1204 S COUNTRY GLEN WAY (3)r , Permit Types
BLD ELE MEC PLM CITY OF ANAHEIM
X
BUILDING DIVISION
Permit Number: BLD2023-02266 — 200 S. ANAHEIM BLVD.
Issued: 05/11/2023 (714) 765 -5153
www.anaheim.net/building
(714)765.4626
Quarter Section: 227
Sit* Address: 1204 S COUNTRY GLEN WAY, ANAHEIM, CA 92808
Legal Description: N TR 14072 BLK LOT 4 UN 156 TRACT 14072, LOT 4 OF
APN: 93026552
Project Description: Residential EV Charger Level 2
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LMng Area: Number of Stories: Valuation: 0.00
Gerege Area: Construction Types:
Carport Area: Occupancy Groups:
Balcony I Deck Area: Fire Spdnidered:
Cool Roof: Total Fees paid for Permit: 0.00
People Associated with Project:
Contractor WILD GOOSE ELECTRIC 3024 N BUTTERFIELD RD ORANGE, CA
Permit Applicant Tom Hull
Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Mechanical Fixtures City
EV Charger 1
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City of Anaheim
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Building Division F z
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Do not occupy this buildino 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 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/Migation Measures
Do not install subfloor or pour floor slab until the follwing applicable items have been
Building Final (714 765-5153)
Last Inspection-Final Only After Above Completed
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
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 Manedi
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
Mechanical Inspections
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 COAIMitagation Measures
Plumbing Inspections
Framing (Only after Plbg., Ele., Mee. & Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable items have been signed:
Drywall
Drywall Penetrations (Ele, Mac & 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: OLD2023-02266
Issued: 05/11/2023
wormanaheim.net/building
(714)765.4626
Quarter Section: 227
CITY OF ANAHEIM
BUILDING DMSION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
Site Address: 1204 S COUNTRY GLEN WAY, ANAHEIM, CA 92606
Legal Description: N TR 14072 BLK LOT 4 UN 156 TRACT 14072, LOT 4 OF
APN: 93026552
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5/ IV 2.3
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 self4nsure for workers compensation, Issued by the Director of Industrial Relations as provided for by
TH 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 end policy are:
Cartier. Policy No.: Expiration Date:
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
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,1 shall forthwith comply with those provisions.
Tom Hull 5/1112023
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.
WILD GOOSE ELECTRIC
5/11/2023
Contractor Signature V Date _ --
NUMBER
686193
EXPIRATION DATE
05/31/2023