1515 S HARBOR BLVD (434)SIGN PERMIT NO. SGN2021.00008 BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 785 - 5153
TYPE OF PERMIT CITY OF A N A H E I M INSPECTION REQUEST LINE:
New Freestanding Sign (714) 765 -4626
DATE: 411312021 QUARTER SECTION: 76
JOB ADDRESS: 1515 S HARBOR BLVD
LEGAL DESCRIPTION:
PERMIT APPLICANT: ROGER C LEE
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
JOB DESCRIPTION: (EPR) DCA - Installation of (1) freestanding monitor display sign.
VALUATION: 50,000.00 PROCESSED BY: AEG
i nepoy tun m under perry or perjury mat i am exempt Troth me contractors License taw Tor Tne Tollowing reason (sec. 1031.5 Business and Professions Code: any city or
county which requires a permit to construct, after, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to Ole a signed
statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9Xcommenclng with Section 7000 of Division 3 of the Business and Profess
Code) or that he Is exempt theretrom end the basis for the staged 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 clothe work, and the stnuture is not intended or offered for sale (Sec. 7044 Business
and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herset or
through his or her own employees, provided that such improvements are not intended or offered for sale. f, 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. 7044 Business and Professions Code: The Contractors
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 Contractors
Ucense Law).
I am exempt under Sec. , B 6 P.C. for this reason:
Daie d- /Il /21 Owner. Dianevland Resort
,../ I hereby affirm under penalty of perjury one of the following declarations:
�D I have and will maintain a cemOrate of consent to self4mure for workers compensation, 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,
or the performance of the work for which this permit Is issued. My workers Compensation insurance carrier
and policy are:
Cartier. Policy Number:
This section need not be completed If t he permit la for one hundred dollars (1100) 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 f l should
become subject to the workers compensation provisions of Section 3700 of the Labor Code. I shall forthwith
comply with those provisions.
Date: 4/13/2021 Applicant
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS UNLAWFUL, AND 1
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.
CONSTRUCTION LENDING AGENCY
I hereby ammi under penalty of perjurymet mere Is a constnrctlen lending agency for the performance of the
work for which this permit is Issued (Sec.3097.CN.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 ender upon the above mentioned property for Inspection purposes.
Date: 4/13/2021
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 inspectoln 365 days from the date of permit issunace. A new permit Is
required to commence or continue work.
LICENSED
say aninn unaar parity or Perjury men I am licerssed
isions of chapter 9 (commencing with Section 700D)
3 of the Business and Professions Code.
Date: 1/132021
Contractor.
NUMBER
EXPIRATION DATE:
TYPE:
4113�Z�
Fees paid for Permit:
Total:
1,013.50