3177 W MONROE AVECITY OF ANAHEIM
BUILDING DEPARTMENT 2016 CALIFORNIA CODES
200 S. Anaheim Blvd., Suite 145 CDDECrcr.E
Anaheim, CA 92805 01/01/2017
714 765-5153 EFFECHVEDAM
www,anabeim.net/building
SMOKE DETECTORS AND CARBON MONOXIDE SELF CERTIFICATION
• Final inspection approval will require this completed form to be on site along with the job card.
Permit Number: ell b 7,00z, ' bo Z l �- Date: 31z -,12b2,;
Project address: 3149 /A O -V\ r-0-0—
Property Owner: VC, I ( rFs As>,�
The undersigned does hereby certify that I am the property owner of the above referenced
property. I further certify that smoke alarms and carbon monoxide alarms are present and
functional in all the following locations. All boxes must be checked below
Smoke Alarms and Carbon Monoxide Alarm: On the ceiling or wall outside of each separate
S
I ng area in the immediate vicinity of bedroorp/s or in each hallway outside of the rooms.
'o Alarms: In each room used for sleeping purposes.
Smoke Alarm and Carbon Monoxide Alarm: In each story, including any habitable basement;
(Note: in dwellings or dwelling units with split levels and without an intervening door between
the adjacent levels, a smoke alarm and a carbon monoxide detector installed on the upper level
shall suffice for the adjacent lower level provided that the lower level is less than one full story
below the upper level.)
%iii dwelling unit- iiiiti auac cw y--awas ra iu-irs ca bor. m.c.mox-1-wo do- toewre.
Signature: ..G✓ . Date: �� 3 2
California Residential Code (CRC) Section R314.6.2,CRC R315.2 states in part that existing dwellings be
"retrofitted with smoke detectors and carbon monoxide detectors when a building permit is issued for work on or
in a building that is valued at $1,000 or more.n CRC Section R314.3, CRC R315.2 defines required locations as
indicted above.
NOTE: This certification is only used when normal access to the interior of the dwelling by the City of Anaheim
Inspector is not achieved during the course of project construction. It is normally used for exterior projects such
as re -roofing, re -siding, patio covers, solar photovoltaic installations, and similar exterior construction work.
200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-0607 Fax FEB 2018
www.anaheim.net(building 8842
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SMOKE/ CO ALARM REQUIRED LOCATIONS
Bedroom Bedroom
Bath Bedroom
Kitchen
Living Room
Figure 1
Family Room
ArilcTop
Bedroom
of Detector
acceptable Here
Wall
Dining
Hall
Bedroom
Living Room
Kitchen
Bedroom
Bedroom
Figure 2 -'I 4• I`
Ceilin
Acceptable �tl
Never
Hen: r
/
ArilcTop
of Detector
acceptable Here
Wall
Bedroom
Hall
Bedroom
Figure 4
Living Room Hail Kitchen
Basement
Figure 3
REQUIRED SMOKE ALARM LOCATION
REQUIRED CARBON MONOXIDE ALARM LOCATION
Garage
Permit Types
BLD ELE MEC*
EC PLM
X
Permit Number: BLD2023-00216
Issued: 01/17/2023
www.anaheim.net/building
(714)765-4626
Quarter Section: 8
Site Address: Address:.3177 W MONROE AVE, ANAHEIM, CA 92801
Legal-Descfiptlon: N TR 1820 BLK LOT.122
APN:13523239
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765.5153
Project Description: Reroof: Remove existing to install (18) sq of composition shingles over house only
Living Area: Number of Stories: 1 valuation: 11,695.00
Garage Area: Construction Types: N/A
Carport Area: Occupancy Groups:
Balcony / Dock Area: Fire Sprinldered:
Cool Roof: Total Fees paid for Permit: 340.52
People Associated with Project:
Permit Applicant Luba Batioff
Owner BROWN RANDALL L TR 3177 MONROE AVE
Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Mechanical Fixtures Qty
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.
P�pNEIM CqC
City of Anaheim o� io
Building Division F z
u >
�04�►DED fah^
Do not occupy this building until the final inspections have been made.
FINAL INSPECTIONS
DATE
INSPECTOR
All applicable items below must be signed before utilities are released
Final Gas Test
Electrical Fina(
Plumbing Final
Mechanical Final
Cross Connection Control (714) 765-4280
Engineering Final (714) 765-5126
INSPECTION DATE I INSPECTOR
Fire Sprinkler (ONLY) (714) 765-5041
Do not pour concrete until the following applicable items have been signed:
Fire Dept. Final (714) 765-5041
Plumbing (Ground/Underfloor Drain Waste)
Water Engineering (714) 765-4591
Electrical Ground Electrode/Ufer
Sub List/Bus. Lic. (714) 765-5194 (Allow 10 business days)
Setback/Forms/Trenches (Footings)
COAIMigation Measures
Do not install subfloor or pour floor slab until the follwing applicable items have been
Building Final (714 765-5153)
Last Inspection-Final Only After Above Completed r3
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
PARTIAL INSPECTIONS
Building Inspections
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
e
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
2n h ar
Mechanical Inspections
of (Sheathing/Dia hragm/Frame) --
nd 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)
Plumbing Inspections
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 Inspections
Electrical Service Meter-(Meter will be set within 2-3
business days after approval) Excludes New
Constructmon
Exterior Plaster (Brown Coat)
T-Bar (Struct., Ele., or Mec.)
Grease Interceptor
Sewer
Water Engineering Backflow, (Testable Only)
Water Service
Permit Types
BLD ELE MEC PLM
X
Permit Number: BLD2023-00216
Issued: 01/17/2023
www.anaheim.net/building
(714)765.4626
Quarter Section: 8
Site Address: 3177 W MONROE AVE, ANAHEIM, CA 92801
Legal Description: N TR 1820 BLK LOT 122
APN: 13523239
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 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.
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to selfwInsure for worker's compensation, issued by the Director of Industrial Relations as provided for by
rJ Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
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:
Policy No.: WC5060019MSZ Expiration Date: 111/2024
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
worker's compensation laws of California, and agree that, if I should become subject to the worker's compensation provisions of Section 3700 of the
Labor Code, l shall forthwith compV with those provisions.
Signature of Applicant V Date
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY:
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit Is Issued
(Sec.3097.Civ.C):
Lender's Name:
Lender's Address:
LICENSED CONTRACTOR'S DECLARATION:
I hereby affirm under the penalty of Perjury that I am licensed under provisions of chapter 9 (commencing with SecOon 7000) of Division 3 of the Business and
Professions Code, and my license is In full force and effect.
N o—'ga
wl
Contractor Signature
NUMBER EXPIRATION DATE LICENSE TYPE (S)
575002 08/31/2023 C39, 8
l -1-7-a-;3
Date