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206 N SHAKESPEARE STt Permit Types BLD ELE MEC PLM X Permit Number: BLD2023-01701 Issued: 04112/2023 www.anaheim.neUbuilding (714)765-0626 Quarter Section: 122 CITY OF ANAHEIM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 Sf s Address: 206 N SHAKESPEARE ST, ANAHEIM, CA 92806 Y T Legal Descriptlon: N TR 2767 ;BLK LOT 69 APN: 26827306 Project Description: Reroof: To remove existing and install (17) sq of composition and shingles for portion of house, and (18) sq of lath for the remaining house and attached garage. LMng Area: Number of Stories: 1 Valuation: 7.000.00 Garage Area: Construction Types: WA Carport Area: Occupancy Groups: Balcony / !Jock Area: Fire Sprinklered: Cool Roof. Total Fees paid for Permit: 340.91 People Associated with Project: Permit Applicant Huyen ThiPham Owner TA TRANG 206 N SHAKESPEARE ST Type Electrical Fbdures City Type Plumbing Fixtures Qty Mechanical Fixtures Qt) r 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 �P .,NOEIM f, ^ " •' O O FINAL INSPECTIONS I DATE I INSPECTOR All applicable Items below must be signed before utilities are released oMIUMV U!Vlbtvrl iF y U a �OVNDED �ay� Do not occupy this building until the final inspections have been made. Final Gas Test Electrical Final 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 ListlBus. Lic. (714) 765-5194 (Allow 10 business days) Setback/Forms/Trenches (Footings) COA1M1Sa1WgLMeasures Do not install subfloor or pour floor slab until the follwing applicable items have been Eildin�gFlnal 14 765-5153) Only Ager Above Completed 2 Plumbing (Ground/Underfloor Water)anal Underfloor Rough Gas PARTIAL INSPECTIONS Buildina Inspections 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 sinned - 1st Floor Shear Firesprinkler (Rough) (Fire Dept.) Mechanical Inspections 2nd_flar Shear heathing/Di hragm/Frame) asonry (Reinf./Bond Beam/Pre-Grout) Rough Plumbing (Top Out) Rough Duct (Mechanical) Rough Mechanical Rough Electrical Rough COA/Mitagation Measures Plumbina Inspections 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 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 BUILDING DIVISION CITY OF ANAHEIM BUILDING DEPARTMENT 2016 CALIFORNIA CODES CODE CYCLE 200 S. Anaheim Blvd., Suite 145 01/01/2017 Anaheim, CA 92805 714 765-5153 E£FECT/VEDATE www.anaheim.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: _ u)'A�r Project address: Property Owner: The undersign d o s hdreFy-66rW 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 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. O 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.) All dwelling unitfkith attadped garages require carbon monoxide Signature: California Residerpial 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, California 92805 (714)765-5153 Phone (714)765-4607 Fax FEB 2018 www.anaheim.neftilding 8842 SMOKE/ CO ALARM REQUIRED LOCATIONS Bedroom Bedroom 6 Bath Bedroom Kitchen Living Room Figure t Family Room Bedroom Dining Living Room Kitchen Bedroom Bedroom Figure 2 / Attic \ IMI Bedroom Hail Bedroom 6:H811 Living Room Kitchen ba Basement Figure 3 (� REQUIRED SMOKE ALARM LOCATION REQUIRED CARBON MONOXIDE ALARM LOCATION V Acceptable J 4" Here Never Here �t2' Top of Detector Acceptable Here Garage Wall Figure 4 CITY OF ANAHEIM BUILDING DIVISION Permit Number: BLD2023-01701 200 S. ANAHEIM BLVD. Issued: 04/12/2023 (714) 765 - 5153 www.anaheim.net/building (714)765-4626 Quarter Section: 122 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 206 N SHAKESPEARE ST. ANAHEIM, CA 92806. 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. 1.1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneous) implies that the roe owner is providing his or her own labor and material personally. I, as an P Y� P. property rtY P 9 P Y• 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 homeowners 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 myself from potential risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. r 5.1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value 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". 1 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. �I P 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 workmanship or materials. P9. 1 understand I may obtain more information regarding my obligations as an "employer" from the internal Revenue Service, r 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.csib.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 - party legally and financially responsible for proposed construction activity at the following address: 206 N SHAKESPEARE Permit Number: BLD2023-01701 Issued: 04/12/2023 www.anaheim.net/building (714)765-0626 Quarter Section: 122 Permit Number: BLD2023-01701 CITY OF ANAHEIM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765.5153 11. 1 agree that, as the party Legally and financially responsible for this proposed construction activity, I will abide by all / 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 responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature.2-3 Property Owner/ . Signature Date: Permit Types BLD : ELE MEC PLM X Permit Number: BLD2023-01701 Issued: 04/12/2023 www.anaheim.net/building (714)765-0626 Quarter Section: 122 CITY OF ANAHEIM Site Address: 206 N SHAKESPEARE ST, ANAHEIM, CA 92806 Legal Description: N TR 2767 BLK LOT 69 APN:26827306 OWNER - BUILDER DECLARATION: BUILDING DIVISION 200 S. ANAHEIM BLVD. (7141 765 - 5153 1 hereby affirm under penalty of perjury that 1 am exempt from the Contractor's License State Law for the following reasons) Indicated below by the eheckmark(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 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). qPI, as owner of property, or my employees with wages as their sole compensation, will do () all or L__) 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). S I, as the owner of the properly, am exclusively contracting with licensed Contractors to constant the project (Sec. 7044 Business and Professions Code: " The Contractors' State License Lew does not appy 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 em exempt from licensure under the Contractors, State License tow 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 if it has not been constructed in its entirely 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://www.leainfo.ce.aov/calaw.html. By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner's behalf. 1 have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction I authorize representativeq 01 this city or countywetser the abov�-:jdentlfie perry for inspection purposes. Signature of Prop);rffs/ OwnerSpAllthorized Agent WORKER'S COMPENSATION DECLARATION: Date 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 have and will maintain worker's compensation insurance, as required by Section 3700 of the tabor Code, for the performance of the work for which this permit is issued. My worker's Compensation insurance carder 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 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: 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 Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Contractor Signature Date NUMBER, EXPIRATION DATE LICENSE TYPE (S) V, D. CITY OF ANAHEIM RECEIVE PLANNING DEPARTMENT APR 12 2023 BUILDING DIVISION CITY 0i= ANAHEIM p,��,,pp ��NN �, a 9JIIDING DEPhr,TM AUTHORIZATION OF AGENT TO ACT ON BEHALF OF PROPERTf6w, R FORM `Per California State Law, if you, the property owner, will be coming to our office to get a permit, we do not require you to complete this form, however, if you are sending someone on your behalf (your agent), please complete and sign the information below. Also make sure that you have provided your agent with a signed Owner -Builder Acknowledgment and Information Verification Form. or Description of Work): Project Location or Address: 206 H S+�A'K S PEARS -Sr ATEA-Hr-)M CA 9OC Name of Authorized Agent: -HUYEI`l 2YAM Address of Authorized Agent: Phone Number of Authorized Agent: . _ _ - , - -� Required Forms of Identification Attached: (Please check one of the forms of identification below in addition to the required California State Issued ID) Property Owner's California State Issued ID with: Property Deed Property Tax Bill _21— Closed escrow document Title Search Mortgage Bill M , _ ._I declare under penalty of perjury that I am theopr_operty.owner for the address listed above an-d,l _personally filled out the above information and certify_its accuracy.- _ Property Owner's Signature: { - Date: 10 - Office Use Only: - ID Verified ✓ Ownership Verified _ Documents Planning Info Permit 200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax OCT 2013 www.anaheim.neUbuilding B720 CITY OF ANAHEIM PLANNING DEPARTMENT BUILDING DIVISION OWNER -BUILDER ACKNOWLEDGMENT AND INFORMATION VERIFICATION FORM *Per California State Law, if you, the property owner, will be coming to our office to get a permit, we will provide you with this form when you arrive. If you are sending your agent, please complete, initial, and sign the information below. Also make sure that you have provided your agent with a signed Authorization to Act on Behalf of the Property Owner Form with the required forms of identification. 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 P�ljQJ R iL, PFA -8C We are providing you with an Owner -Builder Acknowledgment 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. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION 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 wner-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 acting as an Owner -Builder and am aware of the limits of my insurance..coverage for injuries to workers on my property. A:0_2. I 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 td -assume -this responsibility. 43. 1 understand as an "Owner -Builder' I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit frled"in his orher name instead of my own. ` �4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license -numbers -on permits and contracts. - – - — - r , -I understand if I employ or otherwise engage any persons, other than California licensed `Co tractors, and the total value 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 MARCH 2009 200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)7654607 Fax B721 the state and federal government, withhold payroll taxes, provide workers' 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. 4ID-7. I 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 aU 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. 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be he d liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 4-91'. 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.csib.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 party legally and financially responsible for proposed construction activity at the following address: M N S#A kES PA R E sr Nle- 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 44L 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 financial loss 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, pro pefly licensed and the status of their workers' compensation insurance coverage. Before a building permiYcan be -issued, this form must be completed and signed'by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the -property owners driver's license, form notarization,, -or other verification -acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. i Property Owner's Signature: PAGE 2 OF 2 200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)785-5153 Phone (714)7854807 Fax B721 3