1410 S PEMBROOKE LNPermit Types
SI_D ELE MEC PLM
X X
Permit Number: BLD2023-00395
Issued: 01/27/2023
www.anaheim.net/building
(714)765-4626
Quarter Section: 42
CITY OF ANAHEIM
Site Address: ;1410 S PEMBROOKE LN, ANAHEIM, CA 92804
Lega;lDescitption: N.TR 6089 BL'K LOT 35
APW 12862205
Project Description: Residential Photovoltaic System with Inverters
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(7141765.5153
till i'`' t
Living Area:
Number of Stories: Valuation: 15,000.00
Garage Area:
Construction Types:
Carport Area:
Occupancy Groups:
Balcony / Deck Area:
Fire Sprinidered:
Cool Roof.
Total Fees paid for Permit: 167.00
People Associated with Project:
Contractor SOUTH WEST BUILDERS
9752 ETON AVE CHATSWORTH, CA 91605
Permit Applicant Jacob Wickman
Type Electrical Fixtures Qty
Type Plumbing Fixtures Qty Mechanical Fixtures Qty
Sub Panel/Temp Pwr - Under 600 V, up to 1
200 amps
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 issuance. A new permit is required to commence or continue work.
City of Anaheim
Building Division
Do not occupy this building until the final inspections have been made.
INSPECTION I DATE INSPECTOR
Do not pour concrete until the following applicable items have been signed:
Plumbing (Ground/Underfloor Drain Waste)
Electrical Ground Electrode/Ufer
Setback/Forms/Trenches (Footings)
Do not install subfloor or pour floor slab until the follwing applicable items have been
signed:
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre -slab (Compaction/Membrane Reinf.)
Floor (Joist/Girders)
Underfloor Insulation (Raised Foundation Only)
Floor Nailing (Raised Foundation Only)
2nd Floor (Floor Nailing)
Do not cover or conceal the work below until the following applicable items have
been signed:
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Duct (Mechanical)
Rough Mechanical
Rough Electrical
Rough COA/Mitagation Measures
Framing (Only after Plbg., Ele., Mac. & Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable items have been signed:
Drywall
Drywall Penetrations (Ele, Mec & Plbg)
Interior Lath
Exterior Lath
Electrical Service Meter -(Meter will be set within 2-3
business days after approval) Excludes New
Construction
Exterior Plaster (Brown Coat)
T -Bar (Struct., Ele., or Mec.)
Grease Interceptor
(Do not hackfill unless Maned affl
Sewer
Water Engineering Backflow, (Testable Only)
Water Service
FINAL INSPECTIONS DATE I INSPECTOR
All applicable items below must be signed before utilities are released
Final Gas Test
Electrical Final
Plumbing Final
Mechanical Final
Cross Connection Control (714) 765-4280
Engineering Final (714) 765-5126
Fire Sprinkler (ONLY) (714) 765-5041
Fire Dept. Final (714) 765-5041
Water Engineering (714) 765-4591
Sub List/Bus. Lic. (714) 765-5194 (Allow 10 business days)
COA/Migation Measures
Building Final (714 765-5153)
Last Inspection -Final Only After Above Completed
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections
Permit Types
BLD ELE MEC PLM
X X
Permit Number: BLD2023-00395
Issued: 01/27/2023
www.anaheim.net/building
(714)765-0626
Quarter Section: 42
CITY OF ANAHEIM
Site Address: 1410 S PEMBROOKE LN, ANAHEIM, CA 92804
Legal Description: N TR 6089 BLK LOT 35
APN:12862205
BUILDING DIVISION -
200 S. ANAHEIM BLVD.
(714) 765 - 5153
WORKER'S COMPENSATION DECLARATION:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED
FOR IN SECTION 3706 OR THE LABOR CODE. INTEREST, AND ATTORNEYS FEES.
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for worker's compensation, issued by the Director of Industrial Relations as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this permit is Issued.
JW
I have and will maintain workers compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued. My worker's Compensation insurance carrier and policy are:
Cartier.
Name of Agent:
Policy No.: 9156289 Expiration Date: 4[5/2023
Phone No.:
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the
worker's compensation laws of California, and agree that, if I should become subject to the worker's compensation provisions of Section 3700 of the
Labor Code, l shall forthwith comply with those provisions.
Jacob Wickman 1/27/2023
Signature of Applicant
Date
DECLARATION REGARDING 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 Name:
Lenders Address:
LICENSED CONTRACTOR'S DECLARATION:
I hereby affirm under the penalty of Perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license Is in full force and effect.
SOUTH WEST BUILDERS
Contractor Signature
NUMBER EXPIRATION DATE LICENSE TYPE (S)
1012298 03/31/2024 B, C-7, C10
Date
1/27/2023