119 S. Mohler Dr.
TYPE OF PERMIT
Blockwall/Columns CITY
DATE: 711412005
JOB ADDRESS: 119 S MOHLER DR
LEGAL DESCRIPTION: LLA 0000578, PARCEL 3
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 565
QUARTER SECTION: 202
BUILDING PERMIT NO. BLD2005-02159
APPLICANT: BRENT SEPULVEDA
OWNER INFORMATION:
i
CONTRACTOR INFORMATION:
SEPUL VEDA BUILDERS i
518 CARLISLE PL I
ORANGE, CA 928690000 "
BUSINESS PHONE: 714222-1150
JOB DESCRIPTION:lnstall 324' linear feet of property Une wall per city standards:and 28' linear feet of retaining wa.1I per engineered plans;
VALUATION: RE~~dD088-01479 ! PROCESSED BY: JNJ
I OWNER-BUilDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, atter,t.lmprove, demolish or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that he is licen€~d pursuant to the provisionsot the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Profession:~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 subje<;ts the applicant to a dvn penalty of not more than five hundred dollars
~~~ .
o I, as owner of property, or my employees with wages as their sole comperuation, will do the work, and the structure is not intended' or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License Lav! does 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 pf completion, the oWner~builder will have the burden of proving that he
did not build or ,improve for the purpose of sale). t
o I, as the owner of the property, am eXClUsively contracting with licensed cO<I:tractors to construct the project (Sec. 7044 Business and ProfeSSions
Code: The Contractor's Ucense Law does not apply to an owner of property wt,o bunds or improves thereon, and who contracts for such projects with
a contrac1or(s) licensed pursuant to the Contractor's Ucense Law). I
o I am exempt under Sec. , B & P.C. for this reason: t
Date: Owner: ~
I WORKER'S COMPENSATION DECLARATION I I l LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: f I hereby affirm under penalty of perjury that I am
o I have and will maintain a certificate of consent to self-insure for worker's c-;>mpensation, licensed under prOvisions of chapter 9 (commencing
as provided for by Section 3700 of the Labor Code, for the performance of the v;ork for which with Section 7000) Divsion 3 of the Business and
~'s ermit is issued. t Professions ode.
I have and will maintain worker's compensation insurance, as required by E{ection 3700 of 7/14/2005
e bar Code, for the performance of the work for which this permit is issued. jMy worker's Date: Contractor
Compensation insurance carrier and policy are: :t
Carrier: STATE FUND Policy Numbe' 1419298-00i
This section need not be completed if the pennit is for one hundred doIlars($100) OIl,less.
o I certify that in the perfonnance of the work for which this permit is issued, \!Shall not
employ any person in any manner so as to become subject to the worker's comtiensation laws
of Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I shall forthwith comply with thos(!' provisions.
ARCHITECT/ENGINEER INFORMATION:
STEPHEN L WEBER
3434 W. ANTHEM WAY #118
ANTHEM, AZ 8~86
NUMBER
695401
TYPE
EXPIRATION DATE
10/3112006
B
Date: 7/14/2005 Applicant:
WARNING: FAILURE TO SECURE W OMPENSA TION COVERAG:= IS
UNLAWFUL, AND SHALL SUBJECT A EMPLOYER TO CRIMINAL PENALTI~S AND CIVIL
FINES UP TO ONE HUNDRED lHOUSAND DOLLARS ($100,000). IN ADDITl ON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37)6 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. - !-."._-~._-_.-
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:
VN, ,
>~, . '.. .. . .:
---_.,- -_.'''--~:--'--'--_.._-~--'--._--~. -~..._--~~--.-
I certify that I have read this application and state that the above information is correct. I
agree to mply with all city ordinances and state laws relating to building construction, and
hereby aut orize representives of this city to enter upon the above mentioned property for
in~ectio
Date: 7/14/2005
Fees paid for Permit:
Total:
554.51
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 iSSUa1Ce. A
new Dermit is reauired to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water PipefSprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionfMembrane Reint.)
Underpinning (Floor JoistfGirders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Firesprlnkler (Rough)
2nd Floor Shear
Roof (SheathingfDiaphragmfFrame)
Masonry (Reinf.fBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele.. Mec. And Fire)
Insulation (SoundfEnergy)
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
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T-Bar Electrical
T-Bar Mechanical
T.Bar Structural
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
EngineeringfGrading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub LlstfBusiness License 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only
After Above Complete [)-
DATE
INSPECTOR
PARTIAL INSPECTIONS
Mechanical Inspections
Plumbing Inspections
Electrical Inspections
(
9
. .
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 #3
J I q -H-t"S Mohler Drive
Anaheim, CA
Phone:
PRoiECY.;,
Address/Location:
Type of Project:
Lof #:
Tentative Tract #:
No. of Dwelling Units:
some
new
APN#:
[8J Single Family
o Multi Family/Condos/Apt.
>\RESIDEJII.TIAf .
Applicable Fee Level: [8J 1 0 2 0 3 0 4
Total School Facility Fees: $8,346.24
Total School Facility Fees:
Total Square Footage:
Multiplied by Applicable Fee:
Other:
3,726
$2.24
COMMERCIAL,: .
. " ' ",.
Total Square Footage:
Multiplied by Applicable Fee:
$0.36
Total School Facility Fees:
[8J NO 0 YES
REASON:
fhe above representations as to square footage are true dnd correct. Developer/Applicant agrees that if it is
later determined that such representations are not true, then this Certificate of Compliance shall automatically
terminate and the appropriate CitY/:;Shall be notified.
Developer/ Applicant Signature: _ ~.
./:{'t . ;'" '..ice'
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This certifies that the above named Developer/ Applicant has paid school facility fees in compliance with
Education Code Section 17620 et. seq. and Government Code Section 65995 et. seq.
Date: 4/25/05 Name: ~ - . Title: Administrative Secretary
NOTICE: The 90-day period in which you may prates e fee descr-" ed herein will begin on the date this fee is paid. However. if the fee
was imposed by the City or County as a condition of approval for your project. and you have received the requisite notice, the 90-dOY
protest periOd began at the time your project was approved by the City or County.
certificate of compliance
Rev. 02-24-04
f_---'::;;"
PUBLIC WORKS DEPARTMENT FEES
. .. 11c..:-TRAFFIC ENGINEERINGFEES--
BUlLD# 0 S - 00
PROJECT SITE: $.!1ff" S !vi ~ I,/V'I- j;)y-.
SIZE: -3 FD
TRAFFIC SIGNAL FEES:
279-412-F724-3017
TE#9?
rJA'RANSPORTATlON IMPACT AND IMPROVEMENT FEES:
r 278-412-F724-1818 .
~/o3
~//2...
rYtRAFFIC SANTA ANA CANYON FEE: C IY 2..5.-- "'1
r 278-412-F724-2001 .
::...
~ASTERN TRANSPORTATION CORRIDOR FEE:
101"412-F724-6704. .
7/3
~3 0 b
COMMENT:
REVIEWED BY: ALFRED Y ALDA(714) 765-5183 A I'f
. DATE: '-a:>-~O~
--DEVELOPMENT SERVICES FEES-~
RIGHTOFWAY Z/'REVIEWEDBY.e$:f> . DATE: \/~/.a;.
o OLD ZONING CODE (i.e. in plan check or entitlement prior to July 8,2004) 'j
ft NEW ZONING CODE
~::~;TlON. 6~~~~~~\~~~~~)~~' 0
STREET IMPROVEMENTIREP AIR
$,2-50.0 () ACCT#
$6'54-. IS- ACCT #
t--i A ACCT#
GRADlN~: GeA 2004- -02-241 .
WATERQUALITYMANAGEMENTPLAN(WQMP) CJ(ff~-oOI&3
LAND SUBDMSION: PeL- ~ V-A -OOCD37e
REVIEWED BY: 1I1f1 I J-.o 05 .