1420 S HARBOR BLVD (16)Permit Number: SGN2022-00055
Issued: 04/29/2022
www.anaheim.net/building
(714)765-0626
(Quarter Section: 86
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(7141765 - 5153
Site Address: 1420 S HARBOR BLVD, ANAHEIM, CA 92802
Legal Description: S TWP'4 RGE 10 SEC 22 T 4 R 10 SEC 22 POR OF SW1/4
APN: 08217656
Project Description: Installation of (2) illuminated wall signs for "Courtyard by Marriott".
People Associated with Project:
Contractor METRO SIGNS INC 530 E AIRLINE WAY GARDENA, CA 90248
Permit Applicant Rafael Bracamontes
Owner NORTHWEST HOTEL CORP
1380 S HARBOR BLVD
OWNER - BUILDER DECLARATION
1 hereby affirm under penalty of perjury that 1 am exempt from the Contractors License State Law for the following reasons) Indicated below by the
eheckmark(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 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 I, as owner of property, or my employees with wages as their sole compensation, will do () all or U potions 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 1, 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 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).
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 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 peril Is issued.
fCT
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: STATE COMPENSATION INSURANCE FUND Policy No.: 9167823 Expiration Date:
This section need not be completed If the permit Is for one hundred dollars (5700) or less.
❑ 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
shall forthwith comply with
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 ($700,000). 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 LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance I hereby affirm under penalty of perjury that I am
Lenders Information: licensed under provisions of chapter 9 (commencing with
Section 7000) of Division 3 of the Business and
I hereby certify that 1 have read this application and state that the Information above is correct. l agree Professions Code.
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: 04/29/2022
Contractor:
pe� Number: SGN2022-00055 Expiration Date 6/10/2022
Date Signature of Applicant or Agen TYPE: C45
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
continue work.
Fees paid for Permit: $693.00
City of Anaheim
'BUILDING DIVISION
INSPECTION RECORD
SIGN PERMIT
ADDRESS: 1420 S HARBOR BLVD, ANAHEIM, CA 92802
OWNER: NORTHWEST HOTEL CORP
PERMITM SGN2022-00055
DATE ISSUED: 04/29/2022
DESCRIPTION: Installation of (2) illuminated wall signs for "Courtyard
by Marriott".
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
699
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.netlbuilding 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.