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2655 W SERENO PL (7)NV2021 GYM 0 II� I •2 C=ol M01VIDWHII I ya q&2, wi SiGK,a01� , Address: 2655 W SERENO PL INV Site Plan COD2021-09604 Zone: RS -2 Planning Services Division Building Division Required IProposed APPROVED Front �/� Setback BY:Side V I Setback DATE: Rear D scription/Notes: Setback 11eqRAOQ ARI Max. Lot _ ,Ti l n. W Max. 1P'IV� 14- Bldg Plans comply with Title 186f the Height Plan Review Fee Reauired (6tp�j I BY: DATE: Case No. Notes: �The issuance of this permit does not approve violation of any of the Building Codes of the City. The Holder of ming). this permit proceeds at his -own risk. JOB ADDRESS • OF APPLICATION FOR A PIAN Q DEPT BUILDING PERMI -MAHINO CANON U caw". MAILJNG ADDRESS MAILIN�_C W PRESENT c It BUILDING USE PROPOSED OULDING USE DESCRIFTItjN OF WORK NEw 0 AWN 13' . ALTER [3 • REPAIR g6w--DEMOLISH Q DESCRIBE WORK TO BE DONE t 0 a 9p g"cm i "LUATION Ift AREA SO. FT. NO.OF NO. OF DWELLING S}70AIES UNITS FLOOR ' ' O INCIASE AREA Q DECREASE SO FT. LEGI►L DE&�i1PtION• O � Z ♦ SEC' MAP • FIRE OOOU• TYPE ZONE FANCY OONST. ENGINEERING FOFPFSITE OVEMENTS: DEDICATION: STREET IMPROVEMENTPLAN. BOND: SEWERASSESMNr REMBy ED PUB. SERVICE PLAN NECK FEE FIRE PERMIT FEE 0 HEALTH .. STATE TAX . • SANITATION, MICROFILM FEE . PERM. PLAN 0 WITH mm o W=fl PLAN jp�r APP. BY TOTAL FEE , `C hherm TTheVls=arc tMtW Ins perffdt dm not om am a 1=e the v1 t1on of�any slaaft or•Ido l" Nw C� 2OAUGISb TOTAL $39.00" .,,. PERMIT- OQF TRAMSACTI • . ?4 1ibir ' I haw aroUy road and axamlned the show Volatlan and Wow the Arne to be true CW L All Wwls and Laws and Orlin vall CQMerIhQ lNs type Ot Canatrudian will tie led with whathn tied nor not. per•. sen shall be emgClred N rI01a1Iwk.. fife labor Ode Cf CellbrNa 8LDG9 WE SWUr]WdF OW DAGEN eMCMT r ' SET, BACKS ' FRONT • p- "L. SIDE.. , R. SIDE RERR FOUNDATION INSPECTOR DATE 'FRAMING PLASTER MISC. INSPECTION ' DATE Akio ..! . '-FINAL •, HEALTH DEPT. ' •' ELEC: '. REQUIREMENTS F HAL it CONTRACTORS PLUMBING . � RNAL STREET ' A.C. LIGHTS ZONING t REQUIREMENTS ENGINEERING . REQUIREMENTS SANITATION ' : . ' ... :FINAL BUILDING INSP REQUIREMENTS FIRE'DEPT REOUIREMENTS i ..' _ . .. ;V .Ar. -- . .DATE ;EtECI'91C4LREfi11illIT:NO: .EL.E2000-02184 " ' BUILDING'DIVISION" .. .. • .. -20.0.S. ANAHEIM IBLXD. _TY OF PERMIT . (714) 765: 5153 Alteration or Addition to.Existing .' " G11W OF �►[SAH �'I � INSPECTION RECUESi`SlNE .'. ;;::: ..y• 4) 76A;'5161 `• .. • ' DA1TE: t 1/30/200D ' JOB ADDRESS: :' • ":. % r :26741iU.SEREyO PL' . , ,',: .. ©IJARTER SEC nPN: 20' : LEGAL DESCRIPTION: `N *29W LOTAI -APPLICANT::..... ' •,. ; . :• OWNER INFORMATION: • ' CONTRACTOR- INFORMATIOW • ARCHITECT/ENGINEikjNF6RMATION:-' . ..ALL HOME REMODELING, .. 7403 N l3ATAVIA; #'112 ; ORAWO� 928673516 CA JOBDESCRIPTION: , New Fixtures 8•GFCI's - Ref PLM20�.03079 . . PROCESSED BY. RLC ' OWNER43UILDE DRILARATION e y rrrrl under pane y . peryury a am exam rom s ns,e aw e following reason eG us s an Profegp)gns.Code:. any city,or county which requites a permit to Construct; alter, IrnpiWe, demolish pr•repair any,sttuabA, prior to'its Issuance; also• tequires'the applicant for such pormit to file a signed statemerd..that he -is 110iroed pursuant to the provisipns of•the Contractors License* Law ;..(Chaplet 9)(commenc�hg wNh Secbn'7000 of . visbn 3 of the Bgsindss aAAProfessions Code) orthal he:is ezemptth*efrom andthe basis forthe `:• alleged exemption. • Any violation•of Seddon 7031:5 by any:appliFant fora permit tubjectsthe appficalnt to a civil penalty-of riot Mixithen five - 1 pndied.dcllars'($500): I, as owrrer.of pmperty,.or. my employees wlth •wages as.their sola coarpensbtt6n; wql do the.*brk, and the'stnicture lis nountended or offered ; or sale•(Sec: 7044 Business and Professions Code: The•Contractprs L'ictirlse Law ddes.not appy to an.owner of property who builds or improves - thereon, and;who ddes such work himsea dr 4rself.`or, thrcWh his ,or her ewh employees, p*ided that such imprgvements are not intended°or ' ' offered •Tor oils., If, howaver; the building br.l prdvement Is solo with'ohe .4gr of completion, the'ownet:buiber will havethe burden of provingthat' ' he did riot build or inpfove for the purpose ol.sale).' . [[�� 1, awthe owner of tfie property; ain•exciirstvey contiaCOng'V&Iillicsnsed QDntrktors M Construct tho project (Ser" 7044 Business and Professions Code:.TheCq tractors Lkhense.Law does not appy tb 9n. RfvUner ofpropelt •wtio'buids or. improves• thereon, and who contracts for ; such projects with a contractors) licensed pursuantio the Contractors Lio3Ase !� 1 am exempt undi Sec• ° ' .. B 8' P.C.'for•this•ieasori: Date: Owner. • OR R`S COMPENSATION ECLARATION ' : • : LICE7dSED CONTRA ORS ECLARATigN I -hereby affirm under penalty ofpegury one of the fo)lowing.declarations ' y a rm u p perjury a am f have and will ntaintalh a cortificate' of consent to self-insure, for vrorlcaes•compensation, �i°e"Sed`under prdvis tet. 9 (cominenciig Q. ' with S0db 7000) s 3 of.the Business did'.. •: -as -provided •for,by Sectlon.3700 df the Labor;We, for the performanCe.o(.the work for which prates§ions Code, .' this perrnie'Is Issued' I hava.arid wil'maintain works compensation insurance. as-required by Section.3760' o the I.6bor•Cod6; for the.performanas of the work for which this permit h issued.'. My Contractor workers Compensation hsur ince cariier,and polcy aie: 91/30/2004 Carrier: STATE'FUND ' ..:.Policy Number! 228=00']8184 .. • • NUMBER: • : EXPIRATION DATE: „ 600801'.. '08131/2002 0616'seetl" Asad not be'obmpleted bithe.permbt lsfojmre hurdreddolars (t:100).orless. TYPE• •: , .8 7.0 I ce`44.that iii the performance of the work for vififch tills prrrrrri(is issued, l shal`tiot . TYPE:•' • HIC' employ any person in any, manner,so as to become Aubjectto the workees-cornpensatiori .. laws, of Califomia,•and agree Mat-if l Nhculd becpme subject tothe.workeea compensation provisions of Section•3700,ofthe Qabor Code, •I, shel JarttWih'eoinply'with .those•proviibrit. -: Date: 1:1/30/2000:.. • Appl�c. . #t tacles;;switclies,:llghts,: ' 18=; , WARNING:' FAiLURE'TO SECUkE'N6RKER'.S C.OMP.ENSATION.COV�RAGE tS . •' .. •� : : ,E. 'UNLAWFUL, AND.SHALL SUBJECT ANEMP.LOYERT.O'CRIMINAL•PL:NALTIES,AND.' : 'S CIV PINES UP. TO ONE HUNDRED• THOUSAND DOLLARS ,($1Q0,000); HV ADDITION T0: '• THE COST OF CpMPENSATION;.•bAMAGES'AS PRO0DE6.I=OR IN•SEC11bN 3708 OP: ' ...THE LABOR'CODE, INTEREST•ANDATTORNEYSFEES. 5 , • CONSTRUCTIOK:LENDIN AGENCX• :Y • I hereby affirm under penalty cf perjury1hat there- is a Construction lending -agoft for the , perfcrRrance of the•work for••whlch.thit perin*is Issued (See 3097,Civ.C): ;Lenders Inform ` ti 1'beetify'tliaf'I have read g n ' lii:atlori.and4tMaithat thd!above•sitorrrtatiori is'cori`ec� I . 'la .'. pglee to comply with al and &9e' laws relating :to.txiilding'cbnstruciion, and: Total: 48:30: ' hereby at�orine rep this.cly to enter upoh .the abovern6hooned property for trrerleFtiOn purpose • • Date'r11/30/2000 . Signatureo icant or en ; :'11'ha 0ohnif shall expire,by #inhif lon.and beeontp null and:vold itthobuilding.or . work' has not passed final InspeEtlon 36li days from tJhe dale of ReFrntt issuance: no permit Is'requibed tio:domrherice or ontinue work.; ••• -INSPECTION.'RECORD • INSPECTION- : :DATE ' INSPECTOR. Temporary Power Pole • . .Plumbing (Dra(niWaste Pipe) , .Electrical,Ground El60VWbfUfer.'.': SetbacidFormslrrenches (Fodtitgs):, Do•riot'ipstell subflooror'pourfloor. slab.untilthe fo)lowing applicable items have been signed: -Plumbing ffiat# Plpe,SprhW9r:VWlves)• = Meehanical (Giouridwbrk)' . Electrical (Underground Conduit) .Prete ab Gompacti Metnbrane.Rdnf. ' Underpinnidg (Ffoor.JoistlGjrders) I]o' f�ot,00vot oc conceal the Work' ow, urm ,t • follauJing applicable items No- bee n..signed: ' Ilk -Floor Shear Fliesp:tirrider: (Rough 2nd Floor Shear Root SheatbinglDi It • m►Frame . I Masonry. (RelnfJBond Beam/Pre-Grout) .-.Rough`Plurnbing (Top Out Rough'Mechanicai u9. rc Dry Raugh• Electrical' '.Frtiming'=•'(Oary'°afterP�bg.:Elea.•Mech.;arid:F..ire).' • ' •,•: .,•Insit adon ftndlErW - Dq not tape or plaster' 4ptil the following ap.plicabIs , items have been signact:, • .: ' • Drywall Penetrations (Flm.Rated) E eecMcai PenetraUoris (Fire Rate •Mechari(cal Penetrations (Fire Rated) Plumbing'.- . ' .tnterior:Lath • - Ext6dor•Lath ' GENERAL JTIr S. EW'r;or Plsster•(Brown Coat) T -Bar Electrical- .T-Bar lectrical T.Bar Mechanical . . T -Bar Strudtural: Sewer.' - .Water.Engineerinp Backflow.. Water Service FIN;AL'IKSPECYION'S Dhte•" . 'Inspector• Efpctrlcal Final' ' Plumbing Final• •. ' , IMeepahica l'FJnal • ' st Giading Firial.766a128�•pL Fina1.765�4040.ngineean*6 kEn 765.5268'Ususiriess]License 76M) 765-549 d'uitr)Irig Firial , LnAbbve romp e .). PaARTIAL.INSPECTIONS r Buildi"ciinspections' ' Mechanical"lnsipectioris :Plumbing lijspeciioris Me, d Tical 'liisuections ' '- :, •. PLUMOINGAERMIT NO:. PLM2000-0d 19 ;' • ' BUILDING QNIStON , .::. . " ' a00'S; AAAHEIM BLVD.`, TYPE OF,pERM1T, :f : (714) 765-5153 , ,NAHEI.IVI. , . _INSPIsCT10N'REQUES7LINE:: 7.;� '(.7)4)7651.5181.' ' DATE' .,11'/3.OIg000, . i •^ : <A .:: •; J, r JOB:ADDAeS$•.'26T?1 YII SERENO;PL •' r �UART�R SEC1i0N 20 ' LEGAL DESCRIPTION;' •-N TR 2938 LOT2r APPLICANT:' OWNER INFORMATION CONTRACTOR INFORMATION:'... : ARCHITECT/ENOINEEa INFORMATION;. HOWEL'Lk( CROUCH' %ALL NOME' -REMODELING,. 2874 W SERENO PL, :1403•114BATAMA 8112 - • ' ANAHEIM. CA 82804 ORANGF.� l 8673516 -cA JOB pESCRIPTION: Repf49g.Fidures For Bathroom " PRtJCESSED'BYRLC OWNER431.1ILD6. DECLARATION eT ireby'affinn Und8r.pW011Y o P809 mat I am. exempt ium the Contram7q.1.1canSIS LOW • •e Wing reason er. 7031,a ausinos$ a'�' . . Profgssiaris.Code:any dgr.brcounly Whigh requires a pemlk'to bonsfnict, alter, knprove, demolish kir repaii-aeiy.struct4ri, priorto Sts issuance; t�fsb, requireethe toplioant'for such-permBto file a slgned statement°thdt•he islWinsed pursuant' t6'the provistor�,ofaw Contracbrs:l.(.aanse Ww '. • . (Qliapter 9)(coinmenclrig writfY•Sect4ri 7000 of DJviston 3 of the.Business and Profias§ionsCode) or that he Is'b the -basis for -the: - allegeq'e>lemptlon: Any .oblation of Section 7031.5 by any appQcani to'r a partner spbjec tsthe app6cantto•a civil, penalty of rat more then five' hurfdleddollar6 ($500). 1, 'as owner of'prop@rty.. or.my empbyees wkti wages as'theirsole compensation. Mi Bothe work, and the structure is not intended of offered • sale (Sep 7044.Busness end Professiprrs Code: The C4nfrader's LioEhse Law,dees'not apply'to an,pwner of property intro builds or•improyes thereon. wed whv'does such work hirtlsay or herself OF through his or her'c)wn employees,,provided thatsut:h improvempnts•are not•intended of • ' . offeretl:foc sale: • If, liowa%0i, the buildlpb or jnrprgveinent Is- sold;wkh ohs 4air of cQrnpletipn; th®owner-builder wHl haYe'the burden o/ pmvnp that he did not•budd of Improv8 fO the purpose of sets)r : the to con 1, as the ownerof property, am eraGlisivey:c6ritr�Cting.vvrrh licensedaontr8cto's•struct the'project ($ec. 7048 Business and: �Fabsstons Code: The ConmRactWs License Lawdoegtlot appy, Coen ow.rar.ot property vuho'bkipds or improves.thereon, aridwho contracts tor• . surfi proJec� with s c:ontractot(s) ticettsedpersuant to th0 Corstractors Lic rinse Law). am-eiiempf under M. ' • B $11% for thlsteagon:' OatOwner. :. 'WORI�R:S OMPEN$AT10N DECLARATION : , LIGEN HYRACTOR, DI;: LARATION:.' ..:� I hereby affirm Under, pdriaky ofpejuryone bfthe fbl"ng declaratio rs:' y d vm•u r pane y p. ury a am . _ Q' .I,have.and vA maintain o'catificate ofirotm ltto se>r:lnsure for'vvotkests'competisation, ' Itoensedlunder pro ' " of c?tapt 9 (txxnnrencing '•_ ..as prtiykled•for. by Section 37.,D0 of the Labor Cc e; fQr the perfannanoa bf the work for which with Sedior17000 b 3 61.the Busness.and this pemtli Issued scions C ❑❑ Fhave endvirill maintain wdrkefs compdaefen insurarioe; as req6lre4 by Secti0n'3700 : TUie.t.00 Code.•for the performance nftFre work for which thin; permit is .sued. My Dela. Contractor - workefs Cbnlperisatlon in'surancp'carrier. and policy are: .. . : : • • ' 11/30/Z000' . Gamer.'• STATE.F.UND Polky Nuihber: 229-00J8164 NUMBER: E9(PIRATtON;OATE: :.. `-:.This setdon need not be coin led if the reit le.for one hundred doaa 600501. 08/3112002: P� psi Rlllo)•orless: TYPE: B ' Q:. I certify that lrA'•the performance of the work icf which this'Ferrnit is issjed,.l shag not ' TY E- HIC 6M- Ooy any. person in any manner so as to become subject•to the w ticerscpnpensation • - laws.of Caltfornia,•pnd agfee,•that if I should become subjectta the workeesscompensation proyislons of Se3700 otthe Labor Code,1•shaN forthwith corrrplY with those provisior�: ct h Date: '=11/30/Z0D0 :ApPllcarit ,• ITEMS ; WARNING: FAIWRE•TO''SECURE'VN1�RKER'S.C.0MPENSATJONCOV RAGE 18 :UNLAWFUL, AND SHA LL•St)E JECT AN•EMPLOYER �'O C,RIMINAL PEgJALTIES.AND';' ` ' Levetdry, 1 . ' • ' CIVIL* FINE9 UP :TO 014E HUNDRED THOUSAND DOLLARS ($100;000); IN ADIOITk* TO ; � "�'p 1�;�� . • : •'1 . 'THE.COST OF-.COMPENSATION,.DAMAGES AS PROVIDED FOR IN'SE CT(ON 3706 OF . . 'THE tA111OR CODE. INTEREST AND ATTORNEYS;I=EES: ; • CON TRUCiION.LENDI GAGENCX• .• • ' • . .. • , • ... l.hereby affirm'undet penalty of perjury -that the're•h a bonstrildiori leriding pgeney for the. ' pdrfonnance ofthi work.fbrwhichthis permItislssued (Sea$097.Civ:C):" Lend'*s'Iriforrireti6n! *' 1 certify that 1 have rea0 ppliCatibn ani! state that ,the aboYe intorlrgtibn•is eorrrecx ; l• agree to'pdhipty with a inances and state lawrs'refating to building ponstructidn. end : '•;• , hereby.authoriae re es toenteruRon'.the'above mentioaed.property:for. : inspe on puiposes .Datan i l /,3(i oo . igna re p can 'or ,ant s:am r . The perpdt shall'sxplip •by ilinitatiar aril tle6onte n ll.end volq'If the b*trddind oi,- Total: ' 46.7.5, Nock hes not passed f7Aat ihcpeetiori 365 days from the date.of permit issugnee.' r ' neyv;penrrit is required tb ao'mmenoe orcon hue work : . 11 INSPECTION RECOI20 " F-IN/AL: INSPECTIONS : ' . 'date' ' Inspector :. Electrical Final • ' Plumbing; Finai ZQ [PWater hanlcai final'• Test' ineeringfOradl»g Ffib1.765 is Dept; Final. T65•IlOd4 Engi'neering•765-5268': Lfst/8usinei;s Ucense 765-519 ding Ftngt ,etAtiove Compete) 'INSPECTION t DATE ' INSPE.& R •i :Tenrporary:PowerPoIe . -Qlumbinrj (1)ratnlWaste Pipe) - Electriaal• Ground.Eleetiode/Ufer SetbacWFornisffrenches (Footings'- 'Do'not install;subiloor•or. p our• floor flab •unti l the following•applicable•items have been signed: 'Plumbing te�fii .Spdnklet'1(alves). ' Mechanical (Groundwork).' Electtr cal (UnOrground.Conduit). .ple•slab, •ompa�ct .Membrane: n . .. Underpinning (RoorJoist(Girders)•' • ' :Do not co or coneeal.thb work below 'untilt • follgwing'applicatile items have been: signed::: f1'st•Floor•Shear ' .I Firesprinlder-{Rough} 3nd'F.Ioot•Shea�.:� : : '• • ' . •• .':Roof Sheathln Qi hragfdRrariie .t;Masoirry•(WnfJBond BeamlPre-Grbut) ''Roubh`P.iuffibI6b (Top Out) :•Rough.Mechanlcall Roug ecurc Dry Rou h -Electrical • Framing• :• tdnly.sharPibg:; Elec.,teiedi.; anA Fire} .' . ' . .. % In suiatlon(SouridfEnifrgy)" ' .-Do not tape 0.01aster udtil•the following applicable'.... ' .items have peen signed; Penetrations (Firb RaWl). Elsctrlcaf' •P.enetrationg• FireRated) Mechanical Penetratiohs(Fire Rated) PlUoting . ExteHor Lath:•: • • GENeR.AL'•ITEMS.-. F�derior Plaster(Browri Coat) T•Bar Electrical ' `T-Bar'MechalUcal:. '. T -Bar structural . } Sewer.: . . • . .. . • Water Ejigirleeririg Backflow. •• ' .Water Service• w � PARn INSPECTIONS' ' Building Insaictions Machan3cal•'rnsoections ' ' `' • ' Pltilmbina lnstiectlons' EI•ectfical Inspections - i$UILDiN13 PEkMIY.NO:' .gLD200043872 .BUiLpINO DIVISION '• 200 S� ANAHEIM: BLVD. . • :7YPE OF �.: ' ::.. - •: t • :. � � ;�' •• , • (7ida 765.5153 .. • '... ... . �• PERMIT•'• :... ::.:.` . , -:: ... • .::.:.: ::. .' •. RePE . •'CITY F . ' : 140SCil N REOU ' ;•t,• �. •., ;(71.4)•769-'51:6.1:• ";�A'i'�= •1.913012000 • • :.' .. �'.::�:;•::r'' .a:'`: •�` •, . • • . • ' ... • .CENSUS CODE:; : • 4439 JOB.AbORESS; 967414ERENO'FL' QUARTER SECTION: • . LEGAL DESCitIPT'IbN: IV TR 2938 COT 21 APPLICANT: STkvE. pARENTEAU OWNER INFORMATION: :.�CONTRAGTOIZ.INFORMATiON:: • ARCHITECifENGINER.INFORMkTJON: HOWELL R (CROUCH • ALL REMQD0.11VG... 29'f4W SERENO PL • 1403 N SATA�(lA •#112 :. . ' :ANAHEIM; CA 02804' bRANGE..92867516 G% ' . • ' JOS•DE.SCRIPTION:Rdplace Flai•Area Roof VYlitolled Roos. VAL:UAi10�1: ' .` x,400:00 ' : • f; . ' PROCESSED BY: RLC O NAR$UILDER DE LAR�ITJON Y a rm under. Y, Pe4urY a . am exempt, rom 8c s nse e g reason BG . . us mess an Probsol"s Code: any city or county wh'ic2! requires a pemnit to construct;: alter, im :• Prove: demoiish''or re'paItawstructure,.priortdItsissuariLe,.alsii' . gequires the applidant forsuch pWMR to filen signed statement that he is ;ioansed •pursuant fti the p%YisIons•of the Contractors Uoense Law ' (Chapter9)(comrnepcirg 'with Section 7000 of Divisioq,3 0 the' Biislnese a� Professions Gdde) pr that heeikempttherettomand the basis for the ;. . , alldjed 'exemption. •Any.violatio0.of Seetibn Z031.5,by any applicant tor's.pennitsubjedsthe appicantto a civil penalty of-not more than trvq hurrdred•dollars ($500).: • .; <. . ('') k awrrer ofpropeRy,, pr my erppbyees wifh•wages es.thelr sole cohrpensatbn, will do the work, and 08.structure isnot Yitended'or offered' F pale' (Sea 7044 Business p(rd professions Code: The Contractors License LaW does-not apply to'an owner of property wtic builds or,Impr6yes tlrereoh,'and who does•sucKwotk himself or herself through his or.tfer twn employees,'proyideo thatsuch.Imprgvemerrts are:not Intended cr offered for sale• • If, however• tho'bulldirg w improvemtent is•.sold with one?yeaf of comptetibn, the owner builder wl9 have the burden of proving.that• 'he.did not'tiuird or'trriprMe ror the dirrpose of sale). • ; • . I,• as•the owner'of the property, a'm exclosivey tracting wiri Iicentad conirail dors to construct the project (Sed. 7044 8uslriess anQ rofessions Code:'The'Contractoeb license Lowdoes not appy to ag ov+ner of property-who builds or•Improves thereon, And viho contracts for such prpjecta with a contradoKs) licmtsed pursuant to the Contfactoes Ll •ense,Lawj.. .0 •.1 am•exempt under Sec. ' , B.8 P.C: for this reason: - Date: Owner.' y •.' - ' • WORKER'S COMPENSATION DECLARATION_ CONTRACTORS D>lrC RATION erobl►: under penalty.of perjury one of.the,•followtng dedare13M . m y a rim under pens y p ury am ❑ lhave'And.wiN mairitairraomtifiwtae ofcorisent� self irisuie ior;worker's eanpertsotion, Ilceneedund .fpro idles of chap rriencing ss'p'rovld far• by Section 3700 of the Lebot:.Code, for the perfomnane®'o' die work for which -will Sedbri 7 ivsbn 3 of. Hess and. •. , this permit Is issues• Professions . •. . • { ❑° 1have •and Will inaintain,workefs�c ensatbn Insurahce, as requited by Section 3.700 17/3x2000 o�the.t[:abor Code;.for he 0iftmarrce df -the wock1bewhich this-permit. •s+sued: 'My' ' D , 'worke�S Cdrnpensation hsurance carrier and policy are:. ate' Contrac ;r, Cemjer'-STATE-FUNd fvdicyNumtier: 228:0 06164',: • • NUMBE J:XPIRATION DATE.. This'sectio� Hoer nottie aompletadif the permR li taiono hkmdrdA doisre (S1G0) Or It+ad.. GQOS01 06131f2002 .• , TYPI; B i'ceit that. the r1*manc6 of..fhe.won� for TYPE H C dy b Pe tNtkicli this pemilt Is hued; l ���l not I r pfoy;any peisoii In iarry'eiertne; sp as to: become subject tathe worker's•compensation - lawsaf C,aijtorNa.:and.agreathat it Ishould become aubject to the workers compensation , proyiS".. 4 Section 3700 bf the Labor Cade, i dMirlbovAth compiy.wlth those proviso . '.LSate:' lir 0/?000 ;Applicant • _ 'WARNING• FAI_j:URETO` ..ECUFiE.V110RK R'S COMPENSATION Iil?1Gt:•IS= :'•• t1NLANFUC. ANWSHALL SVBJECTAN EMPLOYER TO CIiIMINAL,P,ENALTIE8 AND° •' •. :"� ,' CIVIL' FINES UP:1°O.ONE HUNDRED.TkOUSAND •OGLLARS •($100',000); IN ADDITION TO. SIE'COST OF•COMPENsAtbp(, ,I)AMAGES;AS PROVIDED FOR IK$ECTION 3706 OF ' THE BOA CODE. INT.ERESTANDATTORNEY.S•FEi~S. 0. ST•RUCT ON LENDINGAGENCkY.:.:: t. '. • . :,. f hereby affirm WOet•penaityof.perjuiy Uwt there ls'e•k onstrucGon lendipg sgencyfior the'::.. performshce ofthe'workforwhich,this permit is issued•(Sec•:3097..Civ..CY:' t ends Inforrrlatl T. ': _: certi(jl t118t,i have read this apple ' n andetata that:the.abpve.infOrrtl'dti0r11S.CORBk t;;1.• %agree to oompty'wl a0 dy:6rdilia '6 dtate i 0drig to building eonsfructibn. avid hereby.ayth 'santhres•of r upoir the abgvemeritbneil propertj► fcr ' inspect pu s of • ' .. .. .. ' : • ' ::"• '• .. .•' . Totalc:; :.. 1Da; 11130IY000' 9 D giant or AW ' The piermit sihltll explie•b'y,limltatlon and bda6rve null and void ty'tlie building or, ' w6rk.hn: noi:passed tinal Inspection;65.O iys.fmm•the dobe of porndt ksuance. new Perm t la required t0:c6mmgft1* or Continie work:: , :INSPECTIONi2EC0116 .'•IN,SPEt:TIQN ' ,•.:. QA-! � : -..---ANSP P-0%Power Pole Phimbl .g,{DrairrlWaste Plpe)• .7. •Eledrical GrouodElectrode t fuer..- ..: . SetbaclvFormSlTrertches (FcotIfW)• : '136 --not install:subfkior.br pourr%br-slbb Until tha , following epplicati(t3 ifems Naye besn signed::.' Plumtiing (Watef PI :S rinkler/.alves , .Mechanical-(droth*work) Ebctticat.(Undetground Edridu#t '.. t Pm•s ompaction/ ane. einf. UnOerpinn n* (F pr oistlGirdera): Do ttOt boirer.:.or cotrcea• •the•work'be ow unti •t . following;appiiratile iteina have: been:sigried: , 1st Floor•'Shear' ' Firesprinkler•-(Roug>ti)<• • • '• '.. ;rad• Floor Shear 'Roos 5heathi piaphm 'mlFrarrre •; :a ot- Masgnry'(Reinf 0dpd Beam/Pre-Grdut) Rough Pliarinbtng o' Out Rougli_'Mechanlaal -. ug 'Elects c ( II . Rough Electrical:: :framing..- --(Nafter Pltig•. Elec.. Mech:, and Fife). • . < Insulation (SoutidlEnergy}: } Do'not iape:orplasior •until'the.fo lowlnm` ppliceble •- 0ms'have been slgned: • Penetrations (Fire.Rated) Electrical:. Penetrations (Firs Rated) Mechanical'. • ' ' •j Penetratibns (FIre:Rated Plumbing' . Interior La h Exterio 777= GENERAL ITEMS' ' Exterior'Plastet (8nrnrn Coat • T -Bar Electrlrp) - T -Bar Mechafiicat T-BaT Strui;tGral ' Sewer . . Water Engirieedng $ackfloiW. :. Watbr Service • ' '•:*.. FPFiNAL.1NSt'-ECTION ctrical:FiniinblrigFirial etianica(1=foal:: '. ' i' • ' ' ' ` :Gas Test % ' �Engineerirrgl6rading. Flhal ir�a128 , ' . - FiFe Dept: Flnal 765040 t Water Engineedrig 78515268, Sub ListlBlrsiness Liaense'765-518 ; Zoning •7¢5.518a " Building Fldal ; s Sje Camp jflej; .- � RARTIAL INSPECTIESNS st' ,9(. - Buildino.lnsaectio'ns' i •' .. •4 f r. Mechancal••lns»ections Plumbin'a' Inspections': ".. :. . 7. Elect�lcal'Jrispiections.:• � •i. � �: ' • .. • • .t r • •<•• •'•' �••• ' • .. . .. .. a .. .. .. .. . . • s • ....s. •• •