807 S HAMPSTEAD STPermit Types
BLD ELE MEC PLM
X
Permit Number: BLD2022-05274
Issued: 11/07/2022
www.anaheim.net/building
(714)765-0626
Quarter Section: 64
CITY OF ANAHEIM
Site Address: 807 S HAMPSTEAD ST, ANAHEIM, CA 92802
Legal Description: N TR 1421 BLK LOT 2
APN:03635109
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(7141765-5153
Project Description: Electrical for 200A main panel upgrade and (1) sub -panel. REF: INV2022-00367
Living Area: Number of Stories: 0 Valuation: 0.00
Garage Area: Construction Types: N/A
Carport Area: Occupancy Groups:
Balcony / Deck Area: Fire Sprinldered:
Cool Roof: Total Fees paid for Permit: 167.00
People Associated with Project:
Owner DEVRE INVESTMENTS INC 9315 BOLSA AVE 963
Type Electrical Fixtures City Type Plumbing Fixtures ally Mechanical Fixtures Qty
Meter/Disc Sw - Under 600 V, up to 200 1
amps
Sub Panel)Temp Pwr - Under 600 V, up to 1
200 amps
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.-
City of Anaheim
Building Division
Do not occupy this building until the final inspections have been made.
INSPECTION I DATE INSPECTOR
Do not pour concrete until the following applicable items have been signed:
Plumbing (Ground/Underfloor Drain Waste)
Electrical Ground Electrode/Ufer
Setback/Forms/Trenches (Footings)
Do not install subfloor or pour floor slab until the follwing applicable items have been
Mane&
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
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' ed:
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
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
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 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
Do not hackfill unless sinned off)
Sewer
Water Engineering Backflow (Testable Only)
Water Service
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
Fire Sprinkler (ONLY) (714) 765-5041
Fire Dept. Final (714) 765-5041
Water Engineering (714) 765-4591
Sub ListlBus. Lic. (714) 765-5194 (Allow 10 business days)
COAIMigation Measures
Building Final (714 765-5153)
Last Inspection -Final Only After Above Completed
Building Inspections
PARTIAL INSPECTIONS
"VI
Mechanical Inspections
t
Plumbing Inspections
Electrical Inspections
Permit Types
BLD ELE MECPLM
X
Permit Number: OLD202245274
Issued: '11/0712022
www.anaheim.neUbuilding
(714)765-4626
Quarter Section: 64
CITY OF ANAHEIM
Site Address: 807 S HAMPSTEAD ST, ANAHEIM, CA 92802
Legal Description: N TR 1421 BLK LOT 2
APN:03635109
OWNER • BUILDER DECLARATION:
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 76S - S7 S3
I hereby affirm under penalty of perjury that I am exempt from the Contractors License State Law for the following reason(s) indicated below by the
checkmark(s) t have placed next to the applicable Rem(a) (Sec. 7031.6 Business and Professions Coda: any city or county which requires a permit to
conatruc% 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 a (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 7031.6 by any
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (6500).
. 1 I, as owner of property, or my employees with wages as their sole compensation, will do L__) ell or i I portions of the work, and the structure Is not Intended or
offered for sale (Sec. 7044 Business and Professions Code: The Contractors' State License Lew 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 seta. ff, however, the building or improvement is sold
within one year of completion, the Owner -Builder will have the burden of proving that 0 was not built or Improved for the purpose of sale).
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:
By my signature below 1 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:/Miww.leainfo.ca.aov/calsw.html.
By my signature below, l certify to each of the following:
I am the property owner or authorized to act on the property owners behalf.
1 have read this application and the information I have provided Is correct.
I agree to comply with all applicable city and county ordinances and state laws relating to building construction
I authorize repre tatives of this city or county to enter the above -identified properly for inspection purposes.
ll 7 2
Signat uthorized 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 ATTORNEYS FEES.
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a certificate of consent to self4nsure 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
(CITY OF'ANAHEIM
PLANNING DEPARTMENT,
BUILDING DIVISION
M
OWNEWBUILDER-ACKNOWLEDGMENT AND INFORMATION VERIFICATION FORM
'Per California Slate Lav, if you, the property owner, will be coming to our office to get a permit, we will provide
you with this form when you arrive. If you are sending your agent, please complete, initial, and sign the
information below. Also make sure that you have provided your agent with a signed Authorization to Act on
Behalf of the Pmoertv Owner Form with the required forms of Identification.
Dear Property0wner.
An application for a building permit has been submitted in your name listing,yourself as the builder of
the property, improvements specified at, S. (401145TC40 gr: .
* t -A oft i -)-15A
We are providing you with an Owner -Builder Acknowledgment and InformationMerifCation Form to
make�you aware of your responsibilities and possiblo Tisk you may incur by having this permit issued in
your name as the Owner -Builder.
Me will not issue a building permit until you have read, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of•the owner cannot
execute this notice unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S�ACKNOWLEDGMENTSAND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to'signify you understand or*verify,this
information.
}Lj 1.1 understand a frequent practice of unlicensed persons is to'have the property owner obtain an
"Owner -Builder" building permit that erroneously implies that the property owner is providing his or her
own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious
financial risk for any injuries sustained by an unlicensed person and his or heremployees while
working.on my, property. ,My homeowner's insurance may not provide coverage for those injuries. I am
willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage'for,injuries to
workers on my.property.
_Ltv.2. I understand building, permits are not required to be signed by,property.owners unless they.are
responsible for the construction and are not hiring a,licensed Contractor to assume this responsibility.
kO 3.1 understand as an "Owner -Builder" I am -the responsible party.of record'on the permit. I
understand that I may,protect myself from potential financial risk by hiring a licensed Contractor, and
having the permit filed Whi§ or her name instead of my.own.
4.1 understand Contractors are -required bylaw to be licensed and bonded in California and,to list
thelf.license numbers on permits and contracts.
5.1 understand if liemployor otherwise engage any, persons;,other thamCalifomia licensed
Contractors, and the total value of myconstruction is at least five hundred dollars ($500), including
labor and materiais, I may be considered an "employer" under state and federal law.
6. I. understand ifTam considered an "employee' under state and federal law, I must register -with
MARCH 2009
200 SMnahelm Blvd., Suite 145 Anaheim, Calffomla 92605 (714)765.5153 Phone (714)7654607 Fax
.n..nal__ Bill
the state and federal government, withhold payroll taxes, provide workers' compensation disability
insurance, and contribute to unemployment compensation for each "employee." I also understand my
failure to abide by these laws may subject me to serious financial risk.
JlAj-7. I understand under California Contractors' State License Law, an Owner -Builder who builds
single-family residential structures cannot legally build them with the intent to offer them for sale,
unless all work is performed by licensed subcontractors and the number of structures does not exceed
four within any calendar year, orall of•the work is performed under contract with a licensed general
building Contractor.
fiKi-8.1 understand as an Owner -Builder if I sell the property for which this permit Is issued; I may be
held liable for any financial or, personal injuries sustained by any subsequent owner(s) that result from
any latent construction defects in the workmanship or materials.
kig. I understand I may obtain more information regarding my obligations as an "employer"from the
Inteinal Revenue Service, the United States Small Business Administration, the California Department
of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may
contact the California Contractors' State License Board (CSLB) at 1-800=321=CSLB (2752) or
www.cslb.ca.gov for more information about licensed contractors.
K.. 10.1 am aware of and consent to an Owner -Builder building permit applied for. in my name, and
understand that I am the party legally,and financially responsible for proposed construction activity at
the following
F
address: 5� l�'"'((�t $T /IY-r� CA -
11. I agree that, as the party legally, and financially responsible for this proposed construction
activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as
employers.
o! 12.1 agree to no*,the issuerof this form immediately,of any additions, deletions; or changes to
any.of the information I have provided on this form. Licensed contractors are regulated by, laws
designed to protect,the public. If you contract with someone who does not have a license, the
Contractors' State License Board may be unable to assist you with any financial loss you may, sustain
as a result of a complaint. Your only remedy against unlicensed Contractors maybe in civil court. It is
also important for.you to understand that if an unlicensed Contractor or employee of that individual or
firm is injured while working on,your property, you may be held liable for damages. If you obtain a
permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether•or
not those Contractors are properly licensed and the status of their workers' compensation insurance
average.
Before a building permit can be issued, this form must be completed and signed by the property.owner
and,returned to the agency responsible for issuing the,permit.
Note: A copy,of-the property owner's driver's license, form notarization, or other verification acceptable
to the agency, Is required to be presented when the permit is Issued 'tolverifyrthe.property owner`s
signature.
Property,Owner's Signature:
// bt/saZL
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200 S. Anahelm Blvd., Suite 145 Anaheim, California 92005 (714)7655153 Phone (714)7654607 Fax B721