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500 N EUCLID ST (6)Permit Number: SGN2023-00010 Issued: 04/24/2023 www.anaheim.net/building (714)765-4626 Quarter Section: 53 CITY OF ANAHEIM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765-5153 Site Address: 500 N EUCLID ST, ANAHEIM, CA 92801 Legal Descriptlon: P BK 283 PG 7 PAR 1 PM 283-7 PAR 1 POR OF PAR APNc 0721`1051 Project Description: Installation of (2) illuminated wall signs and (1) non -illuminated blade signs for "Burlington". People Associated with Project: Contractor MATTHEWS SIGNS LLC 560 S QUINCE STREET201806281208284840 ESCONDIDO. CA 92025 Permit Applicant Purvin Lapsiwala Owner PK II ANAHEIM PLAZA LP 3333 NEW HYDE PARK RD 100 OWNER - BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's License State Law for the following reason(s) Indicated below by the ehockmark(s) I have placed next to the applicable Items) (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 file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors' State License 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 more then five hundred dollars ($500). 0 1, 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' Stete License Law 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 Contractors State License law). 1 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 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. 0 1 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: Carrier. INSURANCE COMPANY OF THE WEST Policy No.: WVE508353901 Expiration Date This section need not be completed If the permit is for one hundred dollar= ($100) or less. Q 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 cemolv with thoss'ddrovisions. _ 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. CONSTRUCTION LENDING AGENCY IL LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that there is a construction lending agency for the performance Lenders Information: 1 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. Date Signature of Applicant or Agen The premit 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. I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000) f Division 3 of the Business and Prgfe�slons e. if —1 Date: 04124/2023 Contractor. MATTHEWS SIGNS LLC Number. SGN2023-00010 Expiration Date 12/24/2023 TYPE: C45 Fees paid for Permit: $1,084.00 City of Anaheim BUILDING DIVISION INSPECTION RECORD 4.1 SIGN PERMIT ADDRESS: 500 N EUCLID ST, ANAHEIM, CA 92801 OWNER: PK II ANAHEIM PLAZA LP PERMIT#: SGN2023-00010 DATE ISSUED: 04/24/2023 DESCRIPTION: Installation of (2) illuminated wall signs and (1) non -illuminated blade signs for'Budington'. POST THIS CARD WITH THE APPROVED PLANS IN A CONSPICUOUS PLACE ON THE JOB SITE Inspection Code Date Inspector SET BACK, FORMS, TRENCHES 602 UNDERGROUND 604 CONDUIT MASONRY: REINFORCEMENT, 606 PRE -GROUT FINAL 69717Y�;1_31 JSC PARTIAL APPROVAL NOTES INSPECTION DATE INSPECTOR Inspectors can normally be reached between 7:30 - 8:00 A.M. (714) 765.5153 + 0 signcard 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.net/CitizenAccess To access your inspection timeframe, please go to www.anaheim.net/buildina 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.