170 S. Lakeview Ave.
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:
Jack Bhasin
5 Rue Chateau Royal
Newport Beach, CA 92660
Phone: 310-391-3998
Owner Name:
Address:
same
Phone:
PROjE~T ....
Address/location:
Type of Project:
lot #:
Tentu:ive Trad #:
No, of Dwelling Units:
170 S. lakeview, Anaheim
NSFD APN#:
I2J Single Family
o Multi Family/Condos/Apt.
Total Square Footage:
Multiplied by Applicable Fee:
Other:
6,550
$2.24
'RESIDENtIAL'.''::~
Applicable Fee level: I2J 1 0 2 03 0 4
Total School Facility Fees: /rIll
. Total School Facility Fees: I/P !J"?J
: i',.;~2\Y:; <;:,:':.:1/',:' ,:t' i\X~1:,f~~~~*';1;~Y?!,:i~{:(fP;f;::\t-;-~~:~
, ."." . , . , .' ,'."..." ',_ .. c. '~~', '.".'"
COMMERCIAL.:' .' .
Total Square Footage:
Multiplied by Applicable Fee:
~
Total School Facility Fees: I
NO 0 YES
REASON:
The above representations as to square footage are true and correct. Developer/Applicant agrees that if it is
later determined that such representations are n rue, then t is of Compliance shall automatically
terminate and the appropriate City/County s e nolifie .
Developer/ Applicant Signature:
This certifies that lhe above named Developer/Applicant has paid school facility fees in compliance with
Education Code Sedion 17620 et. seq. and Government de Section 65995 et. seq.
Date: February 7. 2005 . Name: ~ 0 Title: Executive Secretary
NOTICE: The 9Q-day pertad in which you may prolest the tee described herein will begin on the date this tee is paid. However. If the fee
was imposed by the City or County os a condition of approval for your project. and you hove received the requisite notice. the 90wday
protest period began at the time your prajecf was approved by Ihe City or County.
certificate of compliance
Rev. 02-24-04
.
BUILDING PERMIT NO. BLD2004-04455
TYPE OF PERMIT
BlockwalllColumns C I TV
DATE:,12/20/2004
JOB ADDRESS: 170 S LAKEVIEW AVE
LEGAL DESCRIPTION: P BK 71 PG 26 PAR 2
APPLICANT: CHACKO JACOB
OWNER INFORMATION:
Michael J Anderson'
170 S lakeview Ave
Anaheim, CA 92807'
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION. REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 167
, ARCHITECT/ENGINEER INFORMATION:
CONTRACTOR, !NFORMA"ION:
BASIX CONSTRUCTION
2222 MICHELSON #4600
. IRVINE, CA 926120000
BUSINESS PHONE: 94995:,.0039
JOB DESCRIPTION: Install CMU fence and retaining wall 122 lineal feet of 5' h;gh of free standing, 206' 6" of 6' It high of free standing, 94' lineal feet of 4' ,
VALUATION: hig'!Jb~b'll8i'38 wall, and 2 pilasters. All per approved plans.: PROCESSED BY:, EMA
I - , ' , , OWNER-BUILDER DECLARATION. ' - ,
I hereby affirm under penatty of perjury that I am exempt from the Contrac.tor'{ License Law for. the following reason (Sec. 7031.5 Business and
Professions Code: any city or countywhich.requires a permit to construC:t, aii~:", improve, demolish or rePair any structure, prior to.itsissuance,- also
requires the applicant for such permit to file a,signed statement that heis Iicefised pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Prafessk'.;lS Code} or that he is exempt therefrom and the basis for the alleged .
exemption. Any viOlation of Section 7031.5 by any applicant fora permit subj-;clsthe applicant toa civil penalty of not m9re than five-hundred dollars
~~, ' ;
.0 :1, as 'OWner of property,'ormy employees with wages as their sole-comp~rtsatl,on, will do the Work, ana the structure (s not-intended or offered for
sale (Sec. 7044 Business and Professions Code:' The Contractor's license L~\1.. does not apply toan owner of property who bujlds or improves
. thereon, and who doe~ such.work him.c;etf or herself or through his or,her owri emploYE!es, provided that S'-lch improvements are not inte_rided or. _ .
offered for sale. If, however, the building or improvement is sold with one yet/of oompletion, the owner-builder will have the burden of proving that he
didnotbuildClrirnproveforthepurpo~eOf!i><3le). .' , ,:" . , . ", .
. O' I, as the owner of the property, ani exClusively contracting with I:cellsec: ;,nntradors to construct the project (See. 7044 Bu'siness and Professions
Code: Th'e ContraCtor's License Law does' not apply to ,an owner of proparty;....ho builds or improves thereon; and who cOntracts for such projects with
FLQontractor(s) licensed pursua,nt to the Contractor's Lice;,~ ~w). 1 '. '." " -
LJ I am exempt under Sec. " B & P.C. for this reason: _; ..,.
Date: . Owner:
UCENSED.CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that lam ,
'Icens,ed under provision$ of cha . omm~ncing
with Section 7000} of D.ivsion '7i. ess and
Professions Code. '. .
12120/2004_
Date:
WORKER'S COMPENSATION DECLARATION __.' I
I nere Irni under penalty of pe~ury one of the followin,g declarations:
I have and will maintain a certIfICate of-consent to self-insure for'v'lorke-r';; compensation,
as provided for by Section. 3700 'of the.Labor COde, for the periormance Of ih~ work for which
this permit is iSl3ued.
o '1. have a'nd will maintain wolker's c'cmp~msation insurance,.as requi~d b'~ Section 3700 of
the Labor Code, for the perform.ance.ofthe work for which this permit is j'3Sl!~{i. Myworker's .
Compensation insurance carrierand polIcy are: '
Cqrrier: Policy Number. ~
This section need not be completed if the pennitis (or one hundred dollars ($10Q: or less.
o I certify that in the perfonnance of the work f~rwhich this permit is issuJ::!;:;_~h~1I not
employ any person in any manner-so ~s to become subject to the worker's Gli:11pensation laws
of California, and agree that if I should becom ct to the w-ork.er's COlT!j:--,,;'-"ris'ation
proVisions of Section 3700 of the Labor Cod fo hwith complyiMth th.-,;;e provisions.
Date: 12/2012004 'APPllcanX ' ,
WARNING: FAILURE TO SECURE WORK ,ENSATIONCQVERo\GE IS
UNLAWFUL, AND SHALL SUBJECT AN . OYER TO CRIMINAl.;-PENAI.TIES AND CIVil.
FINESUPTO ONE HUNDREDlHOU ,D DOLLARS ($100,000),.iN ADDITION TO THE'
COST OF COMPENSATION, DAMA ES AS PROVIDED FORIN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
. I hereby affirm,~nder ~nalty of perjury that there is a construction lending'agencY:for the
performance ofthework'for_ which: this permit is issued (Sec.3097 ~q~v,C):
Celldefs JniortnatrOn: --'-
NUMBER
840401
TYPE B
Construcidn Tvpes:
V N~ '
I certify that! have read this ,application and state that the above information is correct. I
.. agree to oomply : a,1l city ordina'nces and state laws relating to building construction, and.
hereby author' e sentives of this city to enter upon the above mentioned property for
&.' 'ns.p ,. 'on P ;.( , '
Date: 12/20/2004
_ i ure pf Applicant or Agent
The permit s .expire"by limitation and become null and void if the building or
workha' oi passed final inspection 365 day!! from the date of permit issuance. A
new permit is requiredto commence or continue work.
Fees paid for Permit:
Total:
1.027.80
INSPECTION RECORD
. INSPECTION'
;.
DATE
. FINAL INSPECTIONS
. INSPECTOR ." Electrical Final
Plumbi.ng Final
Date
Inspector
Temporary Power Pole
Plumbing (DrainIWaste Pipe)
EleCtrical Ground Electrode/Uter FJ
SetbaeklFormsfTrenches (Footings) l1i: I X\ "Alft \(./ . .
Do not install subflooror pour floor slab nti the .
following applicable items have been signed: .
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork)
Eledrical (Underground Condu ill
Pre-slab(CompactionlMembrane.Rei nt.
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable. items have been signed: .
1 st Floor Shear .
Firesprinkler. (Rough)
2nd Floor Shear' .
Roof (Shealhing/DiaphragnilFr . ~
Masonry (ReinfJBond BelllJllPre-Grouj). ~~
.Rough Plumbing (Top 0'(+\ -- /
Rough Mechanical, I
Rougn t:IectrlCaI (Dry Wall) .
Rough Electrical
Framing (Only after Plbg.. Elee.. t,,1ecn.. and Fire)
Insulation (SoundlEnergy)
po not tape .or pla~ter until the following applicable
tt&mshave been Signed:' .' .
Drywall .
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing .
Interior Lath.' .
Exterior Lath .
.
Mechanical Final
Gas Test
.
.
Engineering/Grading Final 765.0126 .
'.
'.
Fire Dept. Final 765-4040
Water Engineering 765-5268
I
.
.
.' Sub List/Business License 765-519
Zoning.765.5139 .
BuildingFin~I(Lastlnspection.OrtIY ,,(1r'j../t:..,.-. -:T'
. . AHer Above Complete) .::t lI't' J ~ r \. .
PARTIAL INSPECTIONS
Buildina Insoections . . .'
B.9-0<;" f,,,,'<;rG-44 .~lLltv, Alj clIz:i
4iJ1?( II( p;,roFIJJr,((f-1':lhyihM-,;
. .' ..... .' ','
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(j
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Mechanicallnsoections
" .
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GENERAL ITEMS
Exterior Plaster (Brown Coat)
T-Bar Electrical
. T -Bar Mechanical
T -Bar Structural
Sewer
Water Engineering Backflow
Water Service
Plumbina Insoections
. .
.
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Electricallnsoections
, .
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