168 S FAIRMONT BLVDSIGN PERMIT NO. SGN2021-00037
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
TYPE OF PERMIT
Attached CITY OF A N A H E I M
INSPECTION REQUEST LINE:
New to Structure Sign
(714) 765 - 4626
DATE: 4/8/2021
QUARTER SECTION: 196
JOB ADDRESS: 168 S FAIRMONT BLVD
LEGAL DESCRIPTION: P BK 207 PG 41 PAR 1
PERMIT APPLICANT: MARISOL CHAVARRIA
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
FAIRMONT REMARC LLC SPEED QUALITY SIGNS
23201 LAKE CENTER DR #207 635 S SANTA FE ST
LAKE FOREST, CA 92630.6808 SANTA ANA, 92705 0000 CA
JOB DESCRIPTION: Install (2) illuminated wall signs for "Chow Bakery & Cafe."
VALUATION: 4,500.00 PROCESSED BY: MAL
i nereuy amrrn under penalty or perjury mat i am exempt from me contractors License Law Tor the vxiowing reason (bee tuS1.b business and Professions corle: any city
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. 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 contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law).
El I am exempt under Sec. , B & P.C. for this reason:
Date:
Owner.
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -insure for worker's compensation, as provided for
by Section 3 of the Labor Code, for the performance of the work for which this permit is issued.
I have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code,
or the performance of the work for which this permit is issued. My worker's Compensation insurance carver
and policy are:
Carrier: STATE FUND Policy Number: 9284193-20
This section need not be completed If t he permit is for one hundred dolla 100) or less.
I certify that in the performance t the wow r why this permit is Lie she not employ
any manner so as to become subject to the work is co nsalion laws C lifor agree tl
become subject to the worker's compensation to sio of Section 37 of he Late Code, tsha
comply with those provisions. /
Date: 4/8/2021 Applicant:
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION CMRAGE IS UNLAWFUL. AND
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 I
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 Information: ,t
I certify thyit-IT Iva re I this application arstait 4rba above infor k' 's correct. I agree to comply with
all city c man es in state laws relating onstriiction, and hereby ac=ize represenlives of this
city to,gnter upon th above mentioned p�ispection purposes.
N
Signature of Appligant or
Date: 4/8/2021
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 DECL
I hereby affirm under penalty of perjury I
under provisions of ch e 9 (cq0�mencing w
Of Divsion 3 of the B Ine anImfessions
Date: 4!8/2021 I /Vv Contractor.
NUMBER: EXPIRATION DATE:
BUS2011.03394 2/28/2022
TYPE: C45
TYPE: BUS
Fees paid for ermit:
Total:
672.75