809 S. Western Ave.
BUILDING PERMIT NO. .BLD2003-04&54
ElM
B'UILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
INSPECTION REQUEST LfNE:
(714) 76.5.4626
CENSUS CODE: 434
QUARTER SECTION: 6
TYPE OF PERMIT
Blockwall/Columns CITY
DATE: 12/23/2003
JOB ADDRESS: . 809 S WESTERN AVE
.' LEGAL DESCRIPTION: .
.
APPLICANT: RICHARD MASSE
. OWNER INFORMATION:
Royal C Marten
PO Box 430
Santa Clara, Ut 84765
CONTRACTOR INFORM/,TION: ARCHITECT/ENGINEER INFORMATION:
lODARCY MASSi: CONf-TRUCTION I NC .
2700DAWSON AVE Y'
SIGNAL HILL, CA. 90755 0,)00
BUSINESS PHONE: 562 9;'.).8406
JOB DESCRIPTION:lnstaIl18. 6' pilasters to city specs. .
.'
VALUATION: 3,600.00i. PROCESSEDBY: CAL
I . .' . '. . OWNER'BUILDEf-!,.OECLARATION .' .'
I hereby affirm"underpenalty of perjury that I am exempt from the Contractcii's License Law for the follQwing reason. (Sec. 7031..5 ~tisiness and
Professions Code: any city or county which requires a perm~ to construct, ~';or, improve, demolish or repair any structure, prior to its issuance, als,o.
r~uires theappliG8.ntfor such permit to file a signed statement that he is Iictrlsed pursuant to. tha proVisions of the Contractor's 'License LaW (Chapter
9)(commencing with,Section 7000 of Division 3 of the Business.and prcfeS,sb'11S Cede) or that.he is exempt 'therefrom and the basis for'the all"eged
exemption.: Any violation 'of Section 7031.5 by any applicant for ,a permit su~lscts the applk:ant to a 'civil penalty of not mars than five hl,mdred dollars
($500). . ..' . . '.
D. I, as owner of property,:or my employees with wages as their sole com:.,t.::nsation."will do the w~rk. and the structure js'n~t int~nded or offere_d}or
~ale ,(Sec. 7044 ,Businessaod Profes~jons Code: The Contracto(s Ucens~ 't?W does,not applytc ~m owner cf propertY who.builds or improves- -::' "-
,thereon, and 'who does, such work himself or herself or through his or her O\'\.~ 'employees. provided thst such implOvemer,ts are not intended or . .
offered for-,sale.lf. however, the building'or improvement is sold with one "f.;~r of rompletion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of Sale).. . :. . ..i:' , . . '.'.
01,' as the owner,of the property, am exdusively contracting with lice~l<;''3dbontradOr$ to construct tht; project (Sec. 7044 Business and ProfeSSions '
Code: The Contractor's License law does not apply to an owner of prop~rt_.'i!NhoblJilds or improves thereon, and who contrae:ts for such projects with
tjont.ractor(S}-iicensed pursuant to the Contractor's ,Li~nse Law). . 1 ' ,
: .,1 am exempt under Sec. __' ,B&~.C.for,thisreason: -:oJ
"Date: - Owner: ~l.._.~
I WORKER'S COMPENSATION DECLARATION
. I hereby affirm under penaltY:ofperjury one of the foHowit:l9 declaration':i: ',. '
o I have and will.ma-jntain 'a certificate of oonsent to self-insure for worker'b compensa~lon.
as pr:ovi ed'for by Sedion 3700 of the Labor Code, for the performance oft~.~ work for whim
.' rmil issued. . ' . i .
. '. . I '
I. havt:! and Will maintain worker's compensation insurance, as required t-; Section:.3700 of
t abar Code. for the performance-of the work for which this p'..:mi1it :s iSSLi':d. Mywpr!<:er's
6mpensationinsurance carrier and policy are:' I
,Carrier:, STATE FUND Policy Number. 1704280; t~
; '..,('1
This section need not be compieted if the pennit is for one hundred dollars ($1 Cf..i o(>les~.
D. . ',certify that in the'perfonnan<;e of the work'forwhich th~s permitis IssllE::;d.'1 sba'U not'
employ any, person in-any manner so as to become subject to the worker'.s c,,"mpensation laws
of Califomia,' and agr~e that if I should become subject to the worker's comp,~nsetion _ ',_
provisions of Section'370~, ofthe LaborCo~hall fO~~jth comPI~ with U~JS~ ~rOVisiGris~
Date: 12/2312003 Applicant ~ ~~. .'. .
. WARN ING: FAILURE TO SECURE WORKER'S COMPEN SA TION COVEI.AGE IS
UNLAWFUL, AND SHALL SUBJEC'f AN EMPLOYER TO CRIMINAL PENA'.TIES AND CIViL
FINES UPTOONE HUNDRED THOUSAND DOLLARS{$100,OOO),IN ADCITION TO THE
. COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .
I . J.' . CONSTRUCTION LENDIN9AGENCY" .', . '.
I hereby affirm under penalty of perjury thnt there is 3 construct:.onlendi!l1J 2,te!J~y-.[o!~~~.t~.:-,--_.___ -'-___
pertormance of tl1e work tor whidl this permit is isSued (Sec.3097.Civ.C): "
Lender-s Information:
~
L:CENSED CONTRACTORS DECLARATION i
I hereby,affirm under penalty olperjury that lam
licensed under,provis.ions of chapter 9 (commencing'
with Section 7000) of . ion' 3 of the Business and
P.rofessions COde. '
12123/2003 "?
Date:
Contractor '
NUMBER
733437
TYPE
"TYPE
EXPIRATION DATE
3/31/2005
B
HIC
Construcion Types:
VN, , '.
" ".~-, ",~.. .
, '.
I certify that I have read this application and state that the above information is correct. I
agree to rom ply with all city ordinances and :State laws relating to buDding CO'lStruction, ana
hereby authorize repre tives of thIS dty to enter upon the above'mentioned property for
'i~spectiori purpose
Fees paid 'for Permit:
. Total:
HO.05
~
. , ~i9nature. 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 issuanee. A
. new permit is required to commence or contiilUe work.
Date: 12123/2003
INSPECTION RECORD
. INSPECTION DATE INSPECTOR
Temporary Power Pole ,
Plumbing (DrainlWaste Pipe)
Electrical Ground ElectrOde/Uter .
SetbacklFormslTrenches (Footings)
Do not installsubfloor or pour.'f1oor .slab until the
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves) I
Mechanical, (Groundwork) .
Electrical (~nderground Conduit) . . ,
Pre-slab (Compaction/Membrane.Rei nt. . .
underpinning (FlOOr Joist/Girders) . ' .
Do not cover or'conceal the work below until the
following applicable ilems have been signed: '!
1st Floor Shear . . . .
Firesprinkhir, (Rough) .
2nd Floor Shear .
Roof (Sheathing/Diaphragm/Frame) . I. .11 / .
Masonry (RelnfJBond BeamlPre-GlOUt) .H~.1Xf l7'".l"{
Rough Plumbing (Top Out)
Rough Mechanical ' .
Rough t:Iectriclll\ury wall) .
Rough Electrical ,
Framing (Only after Plbg" Elec, Mech, 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) 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' Date . Inspector
Electrical Final .. . .. ..,
Plumbing Final
Mechanical Final ' . "
Gas Test .
Engineering/Grading Final 765-6126 1 , .
Fire Dep!. Final 765-4040 .
Water Engineering 765.5268 , ' .
Sub List/Business Lic,,"se 765.519
Zoning 765.5139, . r
.
Building Final ~ast Inspection- Only . I \9k~l~ JV) /, h '
Iter Above Complete)
PARTIAL INSPECTIONS
B Uil~.inalnspections....' " . , ..' ".~...
'/~'2'" -pl..MT7#-L--7:~-~ , --
, . //,4~",/ _ k/~
", ., . - ". ,".
Mechanicallnspectioris ,.
Plumbina Inspections
ElectriCal Inspections
,;
,
I
s- 5DOQ Gs~0
PLANNING DEPARTM'ENT
APPROVED
30'1
IC DISTRICT- REVIEW:
I See stamp this pa~e
. cle one on above line
BUILDING PERMIT FOlt;",
ANY CONDITIONS' 7
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APPROVE VIOLA'I \0)\4 OF, ANY OF TH
BUILDING MD<S Vi 1JlE "nY. T~E,,~~L~ER
OF THIS Pl.,~t1 pnac,_,JS A r P... .;.N R.SK
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DEe 2 :3 2003
BUILDING DIVISION Or ANAHEIM
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CONTRACTOR INFORMATION; ARCHITECT/ENGINEER INFORMATION:
LODARCY MASSE CON';TRLJCTION INC PHILLIP R BENNETT .
2700 DAWSON AVE 5535 E. CERRITOS. DR.
SIGNAL HILL, CA 907550::0~' ORANGE, CA 92869 0000
BUSINESS PHONE: 56298:>M06
Joe DESCRIPTIONNew 2story SFD living:2414sf garage:462sf i
VALUATION: 173,689.00 i. PROCESSED BY: CIIL
I . OWNER-BUILDEFf"OECLARATiON
. I hereby a~irm under penalty of. perjurY that I am exempt from the- Contractc?,;; License Law for the fol/owing reason (Sec. 7031.5 Business and
Professions Code: any at! or ~ounty wh~('.i1 require:;) Fl t.-ermit ~o c-:.nstruct, a;;'ei, improve, d.~r.nolish or repa ir any structure, priorto its issuance; also
. requ ires th~ appliC3nt for GUch permit tQ file)~signed~;~t.~:TlS'!t ~t,nt h1;t. i$liC~r;Scd purs:uant to the'pro\lisions ~ftt:le Contractor's License La~ (Chap~er
9){commencin9 with SoCi.!O;1 70CO cfDi\ti:;ic:1 3 of t.ne 8'J'3i'if;f.:-:.and PrcfessipnsCode) Of 1"'al he is exempt ,therefrom and the basis for the alleged. .
"',exemption. Any violation of Section 7031.5 by any apIJli~f1nt fur e perIT'.!tsu~f:cts the applicant tq a dvil penalty of not more than five' hundred dollars.
($500). .' . . {, . . .
0." i, .a. s owner of property, qr my employees with wages a. ,s Ui.eir sole COr.'lj:;'~.'nsation,_ will do the: work, and the.structure is ,not intended 'oroffere~ for
sale (Sec. 7044 BusineSs and Professions Code: The Contractor's Licens& Ipw does not apply to an owner of property who builds or improves '
,thereqn. and_who does'sudl work himself or hei'self or through his or hei oJ".:,'!' empl~>yecs, pr~vided tt'tat such improvements are not intended or
offered for sale: If.; however, the building cr. improvement is sold wi~h one yel-'~r of GOmpletion, the owner-builder will have the burden of prOving that he
did not build orimprove for the purpose af sa,le). " I', ",'"
o I"as the."owner of,the property, am exdusively contracting with licensej,;..:cntl:.:Jc\:oTs to construct the project (Sec. 7044 Business and- Professions
Cod~;,'Tl:1e Contracio..,'s License law'-does nat apply to an awner of p(Qpert~i;\'iho builds Of improves thereon. and who rontracts for such.projecis with
~antract"or(s}l.icensed pur~uant tottie C.ontractor's license law). 1
U lame}tem~t under Sec.. ,8 & P,C. for this reason: _j'
Date: . Owner: .
r . ~. WOP.KER'S COMPENSATION DECLARATION ~~J I
1 hereby affirm under penalty of perjury one of the following de:.:::larations: 1
, . D, I haVe: ?nd will maintain a certificate "of oonsent to. self-insure for v/o.rker'f, compensation,
as provided fo~ by Section 3700 of the, labor Code, for the perfcrmanre of 6.~ work for which .
this permit is issued. ". "
o I h~ve and will maintain rvorker's compensation insuranc_e,-as required b}.-Section 37000f 2/13/2004
the Labor Co1e,'f6r the pertorma'"lce of the work far which this permit is iSSl;~J. Myworker's Date:
,Compensation insurance carrier arid pcliC)l ate: .. i
Carrier:, STATE FUND, poliO! Number. 1704280,1
Thissec~on need nol be coinple1edifthe pennil is for one hul1llred dollars ($1~[ .x las3.
01 certify that in the perfo.rrnance~ft~e work for which th1s permit is issi.J'S~!. I shall not .
employ any person-in any mannersa as to. became subjecfta thewarker'$O,~i;lpensatian .laws
of Califomia, and. agree that if I should 'become subject to. the warker's camp_~r,sation
provisions of Section 3700 'ofthe: labor qode,1 "fart~with comply with'lj-}x>;e provisions..
Date: 2/13/2004. . Applicant: .e ~# '
WARNING: FAILURE TO S.ECUR ORKER'? COMPEN.SATION COVEU.GE is
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAmES AND CIVI~
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000); IN ADDiTION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEGTlm{3706 OF THE
LA80RGODE, INTEREST AND ATTORNEY'S FEES. . ..
'1. CONSTRUCTION LENDING AGENCY _~-~r:---
__~.o~-!-...~.~)v~ru,,r"~"),,!,!, r~",j!t' 0.1' ;:,<:-r!!!r;' t!->_~t tl-!"r~'-.;~~ r:~.~~tr'.'r.fi0r: I?"l"::-"::; !::J;<J~~"-.fi_)r ~~-
- perforrnan~ of the work far which this permit is issued (Sec..3097.Civ.C):
Lender's Information:
.-
aUIWING PERMIT NO. BLDZ003-02506
... ,,,;.o::'t2,,',i',":"i:''5:"<,.: .
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TYPE OF PERM!T
NeW Residenlial Construction
DATE: 2/13/2004
JOB .ADDRESS: 809 S WESTERN AVE
LEGAL DESCRIPTION:
CITY
APPLICANT: RICHARD MASSE
OWNER INFORMATION:
Royal C Marten
PO BOX 30
SanlaClara, Ut 847650060
BUiLDING DIViSiON
200 S. ANAHEIM BLVD.
(714) 765 ~ 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 101
QUARTER SECTION: 6
I d-:..
I.
liCENSED CONTRACTORS DECLARATION
I hereby. affirm under; penalty of perjury that' am
licensed under prcvisibnsof chapter 9 (commenCing
wil~ SeGtio.n 7000) of Di . n 3 of !he Business and
ProfesSians Code.
NUMBER
733437
TYPE
TYPE
Construcion Types:
VN, ,
Occupancy Graups:
R3, U1, , ,
Fire Sprinklered?
DwellinQ UnitS:
Livina Area:
Garaae Area
I certify that I hav~ read thisappllcatian and state that the -above information is carrect. I
. agree to comply with all city ordinances and $tate laws relating to buDding constructio.n, and
hereby authorize repre ntiVes 'af this city to enter upon the abave mentioned property for
i0spection purpo . "
#4~ Date: 2/13/2004
Signalure of Applicant or Agent
The permit shall expi~e by limitation and become null and void if the building or
work has not passed final inspection 365 days f~om the date of pe~mit issuance. A
new permit is ~eq\Ji~ed to commence o~ continue work.
Contractor
EXPIRATION DATE
3/31/2005
B
HIC'
NO. .
1
. 2.414
4$2"
Fees paid for Permit:
Total:
3,023.34
, INSPECTION RECORD
- INSPECTOR
INSPEeTlON ' , DATE
, Temporary Power Pole ' '
Plumb/rig (OrainlWaste Pipe) , ,
EleCtrical Ground Electrode/uter , " ,
SelbacklFormsrrrenches (Footings) L-J '"
Do not install subfloor or pour floor slab until the
following applicable items have been signed: ,
Plumbirig (Water Plpe.Sprinkler Valves)
Mechanical (GrOUndwork) , ,
Electrical (Underground Conduit) ,
Pre-slab {compactlon/Membrane.Reinf. 7-/9'..of ,
,
" lInderpinning (Floor Joist/Girders) , /,,' ,
Do not cover or conceal the work below until the , "
" following applicable items have been signed: ' ,
1 st Floor Sheilr ' , , S/,I. \.A>A ' --
Firesprinkler (Rough) I \ "-
2nd FlooL.Sl1ear , ~
Roof ISheat'M; 'ragm/Frame), 9/,';10- ,~
Masonry \....'"'18000 BeanlPre-Grout)
Rough Plumbing (Top Out) ,
Rough Mechanical ' ' , , ,
Rough aectncal \ury naif) ,
Rough Electrical , ,
, Framing' (Onlyafte, Plbg" Elec., Mech, and Fire) ,
Insulalion (SoundlEnergy) , , ,
Do n'ot tape' or plaster until the following applicable " ^()
items have beensigl)ed: " ' .L1
Drywall , i.."t-vu'f /'1-.,
Penetrations (Fire Rated) Electrical '," ,
Penetrations (Fire Rated) Mechanical , ,
Pene!rations{Fire Rated) Pluml:ling ,
Interior Lath ' " ' " ~ ~^r
Exterior Lath , " lZ~ '
, , GENERAL ITEMS ^ ' ,
Exterior Plaster (Brown Coat) (. df ';r,
T -Bar Electrical ,
T -Bar Mechanical ,
, T -B"r Structural ,
,Sewer'
Water Engineering BackfJow , ,
Water Service
FINAL INSPECTIONS
Electrical Final
Plumbing Fi,nal
,Mechanical Final
Gas Test
Engineering/Grading Fin'" 765-5126 '
Fire Oep\. Final 765-4040
Water Engineering 765-5268 ,
Sub list/Business License ,765-519 '
Date
InSpector
, Zoning 765-5139
Building Final ILast Inspection. Only
, After Above Complete)
..
''to~
PARTIAL INSPECTIONS '
,BuildinQ Inspections
MechanicallnsDectiorls
'PlumbinQ Inspections
Electrical Inspections ,