4852 E LA PALMA AVE (7)ANIUMMIL
City of Anaheim
Mon
BUILDING DIVISION
SET BACK, FORMS,
INSPECTION RECORD
SIGN PERMIT
ADDRESS:
4862 E LA PALMA AVE, ANAHEIM. CA 92807
OWNER:
AJAX LAPALMA INVESTORS LLC
PERMIT #:
SGN2022-00083
DATE ISSUED:
06/29/2022
DESCRIPTION:
Installation of (1) non -illuminated wall sign for
"PhelpsUnited".
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- OUT
FINAL
699
— ,
2
i
PARTIAL APPROVAL NOTES
INSPECTION DATE INSPECTOR
Inspectors can normally be reached between
7:30 - 8:00 A.M.
(714) 765-5153 + 0
signeard
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.netICitizenAccess
To access your Inspection timeframe, please go to
www.anaheim.net/buildirtq 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.
Permit Number: SGN2022-00083
Issued: 06/29/2022
www.anaheim.net/building
(714)765-4626
Quarter Section: 166
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
Site Address: 4852 E LA PALMA AVE, ANAHEIM, CA 92807
Legal Description: A TR M YORBA ALLOT 3RD CLASS LAND BLK M YORBA ALLO
APN: 34619233
Project Description: Installation of (1) non -illuminated wall sign for "PhelpsUnited".
People Associated with Project:
Contractor AMERICA'S INSTANT SIGNS 1260 N HANDCOCK ST STE 105201704181413106279 ANAHEIM, CA 92807
Owner AJAX LAPALMA INVESTORS LLC 18 CYPRESS PT LN
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
checkmark(s) I have placed next to the applicable Item(s) (Sec. 7031.5 Business and Professions Code: any city or county which requires a permit to
construct, atter, 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 than five hundred dollars ($500).
0 I, as owner of property, or my employees with wages as their sole compensation, will do L_, 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' 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 oursuant 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 worker's compensation, Issued by the Director of Industrial Relations as provided for by
SecIldn 3700 of the Labor Code, for the performance of the work for which this permit Is Issued.
lr'Q/ 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. FALLS LAKE FIRE AND CASUALTY COMPANY Policy No.: FLA1712300 Expiration
This section need not be completed H the permit Is for one hundred dollars ($100) 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
worker's compensation laws of California, an ag a that, If I should become subject to the worker's compensation provisions of Section 3700 of the
Labor OthdeJ.sda11 fo-hwith cc wit se Xi;loA) t a .n A
Date Sign ture-orAppticant
WARNING: FAILURE TO SECURE WORK RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIESn
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.
AGENCY
1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance
Lender's 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 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.
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing with
Section 7000) of Djof the Business and
Professions Code. 0. /in w ✓%� /� i
Date: 06/20/2022
Contractor: AMERICAS INSTANT SIGNS
Number: SGN2022-00083 Expiration Date 5/15/2022
TYPE: C45
Fees paid for Permit:
$420.00