. v.In~.'.'r.Of.D:C[J....erty. . or my' empioY~es. with wage. '''thei; "o!e.i.c. ~m.~.)"'. "Hon, ~iii'9~ihe ';",rk. a'rid theSlrUc. h.Jftl --....i.;,..~.ot i.,nt.e. nd"".. 'elf offeredf;;,
~'(:;>ec. 7044 8u$./nes$ and ?rofess~ns COO~: The Contractor's Ll.c~~se~,[;,~.", aoes not apply to an owner of pr.opertywho. bUI!9S0r~!rnP.oves-'
the-toon} :3nd who 'doC:s such.work himself l)r herself6,r thrC"Jgh his dr ;;~;,.cw':{$mj:.loy~,es;_.p~OV;ded lhat such improvemer..ts_are.nct)r.tend.ed or..:
.:;ff6red for S?ie. .,Iflhowever, the bllilding qr improvement l<>._s<?k1..YJithol1e ye/r~of 'xlrr,\;:>>et,ion::-the owner-builder wi!! ha~ethe bllrael1 of ~(o";ingtnQt 11.~
d;dnotbulkfnrimt:.;rovefo;'~hepUlpose_ofsale), ' _ .. --."';_'-".,I)~:-_:~~'~;,,'::'1::~:' ,',' . JJ";'" ,', .,-.. _' .,',.;<::':..
LJ . i,:a$tti~ owne.r'o(;t.h6 prop.€!cty, am e:-:dlISjV'~IyGO~':roctin9, .v1_~~h 1?o;_~n~sdH{H1tr'adf~~:~O t~~lnst(t.l9~ th~proiect (S.~c. 7~ ,i2.i~sine$s and PrO~?~Iorl'$;
COde:-"Tne- Contr~(;tar'$-LiCeflse Law does not applY tc an ownol'(.f propl':mY:fll~O b01!o,"f(-.r improves thereon, am:t who.contracts. f." such -pr~jects with:
'.. . .. . '.. , .' -. -~ ,- '-', .... . . . . , -..' ,
p...1;Dntracjci(s)licen$ad pursusnt to tile Contrac!or'sUcer.se taw},;', ~{~ .,.
t_J..~'-:- ''!m'~,'rdc So' -- p. r~' 0';/:/' :.:.,.,-<.... .
....r."lJ:.~.v'2.u.,..r ~c. _ ,. '.' . . ~ -'1~.. ---. '~-__.-'----'-- .'';7.:.;
Dute.=~C4'. Owner: . .. . -"'~:"tf~~~.r?':'~~ .'
L-,-.':' . 'WORKfR'SCO PENSATIQ.,N DECLi>RATION '~}.;;c....._,.,J r. UCENSED CONTRACTORS. DECLARATION .:.:.J ........
I hen;b'~~ffirrP. und~r'r.t"ind~t~ r,:,{pe~u.f'J {me ot the .rollV\~in9- qecl.<1r~tiO:l~:" . .... .' '. . . _"" :.-_ Cher~b~ affirm ,u~er petl~lty ot~~rjl;iY..!tI~!/.~,nl_,,: .
[J'-'-,~~~,ve 8;;0 wi!! fnG!ntsin ;) cert~f:cat.~'of _oonssnt to se!f,~~~..suref?:r work1:;r?~?C-I<19f3f'\:.:~Uo,!; 'f }~;:1S~ l~no;:,piOVIS!OI~Sof c~ap~ter9 ~~o~~:nCI':1Q;:
CIS pT~i...'-idl3{j ter by Sect_icn'37QO of the: Labor CQd.e, ':f.:;;r the j.Jt'1lformaoc<--; of;,;;:", ;.1(.'>rk' ;0. 'Nhid1 I' v.",.., S~,c".)n . oOO} of Dlvslon ,) Of the B,.Slnes... ,=!r.~:d, '
this ~rrrllt is isslled. . , . . ': '., '. .<" . - '1 Prof~$SiOiiS Code. .
OJ have.end_wla mai:1ta:n worker's _compens<'l.tion inSUr<':lfice. as l"f)q~Jirc.C-~I)~~CbDn 3700 of I 11/512n04
thr:- L2:bcr COIj'E:. for the, ~a-rforrnance of the wcrk.f0r which thIS perrr.!t is ;.sSU1."'~'_ r..~y \'i'~~':~e!'s' D"He:
:,;ompcn~tpl1 jnsurar:c~ carner ~nd policy are: .. . . _'-f~ " . I
Ca:-rief~ . POlicy NlImne;r- '. . NUMBER
.'~
Tt.JS $ectfc-n nced r'!(it be c{,.'mpleiad if the pelmit:$ for ,one hunore:! dOllars {$1QC. ~r :~lS~. '" TYPE
...;;:..1 I certify tnat in ;h13 ::,.-arforrnsnce of the work for whIch this perm!! ~s 1S.~.lt,H F;:). <;l-:!al! (;ot '
~7tplOY ;:my jJerscn in allY rr.anner so as to become 8.ubject to thf' worker's <;..>&j:~~ris-atio'1 Jaws ~
of Ca!lfomia, and ~qfee that If I should become subject to the wGrker'~~ comp~ f,~::;1f6n -
Drov>s'cns of Section 3700 of the L~c7~. hwitn . mp~, W,tll t~< "'~ ~eOvis;or'" eO~~:,:,Cion Types:
Date 11/5:2004 '" Applicant: '. .... (c.?~~~ . ,Fhe$pr.nklered?
WARNiNG: FAILIJRETO SECURE WORKER'S COMPENSATION COVERe\G"I~ . . I
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIM INN, PEN.",Li!cS'AND CIViL I
fiNES UP TO ONE HUNDRED 1HOUSAND DOLLARS ($lOD.()OOi, IN ADD!tiO. N.TO THE'j
COST OF <;:OMPENSATICN; DAMAGES AS PROVIDED FOr, !N t;ECTiON 1706 OF THE
LABOR COOt. INTEREST AND ATTORNEY'S FEES, . . '.' ,
I . . .. .. . CONSTRUCTIONLENPING..AGENCY .... -i---~,,-,-,,-J
I h~reby affinnuiioer penalty ofper:u;y that there is a constiuctiOr. !ef,\ding ,3Qt.'::>cy,icr,thc;,:':- - I
.p:erio;manceof~heworJ~ fo::.wr.id1 thi::5..perrr:lt is i-ssue-..d {Sec"':'K197 .Ciy,:~.); l'
<.-.-i.;:~~--::t4~e:"'~::.:;n-:-.-'-,~",~""",-,--:; ... "_...._,, ._",_.. ---O.~--;"<=.o.~;:;C,,_:',:':7;"- ........" ---.:..---~~ ',-,-,.'.>
CONrRACTOR INFORM!<TI(:lN:
ARCHITECT/ENGINEER INFORMATION:
.(
Contractor
EXPiRATION DAcE
NO
- .1 certify that I have read -this application ~fnd state"that the above InfGrrnatiol1 is ccrr~(;t I
agree to comply with all city ordinances and state laws relating to buijding comtruction, and
. .~~ere~Yau1~orl<e rr~sentives of this dt enter upon the above mentioned property for
'7t Date: 11/5/2004
. . Signa ure of Applicant or Agent.
The permit shall expire by limitallonand 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:
973.06
. '. INSPECTION RECORD FINAL INSPECTIONS . Date Inspector. .
, INSPECTION '., INSPECTOR . Electrical Final'
, DATE .
Tempor.lry Power Pole . .' . Plumbing Final . ,
Plumbing (DrainIWastePipe) MecfJanical Final . . '.
EIe~rical Ground Elec Gas Test. ,
Selback/Forms/Trenc~ (Footings) /I-I'J-c !:/e 'L.
00 not install subfloor or....."... uuor slab until the / Engineering/Grading Fina.1 765~126 .
fOllowing applicable items have been signed: .
Plumbing (Water Pipe.Sprinkler Valves) . . Fire Dept. Final 765-4040 . . .
, .
Meehanical(Groundwork) Water Engineering 765:5268 ". .~
Electrical (Underground Conduit) . .
Sub List/Business License 765.519' '" .
I pre-slab (Compactlon(Membrane.Keim. . .. '.
Uoderpinning (Floor JoistlGirders) Zoning 765.5139 . . .'
00 nOleavet or. conceal the work below until the '. Building Final Ifast Inspeclion-Only . ~,y
followlng'applicable .items have been signed:'. . fler Above Complete) '.z-no'
1st .Floor Shear . . .' PARTIAL INSPECTIONS '. f.#
Firesprinkler (~h)
2nd Floor Shear' .' BUildinalnS~? .d..t.' '. .~..
Roof. (Sh$alhiIl!llDiaphraamlFram.el I . ~ . ~-9-o<f J . . . . ~V ~~/J~
Masonry (ReinfJBond Beapl1Pte-GjpYt) Irz1Jlii!:. .'
.-/C-t>t.( ~'\,. '. H.
Rough Plumbing (Top Outr' . , . . /. \\.I.~-. \ ~~ \l~, ,\"iArJ ,\,/. plw- \ ~l\ IrAwJ....
Rough Mechanical. , . / . .
Rough E1ectricallLJrY IYall) . . ~ U~. .
Rough Electrical . ',. ' . c1t1 1.1";- \ dic..~I'I1J.--r 6V- WCI. II ... '.' ..'
Framlnl1 {Onlyaffer Plbg" Elec.. f.-lech.. and'Fire} . W-~e.).'.~ \~~1'
Insulation (SoundlEnergy) . '. .
Do not tape or plaster until the fOllowing applicable '. . Mechanical Inspections .
items have been signed: . . . .' .
DryWall . .' .
Penetrations (Fire Rated)Electrical I . .
Penetrations (Fhe Rated) Mechanical. . '. .
Penetrations (Fire Rated) Plumbing '. .
Interior Lath . .'
. .
Ext.rior Lath '. Plumbina Inspections'
.' GENERAL ITEMS
Exterior Plaster (Brown Coat).. '. . . .'
T ,Bar, Electrical . . . . ':.
T -Bar Mechanical . . . .
T -Bar Structural . . . . , .
Sewer. '. . . .
Water Engll)!iering Backflow . ElectricallnsDections . '
W~ter' S!itvlce . .
"