500-1106 E SANTA ANA STPermit Types
BLD ELE ME4m-
Pervnit
X Number: BLD2022-05346
Issued: 11/10/2022
www.anaheim.neUbuilding
(714)765-4626
Quarter Section: 93
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(7141765.5153
Site Address: 500-1106 E SANTA ANA ST, ANAHEIM, CA 92805
Ltagal DesctiptIon: N TR 3261 BLK LOT 17 TR 3251 LOT 17 N 17 FT(AND LO
AFN: 03727222
Project Description: Reroof: Remove existing material, and install (120) squares of flat roof for the entire commercial location
Living Area: Number of Stories: 1 Valuation: 45,000.00
Garage Area: Construction Types: NIA
Carport Area: Occupancy Groups:
Balcony I Deck Area: Fire Sprinidered:
Cool Roof: Total Fees paid for Permit: 550.60
People Associated with Project:
Owner HELMBRECHT MICHAEL A TR 920 CARMEL 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�pHEIM c9< FINAL INSPECTIONS DATE INSPECTOR
City of Anaheim o� io All applicable items below must be signed before utilities are released
Building Division z Final Gas Test
u > Electrical Final
Plumbing Final
�DG�vDED �$y^ Mechanical Final
Cross Connection Control (714) 765-4280
Do not occupy this buildinq until the final inspections have been made. 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 ElectrodelUfer
Sub List/Bus. Lic. (714) 765-5194 (Allow 10 business days)
Setback/Forms/Trenches (Footings)
COA/Mi a ' Measures
Do not install subfloor or pour floor slab until the follwing applicable items have been
s' ed•
Building Final (71 765-5153) 00-k�
• final Only After Above Completed
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
PARTIAL INSPECTIONS
Buildinq 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 s*aned7
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
Mechanical Inspections
2nd Floor Shear
o heathing/Diaphragm/Frame) r—
as . Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Duct (Mechanical)
Rough Mechanical
Rough Electrical
Rough COA/Mitagation Measures
Plumbinq 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 backfill unless suanad ofn
Sewer
Water Engineering Backflow (Testable Only)
Water Service
Permit Types
BLD TELE MEC PLM
X
Permit Number.13LD2022-05346
Issued: 11/10/2022
www.anaheim.net/building
(714)765-0626
Quarter Section: 93
Or#- AJJ—. ern i
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765-5153
- - --• ---• --� �.. vn". I n wrvri J 1, AFMAr1GM, GA 92805
Legal Description: N TR 3251 BLK LOT 17 TR 3251 LOT 17 N 17 FT(AND LO
APN: 03727222
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:
I have and will maintain a certificate of consent to self4nsure for workers 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. ;JAM COMPENSATION INSURANC;: FUND Policy No: 1846928 Expiration Date: 01112023
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 workers compensation provisions of Section 3700 of the
Labor Code, l shall forthwith comply with those provisions.
4-z&� H /0
S1969furftof Applicant Date
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY:
1 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 efecL
ntractor Signature
NUMBER EXPIRATION DATE LICENSE TYPE (Sl
759006 10/31/2023 C39, C39, C39, C39
��• /� •2o2
Date