7870 Samantha Cir.
BUILDING PERMIT NO. BLD2005.00373
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
INSPECTION REQUEST LINE:
(714) 765.4626
CENSUS CODi;: 434
QUARTER SECTION: 200
TYPE Of PERMIT
Blockwall/ Columns
DATE: 2/1012005
JOB ADDRESS.:' 7870 E SAMANTHA CIR
LEGAL DESCRIPTION: . N TR 8831 LOT 96
APPLlC;ANT: MIKE, THOMPSON
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:.
MICHAEL THOMPSON
7870 E Samantha Cir
Anaheim, CA 92807
, JOB DESCRIPTION:Build 43 lineal feet of 6 foot high block wall per city specifi;"'tions.
VALUATION: 1,032,00 PROCESSED.BY: SAM
I OWNER:BUILDER DECLARATION '.
lhereby affirm under penalty of, perjury that' am exempt from the COT1tractor's-Licens:e,~w for the following reason (Sec. 703_1.5'Busihess and
Professions Code: any city or county which requires a.permit to construct; aJt;1-r, 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 Iiceri'sed pursuant to the provisions of the Contractor's License Law (Chapter
9}(commencing with Section 7000 of Division 3.of the BUl5iness and ?rofessicns C'ode) or that he is e,xempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subj~ts the applicant. to a dv~ penalty of not more than five !1undred dollars
$ ~ ' , ' " ',' ,
I, as ownerofproperty, or my employees with wages as their sole CoITtpt.;'nsation, will do the w'ork, and the structure is not intend~ or offered for
s Ie _(Sec. 7044 Business and Professions Code: TheContractor's License L'~\IIldoes not appl'yto an owner of property who builds or improves
t~ereon, and who ?oes such work himself or herself orthrough his gf.tmf owr:empioyees, provided that such improvements,are not intended or .
offered for sale. If,however, .the building orimprovement is sold ith on.e ye;-.f of completion, the, owner-builder will have the-burden of proving that he
did not build of improve for the, purpose of sale).. . _- ,
o I; as the owner of the property, am exdusively 'C?on . 9 Wit~eosed i:tJntr~~ors' to construct the projeCt {See. 7044 BUsiness and Professions
Code:, The Contractor's License Law does not. ap !Eo 'owne .f " e .who 'ilds or improves thereon, and who contracts for,such projects with
fl.!(ontractor(s} licensed pursuant to the Contr~~i. n~ ..'
U I am exempt under Sec. , B ~C. fOr' reason: _____
Date: Owner:
WORKER'S CO ENSATION DECLARATION . I'
I hereby affirm under penalty of perjury one of the fOllowing declaratiohs:
o I have and will maintain a certific~te of consent to self-insure: for worker'::: compensation,
as providedfor by Section 3700 of the Labor Code, for the peTformanceofth~-:: 'Norkldrwhid1
tni~ permit is issued. . ,
o I have and wili maintain worker's compens~tion insurance, as required b}; Section 3700 of
the Labor Code, for the performance of the work for which this permit is_ iSSUE..:.'. Myworker's
Compe,nsatiOn insurance.CC!rrier and policy are: '
Carrier: 'Policy Number.
UCENSED CONTRACTORS, DECLARATION
I hereby affirm un er penal~ of perjury that I am
licensed u.nder provisions of chapter 9{commi:mcing
with Section 7000) of Di\lS)6n 3 of the_ Business and
ProfessiOns Code.
2110/2005
Date:
CQntractQr
NUMBER
EXPIRATION DATE
This section need not be completed if the p"ennit is for. one hundred dollars j.$1;OO) .>r less:
~' ., ertify tha't in the performa nee oft.he work for which this y it1Si~ued..A shalt not-
em any person in arty manner so as to become 5ubjec. w9.fKer. mpensaticn laws
of lifomia, and agree that if I should become subje e 0 er' pensation.. . .
provisions of Section 3700 of the Labor Code,l t ~~s~ons.
Date:' 2/10/2005' Applicant:
WARNING:"FAILtjRE TO SECUR WORKER'S COMPE SATION COVERi\GE is
UNLAWFUL, AND SHALl SUBJECT AN EMPlOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000)./NADDITlON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTICli'\!' 3706 OF THE
LABQR CODE, INTEREST AND ATTORNEY'S FEES. '
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that there is aconstruction lending a~f1cyfor the
performance of the work for which this permit is iswed (Sec.3097 .Civ.C):
. L~naei'sillformation: --
TYPE
Construcion Tvpes:
VN, ,
Fire Sprlnklered? . NO
at the above information is correct. ,I
~nces lavils relating to building construction, and
iv ('of thO c::ter upon the above mentioned property for
',,/ ,
- " Date: 2/10/2005
Signature of plicant or Agent
The permit'shall expire Iiy I,imitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
I certify that I have read this a
agree to cOmply with all
hereby authorize
inspection purpose .
Fees paid for Permit:
Total: '125.04
INSPECTION RECORD
IN$Pl:CTlON , I'DATE INSPECTO~
T &n1porary Power ,Pole
Plumbing (Drain,waste Pipe)
Electrical Ground Electrodel " . ' 'A ~ ~ II
'SetbacklFormslTrerlChes (~,"!I<{/O< '''"" (..wV 1.,
So not install subfloor or piS , or slab until the '
following applicable ilems have be,en signed: '
Plumbing (Water Pipe.Sprinkler Valves) ,
Mechanical, (Groundwork) , ' " "
Electrical (Undernround Condu it)
Pre-slab (CompactionlMemllrane.Reinf.j ,
Underpinning (Floor Joist/Girders) , ,',
00 not cover or conceal the work below until the ,
following applicable items'have been signed: '
1st Floor Shear
Firesprinkler (Rough) , .
2nd Floor Shear ' ,
Roof (Sheathing/Diaphragm'Fr
Masonry (ReinfJBond Beapl1Pre.GroutI' <J11Il/<>( 'f""", ~
Rough Plumbing .(TOp,O , r
Rough Mechanical , ' ,
Rougn t:IectrlCaI ,....y lfTdll"
Rough Electrical
Framing .(Only after P/bg.. EJec.. Mech.: and Fire)
Insullillon (SoundlEnergy)'
po not tape or pla~ter until the following applicable
It..ms have been sIgned:, " ,
Drywall
Penetrations (Fire Rated) Electrical ,
Penetrations (Fire Rated) MeChanical
Penetrations (Fil'll Rated) Plumbing " , ,
Interior Lath ' , , .
Exterior Lath
, , GENERAL ITEMS "C'
Exterior Plaster (Brown Coat)
T -Bar Electrical, ,
T-Bar Mechanical ,
T -Bar Structural
Sewer, ' , ,
Water Engineering Backflow " '
Water Service c
-
FINAL INSPECTIONS DatE: ' Inspector
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 765-519
Zoning 765-5139 ,
Building Final ~ast Inspectian. Only r AI A~ <1l.' fj
,fler Abave Camplelel
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections ,
Plumbina Inspections
ElectricallnsDections
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THE' ISSUANCE OF THIS PERM/. ooes
NOT APPROVE VIOLATION OF ANY OF
THE BUILDING CODES OF THE: CITY,
THE HOLDER OF THIS PERMIT
PROCEE:DS AT HIS OWN RISI<.
FEB 1 0 2005
/'
\J~ e
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~:eS-3 Qs"
PLANN/i\lG DEPAfo1' ',900
A ~. ,\ IvIENT
"PPRQvr-O
DA TE __",;2d;qjp.'f?b
8Y~~_JWJ
! FLOOD ZONE X (Initi6.!s;)
I HISTORIC DISTRICT -
I' ~ ~ REVIEW,
. ~)C(;l stfimo t!-. .
eEE BU'SL;'1e on ;'-b;;;.I;~n:ag,e
ING PERMIT Fa
!l:N~_CONOITIONS R
oIL f;r -
6L~ 01~~f:r~ b ~
~
BUlI.D:NG PERMiT NO. BLD2004-ij0219
_.........._..-..--...J._;,..,~
, l;;f~.,:~L;;,,~~\
CITY :,:'<"~~,~,:N.HEIM
" ' 'E:'tW.~':Jrjf
'\ " '~';;J!r ,> '
~~tLqt','r~~.\'iJ/'
BUiLDING DIVISION
200 S, ANAHEIM BLVD.
(714) 765 - 5153
, ,
INSPECTION REQUEST LINE:
(714) 765 -4626
CENSUS CODE: . 434
QU~.RTER SECTION: 200
TYPE OF PERMIT
Reroof
DATE:, 1/23/2004
JOB ADDRESS, 7870 E SAMANTHA CIR
LEGAL DESCRIPTION: N TR 8831 LOT 96
CO~~TRACTOR INFORf,!!\TION:
YORBA LINDA Room,q
3924 : MIRALOMA AVE #."
, AtJAHEIM;CA 9280601)(-)' ,
BUSINESS PHONE: '714 9~,-1307
JCB DESCRIPTION:Tear off wood shake and Install 15 squares of Au"u," .';';S 12.5 Lbs ICBO # 2310
VALUATION: 6,000.00 \ PROCESSED BY: ODC
I OWNER'BUILD;=,illECLl\RATION ==J
I'hereby affirm under f)P.nalty of .perjury that I am,exempt from the Con!racr::)i:J U~enst.. ,laV(for the following reason'(Sec.-7031.5 Business ~nd
professions Code: any 'dty.or county which requires,a permiU':l ~onstrll(.t, <'\:,-;:'r. !''':1proVE':, demolish ,or repair anystructur,=. prior to its issuance, also
requires the app1icant for sucn permit to'file asignw statement th,'t he is I ic),r sed pi.lrsua__r,~ to the provisicnsoftheContractt'r's License Law (Chapter
9)(commenciI)9 with Section 7000 of Divisi,on 3 of the, Business and Prof~3,:<';:"!s Gode) or that ~c is exempt therefrom. and the bas;s.for the ailegad
exemption. Any vio'~ation of Section 7031.5 by any applicaJ"lt fvr a permit !,Urle'!C+_s th~ applicant to a dvii penalty of not mere thal'\five hundre~ dollars
($500). " " .. 'i ' " " , , '
o I, as owner of'property" or my employees with wages as the;, :sole ,;nmr:,ensatlon, wi{/ do the work, and the structure is not intended or offered for
sale (-S:ec. 704A8usiness .2~d protessions Code; The Contractor':; L:cen!:o.li~w c!oes not apply to an o~n~lrof property who builds or :mproves.
thereon, nnd who dC~$ such work himself or herself ar through his or hS(-OWil e'n~!oyees, provided that such improvements are not Ir.tench:.d or
. offered for sale. If, t;cwever, the building or improvemi:mt is seld with one y~~r of 'completion, the awher.builderwill ha~'e!he burden of preYing 1Jjat he
did :'lOtbuijd or imprvve for i.he purpose pf sale);' \ . . _ . '.
C-j _I, a~ the owner of th.e property, am exdusively cO!1tracting .with Iicens('.j;~.j!1~:-<;~tcrs to construct the proj'9ct (Se9-. 7044 B,Jsiness and profe,ssions
Code: The Cont!"a~tor's License Law does not 3!JPIy to an owner of pr..:r:::\e.ty'....-t"o bUl;di; or irnprcves}hp-reon, and who contracts for su.j, rdojects. with
~ontrador(s) licensed pur~uant to the Contractor's"1JcenSe Law).
LJI am ~ernpt LInder Sec:. . .8-& P.C. for this reason:
Oate: . . Ownei:
c=_~_- WORKElis COMPENSA"nON DECLARATION _,.__, 'l
I hereby affirm undorpenalty of perjury one ofthefolrowing-dedarations; j
O' I have and \~:jlrY'.aintain a certificate of consant to self-insure for \vorl<...r~ (:ompensation,
as provided for ,by Section 3700 of the Labor Code, for the performance of tc~ 'NorK fer \\lhlch
this permit is issued. . . .
o , have and will maintain worker's compensation insurance, as required i',::' Section 3700 cf
the Labor Code, fo~ the performance of the work for which thi~ permit is iSS~.II'~' Mywor!\er's
Compensation insurance carrier and policy are,:
Carrier: EXEMPT "
APPLICANT: MITCH ATCHLEY
OWNER INFORMATION:
D<Jle R Thayer.
7870 E Samantha Clr
Anahalm, CA 92807
ARCHITECT/ENGI.Nf,ER INF.ORMATION:
.~
LICENSED CONTRACTORS DECLARATION I
J hereby affirm under penalty of perjury that I am
Hcensed under provisions of chapter 9 (commencipg
..vithSection\~iori3ofthe Business and
Professions ~,_ _ .~ '
1/23/2004 / '_
.
Date: Contr;::lctor
Policy Nu,"'1be.r: NO EMP~OYEES
NUMBER
, 549263
TYPE
TYPE
EXPIRATION DATE
, 11/30/2004
This s on need not be completed if the permit-is for OM hundrerl-dol!1lYs($~iK; :r- ,!ess.
I certify th<;1t in the performance ofthe work forwhichthis.Germit iSis~tej;'-Shall not
employ.any person in any manner so as to become subject to the worke-fs:i'C(:lllp€nsation laws
of Califomia, and agree that if i should become subject to the worker's COr11P:Jo.$ation . .
provisions of Section 3700 of the Labo~ Cod . all' .~orthwith con:pl!, Vi:.U, tt'J3~_ provisions. Constru.:;ion Tvpes:
, d-- ' V N. ,
Date: 1123/2004 Applicant:' , _,;.11. " " I Fire Sprlnklered?
WARNING: FAILURE TO SECURE WORKER'S COMPENSAT1QN COy:1< \02 IS , , 'I
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRiMINAL PE'tlt:. ":!OS AND CIVIL ' '.
FINES UP TOONE HUNDRED THOUSAND DOLLARS ($100,000)..!NA6~'T1C'J\1,TO THE.
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTI~' 3106 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. '. "'," '. ',.' '
, [ , , ,CONSTRUCTION LENDING AGENQYi}, , :C__"'
I hereby affirm under penalty of perjury that there isa con!ltn..!ction reT1c!in~.i -~,~C ~ncy fqr the
rc.,4"~..=,,",s.!'!~ ,::i~~ ...:-...4- 0'" '.vh:~ ~l..+..; ~~...~;~ 1:.- :::~. :~..'"1- ~S_"'-:": ~:",:?f":'~~~,-"! )-~~-.......">- -~. .
C39
HIC
NO
L~;;G~r S Illrcrmanon:
I certify that I have react .this application and state that the above information i.s correct I
agree to romply with 8:11 city ordinances and state laws relating to bu iding construction, and
. hereby authorize representiVes of this dty to enter upon the ab.ove m'entioned property for
in~r' ->
Fees paid for Permit:
Total:
235.99
Date: 1/23/2004
SI9nature of Applicant or Agent
The. permit shaUexpire by limitatiOn and become null and void if the building or
work has not pasSed final inspection 365 dajlS from the date of permit issuance; A
neW permit is required to commence or c:;:ontinue work.
INSPECTION RECORD
. . INSPECTION DATE INSPECTOR
Temporary Power Pole . .
Plumbing (DralnlWaste Pipe)
Electrical Ground Electrode/lifer
SetbacklFormsrrrenches (Footings) .
Do not install subfloor or pour floor slab until the
fOllowing applicable items haye been .signed:
Plumbing (WaterPlpe.Sprinkler Valves)
Mechanical (Groundwol'k) . .
Electrical (Underground Conduit) ., ..
. Pre.slab (Compaction/Membrane.Reinf.
Underpi!lning (FlOOr Joist/Girders)
. Do not cover or cPoceal the work below untolthe . .
following applicable items .have been signed: .
1 st Floor Shear. . .
Firesprinkler (Rough) .
2nd Floor Shear .. ~
Roof (Sheathing/Diaphragm/Frane) ( -. .
Masonry (ReinfJBond BeanlPre-Grout) .
Rough Plumbing (Top Out) .
Rough Mechanical ..
KOugh .t1ectrical aliI
. Rough Electrical. .
Framing, (Only after Plbg., ;.lec., Mech.. and Fire) /171{CiI;- ..;;>>:::::,--. .
Insulation (SoundlEnergy) .
po not tape or pla~ter until the following applicable
Items have been signed: . . .
Drywall. . . .
Penetr-,ons (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 ,..
FINAUNSPECTIONS . Date InspeClor
Electrical Final . . .. ..
Plumbing Final . .
Mechanical Final .. r
Gas Test
EngineeringlGrading Final 765-5126 .
Fire.Dept. Final 765-4040 . .
Water Engineering 765.5268 ,.
Sub List/Business licen$e 765-519 . .
Zoning 765-5139 . ..
Building Final ~ast Inspeclion. Only., !0;-~ ..-'R.. /:;
. tw Above Complete)
PARTIAll.NSPECTIONS
Buildina Inspections
Mechanical Inspections .
Plumbina Inspections
. Electrical Inspections