2790 W. Lincoln Ave.
~~~O~?F PERMIT CllY
DATE: 4/11/2005
JOB ADDRESS: 2790 W LINCOLN AVE
LEGAL DESCRIPTION: SEC 13 T4 R 11 N 288 FT NW1/4
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765-5153.
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 20
BUILDING PERMIT NO. BLD2005-00986
CONTRACTOR INFORMATION: '
STEVE SUDDUTH CONSlRUCTION
3871 URIS CT
IRVINE, ,CA 926060000
BUSINESS PHONE: 949 551-21~0
JOB DESCRIPTION: Tear off existing and Install 20 squares with BUR
VALUATION: 4,000.00
I OWNER-BUILDER DECLARATION
r hereby affirm under penalty of perjury that I am exempt from, the Oontractor's License Law for the following reason ,(Sec. 7031.5 Business and,
Professions Code: any city or county which requires a permit. to construct,' a fte r, improve, demolish or repair any structure, prior to it~ issuance,.~also- .
requires the-applicant for'such permit tq tile a signed statement that he is license~ pursuant to the prpvisions of the Contractor's LicenseJaw (Chapter
9)(c,ommencing with Section 7000 ofDivision-3 of the Business and Professions Cade) or that he is exempt therefrom and the basis forthe' alle~ged
exemption. . Any violation of Secti<;)I''17031:5 by any applicant for a permitsubject&the applicant to a civil-penalty of not more than five hundred dollars
_~ ,'. 'I,,'
0, I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License Law ~oes not apply to an owner of property who builds or improves
thereon, and who does.such work himself or herself or through his or her own employees, provided that such improvements are not intended or . _
offered for sale~ If, however, the building or improvement is sold with one year of completion, the owner-builde'r will have the burden of proving that he
did not build or._improve forthepiupqseof sale). , ; _ ,'. " _'
D. I,_'as the owner of the property, am exclusively ,contracting with licensed contractors to construct the project (Sec. 7044 Business and Pro1~ssions
Code: The Contractor's liCense -Law does not apply ,to an owner of propertywhq'builds or improves thereon, and who contracts for such projects with
a coritractor(s) licensed pursuant to the Contractor's License Law). . ~
D I am exempt'under Sec. ' ;,6 &' P.C. for this reason:
Date: ,Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
D I have and will maintain a c'e~ificatei of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is is sued.. ";
.vrTii'ave and will maintain worker's compensation insurance, as required by S~ctjon 3700 of 4/11/2005
~borCode, for the performance of the work for which this permit is issued, Myworker';:; . Date:
.compensation-insuranCe carrier and policy are:
Carrier: STATE, FUND ' Policy Number. 16860252 ,
- . i
This seCtion need not be completed if the pennit is for one hundred dollars ($1 00) or less.
o I certify that in the performance of the work for which this permit ,is i~ued, l;sha~ not
employ a,ny person in any m~nner so as to become subje<;it to the worker's compensation raws
of Californi'a, and agree that if I should become su to the worker's compens~tion
provisions of ,Section 3700 of the Labor Code, I forth 'th comply with thoseproyisions.
Dale: 4/11/2005 . APPliC"~
WARNIN'G: FAILURE TO SE~~E~ 'SCOMPENSATION COVERAGE,IS,
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIM INAL PENALTIES AND CIVIL
FINES U PTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADD11lON TO THE,
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDINGAG,ENCY
1 hereby affirm under penalty of perjury that there. is a construction lending ager~y for the
performance oflhe work for which th.ls'permit'is issued (Sec.3097.Civ.C):
Lender's Information:
APPLICANT: DAN HI LL
OWNER INFORMATION:
Christo$ P Tsachpinis
156 S Calle Dlaz
Anaheim, CA 92807
ARCHITE,CT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
LICENSED CONTRACTORS DECLARATION
I ereby affirm under penalty ,of perjury that..1 am
licensed. under provisions of chapter 9 (commencing
with Section 7000) of Divs' of the Business and
Professions Code.
NUMBER
746046
TYPE
TYPE
TYPE
EXPI RATION 'DA T.t:
2/28/2006
B
C39
HIC'
Construcion Tvpes:
VN, "
-- . -,~-,----~'--,,,_.:"':'.---~',---,~:.-.
I certify that I have read this application ,and state that the above information is correct. I
agree to compl'y with city ordinances and state laws relating to building construction, and
hereby authorize re ntives of this city to enter upon-the abov.e mentioned property for
inspection purpo
Date: 4/11/2005
Fees paid for Permit:
Total:
160.95
ignature of Applicant or Agent
lh,e permit shall expire by limitation and become null and void if the building or
work has hOt passed final inspection 365.days from the date of permit is,sumce. A
new permii is required to commence or continue work.
INSPECTION RECORD '
, INSPECTION OAT!' INSPECTOR
Temporary Power Pole , ' "
Plumbing (Draln/Waste'Pipe) ,
Electri,c;al Ground Electrode/uter ,
SetbacklFormSfTrenChes (Footings)
Do not install,subfloor or pour floor slab until the "
following'applicable itemS have ,been signed:
Plumbing (Water P1oe.Sprinkler Valves) , ,
Mechanical (Groundwork)
Electrical (Underground Conduit) , "
Pre-slab (Compaction/Membrane.Rei nf.: ' '
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until,the
following applicable 'items have been signed:
1 st Floor Shear ' ,
FiresprinkJer (Rough) ,
,2nd Flo,or Shear I . II,
RooflSheat' 'aphragmlFrame) toIllHI6 )'1.,
Masonry (RelnfJBond BeamJPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Kougn l::lectrlCaI' aliI
Rouah Electrical "
Framing (Only after Plbg,: Elec.. Mech, andFire) ,
Insulatian (SoundlEnergy) , ,
Do l'Iot 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 ..
exterior Lath,
GENERAL ITEMS
Exterior Plaster (Brown Coat) I,
" T -Bar Electrical
T -Bar Mechanical
,T-Bar Structural , I,
Sewer ' , "
Water Engineering Backflow ,
[ij.ter Service ' , , "c-
, ,
FINAL INSPECTIONS , , ' Date' Inspector
Electrical Final' , , ,
Plumbing Final ,
, ,
Mechanlca,l Final
,Gas Test ' ,
Engineering/Grading Final 765~126 "
Fire Dept. Final 765-4040
Water Engineering 765.5268
Sub List/Business License 765.519
Zoning 765-5139 "
Building.Flnal l(-ast Inspection- Only ~-:s/OS'" -.--"". i ' ",
fter Above Complete) , 'if!;-
,PARTIAL INSPECTIONS '.~ I ,
Buildina fnsoections
J,l<..,
Mechanicallnsoections
Pfumbina Insoections
Electricallnsoections
BUILDING PERMIT NO. BLD2005-00663
TYPE OF PERMIT
Repair
DATE: 3/10/2005
JOB ADDRESS: 2790 W LINCOLN AVE
l~1~.;:I:~~~~\ .
CITY OS~?~bf.I\'HEIM
. '\\~~~i"~Y:./ .
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE: .
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 20
. LEGAL DESCRIPTION: SEC 13 T 4 R 11 N 288 FT NW1/4
CONTRACTOR INFORMITfoN:
NEWPORT RESTORATICH INC
2282 BUSINESS WAY.
RIVERSIDE, CA 92501 Coco.
BUSINESS PHONE: 714 25~:-0440
JOB DESCRIPTION:Replace 950 sq. ft. of drywall due to fire damage. (Ref. IN'n005-000C7)
VALUATION: 8,000.00
I OWNER-BUILDER'.QECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor:> license Law for the following- reason (Sec. 7031.5 Business and ,
professions Code: any city or countywhiC:h requires a. permit to Gonstruct, a't;;" irripm~e. demolish or" repair any structure, prior to its issuance. a/s'b--"
requires the applicant for such permit to file a s'igned statement that he is iici~sed pursuant ~o the provisiOf1S of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he i& exempt.'therefrcm and the basis_ for the alleged
exemption. Any violation of Sectian 7031.5 by any applicant far' a' per'mit 5LJb;~-cts the applicant to a civil penaltypf nat more ihan five'hundreddollars
($500). .. . . . . .. 1 ... . .
o 'l;a5 owner of property, or my e'mployees with wages as their sole <:.ornp':l"'satic'I"I, will ~o the work, cnd. the <structure is not intended or offered for
sale (S&C; 7044 ~~siness and.Prof~sions Code: The Contractor's licensE" l?:V~ dnes not apply to an ownerof property w!1o builds or irr~proves
thereon, and who'does such' work himself or herself or through his or her owr; 6mp;OYE;l~S, provided tflat such !mpro.vementsare not 'intended or
offered'for Sale. -If. however, the building or improvement is sold with one YE;~.r ofC'_omplei:ion, the'owner-buiJder will have 'the burden'of'prov!ng' that he
did notbld!d 01 improve for the purpose of sale)., ~
o I, as the owner oft~e property, am\~xdu$.ively contracting w!~h licf.lDSed ~xmtract"rs to construCt the project (8eC'.. 7044 Bu'sines~-; and Professions
C"ge: The Contractor's License Law does not apply-to an owner of IJroperty}ir..o builds 'or imp;OVE:s thereon, and who,oontracis for such projects with
fu;:ontractor(s) nc~nsed pursuant to the Contractor's Uce-nse Law).' ,
L.J I am exempt'u!1der See_ .' .,', B & P.C. for this reason:,
Date: Owner:
I
APPLICANT: KURT NIX
OWNER INFORMATION:
Christos P Tsachpinis
156 S Cane Dlaz
Anaheim, CA 92807
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: ENO
. WORKER'S COMPENSATION DECLARATiON . :'__,-'-"l IUCENSED CONTRACTORS DECLARATION -.-l
_, hereby affirm und~r penalty of perjury one of the following deciaratj(Jns; 1. I I hereby affirm ~l~der penalty of perjury that I am
o I have and will maintain a certificate of consent to self~jnsure for worker:! :,cmpensation, t. licensed under prOVlSIOI1S of chapter 9 (commencrng
as provided for by SectIon 3700 of_ the labor Code" for the performance ofthO;.~ w.?/i<, for whic~l I with Section 7000) of Divsicn 3 of the Business and
this permit is issued..' ,), Professions Code.
D I hiJve,and wiJI mai.ntain worker's compensation insurance, as required 'c~ SectiOn 37;)0 of I :~;10)2005
the Lab?r qode, for the pe~forma~ce of the work for Wh,ich this permit is iSSL:':".".oL My wor\<;er's I -Date:
Compensation insurance carrier and policy are: ".:~.
Carrier: 'STATE COMPo FUND " Policy Number: 1767b24;.\)4 .' "NUMBER
779412
TYPE
TYpE
Con tractor
This section need not be completed if the pennit is for one l1undred dolJars(~1 nC) jr Jess.
e ,I certify that in'the peifomlance of the work for which this r;etmlt is issuc::l, I sl1~U not
employ any person in any manner so as to become subject to the wOlker's CC"Jllpensation' laws
of Califomia, and agree that if I should.become subject to the worker's compellsation
proVisions of. Section 3700 'of the L~bor Code, ~ shz.1I forthwith comply with t:-;.~~d provis!'ons.
. EXPIRATION PATE
5/3112006
B
HIC
. Date: 3/1 0/2005 Applicant:
. WARNiNG:. FAILURE TO SECURE WORKER'S COMPENSATiON CO\!E~."3E IS
UNLAwFUL, AND SHALL SUBJECT AN EMPLOYER. TO CRIMINAL PlONA' TIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSANDDOLLARS ($100,000), IN ADr"TloN 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 ._
, I 11 Hl"f'lJy p.,ff,irf"'"'l IJry!~r !;:F.!r..fdty 0f ~tiIJ~ th?t th~re :s. ;; ('"..."n~tr'.I':"Jhn l;:>.~'rh('{!~.~'.i-!nr:~!l'r,~h~ __ _....___ __
performance of th~ work for which this permit is issued (See. 3097 .Civ.C):
'Lender's Inforf!lation:
Constn.icion Types:
VN, ,
Fire Sprinklered?
NO
I ,certify that I have ,read this app!icationand state that the above information is correct. ,
agree to comply with all city ordinc;tnces and state laws 'relating to building construction, .and
hereby authorize representives of this pity to enter upon the above mentiont.'>d property for
inspection purposes. ~ '
, '
Date: 3110/2005
Fees paid for Permit:
Total:
16{79
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
.. .
. . INSPECTION . DATE' INSPECTOR
Temporary Power Pole . . .
Plumbing (DrainNVaste Pip")
Electrical Ground Electrode/uter . .'
. SetbackfFOImsrrrenches (Footings) .
Do not install sUbflQOr or pour floor slab until the "
following applicable items have been signed:
Plumbing (Water Plpe.Sprinkler Valves) .
Mecllanlcal(Groundwork) .
Electrical (Undergr.ound Conduit) . I
Pm-slab (Compaction/Membrane.Rllinf. '.
underpinning (Floor JoistlGin:lers) . .
Do not cover or conceal the woO< below until the
fOllowingapp.IJ,c.qble items have been ~i9ned: '. .,
1 st Floor Shear . , . .
FireSprinkler (Rough) . .
2nd Floor Shear . .
Roof (Sheathing/Diaphragm/Frane) .'
Masonry (ReinfJBOnd BeanlPre-GlO\It) . .
Rough Plumbing (Top Out) .
Rough Mechanical. . . .
'. ROugn ~eetrlCaI .(ory wall). . .' .
Rough Electrical . , . . : .
. Framing (Only after Plbg.. Elec.. Mech and Fire) .
!nsulation (SoundlEnergy)
po not tape or pl,,~tet uritirthe following al1plicable . . .
Items have been signed:' . '. .
Drywall . ~ vU wr r
Penetrations (F!R! Rated) Electrical .
Penlllralions(FiR! Rated) Mechanical ,
Penetrations (Fire Rated) Plurnbil!\l ' . .
Interior Lath " .' . ' . . .'.
. Exterior Lath . . .'
GENERAL ITEMS ,. .
ExteriOlPJaster (Brown Coat) .'
T'Bar Electrical
T -Bar Mechanical
T.Bar'Structural .
Sewer. . .' .
Water Engineering B.ackflow
Wat..r Service . . "
. Dale.
Inspector
Electrical Final
Plumbiitg Final.
Mechanical Final
Gas Test
Engineering/Grading Final 765'5126
Fir" Cep!. Final 765-4040
\/Vater E.nglneeting 765-5268
Sub Listisusiness License 765-519
Zoning 765-5139
'Buildlng FI.nal . (Last Inspection-Only .
After Above Complete)
PARTIAL INSPECTIONS
Buildina Inspections
zA.;
. Mechanical Inspections .
Plumbina Inspections
Electrical Inspections