2159 W LA PALMA AVEPermit Types
BLD ELE MEC PLM
X
Permit Number: BLD2022-05343
Issued: 11/10/2022
www.anaheim.nettbuilding
(714)765-4626
Quarter Section: 37
CiY�'I�1�_L`L�;
BUILDING DIVISION
200 S. ANAHEIM BLVD.
1714) 765.5153
Site Address: 2159 W LA PALMA AVE, Anaheim, CA 92801
Legal Description: S TWP 4 RGE 10 SEC 5 US R1 OW SEC 5 POR SWIM
APN:07241550
Project Description: Electrical for 200 amp Temp Power Pole with 200 amp distribution panel
Living Area: Number of Stories. 1 Valuation: 0.00
Garage Area: Construction Types: NIA
Carport Area: Occupancy Groups:
Balcony / Deck Area: Fire Sprinklered:
Cool Roof: Total Fees paid for Permit: 167.00
People Associated with Project:
Owner RONITA LLC 3728 E WOODBINE RD
Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Mechanical Fixtures Qty
Sub Pole (inclues outlets) 1
Temp Power Pale/Pedestal (includes 1
meter)
The permit 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.
City of Anaheim
Building Division
Do not occupy this building until the final inspections have been made.
INSPECTION 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
signed:
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 sinned*
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reint/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
Sewer
Water Engineering Backflow, (Testable Only)
Water Service
FINAL INSPECTIONS DATE I 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 List/Bus. Lic. (714) 765-5194 (Allow 10 business days)
COA/Migation Measures
Building Final (714 765-5153)
Last Inspection -Final Only After Above Completed
PARTIAL INSPECTIONS
Buildinq Inspections
Mechanical Inspections
Plumbinq Inspections
Electrical Inspections
Permit Types
BLD ELE MEC PLM
' X
Permit Number: BLD2022-05343
Issued: 11/10/2022
www.anaheim.net/building
(714)765-0626
Quarter Section: 37
Site Address: 2159 W LA
nvc, P%naneim, UA UZUU1
Legal Description: S TWP 4 RGE 10 SEC 5 US R10W SEC 5 POR SWIM
APN: 07241550
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(7141 765 - 5153
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 selfinsure for worker's 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: FEDERAL INSURANCE COMPANY Policy No.: 54309652 Expiration Date: 3/31/2023
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, I s II forthwith comply with those provisions.
1
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 perlonnance of the work for which this permit Is Issued
(Sec.3097.Civ.C):
Lenders Name:
Lenders 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 Dhrision 3 of the Business and
Prolesslons Code, and my (0-8-nsp is in full force and effect.
1
Contractor Signature'Date
NUMBER EXPIRATION DATE LICENSE TYPE (Si
980589 01/31/2023 B. C10, D31