1000 N. State College Blvd.
BUILDING PERMIT NO. BLD2003..o3455
TYPE OF PERMIT . C
. Tenant Improvement (Limited) . ITV'
DATE: 9/3/2003
JOB ADDRESS: 1000N STATE COLLEGE BLVD
LEGAL DESCRIPTION: SEC 1 T 4 R 10 POR SW1/4 SW1f4
APPLICANT: ALANNA ISAAC
. OWNER INFORMATION:
Glona 0 Vickery
1000 N State COllege Blvd
Anaheimj CA 92806
BU.1LDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626 .
CENSUS CODE: 437
QUARTER SECTION: 111
C'/.? q-~~6l\
CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
COMMONWEALTH COWRACTING CORP PATRICK 0 FIEDLER'
2003 W RYAMER #A 2322 W. THIRD ST.
FULLERTON, CA 92833 0000 LOS ANGELES. CA 90057.
BUSINESS PHONE: 714 87C.. 0400
. JOB DESCRl'PTIONJenant Improvement. Voluntary upgrade of accessibility fetitures;
.. .. \
VALUATION:' 5,500.00
I OWNER-BUILDER DECLARATiON
thereby affirm under penalty of, perjury that I'.am e)Cemptfron;-a tre Contractcr'~__LicehseLaw forthe following reason (Sec. 7031.5 Business ,and
ProJessions, Code: any city qrcountywhich requires a permit to construct, alt:rIr,improve. demolish or repair any structure, Priorto its issuance. also
requires the applicant for such permit to file.a signed ,statementthat he is Iice;is~d pursuant to the prqvi~ions of the Contractor's License law(Chapter
9)(commencin9 wIth Section 7.000 of Division 3 of the Busin?5sand Professi6ns Code) or that heis exe~pt therefrom and the bas!s'for the alleged
exemption, Any violation of Section 70~1.5 by any applicant for a p'ermit su:;';;:lcts the'apPlicant to a dviJ Penalty.of npt more than-five hundred dof!ars
($500).' .' . . , " .,: ~. .....
o I, as Qwn~r of property, or my employees with'wages as their sole comp.~nsatio.n; will" do the work, and the structure is notintended or offere.;j for
~ale (Sec. 7044 Business and Pr9fession~ Code: The Contractoris license Law does not apply to an owner of property who builds or 'improves
thereon, ,and who does such work himself or herself orthrough hls or her oWlY-employees, provided tha~ S!uch imp_rOvements are not intended or.
offered fOj sale. If, however, t~e building or improvement is sold with one yec:r of completion, the owner-buifder will have the burden of proving that he
did not buUdor !mprove for the purpose of sa~e)., ,'. . . -
o I, as the' owner oftha property" am exdusively contracting \vith licensed ':::ontracfors to constrUct the project (S.e0.7044 Business aild Profe~ions
Code: The Contractor's License Law does not apply to an owner of prope.rty' -vho builds or improves'thereon, and who contracts for such projects with
,a.J(ontractor{s)Jlcensed pursuant t<:> the Contractor'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:., . ~
o I have and will maintain ,a'. certificate of oonsent to .self-insure for~vor!<:ar'~ compensation,
as provid or by-Section 3700 of the labor Code, for th~ performariceof .th,l' work tor whi,ch
is pe it is ,issued. . . '
have and will maintainwoTker's compensation.insurance, as required by Section 3700 of 9/4/2003
. the Labor CO.cle, for the performance of the work for which this permit j5jssueoi: Myworker's Date:
Compensation insurance'C:arrier and policy are:
Carrier: STATE COMPENSATION. Policy Number.046-001~)6B
This section need riot be completed ifthepennit is for one hundred dolJars_($10"'1 ~'Ies:S.
o I c-ertify that in ttV:, performance ofthe work for which this perm.it'iS::i~~He~iXsba.n.~ot
em'ploy any.person in any manner,so as to become subject to the WOrke(S_:CI)I~Qi9ilsatiop raws
of California, and.agreethat if I should become subject totheWOrker's\'bal~.>enG:atlon ,,"",;
. '- . . '. '. ".':;,-"N.' ......>'.... '. _...... .
provisions of Section 3700 bfthe Labor Code aU forttJwithcomply . .t~;Iho5~~8:ovjsions.
P'ROCESSED BY: ODC
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty 0 perjury that lam
licensed under provisions of chapter 9 (commendng
withSection70o.0}0.f ivsion30ftheBusin sand'
Professions Code.
NUMBER
. 748075
TYPE
. TYPE
TYPE
. EXPIRATION DATE
4/30/2005
B
C20 VENT
HIC
Construcion Types:
VN, , .
Fire Sprinklered?
NO.
Date: 9/412003 . Applicant:
WARNING: FAILURE TO SECURE WORKER'S COMPENSATiON CqYER.',GEIS '. .
UNLAWFUL, ANDSI-;!ALL SUBJECT AN EMPLOYER TO CRIMINALP.ENAl TIES AND CIVIL
FINES UP TO.oNE HUNDRED THOUSAND DOLLARS ($100,OOO),IN'!IbDino.'l TOTHE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF'fHE
LABOR CODE, INTEREST AND ATTORNEY'S FEES: . -:,:1Y;'" ~ ;""',,
r' CONSTRUCTION LENDING AGENCY ''''''{. . ,1,'
,1_heT~~Y' ~fftrm under ps:nafty of perjury that ther~~is aconstrud}on 1~,ndi!1,fK9.1!.;lncYf?"r,th,~',
f.0rfAr~~~r.-M-0(._the w?r~:-.fQ-!, U,'hf;;l~ thj~p-"!!Tni! i~ rSs~.H::': ~S&::.3097 .ef! .C1>-:'~, '-""~_..~."'",~:'.
Lender's Informatfon.: .
I certify'that I have read thisapplication and state that the above information is cqrrect. .1
,agree to .oomply' \."lith all city ordinances and stat~:faws relating to-bunding,construction,'and
hereby authorize representives ofthis city to'enter upon' the above mentioned prope,rty 'for
in.rn purPOd~' '. ' a".
. " '-ilU.. ~ tf A/f ~
Sigl.1ature of Applican 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.
. Date: 9/412003
.\
fees I?aid for Permit:
Total: .
258.68
INSPECTION RECORD
INSPECTION' " . DATE INSPECTOR
Temporary Power Pole . , . ..
Plumbing (DrainIWaste Pipe)
Electrical Ground Electrode/lifer,
. SelbacklF()I'mslTrenclies (Footings) . .
Do not install subfloor or pour floor slab until the .
following applicable items have been signed: ,
Plumbing (Water Pipe.Sprinkler Valve!!) .
Mechanical (Groundwork)
Electrical (Underground Condu it) , ..
Pre-!!,lab (CompactionlMembrane,Reint., , .
Underpinning (Floor Joist/Girders) .
. Do not cover or conceal the worj( below .until the
following applicable items have been signed: , .
1 st Floor Shear '. ' . .
Firesprinlder (Rough) . .
2nd FloorShear "
Roof (SheathiIl!llOiaphraam'Framel' . I
. Masonry (ReinfJBond BeamlPre,Grout) .. .
Rough Plumbing, (Top Out) .
Rough Mechanical ,
I KOugh ~ectricllllury wall)
Rough 'Electrical
Framing :(On~ afterPlbg,.Elec" Mech" and Fire)
Insulation (SoundlEnergy). . .
Do not tape or plaster. until the following applicable
items have been signed: . . . , . . . .
Drywall . . . .
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing ,
Interior Lath ' . I
Exterior Lath . . . . .
, , GENERAL ITEMS . ..'
ExteriOr Plaster (Brown Coat) , I
T -Bar Electrical '. ' .. '.
T -Bar Mechanical I
T-Bar Structural' . . . . ..
, Sewer
Water Engineering Backflow
Water Service ' ,
FINAL INSPECTIONS . Date Inspector
Electrical Final' '.
Plumbing Final ' . "
. .
Mechanical Final
Gas Test .
Engineering/Grading Final',765-5126, . ,
Fire Dept. Final 7654()40 .
Water Engineering 765-5268 .' . "
Sub List/Business License 765-519 .
Zoning 765-5139 '.
, ','
Building Final ~ast InSpection. Only
, fter Above. Complete) .. .
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections
"
Plumbina Inspections
Electrical Inspections
PERMIT, EXPIRe)
.. ,
INSPECTION
NOT COMPLEl ~J
DATE: \\-n-oq