164 N ROSE BLOSSOM LN (3)Permit Types
BLD ELE MEC PLM
X X
Permit Number. BLD202244681
Issued: 10/04/2022
www.anaheim.neUbuilding
(714)765-4626
Quarter Section: 185
CITY OF ANAHEIM
Site Addrtiss:_.164 N. ROSE BLOSSOM LN, ANAHEIM, CA 92807
Legal:Description: N TR 16254 BLK LOT 43
APN: 358341/0 =�
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
S�
Project Description: Patio Cover: 239 sq ft for new attached allumawood solid patio cover with electrical
I
Living Area: Number of Stories: 0 Valuation: 81500.00
Gerage Area: Construction Types: WA
CarportArea: Occupancy Groups:
Balcony I Deck Area: Fire Sprinkiered: No
Cool Roof: Total Fees paid for Permit: 652.98
People Associated with Project:
Permit Applicant Thomas Medina
Owner TIEU HAO TUAN 8 ALICE 164 N ROSE BLOSSOM LN
Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Mechanical Fixtures Qty
Receptacle, switches, lights 5
• 5
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 �q<,� s
OO
) FINAL INSPECTIONS I DATE ) INSPECTOR I
) All applicable items below must be signed before utilities are released
awiaing luivislvn fix i
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DED �$y^
Do not occupy this building until the final inspections have been made.
Final Gas Test
Electrical Final
umbing Final
Mechanical Final
Cross Connection Control (714) 765-4280
Engineering Final (714) 765-5126
INSPECTION I 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/Trench ootings —K—wjCOA/MWaft
Measures
Do not install subfloor or po or slab until the follwing applicable items ve e
Mane
ilding Fin (714 765-5153)
ast Ins on -Final Only After Above Co46 —
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
661ve(�
0,. 02-ZPARTIAL INSPECTIONS
I I I s ec ions
Q
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 sionede
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
Mechanical Inspections
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 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
(Do not harkfill unless sbanadofn
Sewer
Water Engineering Backflow (Testable Only)
Water Service
Permit Types
BLD ELE MEC PLM
X X
Permit Number. BLD2022-04681
Issued: 10/04/2022
www.anaheim.net/building
(714)765.4626
Quarter Section: 185
CITY OF ANAHEIM
Site Address: 164 N ROSE BLOSSOM LN, ANAHEIM, CA 92807
Legal Description: N TR 16254 BLK LOT 43
APN:35834110
WORKER'S COMPENSATION DECLARATION:
BUILDING DIVISION
200 S. ANAHEIM BLVD.
1711411765-51153
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 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.
1 1A 1 have and will maintain workers compensation Insurance, as required by Section 3700 of the labor Code, for the performance of the work for which
ll this permit is issued. My workers Compensation insurance carrier and policy are:
Cartier. MARKEL INSURANCE COMPANY Pol1_cyNo.:W=1744S03 Expiration Date: 92=23 J 31-3 Name of Agent "wµ 5 / " U � .,L Phone No.: L -7t -q / 3 °r l
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
workers compensation laws of California, and agree that, if I should become subject to the workers 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):
Lender's Name:
Lenders Address:
LICENSED CONTRACTOR'S DECLARATION:
I hereby affirm under the penalty of Perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000) of DMsion 3 of the Business and
Professions Code, and my license Is In full force and effect.
Contractor Sigture Date
NUMBER EXPIRATION DATE LICENSE TYPE (S)
1019675 04/30/2023 C27,003