219 S BARBARA WAY/ L
BUILDING DIVISION
CITY OF ANAHEIM
BUILDING DEPARTMENT 2013 CALIFORNIA CODES
CODE 200 S. Anaheim Blvd., Suite 145 1/200144
01/001/20
Anaheim, CA 92805
EFFECf/VE DATE
714 765-5153
www.anaheim.net/building
SMOKE DETECTORS AND CARBON MONOXIDE SELF CERTIFICATION
Final Inspection approval will require this completed form to be on site along with the job card.
Permit Number: -ZOZ2 — (0 J ID Date: 0�
Project address:
Property Owner: 1 '
The undersigned does hereby certify that I am the property owner of the
property. I further certify that smoke alarms and carbon monoxide alarms
functional in all the following locations. All boxes must be checked below
above referenced
are present and '
W Smoke Alarms and Carbon Monoxide Alarm: On the ceiling or wall outside of each separate
sleeping area in the immediate vicinity of bedroom/s or in each hallway outside of the rooms.
O Smoke Alarms: In each room used for sleeping purposes.
17 Smoke Alarm and Carbon Monoxide Alarm: In each story, including any habitable basement;
(Note: in dwellings or dwelling units with split levels and without an intervening door between
the adjacent levels, a smoke alarm and a carbon monoxide detector installed on the upper level
shall suffice for the adjacent lower level provided that the lower level is less than one full story
below the upper level.)
All dwelling
require carbon monoxide detectors.
112-
California
2_
Califomia Residential Code (CRC) Section R314.6.2,CRC R315.2 States in part that existing dwellings be
"retrofitted with smoke detectors and carbon monoxide detectors when a building permit is issued for work on or
in a building that is valued at $1,000 or more." CRC Section R314.3, CRC R315.2 defines required locations as
indicted above.
NOTE: This certification is only used when normal access to the interior of the dwelling by the City of Anaheim
Inspector is not achieved during the course of project construction. It is normally used for exterior projects such
as re -roofing, re -siding, patio covers, solar photovoltaic installations, and similar exterior construction work.
200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)7654153 Phone (714)765-4607 Fax SEPT 2015
www.anaheim.net/building 8842
SMOKE/ CO ALARM REQUIRED LOCATIONS
Figure 1
Attic
Bedroom I Hall
20
Living Room
Basement
Family Room Bedroom
Dining
Living Room
Kitchen
Bedmomredroom
Figure 2 I a" I
Ceilin I I
4"
Acceptable Never
Here Here �12"
Top of Detector
Acceptable Here
tBedroom
Wail
Figure 4
Kitchen
Figure 3
& REQUIRED SMOKE ALARM LOCATION
'o REQUIRED CARBON MONOXIDE ALARM LOCATION
Garage
Permit Types
BLD ELE MEC PLM
X
Permit Number: BLD2022-05810
Issued: 12/08/2022
www.anaheim.net/building
(714)765-0626
Quarter Section: 134
Site Address: 219 S BARBARA WAY, ANAHEIM, CA 92806
Legal Description: N TR 6820 BLK LOT 25
APN:26863134
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
Project Description: Reroof: Remove existing to install (24) sq of composition shingles over house and (5) sq flat torch down over garage
Living Area: Number of Stories: 1 Valuation: 11,200.00
Garage Area: Construction Types: NIA
Carport Area: Occupancy Groups:
Balcony I Dedc Area: Fire Sprinidered:
Cool Roof Total Fees paid for Permit: 340.46
People Associated with Project:
Permit Applicant Joseph GDe Lorenzo 616 W Hart PI Montebello, CA 90640
Owner REICHEL STACEY L 219 S BARBARA WAY
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�PNEIM CSC
City of Anaheim D� �O
Building Division F i
u >
�D��►DED day^
Do not occupy this buildinq 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 ElectrodelUfer
Sub List/Bus. Lic. (714) 765-5194 (Allow 1 D business days)
Setback/Forms/Trenches (Footings)
COA/M' ation Measures
Do not install subfloor or pour floor slab until the follwing applicable items have been
si ne •
ritl.dg Fin (714 765-5153)
ion-Final Only After Abov Completed
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
PARTIAL INSPECTIONS
Buildinq 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 sioned7
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
Mechanical Inspections
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame) /3,
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Duct (Mechanical)
Rough Mechanical
Rough Electrical
Rough COA/Mitagation Measures
Plumbinq 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
Sewer
Water Engineering Backflow (Testable Only)
Water Service
Permit Types
BLD ELE MEC PLM
X
Permit Number: BLD2022-05810
Issued: 12/08/2022
www.gnaheim.net/building
(714)765-4626
Quarter Section: 134
Site Address: 219 S BARBARA WAY, ANAHEIM, CA 92806
Legal Description: N TR 6820 BLK LOT 25
APN: 26803134
WORKER'S COMPENSATION DECLARATION:
CITY OF ANAHEIM
BUILDING DMSION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
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 pedury one of the following declarations:
I have and will maintain a certificate of consent to self4nsure 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.
ei I have and will maintain worker's 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., STATE COMPENSATION INSURANCE FUND Policy No.: 9020345 Expiration Date: 1011/2023
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 worker's compensation provisions of Section 3700 of the
Labor Code, I shall forthwith comply with those provisions.
Sig lure of Applicant 12—
2
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):
Lenders Name:
Lenders Address:
LICENSED CONTRACTOR'S DECLARATION:
I hereby affirm under the penalty of Perjury that 1 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.
Contra- cto� rSignature
NUMBER EXPIRATION DATE LICENSE TYPE (Sl
660528 12/31/2024 C39
Date
12rG- 2�