4111 E CHURCH HAVEN WAY (5)Permit Types
BLD ELE MEC PLM
X
Permit Number: BLID2023-00105
Issued: 01/13/2023
www.anaheim.net/building
(714)765-4626
Quarter Section: 163
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CITY OF ANAHEIM 1/13123
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
Site Address: 4111 E CHURCH HAVEN WAY, ANAHEIM, CA 92807
Legal Description: N TR 4567 BLK LOT 25
s:
APN:36113104
Project Description: Residential EV Charger Level 2
1ti r
` �4k
Living Area: Number of Stories: Valuation: 0.00
Garage Area: Construction Types:
Carport Area: Occupancy Groups:
Balcony / Deck Area: Fire Sprinldered:
Cool Roof: Total Fees paid for Permit: 0.00
People Associated with Project:
Permit Applicant Daniel Llamas
Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Mechanical Fixtures Qty
EV Charger 1
The permit shall expire by limitation and become null and vold 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.
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P�pNEIM �q<
Cityof Anaheim o� io
Building Division F z
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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 I A V it, 'f j0 -
Plumbing Final
Mechanical Final
Cross Connection Control (714) 765-4280
Engineering Final (714) 765-5126
INSPECTION 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 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
s' e •
Building Final (714 765-5153)
Last Inspection -Final Only After Above Completed
I
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 s*aneds
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 COA/Mitagation Measures
Plumbinq Inspections
Framing (Only after Plbg., Elea, 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. BLD2011-00105
Issued: 01/13/2023
www.anaheim.net/building
(714)765-4626
Quarter Section: 163
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
Site Address: 4111 E CHURCH HAVEN WAY, ANAHEIM, CA 92807
Legal Description: N TR 4567 BLK LOT 25
APN:36113104
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 ATTORNEYS 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 worker's compensation, Issued by the Director of Industrial Relations as provided for by
DL Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
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. HARTFORD FIRE INSURANCE COMPANY 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 warkees compensation provisions of Section 3700 of the
Labor Code, I shall forthwith comply with those provisions.
Daniel Llamas 1/13/2023
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.
AZTLAN ELECTRICAL CONTRAC
Contractor Signature
NUMBER
EXPIRATION DATE
LICENSE TYPE (Sl
685860 03/31/2024 C10
Date
1/13/2023