111 S. Mohler Dr.
,
BUILDING PERMIT NO', BLD2005-01479
-
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: UNK
QUARTER SECTION: 202
TYPE OF PERMIT
Blockwall/Columns CITY
DATE: 7/14/2005
JOB ADDRESS: 111 S MOHLER DR
LEGAL DESCRIPTION: SEC 36 T 3 R 9 POR SE1/4
APPLICANT: BRENT SEPULVEDA
OWNER INFORMATION:
SEPULVEDA BUILDERS
CONTRACTOR INFORMATION:
SEPULVEDA BUILDERS,
518 CARLISLE PL f
ORANGE, CA 92869 0000 1
BUSINESS PHONE: 714222-,,150
JOB DESCRIPTION:lnstall 374' linear feet of 6' feet high blockwall per city stan~rds, 262' linear feet of retaining wall per enginaered plans and (3) 6' feet
VALUATION: hi9ts~~18BbebtfOr traffic and pedestrian gates per engineerediplans PROCESSED BY: JNJ
I OWNER.BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Weense Law for the following reason {Sec. 7031.5 usiness and
Professions Code: any city or county which requires a permit to construct, alter~improve, demolish or repair any structure, prior to its issuance, also
requires the appncant for such permit to fjle a signed statement that he is licen*d pursuant to the provisions of the Contractor's License Law (Chapter
9}(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjeCts the applicant to a civil penalty of not more than 1ive hundred dollars
($500). "
o I, as owner of property, or my employees with wages as their sole compe":b. ation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Pro1essions Code: The Contractor's License La~ does not apply to an owner of property who builds or improves
thereon, and who does such work himself or helSelf or through his or her own ~fployees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year:pf completion, the owner~builder will have the burden of proving that he
did not build or improve for the purpose 01 sale)'!r
o I, as the owner of the property, am exclusively contracting with licensed C<!rtractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's Ucense Law does not apply to an owner of propertyw!~o builds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractor's License Law). ;i~
o I am exempt under Sec. , B & P .C. for this reason: '~
Date: Owner: 11
I WORKER'S COMPENSATION DECLARATION' I
I hereby affirm under penalty of perjury one of the following declarations: ;t
o I have and will maintain a certificate of consent to self~jnsure for worker's cpmpensation,
as provided for by Section 3700 of the Labor Code, for the pertormance of the work for which
~i permit is issued. ,f:
. I have and wili maintain worKer's compensation insurance, as required by~"ction 3700 of
t e bar Code, for the performance of the work for which this permit is issued.-~~ My worker's
ompensation insurance carrier and policy are:~'.
arrler: STATE FUND Policy Numbe' 1419298-09
This section need not be completed if 1he penni! is for one hundred dollars ($1 00) 0; less.
o I certify that in the perfonnance of the work for which this permit is issued,) shan not
employ any person in any manner so as to become subject to the worker's com'pensation laws
of Calitomia, and agree that if I should b ome subject to the worker's compensation
provisions of Section 3700 of the Labor 0 e, I shall forthwith comply with those provisions.
ARCHITECT/ENGINEER INFORMATION:
SlEPHEN L WEBER
3434W. ANTHEM WAY #118
ANTHEM, AZ 850860000
LICENSED CONTRACTORS DECLARATION I
[hereby a irm under penalty 01 perjury that I am
licensed under provisions of chapter 9 {commencing
with Section 7000) f Divsion 3 of the Business and
Professio, Cod
711412005
Date:
Contractor
NUMBER
695401
TYPE
EXPIRATION DATE
1013112006
B
Date: 711412005 Applicant:
WARNING: FAILURE TO SEC E ORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTES AND CIVIL
FINES U P TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3 '06 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. L
, . CONSTRUCTION LENDING AGENCY~-
I hereby affirm under penalty 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 Information:
Construcion Types:
V N, ,
Fire Sprinklered?
NO
1 certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby au or" e representives of this city to enter upon the above mentioned property for
inspectio poses.
Date: 711412005
Fees paid for Permit:
Total:
1,734.03
Signature of Applicant or Agent
Th 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 issumce. A
new permit is required to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormslTrenches (Footings)
Do not install subtloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
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 (Sheathing/Diaphragm/Frame)
Masonry (ReinfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Eiectrical (DryWall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable
items have been signed:
INSPECTOR
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
Exterior Plaster (Brown Coat)
T-Bar Electrical
T-Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backllow
Water Service
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FINAL INSPECTIONS DATE
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-5194
Zonit\g 765-5139
Building Final (Last Inspection - Only
After Above CompJe
INSPECTOR
PARTIAllNSPECTI
Mechanical Inspections
Plumbing Inspections
Electrical Inspections
.
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:
Sepulveda Builders
518 N. Carlisle Place
Orange, CA 92869
Phone: 714-288-0732
Owner Name:
Address:
Parcel # 1
,n~nl~'lVroFiref'Dfive ',;
~"-"-.---".'--"'-'--"'--~"",.-",,,,-,,
Anaheim, CA
Phone:
PROJECT
Address/Location:
Type of PrQiect:
Lot #:
Tentative Tract #:
No. of Dwelling Units:
same
new
APN#:
[8] Single Family
o Multi Family/Condos/Apt.
RESIDENTIAL
Total Square Footage:
Multiplied by Applicable Fee:
Other:
3645
$2.24
Applicable Fee Level: \8l1
Total School Facility Fees:
Total School Facility Fees:
020304
$8164.80
Total Square Footage:
Multiplied by Applicable Fee:
$0.36
Total School Facility Fees:
[8] NO 0 YES
REASON:
The above representations as to square footage are true and correct. Developer/ Applicant agrees that it it is
later determined that such representation are not true, then this Certificate of Compliance shall automaticolly
terminate and the appropriate City/Cou t hall be notitied.
Developer/ Applicant Signature:
This certifies that the above named Developer/ Applicant has paid school facilify fees in compliance with
Education Code Section 17620 ef. seq. and ~o~ern~ent Code sect~65995 et. seq.
Date: 4/25/05 Name: f71:::" Z~ K ~ Title: Administrative Secretary
NOTICE: The 90-day periOd in which you may protest fee desc( ed herein will begin on the date this fee is paid. However, if the fee
was imposed by the City or County as 0 condition at approval for your project. and you have received the requisite notice, the 90-day
protest period began at the time your project was approved by the City or County.
certificate of compliance
Rev. 02-24-04
~
PUBLIC WORKS DEPARTMENT FEES
--TRAFFIC ENGINEERINGFEES--,
BUILD# o~ - OOOCl' I
PROJECT SITE: 1/1 .3 I\.f 0 J,.cI\... DV.
SIZE: SF 'D
~ TRAFFIC SIGNAL FEES:
279-412-F724-3017
TE# S-<P
TRAFFIC SANTA ANA CANYON FEE: ('4~- 712.'
278-412-F724-2001 ' ,,'
, '
~.-';'"
I()~
''7,2-
'i7/.3
~RANSPORTATION IMPACT ANDIMPROVEM)j;NT FEES:
278-412-F724-1818 " '
COMMENT:
~EASTERN TRANSPORTATION CORRIDOR FEE:
101-412-F724-6704 ' '
,
REVIEWED BY: ALFRED Y ALDA (714) 765-5183
A"'\
DATE: \-\ \-2(.1# "
--DEVELOPMENT SERVICES FEES--
RIGHT OF WAY '2-1' WJ REVIEWED'BY c.w DATE: llll/OS
o OLD ZONING CODE (i.e. in plan check or entitlement prior to July 8, 2004)
P NEW ZONING CODE
DEDICATION 6' t>rolcJ<\101J ~ M()\tu2{l.. CovWo'-t-C>>r~. ~G"
, '~v/!<re <;;;A~ '
CREDIT
STREETIMPROVEMENTlREPAIR'lo ~ D'F CJJt.t..,(4' 6'vJ b'f\,Vj,
SEWER CONNECTION FEE , ~23D ;~tJ ACCT #
CITY SEWER ASSESSMENT :j..6&Q ~r;- ACCT#
DRAINAGE ASSESSMENT FEE 1t ACCT # '
GRADING: (jjJ.. Joo. ' -oJ2-f
WATER QUALITY MANAGEMENT PLAN (WQMP) CfTbf:;2./)o 4 _ 00 (0 3
~D SUBDIVISION:
r vi 1 LIrA. ~ 00005713
REVIEWED BY: VJ