1101 N MAGNOLIA AVE (6)1_ a
Permit Number: SGN2022-00098
Issued: 09/15/2022
www.anaheim.netlbuilding
(714)765-0626
Quarter Section: 17
CITY OF ANAHEIM
Site Address: 1101 N.MAGNOLIA AVE, ANAHEIM, CA 92801
Legal Description: P BK 113 PG 21 PAR 1
APN: ;07076212
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 766 - 6163
Project Description: Installation of (4) illuminated signs attached to gas dispenser canopy for "Chevron".
People Associated with Project:
Permit Applicant Brian D.Collins
Owner BEYOND SERENITY AT ANAHEIM L P 1233 PARK ROW
OWNER - BUILDER DECLARATION
I hereby affirm under penalty of perjury that t 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 Items) (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 taw 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).
13 I, as owner of property, or my employees with wages as their sole compensation, will do (_, 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 pursuant to the Contractor's 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:
Q 1 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
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
C ® 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. TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Policy No.: UB7K6164
This section need not be completed r the permit 1s for one hundred dollars (1100) 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, it I should become subject to the worker's compensation provisions of Section 3700 of the
Labor Code. I shall forthwith comply with those provisions.
9/15122 Brian Collins _
Date Signatureof Applicant)
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 that there Is a construction lending agency for the performance
Lenders Information:
I hereby car* that 1 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.
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 alum under penalty of pedury that I am
licensed under provisions of chapter 9 (commencing with
Section 7000) of Division 3 of the Business and
Professions Code. Brian Collins --
i
Date: 09/15/2022
Contractor: CALCRAFT CORPORATION
Number: SGN2022-00098 Expiration Date 3/26/2022
TYPE: B, C43, C33, C51, C10, HAZ, C45, C46
Fees paid for Permit: $1,050.00
Inspection
City of Anaheim
Date
BUILDING DIVISION
SET BACK, FORMS,
INSPECTION RECORD
SIGN PERMIT
ADDRESS:
1101 N MAGNOLIA AVE, ANAHEIM, CA 92801
OWNER:
BEYOND SERENITY AT ANAHEIM L P
PERMIT #:
SGN2022-00098
DATE ISSUED:
09/15/2022
DESCRIPTION:
Installation of (4) illuminated signs attached to gas
dispenser canopy for "Chevron".
POST THIS CARD WITH THE APPROVED PLANS
IN A CONSPICUOUS PLACE
ON THE JOB SITE
Inspection
Code
Date
Inspector
SET BACK, FORMS,
602
TRENCHES
UNDERGROUND
604
CONDUIT.
MASONRY:
REINFORCEMENT,
606
PRE -GROUT
FINAL
699
PARTIAL APPROVAL NOTES
INSPECTION I DATE I 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:Haca.anaheim.net/CitizenAccess
To access your Inspection timeframe, please go to
www.anaheim.netlbuildina 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.
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