215 S PRIMROSE STPermit Types
BLD ELE MEC PLM CITY OF ANAHEIM
X
BUILDING DIVISION
PermitiMumber: OLD2023-00538 200 S. ANAHEIM BLVD. '
Issued: 02/01/2023 (7141 765 - 5153
www.anaheim.net/building
(714)765-4626
Quarter Section: 40
Site Address: 215 S PRIMROSE ST, ANAHEIM, CA 92804
Legal Description: N TR 2299 BLK LOT 164
APN:12803304
Project Description: Reroof: Remove existing to install (29) sq of composition shingles over entire house and attached garage
Living Area: Number of Stories: 1 valuation: 7,000.00
Garage Area: Construction Types: N/A
Carport Area: Occupancy Groups:
Balcony / Deck Area: Fire Sprinklered:
Cool Root Total Fees paid for Permit: 340.91
People Associated with Project:
Owner GUEVARA RICK A TR 215 S PRIMROSE ST
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�pHEIM C, FINAL INSPECTIONS
City of Anaheim O� A r All applicable items below must be
DATE I INSPECTOR
before utilities are released
aunafng ufvlsion F g
Final Gas Test
u >
Electrical Final
Plumbing Final
�DUNDED day^
Mechanical Final
Cross Connection Control (714) 765.4280
Do not occupy this building until the final inspections have been made.
Engineering Final (714) 765-5126
INSPECTION I DATE 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 foliwing applicable items have been
Sewer
si ne •
tiding Fin 714 765-5153)
Plumbing (Ground/Underfloor Water)
ton -Final Only After AbdVe Completed
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 foll
st Floor Shear
Shear
Beam/Pre-Grout)
Duct (Mechanical)
Mechanical
Electrical
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Rough COA/Mitagation Measures Plumbing Inspections
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 Inspections
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
CITY OF ANAHEIM
BUILDING DEPARTMENT 2016 CALIFORNIA CODES
200 S. Anaheim Blvd., Suite 14S CODE CYCLE
Anaheim, CA 92805 01/01/2017
714 765-5153 EFFECTREDATE
www.anaheimnet/building
SMOKE DETECTORS AND CARBON MONOXIDE SELF CERTIFICATION
• Final inspection approval will require this complated_form to be on site along with the lob card.
Permit Number: 2– Date: F� J -G
Project address: d yW,
Property Owner:
The unders gned does hereby certify that 1 aln the property owner of the above referenced
properly.—1 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
sleeping area in the immediate vicinity of bedroom/s or in each hallway outside of the rooms.
❑ Smoke 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 suffic for the adjacent lower level provided that the lower level is less than one full story
below the upper level.)
All dwelling��r
Signature:
vitjh attac garages r ire carbon monoxide detectors.
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." 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, Califomia 92805 (714)765-5153 Phone (714)765-4607 Fax FEB 2018
www.anaheim.netlbuilding 8842
Permit Types
BLD ELE MEC PLM
X
Permit Nuariber: BLD202340538
Issued: 02/01/2023
www.anaheim.net/building
(714)765-4626
Quarter Section: 40
Site Address: 215 S PRIMROSE ST, ANAHEIM, CA 92804
Legal Description: N TR 2299 BLK LOT 164
APN: 12803304
OWNER - BUILDER DECLARATION:
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
1 hereby affirm under penalty of perjury that 1 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, 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 6 (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).
1, as owner of property, or my employees with wages as their sole compensation, will do (__j 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 Improvement is sold
within one year of completion, the Owner -Builder will have the burden of proving that it was not built or Improved for the purpose of sale).
r _ 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 Low 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:
By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the
Improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -builder B it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, Is available upon request when this application
Is submitted or at the following Web site: htto:/Mwww.leeinfo.co.eov/calaw.html.
By my signature below, I certify to each of the following:
I am the propf rly owner or aut orized to act on the property owner's behalf.
I have read tTiis application anVthe information I have provided is correct.
I agree to ply with all applica 'ty and county ordinances and state laws relating to building construction
I autho ' presentatives of IN r
or county to enter the above -identified property for inspection purposes. `
Signa re f Property Owner or Authorized Agent Date
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 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 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.: Expiration Date:
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, I shall forthwith comply with those provisions.
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 performance of the work for which this permit is issued
(Sec.3097.Civ.C):
f • X59' �. • 15?.
Lenders Name:
Lender's Address:
LICENSED CONTRACTOR'S DECLARATION:
I hereby affirm under the 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, arid my license is in full force and effect.
Contractor Signature Date
NUMBER EXPIRATION DATE LICENSE TYPE (SI
CITY OF ANAHEIM
BUILDING DIVISION
Permit Number: BLD2023-00538 200 S. ANAHEIM BLVD.
Issued: 02/01/2023 (7141 765 - 5153
www.anaheim.neUbuilding
(714)765-4626
Quarter Section: 40
OWNER -BUILDER ACKNOWLEDGEMENT AND INFORMATION VERIFICATION FORM
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements
specified at 215 S PRIMROSE ST. ANAHEIM, CA 92804.
We are providing you with an Owner -Builder Acknowledgement and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the Owner. Builder.
We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this
form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner,
obtain the prior approval of the permitting authority.
Directions: Read and initial each statement below to signify you understand or verify this information.
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building
permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an
Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
" injuries. I am willfully working as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to
2.1 understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
` /3.1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
— \�J myself from potential risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own.
_ UV -4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
V 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
V of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
6.1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers's compensation disability insurance, and contribute to unemployment
compensation for each "employee". I also understand my failure to abide by these laws may subject me to serious financial
risk.
_ 7.1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
l 1� 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial
or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
,Jworkmanship or materials.
9. 1 understand I may obtain more information regarding my obligations as an "employer" from the internal Revenue Service,
the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at
` / 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
_'� / 10.1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
���J""" party legally and financially responsible for proposed construction activity at the following address: 215 S PRIMROSE ST.
Permit Nuinber: BLD2023-00538
Issued: 02/01/2023
www.anaheim.net/building
(714)765-0626
Quarter Section: 40
CITY OF ANAHEIM
BUILDING DIVISION
x"'200 S. ANAHEIM BLVD.
(714) 765 - 5153
Permit Number: BLD2023-00538
11.1 agree that, as the party Legally and financially responsible for this proposed construction activity, I will abide by all
i applicable laws and requirements that govern Owner -Builders as well as employers.
12.1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board may be unable to assist you with any
financialloss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil
court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is
injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and
wish to hire
Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of
their workers' compensation insurance coverage:
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the
agency r sponsibla for issuing the permit.
r
Note: A ' py of the perry owner's driver's license, form notarization, or other verification acceptable to the agency is required
to be r ented w e the permit is issued to verify the property owner's signature.
�perty"Owner's Signature
1�