777 N ANAHEIM BLVDPermit Types
BLD ELE MEC PLM
X
Permit Number: BLD2023-00037
Issued: 01/05/2023
www.anaheim.net/building
(714)765-4626
Quarter Section: 71
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(7141765-5153
SIte.Address: 777 N ANAHEIM BLVD, ANAHEIM, CA 92805
Legal.Descrlptlon: N TR 23 BLK E LOT 13 TR 23 LOT 13 BLK E AND LOTS 1
APN:03508229
Project Description: Commercial Reroof: Remove existing to install (10) sq of composition shingles and (14) sq of flat roof over entire
building
Living Area: Number of Stories: 0 valuation: 19,000.00
Garage Area: Construction Types: N/A
Carport Area: Occupancy Groups:
Balcony I Deck Area: Fire Sprinklered:
Cool Roof: Total Fees paid for Permit: 341.47
People Associated with Project:
Permit Applicant Takeo Tokillas
Owner GALLARDO DOROTHY TR PO BOX 1278222
Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Mechanical Fixtures Qty
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.
P�pHEIM Cq<
City of Anaheim 04 io
Building Division F i
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�D��►DED �$y�
Do not occupy this building until the final inspections have been made.
FINAL INSPECTIONS DATE 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
INSPECTION I DATE I INSPECTOR
Fire Sprinkler (ONLY) (714) 765-5041
Do not pour concrete until the following applicable items have been signed:
Fire Dept. Final (714) 765-5041
Plumbing (Ground/Underfloor Drain Waste)
Water Engineering (714) 765-4591
Electrical Ground Electrode/Ufer
Sub List/Bus. Lic. (714) 765-5194 (Allow 10 business days)
Setback/Forms/Trenches (Footings)
COA/Migatio Measures
Do not install subfloor or pour floor slab until the follwing applicable items have been
si ned:
rul!dIngnUal 765-5153)
t Ins alFinal Only After Above Com�Ieted
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
LP Y11 r1i -
PARTIAL INSPECTIONS
Building Inspections
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 sinned*
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
Mechanical Inspections
2nd Flo ear
oof (Sheathin iaphragm/Frame) — 3
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Duct (Mechanical)
Rough Mechanical
Rough Electrical
Rough COA/Mitagation Measures
Plumbing Inspections
Framing (Only after Plbg., Ele., Mec. & 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 Inspections
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 backfill unless sioned ofi)
Sewer
Water Engineering Backflow, (Testable Only)
Water Service
Permit Types
BLD ELE MEC PLM
X
Permit Number: BLD2023-00037
Issued: 01/05/2023
www.anaheim.net/building
(714)765-4626
Quarter Section: 71
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765-5153
Site Address: 777 N ANAHEIM BLVD, ANAHEIM, CA 92805
Legal Description: N TR 23 BLK E LOT 13 TR 23 LOT 13 BLK E AND LOTS 1
APN:03508229
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 ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to sefinsure 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.
�J 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. ZURICH AMERICAN INSURANCE COMPANY Policy No.: WC112580503 Expiration Date: 1=1112022
Name of Agent: 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 workers compensation provisions of Section 3700 of the
Labor Code, I shall forthwith comply with those provisions.
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:
Lender's 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.
Contractor Signature
NUMBER EXPIRATION DATE LICENSE TYPE fSl
606111 12/31/2022 C39, D24, C-2
.(< Z
Date