571 N. CLEMSON DRPermit Types CITY OF ANAHEIMPLMBLDELEMEC
X X X X
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(714)765-5153
Permit Number:BLD2023-00732
Issued;04/11/2023
www.anaheim.net/buildjng
(714)765-4626
Quarter Section:39
Site Address:571 N CLEMSON DR,ANAHEIM.CA 92801
Legal Description:N TR 12102 BLK LOT 4 UN 117TR 12102 LOT 4 UNIT 11
APN:93777178
Project Description:Repair;Replace fire damaged roof framing,roof sheathing,(10)squares of tile roofing material,350 sq.ft.of siding,
320 sq.ft.of drywall and remove prefabricated fireplace and replace with new vent fireplace with electrical,mechanical and plumbing.
REF:INV2023-00014
2 Valuation:
Construction Types:
Occupancy Groups:
Fire Sprinklered:
Total Fees paid for Permit:
Living Area:
Garage Area:
Carport Area:
Balcony /Deck Area:
Cool Roof:
Number of Stories:15,000-00
VB
No
1,830.95
People Associated with Project:
Permit Applicant
Owner
Contractor
ArchKect^ngineer
Angel Torres
GILLESPIE SHAWN HUSHELL II
SERVPRO OF DOWNEY MONTEBELLO COMP
PEDRO R MONTENEGRO
571 N CLEMSON DR 117
8251 LA PALMA AVE #402 BUENA PARK,CA 0
8660 MISSION DR ROSEMEAD,CA 91770
Type Qty Type
10 Gas System (outlets)
QtyElectricalFixturesPlumbingFixtures Mechanical Fixtures Qty
Receptacle,switches,lights 1 Ventilation Fan -<=300 cfm on single duct
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.
DATE INSPECTORFINALINSPECTIONS
City of Anaheim
Building Division
All applicable items below must be signed before utilities are released
Final Gas Test
1/^Electrical Final
Plumbing Final
Mechanical Final
Cross Connection Control (714)765-4280
Do not occupy this building until the final inspections have been made.Engineering Final (714)765-5126
Fire Sprinkler (ONLY)(714)765-5041DATEINSPECTORINSPECTION
Do not pour concrete until the following applicable items have been signed:Fire Dept.Final (714)765-5041
Water Engineering (714)765-4591Plumbing(Ground/Underfloor Drain Waste)
Sub List/Bus.Lie.(714)765-5194 (Allow 10 business days)Electrical Ground Electrode/Ufer
COA/Migation MeasuresSetbacldForms/Trenches (Footings)
Do not install subfloor or pour floor slab until the follwing applicable items have been
signed Building Final (714 765-5153)
Last Inspection-Final Only After Above CompletedPlumbing(Ground/Underfloor Water)
Underfloor Rough Gas
PARTIAL INSPECTIONSMechanical(Groundwork)
Building InspectionsElectrical(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 signed
X 1st Floor Shear mr.
●y
Mechanical InspectionsFiresprinkler(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
Plumbing InspectionsRoughCOA/Mitagation Measures
7 0-^7Framing(Only after PIbg.,Ele.,Mec.&Fire)
7V?‘2 JInsulation(Sound/Energy)
Do not tape or plaster until the following applicable items have been signe^:
iSDrywall
Drywall Penetrations (Ele,Mec &PIbg)
Interior Lath
Electrical InspectionsExteriorLath
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
iDg not backfill unless sianed.otll
Sewer
Water Engineering Backflow (Testable Only)
Water Service
Permit Types
BLD ELE MEC PLM
X X X X
Permit Number: BLD202340732
Issued: 04/11/2023
www.anaheim.net/building
(714)765-4626
Quarter Section: 39
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 -5153
Site Address: 571 N CLEMSON DR, ANAHEIM, CA 92801
Legal Description: N TR 12102 BLK LOT 4 UN 117 TR 12102 LOT 4 UNIT 11
APN: 93777178
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 ATTORNEYS FEES.
I hereby affirm under penalty of perjury one of the following declarations:
I 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
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 workefs Compensation insurance carrier and policy are:
Carrier. BENCHMARK INSURANCE COMPANY Policy No.: CSTS023194 Expiration Date: 3/1/2023
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
workers compensation laws of California, and agree that, If I should become subject to the worker's compensation provisions of Section 3700 of the
Labor Code, I shall forthwith comply with those provisions.
� C) q-1 l -;k 3
Signa pIIcant 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 1 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 Signatu
NUMBER EXPIRATION DATE LICENSE TYPE ISI
1065918 05/31/2024
Date