640 S BROADVIEW STPermit Types
BLD ELE MEC PLM
X
Permit Number: BLD2023-01521
Issued: 03/31/2023
www.anaheim.neUbuilding
(714)765-4626
Quarter Section: 48
CITY OF ANAHEIM
Site.Address: 640 S'BROADVIEW ST, ANAHEIM, CA 92804
X`>:
:LeBalDescription: N TR -2425 BLK LOT 118
'APNr12822406
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(7141765.5153
Project Description: Re -roof: tear -off and install (20) sq of composition shingles, undedayment if needed.
Living Area: Number of Stories: 1 Valuation: 6,000.00
Garage Area: Constnrction Types: NIA
Carport Area: Occupancy Groups:
Balcony I Dedc Area: Fire Sprinklered:
Cool Roof: Total Fees paid for Permit: 339.78
People Associated with Project:
Permit Applicant Thang Le
Owner LE THANG T 640 S BROADVIEW ST
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�Pt1E114 C9<
Cityof Anaheim D� �o
Building Division F i
u
�DDNDED %
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 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 ListlBus. Lic. (714) 765-5194 (Allow 10 business days)
Setback/Forms/Trenches (Footings)
COA/Migation Measures
Do not install subfloor or pour floor slab until the follwing applicable items have been
si ned•
Building Final (714 765-5153)
Last Inspection-Final Only After Above Completed
`�
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
Underfloor
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 e
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
Mechanical Inspections
d S earof
Vo(Sheathin iaphragm/Frame)
Wlesuffy (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
Mn not backfill unless smaned afl)
Sewer
Water Engineering Backflow (Testable Only)
Water Service
Permit Types
BLD ELE MECPLM
X i I
Permit Number: BLD2023-01521
Issued: 03/31/2023
www.anaheim.net/building
(714)765-0626
Quarter Section: 48
CITY OF ANAHEIM
BUILDING DMSION
200 S. ANAHEIM BLVD.
(7141 765 -5153
Site Address: 640 S BROADVIEW ST, ANAHEIM, CA 92804
Legal Description: N TR 2425 BLK LOT 118 k.
APN:12822406
OWNER - BUILDER DECLARATION:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License State Lew for the following reason(s) Indicated below by the
checkmark(s) I have placed next to the applicable Item(s) (Sec. 7031.5 Business and Professions Code: any city or county which requires a permit to
construct, alter, Improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for the permit to file a signed statement that he
or she is licensed pursuant to the provisions of the Contractors' State License Law Chapter B (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred delta ►q ($500).
I, as owner of property, or my employees with wages as their sole compensation, will doyU/ all or I ) pardons of the work, and the structure is not Intended or
(� offered for sale (Sec. 7044 Business and Professions Code: The Contractors' State License Law does not appy to an owner of property who, through employees' or
personal efforts, builds or improves the property, provided that the Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold
within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale).
1, as the owner of the property, am exclusively contracting with licensed Contractors to construct the project (Sec. 7044 Business and Professions Code:
The Contractors' State License Law does not appy to an owner of property who builds or Improves thereon, and who contracts for the projects with a licensed
Contractor pursuant to the Contractors State License Law).
I am exempt from licensure under the Contractors, State License Law for the following reason:
By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the
Improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -builder If it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, Is available upon request when this application
Is submitted or at the following Web site: htto:ihvww.leainfo.ce.eov/celaw.html.
By my signature below. I certify to each of the following:
I am the property owner or authorized to act on the property owners behalf.
I have read this application and the information 1 have provided is correct.
I agree to comply with all applicable city and county ordinances and state laws relating to building construction
I authorize representatives of this city or county to enter the above-tdentified property for inspection purposes.
it IC e s
Signature of Property Owner or Authorized Agent Date
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 pedury one of the following declarations:
I have and will maintain a certificate of consent to selfansure for workers 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.
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 workers Compensation insurance carrier and policy are:
Cartier: Policy No.: Expiration Date:
Name of Agent:
Phone No.:
1 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
workers 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 Date
NUMBER EXPIRATION DATE LICENSE TYPE (S1