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5115 E LA PALMA AVE (23)Permit Types BLD • ELE MEC PLM r _X Pennit Number: BLD2010-00295 Issued: 02/09/2010 INSPECTION REQUEST LINE: (714) 765 - 4626 Quarter Section: 172 Site Add -toss: 5115 E LA;PALMA AVE Legal Description: F=AId►'IV EI M 200 S:=ANA_HEIM'BLVD. (714) 765 - 5153 Project Description: Electrical for Tenant Improvement: 192 sf. tenant improvement to create stoarge room. Add Gabel conveyor system, 2 new storage silos, chiller and pad foundation. (Ref: BLD2009-04194) Valuation: Construcion Types: VB, , Fire Sprinklered? Yes Cool Roof No Total Fees paid for Perrttit: 1.424.86 People Associated with Project: Owner KILROY REALTY LP %HEIDI ROTH PO BOX 64733 LOS ANGELES CA 90064-0733 Contractor R J ELECTRIC 1216 W BARKLEY ORANGE CA 92868 0000 Permit Applicant JEFF BRICKERHOFF Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Type Mechanical Fixtures Qty Sub Panel/Temp Pwr - < 600 V, 0 < amps 1 <= 200 Conduit and Conductors - per 50 ft. 14 Generators/Transformers - up to 1 hp, up to 7 1 kva Generators/Transformers - 1 to 10 hp, 1 to 4 75 kva Generators/Transformers - over 10 hp, over 2 75 kva 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. fbld permit combo City of Anaheim Building Division Do not occupy this building until the final inspections have been made. BUILDING PERMIT DOES NOT AUTHORIZE ELECTRICAL, PLUMBING, OR MECHANICAL INSTALLATIONS - SEPARATE PERMITS ARE REQUIRED. INSPECTION I DATE I INSPECTOR Do not pour concrete until the following applicable items have been signed: Plumbing (Ground/Underfloor Drain Waste) Electrical Ground Electrode/Ufer Setback/Forms/Trenches (Footings) Do not install subfloor or pour floor slab until the foliwing applicable items have been signed: Plumbing (Ground/Underfloor Water) Underfloor Rough Gas Mechanical (Groundwork) Electrical (Underground Conduit) Pre -slab (CompactionlMembrane Relnf.) Floor (Jofst/Girdere) Underfloor Insulation (Raised Foundation Only) 2nd Floor (Floor Nailing) Do not cover or conceal the work below until the following applicable items have been signed: 1st Floor Shear Firesprinkler (Rough) (Fire Dept.) 2nd Floor Shear Roof (Sheathing/Diaphragm/Frame) Masonry (ReinfJBond Beam/Pre-Grout) Rough Plumbing (Top Out) Rough Duct (Mechanical) Rough Mechanical Rough Electrical Framing (Only after Plbg., Ele., Mac. 8 Fire) Insulation (Sound/Energy) Do not tape or plaster until the following applicable items have been signed: Drywall Drywall Penetrations (Ele., Mac. & Plbg.) Interior Lath Exterior Lath GENERAL ITEMS Electrical Service Meter Exterior Plaster (Brown Coat) T-Bar (Struct., Ele., or Mac.) Sewer Water Engineering Backflow (Testable Only) Water Service All applicable items below must be signed before utilities will bwTeleased7 FINAL INSPECTIONS DATE INSPECTOR Final Gas Test Electrical Final Plumbing Final Mechanical Final Cross Connection Control (7u) 76s O Engineering/Grading Final put 76s 126 Fire Dept. Final (714) 765-5041 Fire Sprinkler Final (714) 765.5041 Water Engineering (714) 765-4591 Sub List/Business License (714) 765S194 Zoning (714) 765.5139 Building Final (Last Inspection - Only After Above Complete) FINAL INSPECTION must be approved by the Building Division. PARTIAL INSPECTIONS Building Inspections Mechanical Inspections Plumbing Inspections Electrical Inspections JtAl 2 wi Permit Backs Master-2008.xis Permit Types BLD ELE MEC PLM r zX Permit Number: BLD2010-00295 Issued: 02/09/2010 INSPECTION REQUEST LINE: (714) 765 - 4626 Quarter Section: 172 Site Address: 5115 E LA PALMA AVE Legal Description: CITY OF ANAHEIM BUILDING DIVISION 20D S. ANAHEIM BLVD. (714) 765 - 5153 OWNER - BUILDER DECLARATION: I hereby affirm under penalty of perjury that I am exempt from the Contractor's License State Law forthe following reason(s) indicated below by the checkmark(s) I have placed next tothe applicable ftem(s) (Sec. 7031.5 Business and Professions Code: any city or county which requires a permit to construct, after, improve, demolish or repair any structure, priorto its issuance, also requires the applicant forthe permit to flea signed statement that he or she is licensed pursuant tothe provisions of the Contractors' State License Law Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a Permit sublects the applicant to a civil penaftv of not more than five hundred dollars (S500). -- I, as owner of property, or my employees with wages as their sole compensation, will do ( all or (__) portions of the work, and the structure is not intended or offered for sale (Sec. 7044 Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal efforts, builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale). I, as the owner of the property, am exclusively contracting with licensed Contractors to construct the project (Sec. 7044 Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractor's State License law). I am exempt from licensure under the Contractors' State License Law for the following reason: By my signature below I ackonowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application issubmftted or at the following Web site: http://www.leciinfo.m.gov/calaw.htmi. By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner's behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction I authorize representatives of this city or county to enter the above -identified property for inspection purposes. Signature of Property Owner or Authorized Agent Date WORKER'S COMPENSATION DECLARATION: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OR THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby a irm under penalty of perjury one of the following declarations: I ave and will maintain a certificate of consent to self -insure for works is compensation, issued by the Director of Industrial Relations as provided f r by Section 3700 of the Labor Code, for the performance of the work for which this pe rtnit is issued. have and will maintain worker's compensation insurence, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's Compensation insurance carrier and policy are: Carrier: REDLAND INSURANCE CO. Name of Agent: Phone No.: Policy NP.PSI1000800 Expiration Date: —_ I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the works is compensation laws of California, and agree that, if I should become subject to the worker's compensation provisions of Section 3700 of the tabor Code, I shall forthwith comply wfth those provisions. Signalure Of 60plicant to Doke -� Permit Number: BLD2010-00295 DECLARATION REGARDING CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec.3097. Civ.C): Lender's Name: Lender's Address: LICENSED CONTRACTORS DECLARATION: I hereby affirm under the penalty of perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Co ct r i,fn ture� " NUMBER EXPIRATION DATE LICENSE TYPE (S) 744117 12/31/2011 C10 The permit shall expire by limitation and become null and void if the building or work has not passedfkral inspection 365 days from the date of permit issuance. A new permit is required to commence or continue work.