6103 E PASEO RIO VERDE (5)CITY OF ANAHEIM
Permit Ofumber: BLD2023-00024
Issued: 01/05/2023
www.anaheim.neUbuilding
(714)765-0626
Quarter Section: 191
Site Address: 6103 E PASEO RIO VERDEANAHEIM, CA 92807
Legal Desc`ription:' N TR 7786 BLK LOT 52
V -4r I..:._.. . .. ..
APN:35809317
Project Description: Residential EV Charger Level 2
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
Living Area: Number of Stories: Valuation: 0.00
Garage Area: Construction Types:
Carport Area: Occupancy Groups:
Balcony / Dock Area: Fire Sprinklered:
Cool Roos: Total Fees paid for Permit: 0.00
People Associated with Project:
Permit Applicant Sebastian Belowski
Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Mechanical Fixtures Qty
EV Charger 1
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 I 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
sine:
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 s'
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Duct (Mechanical)
Rough Mechanical
Rough Electrical
Rough COAIMitagation Measures
Framing (Only after Plbg., Ele., Mac. & 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
(Do not backfill unless smnnpd offi
Sewer
Water Engineering Backflow, (Testable Only)
Water Service
FINAL INSPECTIONS I DATE
All applicable items below must be signed before utilities
Final Gas Test
Electrical Final (� 2
Plumbing Final
Mechanical Final
Cross Connection Control (714) 765.4280
Engineering Final (714) 765-5126
Fire Sprinkler (ONLY) (714) 765-5041
Fin: 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
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections
ISPECTOR
-M orz..
Permit Types
BLD ELE MEC PLM
X
Permit Number: BLD2023-00024
Issued: 01/05/2023
www.anaheim.net/building
(714)765-4626
Quarter Section: 191
CITY OF ANAHEIM
Site Address: 6103 E PASEO RIO VERDEANAHEIM, CA 92807
Legal Description: N TR 7786 BLK LOT 52
APN:35809317
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.
I hereby affirm under penalty of perjury one of the following declarations:
1 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
SB 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. EMPLOYERS COMPENSATION INSURANCE COMPANY Policy No.: EIG5005191 Expiration Date: 5/30/2023
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
worker's compensation laws of California, and agree that, if 1 should become subject to the worker's compensation provisions of Section 3700 of the
Labor Code, I shall forthwith comply with those provisions.
Sebastian Belowski 1/5/2023
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):
Lender's Name:
Lender's Address:
LICENSED CONTRACTOR'S DECLARATION:
1 hereby affirm under the penalty of Perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect.
TRINETWORK INC
Contractor Signature
NUMBER
956106
EXPIRATION DATE
07/31/2023
LICENSE TYPE (Sl
C-7; C10
Date
1/5/2023