110 W BALL RD (16)SIGN PERMIT NO, SGN2021-00062 BUILDING DIVISION
200 S. ANAHEIM BLVD.
TYPE OF(714) 765 - 5153
New
stands CITY OF ANAHEIM INSPECTION REQUEST LINE:
New Freestanding Sign
(714) 785 - 4828
DATE: 7n/2021 QUARTER SECTION: 86
JOB ADDRESS: 110 W BALL RD
LEGAL DESCRIPTION: TR 2090 LOT 1 POR OF LOT
PERMIT APPLICANT: PATRICK FARANAL
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
NATIONAL SIGN 8 MARKETING CORP
13580 FIFTH ST
CHINO, 91710 0000 CA
JOB DESCRIPTION: (EPR) installation of (1) digital preview board, (1) staggered menu (ward and (1) order point with attached ladder cenopy.'El
VALUATION: 15,000.00 Polio Loco" PROCESSED BY: AEG
OWNER43UILDER DECLARATION
hereby a rm under penalty of periury that 1 am exempt m e Contractors License r following reason (Sac, 7031.5 Business and rofesslons e: any city or
county which requires a penntt io consWU. alter. Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit n filess a dsigned
Prof
statement that he is licensed pursuant to the provisions ct the Contractors License Law (Chapter 9Nwmmenokng with Section 700D of DMalon 3 of the Bupeae end Proasabe
Code) or that he Is exempt therefrom and the basis for the alleged exemption. Any vlolaflon of Section 7031.5 by any applicant for a permit subjects the applicant to a civil
penally, of not more than live hundred dollars (55M).
❑ I, as owner of property, or my smPbyes with wages es their sole compensation, will do the work, and the SWcture is not idended or offered for sale (Sec. 7044 Business
and Professions Code: The Contractors License Law does not apply to an owner of property who bullds 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. V. however, the building or Improvement is sod 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).
U I, as the owner of the property. am exclusively contracting with licensed conintctom to construct the project (Sec. 7044 Business and Professions Code: The Contractor,
License Law does not apply to an Owner of property who builds or improves thereon, and who contracts for such projects with a ocnVacbr(s) licensed pursuant to the Contractors
License Law).
❑ I am exempt under Sec. , B 8 P.C. for this reason:
Date: Owner.
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to se0-insure for workers compensation, "provided for
by Section 3700 of tits tabor 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,
he performance of the work for which this permit is Issued. My workers Compensation insurance center
and policy are:
Cartier TRAVELERS PROPERTY CASUALTY CO Policy Number: UB9M69819321
This section need not be completed if t he permti is for one hundred dollars ($1 DO) or Was.
❑ I cenlfy that in the performance of the work far 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 lf I should
become subject to the workers compensation provisoes of Section 3700 of the Labor Code, I Nall forthwith
comply with those provisions. owvpva.<wrw,nr.,.w
Patrick Faranal °�°�°°--�•
Date: 7/7/2021 Applicant - me nzroru�,�.n o orvo
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 ($100.00D), 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
Is a construction lending
work for which this permit is
Lenders Information:
I oenify that I have read this application and state that the above information Is correct I agree to comply whn
all city ordinances and sate laws relating to building wnstruction, and hereby au0rorire raprasenthms of this
city to enter upon the stove mentioned property for inspection purposes.
Patrick Faranal q�=
=I wall, ) -�
Data 7n1202+
Signature of Applicant a Agent
The permit shall expire by limitation and become null and void if the building or work has
not passed final inspectoln 365 days from the date of permit Issunace. A new permit Is
required to commence or continue work.
under pmvisions of chapter 9 (commencing with Section 7000)
of Divskm 3 of the Business and Professions Code.
4b•,+vw-0Mr�rm
Patrick Faranal_°�-��
Date: 7n12021 Contractor
NUMBER:
EXPIRATION DATE:
B U S2000.03588 1131/2022
TYPE:
B
TYPE:
C10
TYPE:
C45
TYPE:
BUS
PERMIT EXPIRED
INSPECTION
NOT C0114PLEETED
DATE: 7L2�
ass paid for errs
Total:
1,264.00