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794 N BROOKHURST STCITY OF ANAHEIM Pemttt Number: SON2022-00037 Issued: 04252022 www.anaheim. neVbullding (714)765-4626 Quarter Section: 38 Site Address: 794 N BROOKHURST ST, ANAHEIM, CA 92801 Legal Description: P BK 328 PG 6 PAR 1 APN: 07206062 BUILDING DIVISION 200 S. ANAHEIM BLVD. 17141 766 - 6153 Project Description: Installation of (1) illuminated order point canopy, (1) digital preview board and (1) digital menu board for "Carl's Jr". People Associated with Project: Contractor NATIONAL SIGN & MARKETING CORPOR 13580 5TH STREET200009141114589060 CHINO, CA 91710 Permit Applicant Patrick Faranel Owner LEONID GRINSERG LLC 1048 IRVINE AVE 350 OWNER - BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License State Law for the following reasonts) Indicated below by the checkmark(s) I have placed near to the applicable Items) (Sec. 7031.5 Business and Professions Code: any city or county which requires a by thuft e construct, after, Improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for the permit to file a signed statement that M or she Is licensed pursuant to the provisions of the Contractors' State License Law Chapter 6 (commencing with Section 7000) of OlWslon 3 to e Business and Professions Code) or that he or she is exempt from Ilcensure and me basis for the alleged exemption. Any violation of Section 3 7031.E by any he applicant for a permit subjects the applicant to a civil penalty of not more than Me hundred dollars ($500). ❑ I, as owner of property, or my employees with wages as their sole compensation, will do( all a (_I pomons of the work, and the structure Is not intended or offered for sets (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. Wilds or improves the property, provided that the Improvements are not intended or offered for sale. ff, however, the building or 17 I. as the owner of the property, am exduarmly contrectirg with licensed Contractors to construct the project (Sec. 7044 Business and Professions Cods The Contractors' State License Law does not apply to an owner of property wno builds a improves thereon, and who DDrltrects for the projects with a licensed Contractor Dursuant to the Contractors State License Lew). I am exempt from Iloensure under the Contractors, State License Law for the following reason: Date Signature of Property Owner Or AuOwrized April WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following dedaradons: ❑ I have and will maintain a certificate of consent to sett -insure for workers compensaton, 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. ❑ x I have and will maintain workers compensation insurance, as required by Section 37DO of the Labor Code, for the performance of the work for which this permit is issued. My workers Compensation insurance tamer and policy are. _ G8mwIB&ELEESPROPFRTYCASU6LaQOMPANYOFAMFRICA Policy No.: UB911,16981 Thls secdon need nor M co pl d ff ffw permn Is for ons hundred dollars (6100) w loss. r ❑ 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 oompensetim laws of California, and agree that. N I should become subject to the workers compensation provisions of Section 3700 0/ tip (111 Labor Code. I shall forthwith Cori with those Drovlsions, M��br �• 1 / / Data Patrock Signature of Applicant oenvr»n n»a mm 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 (S100,000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3708 OR THE LABOR CODE. INTEREST. AND ATTORNEYS FEES. I hereby affirm under penalty Of Perjury that there is a construction lending agency for the performance Lenders Information: I hereby celery that i have read this application and stale that the information above is cored. I agree to comply with all city ordinances and stale laws relating Wildirg construction, and hereby authorize representives of this city to enter upon the above mentioned property for inspection purposes. Date Signature of Applicant or Again The Premit shall expire by limitation and became null and void if the Wilding or work has not passed final inspection 365 days from the date of permd issuance. A new permit is required to commence or continue work. I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 (commenting with Section 70M) of Division 3 of the Business and ww•s••awwr..,a PrDreasana Cade. Patrick Faranal ors•^+-+^• Date: m5/2022 Contractor NATIONAL SIGN & MARKETING Number SGN2022-00037 Expiration Date 11112023 TYPE: B, C10, G15 Fees paw for Perrin: $1.547.00