941 S TRIDENT ST (2)Permit Types
BLD ELE MEC PLM
X
Permit Number: OLD2023-01797
Issued: 04/17/2023
www.anaheim.net/building
(714)765.4626
Quarter Section: 48
Sit* Address: 941 S TRIDENT ST, ANAHEIM, CA 92804
Legal Description: N TR 3266 BLK LOT 7
APN: 12829125
CITY OF ANAHEIM
BUILDING DMSION
200 S. ANAHEIM BLVD.
(7141 765 - 5153
Project Description: Residential Remodel: To change out (28) retro fit windows for (Units 1-8)
Living Area: Number of Stories: 2 Valuation: 3,000.00
Garage Area: Construction Types: NIA
Carport Area: Occupancy Groups:
Balcony / Dock Area: Fire Sprinidered:
Cool Root Total Fen paid for Permit: 544.84
People Associated with Project:
Permit Applicant Randy Chang
Owner C&H UNIWEALTH LLC 12918 ARABELLA PL
Type Electrical Fixtures Qty Type Plumbing Fixtures City 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 Cq<
City of Anaheim D� io
Building Division F z
�OVNDED �$y'
Do not occupy this building until the final inspections have been made.
FINAL INSPECTIONS DATE INSPECTOR
All applicable Items below must be signed before utilities are released
Final Gas Test
Electrical Final
Plumbing Final
Mechanical Final
Cross Connection Control (714) 765-4280
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)
COA/Migation Measures
Do not install subfloor or pour floor slab until the follwing applicable items have been
s*aned7
Building Final (714 7654153)
Last Inspection-Final Only After Above Completed
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
PARTIAL INSPECTIONS
Building 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
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
Constructeon
Exterior Plaster (Brown Coat)
T-Bar (Strutt., Ele., or Mec.)
Grease Interceptor
Sewer
Water Engineering Backflow (Testable Only)
Water Service
Permit Types
BLD I IELEJ .MEC PLM
X
Permit Number: OLD2023-01797
Issued: 04/17/2023
www.anaheim.net/building
(714)765-0626
Quarter Section: 48
Site Address: 941 S TRIDENT ST, ANAHEIM, CA 92804
Legal Description: N TR 3266 BLK LOT 7
APN:12829125
CITY OF ANAHEIM
BUILDING DMSION
200 S. ANAHEIM BLVD.
(7141765-5153
OWNER - BUILDER DECLARATION:
1 hereby affirm under penalty of perjury that I 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 ftem(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).
1, as owner of property, or my employees with wages as their sole compensation, will do"all or LJ 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 properly, 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).
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 Lew 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 Contractor's State License Law).
I am exempt from licensure under the Contractors, State License Lew 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 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://www.leginfA.ca.qovkolaw.himi.
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.
I have read this application and the information 1 have provided is correct.
I agree to comply with all appli city and county ordinances and state laws relating to building construction
1 authorize repres iv s is ' or county to enter the ebove-Identified property for inspection purposes.
I
11 Lz�—
Signature of Property Olvner o-rAfftorized 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 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.
I have and will maintain workers compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued. My workers 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
workers compensation laws of California, and agree that, if 1 should become subject to the workers compensation provisions of Section 3700 of the
Labor Code, l 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):
Lenders Name:
Lender's Address:
LICENSED CONTRACTOR'S DECLARATION:
I he 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 IS!
t
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 Pro6erty Owner Form with the required forms of identification.
Dear Property Owner.
An application for a building permit has beon submitted in r name listing yourself as the builder of
the property Improvements specified at Q T (a ,,p n k
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.
DIRECTIONS: Read and initial each statement below to sig ni ~� �Vry ur �mFVRnnAT1oN
Information. signify you understand or verify this
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an
"Owner-Buiidee 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 soyeeubjects to serious
financial risk for any injuries sustained by an unlicensed person and his or her am to while
working on my property. My homeownees 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.
..q,_,2.1 understand building permits are not required to be signed by property owners unless
are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
(j3.1 understand as an 'Owner -Builder" I am the responsible party of record on the
Lerstand that I may protect myself from potential financial risk by hiring a licensed permit.
Contractor and
having the permit filed in his or her name instead of my own.
i4. I understand Contractors are required by law to be licensed and bonded in California and to list
elr license numbers on permits and contracts.
i—5.1 understand N I employ or otherwise engage any persons, other than California licensed
ntbractms, 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.
ke. I understand if I am considered an "employer under state and federal law, I must register with
200 S. Mahebn Blvd., Salto 145 Mahaim. Celiromle 92805 (714)7856163 Phone (714)7854807 Fox I MARCH 2W9
--&.- ...,�..,,.�_ 13721
r'Oor
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
I ilure 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
ngle famlly residential structures cannot legally build them with the Intent to offer them for sale,
unless ail 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
Id 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.
kntemlg.1 understand I may obtain more Information regarding my obligations as an "employerfrom the
aRevenue Service, the United States Small Business Administration, the Califomia 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
nderstand that I am thepa egally and financially responsible for proposed construction activity at
the following 1
address: N !�
11. I 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
ny 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
tinn 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.
Property Owner's Signature:
9/2%7/,7
200 S. Anaheim Blvd., Sufte 145 Anaheim, CalUomia 92805 (714)7655153 Phone (714)765-4607 Fax PAGE 2 OF 2
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