910 S BROOKHURST STSIGN PERMIT NO. SGN2021-00081
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
TYPE OF PERMIT
CITY OF A N A H E I M
INSPECTON QUEST LINE:
New Attached to Structure Sign
(7 q) 7651- 626
DATE: 7/20/2021
QUARTER SECTION: 41
JOB ADDRESS: 910 S BROOKHURST ST
LEGAL DESCRIPTION: SEC 17 T 4 R 10 FOR W 1/2 SW I A
PERMIT APPLICANT: STEVE THERRIAULT
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
EVERETT H MILLER JR TR SIGNTECH ELECTRICAL ADVERTISING INC
%WASHINGTON MUTUAL BANK 4444 FEDERAL BLVD
NEWPORT BEACH, CA 92658-7788 SAN DIEGO, 921022505 CA
JOB DESCRIPTION: Install (2) illuminated channel letter signs for 'CHASE"
VALUATION: 10,000.00
PROCESSED BY: MAL
county which requires a permit to construct. alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed
statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9)(commencing with Section 7000 of Division 3 of the Business and Profs
Code) or that he is exempt therefrom 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).
I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044 Business
and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or
through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold with one year of
completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale).
❑ I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 70" Business and Professions Code: The Contractor's
License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law).
❑ I am exempt under Sec. B & P.C. for this reason:
Date:
Owner:
I WORKER'S COMPENSATION DECLARATION I
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a cartificate of consent to self -insure for worker's compensation, as provided for
by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
P' I have and will maintain workers compensation insurance, as required by Section 3700 of the tabor Code,
or the performance of the work for which this permit is issued. My workers Compensation insurance carrier
and policy are:
Carder: ZURICH AMERICAN Policy Number. WC5513790
This section need not be completed ff t he permit Is for one hundred dollars ($100) or less.
❑ 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 0 1 should
become subject to the workers compensation provisions of Section WOO of the Labor Code, I shall forthwith
comply with those provisions.
Date: 7/20/2021 Applicant: v
WARNING: FAILURE TO SECURE WORKER'S 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 OF THE LABOR CODE, INTEREST AND ATTORNEYS FEES.
I CONSTRUCTION LENDING AGENCY 1
performance of the
work for which this permit is issued (Sec.309ZCiv.C):
Lenders Information:
I certify that I have read this application and state that the above information is correct. I agree to comply with
all city ordinances and state laws relating to building construction, and hereby authorize representives of this
city to enter upon the abov.g mentio property inspection purposes.
` Date: 7/20/2021
Signature of Applicant or Agent
The permit shall expire by limitation and become null and void if the building or work has
not passed final inspectoin 365 days from the date of permit Issunace. A new permit is
required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed
under provisions of chapter 9 (commencing with Section 000)
of Divsion 3 of the Business and Profession ode.
s
Date: 7/20/2021 Contractor:
NUMBER: EXPIRATION DATE:
BUS 1998-030281 6/30/2022
TYPE: C45
TYPE: BUS
DATE -
I LW--
Total:
ees paid for Permit:
676.75