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999 S BROOKHURST ST (4)°r-1� " 'PerAltlumtier: SON2023-00016 Issued: 02/28/2023 www.anaheim.net/building (714)765.4626 Quarter Section: 34 CITY OF ANAHEIM BUILDING DMSION 200 S. ANAHEIM BLVd.' (714) 765 -5153 Site Address: 999 S BROOKHURST ST, ANAHEIM, CA 92804 Legal Description: S TWP 4 RGE 10 SEC 18 SEC 18 T 4 R 10 E 190 FT S 2 APN:12726120 Project Description: Installation of (1) illuminated monument sign "Jack In The Box" People Associated with Project: Contractor SIGNTECH ELECTRICAL ADVERTISING INC 4444 FEDERAL BLVDABCDE71165630 SAN DIEGO, CA 92102 Permit Applicant Steve Therdault 4444 Federal Blvd San Diego, CA 92102 Owner PK II BROOKHURST CENTER LP 3333 NEW HYDE PARK RD 100 OWNER - BUILDER DECLARATION 1 hereby affirm under penalty of perjury that 1 am exempt from the Contractor's License State Law for the following reasons) indicated below by the checkmark(s) I have placed next to the applicable Item(s) (See. 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 foe a signed statement that he or she Is licensed pursuant to the provisions of the Contractors' State Ueense Law Chapter 9 (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 mora than five hundred dollars ($500). 13 I, as owner of property, or my employees with wages as their sole compensation, will do U all or ( portions 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 apply 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 0 I, 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 Lew does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractor's State License Law). I am exempt from licensure under the Contractors, State License Law for the following reason: Date Signature of Property Owner or Authorized Agent WORKER'S COMPENSATION DECLARATION 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. ❑ 1 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: Carrier: ZURICH AMERICAN INSURANCE COMPANY Policy No.: WC5513790 Expiration Dat This section need not be completed N the permit Is for one hundred dollars (1100) or less. ❑ 1 certify that in the performance of the work for which this permit Is issued, l 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 gmbject (;o th#\wQrkefs compensation provisions of Section 3700 of the Labor Code. I shall forthwith comoly with those orovisions. 2 -zit - Z's Date Signature of Applicant 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 that there is a construction lending agency for the performance Lender's Information: I hereby certify that i have read this application and state that the information above is correct. I agree to comply with all city ordinances and state laws relating building construction, and hereby authorize representives of this city to enter upon the above mentioned property for Inspection purposes. The premit 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 1 hereby affirm under 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. Date: 02/28/2023 Contractor. SIGNTECH ELECTRICAL ADVER Number: SGN2023-00016 Expiration Date 10/1/2023 TYPE: C45 continue work. I Fees paid for Permit: $988.00 Inspection City of Anaheim ell h,13lj&DIN%PjVISI0N SET BACK, F INSPECTION RECORD SIGN PERMIT ADDRESS: 999 S BROOKHURST ST. ANAHEIM, CA 92804 OWNER: PK II BROOKHURST CENTER LP PERMITM SGN2023-00016 DATE ISSUED: 02/28/2023 DESCRIPTION: Installation of (1) Illuminated monument sign "Jack In CONDUIT The Box` POST THIS CARD WITH THE APPROVED PLANS IN A CONSPICUOUS PLACE ON THE JOB SITE Inspection Code Date Inspector SET BACK, F R S, I TRENCHES 602 _ UNDERGROUND 604 CONDUIT MASONRY: REINFORCEMENT, 606 PRE -GROUT FINAL1 699 ' PARTIAL APPROVAL NOTES INSPECTION DATE INSPECTOR Inspectors can normally be reached between 7:30 - 8:00 A.M. (714) 765-5153 + 0 signcard he I INSPECTION REQUIREMENTS A representative is required to be on the site to expose any concealed wiring for final inspection. INSPECTION REQUESTS Inspection requests made prior to 5:00 pm Monday - Friday will be scheduled on the following workday. To schedule your building inspection online, please go to https://aca.anaheim.netICitizenAccess To access your inspection timeframe, please go to www.anaheim.netlbuiidina after 7:30 am on the day of your Inspection. Under Online Services, click on the "Inspection Timeframes" link or call (714) 765.5153 + 0.