7850 E. Samantha Cir.
TYPE OF PERMIT
Residential Addition C ITV
DATE: 11/8/2004
JOB ADDRESS: 7850 E SAMANTHA CIR
LEGAL DESCRIPTION: N TR 8831 LOT 98
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 200
BUILDING PERMIT NO. BLD2004-04076
CONTRACTOR INFORMt,'nON:
LOPEZ BETTER LJViNG eUILDERS
1059 S. SUNDANCE
ANAHEIM, CA92808 :
BUSINESS PHONE: 714261-3883
JOB DESCRIPTION:Build 280 square feet of second story patio deck (REF: B!;P2004-01680).
VALUATION: 8,000.00 . .. )
I OWNER-BUILDEPpECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractcr\:;_ License Law for the following reason (Sec. 7031.5 Bus!ness and
Professions Code: any city' or cO,\mtywhich requires a permit to construct, 8:::~~~,improve, demolish or repair any structure. prior to its issuance, also
requires the applicant for such permit to _ file a signed statement that he is lic~:,lsed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 70DO,of Divisiori.3 of the Business and Professi;:rns Code) or.that he is exempt therefrom and thebasis'for the alleged
exemption. Any violation of Section 7031.5 by any 'applican~ for a permit si.!hb~ts the 'applicant to a' dvil penalty of not more than five hu'ndred dollars
~~ . . ~ ..
D I, .asowner of property, or my employees with wages as their sele comr~~rlsation, wili do the 'Nork, and the structure is not intended.or offered for
sale (~13C, 7044 Business ar"!d Professions Code: The Contractor's License W3W noes not applyto;an owner of property wr"l builds or:improves
thereon, and who does suu-', work himself or herself or through his or her ow;~ employees, provided that such improvemenu;are net intended or
offered for sale, If, howevef, the building or improvement is soJei with one ye~::r of completion,the owner-builder wil(have the I)urdenof preving that he
did not build or improve for the purpose of sale), _ .'. . "." .
o I, .as the owner of the property, am exdusively ccntractin~ with licensed !:cntl.actors to construct the project (See. .7044 Business and Professions
Code: The Contractor's License Lawctoes' not apply to an olimer of prope;ty~no builds or improves thereon, and whi') oontracts for sum projects with
p...!(piltractor(s) licensed pursuant to the Contractor's License Law). . .) , , -'.
U lamexemptunderSec. ,B&P.C.fortnisreason: ~ ' , ' . .'
Dat~: Owner: ~
I
APPLlCANT:JOHN LOPEz
OWNER INFORMATION:
Robert M UndelWood
. 7850 E Samantha Cir
Anaheim, CA 92807
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: MSM
-l
I hereby affirm under penalty of perjury one of the following deciaratiol1s: ~
0, I have and will mairitai~ a. certificate of consent to self-iij'slJre tor works.-<! compensation,
as provided for-by Section, 3700 of the Labor Code, .foT the perforitlance ofti"=;~ work for whid1
~hi permit is issued.j -
!,1 have and will maintain WO-rker's. compensation insur~;'j(;e, as reqUired b:'( Section 3700 of
. he Labor Code, for the performance of the work for-which this permit is issue::i. ~,."'vworker's
Compensation insurance carrier and policy are: ! .
Carrier: STATE FUND Policy Number. 1786525p'
This ,section need not be compJeted if the pennit is for one hundred dollars ($10Qr..er I~s.
o " certify that in the perfolmance of the work for which this permit is issl!~~:I~ J shan' not
employ any person in any manner so as ecom subje to the worker's CCYllpensation laws
of Califomia, and agree that if I shoul become s je the worker's compe'nsation
provisions of Section 3700 of the La 0 -Code, rthwith comply w,ith these provisions.
WORKER'S COMPENSATION DECLARATION.
11/8/2004
Date:
/..../~
~
NUMBER
783521
TYPE
.B
Date: 11/8/2004 Applicant:
WARNING: FAILURE TO SECUR ORK R'S CO
UNLAWFUL. AND SHALL SUBJECT AN EMPLOY TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND D ARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS P OVIDED FOR IN SECTION:3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. '
I CONSTRUCTION LENDING AGENCY.
I hereby affirm under penattY of perjury that there is a constrllction lending a~rmcy for the
"---iJ-eifO(rricii~';:e'ffilli-CwoI'KiOi-q.t1idf:t.ilS oormii !5 ~s&re-d _(S,~.::: :~.ot.i .Go-.C); - '-
Lender'S Information: .
NSATION COVER;,GE IS
Construcion Types:
VN, ,
Fire Sprinklered?
NO
Fees paid for Permit:
Total:
470,50
Date: 11/812004
Signa r. of Appli t or Agent
The permit shall ex re by Ii ation and b""omenull 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
.. . DATE. ',. .
. INSPECTION . INSPECTO~
Temporary Power Pole .
, Plumbing (DrainIWaste Pipe) .
EIe'ctrical Ground Electrode/Ufer
~ SetbacklFormsfTrenches(Footings) , . , .
Do not install subflqor or p<?ur floor slab until t~e
'following applicable items hav~ been signed:
Plumbing (Water Pipe.Sprinkler .Valves) .
Mechanical (Groundwork) ,
I
.. Electrical (Underground Condu~)
Pre-slab (Compaction/Membrane.Reinf. . .
Underpinning (Floor Joist/Girders) . .
Do not cover or conceal the work below until the
followjngapP'li.t~:ble items h"ave been sigoed: " .
. 1 st Floor Shear ' . ,
Firespri nkJer ..(Roug h) , .. .
2nd Fioor Shear .
Roof (Sheathing/Diaphragm/Frame) . .
Masonry (RPinfJBond Beam/Pre-GIO\II) ..
Rough Plumbing, (Top Out)
Rough Mechanical .
, . Rough Electrical (Dry Wall) . . '
,Rough Electrical . .
Framing (Only after Plbg.. Elec.. r.-lech and Fire)
Insulation (SoundlEnergy) .
Do not tape or plaster until the following applicable
items have been signed: . " . ' '.
Drywall " .. ,
.
Penetrations (Fire Rated) Electrical .
Penetrations (Fire Rated) Mechanical
PenetrationS (Fire Rated) Plwnbil19 .
Interior Lath ,~
ExteriorLath . "
GENERAL. ITEMS
Exterior Plaster (Brown Coat)
T .Bar Electrical .
T.Bar Mechanical .: .
; T .BarStructuraJ
Sewer ' .
Water Engineering Backflow ..
Water Service .
FINAllNSPECTIQNS
Electrical Final,'
Plumbing Fihal
Mechanical Final
Gas Test
Engineering/Grading Final 765,s126
Fire Dept. Final '7654040
Water Engineering 765-5268
Sub List/Business License 765-519
Zoning 765-5139
Building Final (Las! Inspection. Only, ,
, '. , After Above Complete)
Date
Inspector
~
,Build in
Mechanical Inspections
,Plumbinq Inspections,
ElectricallnspectioilS
--..n;'-,.....-
"'~"""""...,.,.....- -:'-..
BUILDING PERMIT NO. BLD2004-01680
.
BUILDING DIVISION
200 S,ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE:'
(714) 765 - 4626
CENSUS CODE' 434
QUARTER SECTION; 200
DATE: 5/2612004
JOB ADDRESS: 78:)0 E SAMANTHA CIR
LEGAL DESCRIPTION: N TR 8831 LOT 98
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;
TYPE OF PERMIT C
' , Residential Addition . lTY
i'
APPLICANT: JOHN LOPEZ 1
OWNER INFORMATION: CONTRACTOR INFORW.trON: ARCHITECT/ENGINEER INFORMATION:
Robert M Underwood LOPEZ BETTER LIVING fi:I;LDERS MOHAMMAD MAHPAR
7850 E Samantha Cir .3300 W LINCOLN AVE # 20e{- 702 W, LINCOLN AVE:
Anaheim, CA 92807 : ANAHEiM, CA 928010000: ANAHEIM, CA 92805
.- ' . l. '. _ .
" " BUSINESS'PHONE: 71420T,1>883 " " . , " ' . '
JOB DESCRIPTION Room Addition~2nd story rcom additicn'~nd 1$t floor remo_!i'e!. Enlarge bedroom, add master bathroom alJd conv€;:rt.existing bath room
VALUATION: 'to 1"5W,5S'or88m. ',' , .1' PROCESSEDBY: CA~ ,.
I ' ' . .' . '. OWNER-BUILDER,bEGLARATION ", '," , ' ,~
I hereby affirm ~nder penalty of perjury that I arr: exempt from the Contractc.-'fI..icens-e Law for"the following reason (Sec. 7031.5 Business and" .
P rolessions Cod e:, a ny d ty_or county wl1:ch req uijes a perrn;t to construct. a ttlr, . im prove. -d emo lish or r~pa:( any str'ucture, prio r t6 its issuance.' also
reqUire. s the a,PP!iCZ. ~t f,)r ElIch ::>er,,,,.a to file Cl siH'ned 3t.8te'Tie-Pt that.he is !i'C<~,' "..ed pu.r:8uant',tb~he, provi.sions Of, the contr,'a, Ctor'S'L.ice. n.se Law (el'Ja pter
9)(comr:1sncing witi; S'3dion ::"000 of Oivisron 3 of ti~e E:usiness and Profe.ssir 's Co~e) or t~at.he is exempt therefrom a'nd thebasi~ for the alreged
'-,{;;;J~i~n. A.nY,V~latjOn of Section,7031.S by.ar.ly-~pp[jcant for ~ permitSUL~"" ds the ap~ic~ilft~ a-~vil pe~alty ~f n~t m0.ie th~n five hun<1red d.ollar~. :
D' I. a_s owner of pr9perty, or my employee:; wi~h wages as their sol.,:, comp' ~lsalicn. wi!l dC!; the w.Qrk, and the structure' is .not ill tc..nded or off~(ed for'.
sale (Sec; 7044 8usiness and Professions Code;: , The.Gontractorjs.Uc~""!~e I .wc.ioes not <lpplyto an qwner of prbpertY-whObl!i1dsQr improves
'- thereon. ,and wI'J0 d oessud1 work hi mself. or he !'Self orthroug_h hi's or :-,er'\-..w:-em9loyees, provided that such imp rove 'me'r.ts a re not 'in tend ed _.or
. offered f.or sale. If. hoWever, .the bUilding or impfovement.issold With one y~, r of ccmpletion,.the o'N.~er-builder wUI hav.~..the burden of pro'/jng.~hat'~e
._did:nQtbuild?rimprove'forthe purpose of saJe). . ..... ';'1 . ,._, " ........c;. -,'
[J. I. as the.owr.er bfthe'pr.op,erty, am e~dusive'Y co~tracting with 10ensed,~~I!tr.:lctQr$ to construc~t the project (Sec. 7044; 8usiness :::llld.Prof':l~jons
Code:' Th~ Contractor's Licer1~e Law does not aprly to an ownercf pr-:)pel:y :t'iilJ builds,or improves thereon, and ,wl:lo contracts for sU,ctf projects wit.h
'~-qontra~or(~) licen~ed p~r~ua~t to the.C.ontractor's License Law). .a , ..' .' . ~ ..' -. .'
L~.J, .!. am exempt under S~C. '. e 1$ P.C. for ~his reason:. '.-~H-. ".
Date: Owner:. ._____'.
'L ..' .' '. W.ORKER'S COMPENSATIONDECLARATio1i~-, :==J
I hereby affir.m under 'pe:naltY of pe~ury 'one .of the following ~eclarations: .' . If -
D I have' and will ~intain ~ cert.ifi<?ate of oonsent to se!f-i~ure for wC;ke/~ '~;o!T:pensatio(.J,
as pr.ovid~_for by Section 3700 of the Labor Code. f.or the pl?:1ormance oftri;r wo:i< for v/hk:h
this permit is issued.. ' . '. . ~:!. .
.0 I have and will maintain worlser's ,c.ompensation insurance, as reauired r;~ S.::etion 3700 9f
the Labor Code. forlhe periormance of'the work for which this permit is is::u~~j, Myworker's
ComPensation insoraneecarrierand policy are:., 'i
Carrier: NO EMPLOYEES. Policy Number. EXEMP'r
Date: 5/26/2004' Applicant: ..
,WARNING: FAILURE. TO SECU KER'S PSATIQNCOVEi"~\i,e IS>.,'
UNLAWFUL. AND SHALL SUBJ, EMPL E, Q CRIMINAL PENAl';'IE$ AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000); IN ADCij]ON TO THE'
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIP!" ~706 OF.THE
. LABOR CODE, INTEREST AND ATTORNEY'S FEES. Ti>
I:. " , 'CONSTRUCTION LENDING AGENCY',": L;"',' .
~: -~~':,:;:::<-=:J;;;.;:::_L~~:'" 'i=~~~ ~/ ;;:1"--~?:j ~:'t,:h;;;U;:~.~;_;s:-~-'::;~~1~~t:~t;":~6;~~~~'E.~:;L:;~ -.:-~':S~ .' :.c.-f ~,,-~~,L -_.~ -:"'~'-
perforrr.ar:ce .of the work 'for whid1 this permit is issued (See. 3097 .Civ .C):
Lender'.s Information: '
Construcion Types: -
VN, , '
Occupancy Groups:
R3, . ", '
Fire Sprinklereci?'
LivinQ Ar~a:
Balcony I Deck Area:
NO
196
50
'~:';-'~~'~':""""'---,-"--
I certify that I have-re~' this applicati.on and state that the above information'is correct. I
agree to,co ith al i i;>rdinances and State Jaws relating to bu'ifding cO'1struction, and
here.b horize re se ives 0 his 'City to enter upon the above mentione~} property for
insp ion pur ff-
Datl' 5/2612004
Applicant or Agent ,
The permit shail e by limitation aildbecome null and void if th.! building or.
work has. not passed final inspection 365 days from the date of permit issuance. A
new permit is required to ~mmence.or continue work.
Fees 'paid for Permit:
Total:
5.00
'INSPECTiON RECORD
" " ' ,
',: ' INSI'ECTION' :' '"DATE ,INSI'ECTOR
TemporarY Power Pole" , , :', ,',
Plumbing (DrainlWaste Pipe)', " " ' , '"
Electrical Giciuhc\ ElectrodetUfer , " '
, Selbll(:k1FormslTrenCheS (Footings) :
QQ, no1.mstall. s!Jbfloor or pour floor slab untIl the
follOwing 'appl~cable items ,have beensigned(. .
plumbing (Water Pipe.Sprinkler Valves)
MechaniCal (Grciundwork)
~ctrical (Undergr,ound Conduit)
Pre-s~b, (CompliCtioni brane.Reinf.
,Underpinning (AoorJoistlGinlers)
hot CQver or concelll the work below untIl the
foUo~ingapplicable items have been signed: ,
1 stFloor Shear,
Firesprinkler (Rough)
2nd Floor Shear
,ROof (Sheathing/Di hragmlFrame)
Masonry (ReinfJBond BeamlPre-Grout)
Rough Plumbing (Top Out)
~oughMechanlcal
Rough ectrlCaI all
Rough Electrical
F:raming",.. JOnly afteTPlbg., Etec., Mech" and'Fire). "-d
InS!Jlati6h(SoUndlEnergy)
Do nottape or plaster' unlil,thefollowlAg applicabe
item,S have been signed:, '. " "', >:.
Drywall
Penetrations (Fire Rated) Electri
Penetrallons(Fire Rated) Mechanical ,
Penetrations (Fire Rated) Plumbing"
InteriilrLath'
Exterior Lath
GENERALlT MS
Exterior Plaster (Bl'O\Nn Coat)
,T -Bar Electrical
T-Bar Mechanical, ' '
',T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
\
"
",
FINAL ,INSPECTIONS'
Electrical F,inal
.Date
Inspector
'v
v
Plumbing Final
Mecha~ic~IFinal'
Gas Test
, " Engineering/Grading Final 765-S126
Fire Dept.FinaI765-4040
Water E~gineering .765,-5268
Sub List/BusinesS License 765-5,19
Zoning 765-5,139
Buildlng Final' (Last InspectiOn. Only " ~
, ,'After !\bov,e Complete), 1.(;(
, PARTIAL INSPECTIONS
BUildina,lnspections
6'-/,.:.,-
'6-'7/-0
b.t!!~'/
e
Mechanical Inspections
',' PlumbinQlnspections ' '
Electrical inspections