270 S CLEMENTINE STSIGN PERMIT NO. SGN2012-00128
BUILDING DIVISION
200 S. ANAHEIM BLVD,
765 - 5153
TYP(714)
New EAttach dOF Ntlo Structure Sign CITY OF ANAHEIM
INSPECTION REQUEST LINE:
(714) 765 - 4626
DATE: 8/9/2012
QUARTER SECTION:72
JOB ADDRESS: 270 S CLEMENTINE ST RETAIL SPACE
LEGAL DESCRIPTION:
PERMIT APPLICANT: KIM-THAHN THI MAI
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
SIGNEX
10772 CAPITAL AVE #7A
GARDEN GROVE, 92843 0000 CA
JOB DESCRIPTION: Install (1) Illuminated wall sign for "Eat Streer
VALUATION: 1,500.00
PROCESSED BY: ZAC
, ne,eey dirrn unuer penny or perjury mat i am exempt Trom the Contractor's License Law for the following reason (Sec. 7031.5 Business and Professions Code: any city or
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 Contractors License Law (Chapter 9xcommencing with Section 7000 of Division 3 of the Business and Professions
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 Contractors 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. lf, 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 contractors) licensed pursuant to the Contractors
License Law).
I am exempt under Sec.
Date:
Owner.
B 8 P.C. for this reason:
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 workers compensation, as provided for
by Section 3700 of the Labor Code. for the performance of the work for which this permit is issued.
Khave 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 carder
and policy are:
Carder: EXEMPT Policy Number: EXEMPT
This section need not be completed If the permit is for one hundred dollars ($100) or less.
1 certify that in the performance of the work for which this permit is issued, I shall not employ any person it
any manner so as to become subject to the workers compensation laws of California, and agree that If I should
became subject to the workers compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions. A /
Date: 8/9/2012 Applicant:
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS UWNFUL 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.
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):
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 reprewntives of this
city to enter upon the above entione property for inspection purposes.
Date: 8/9/2012
Signature of Applicant orwgent
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 7000)
of Divskm 3 of the Business and Professions Code.
Date: 8r9Q012 Contractor
NUMBER: EXPIRATION DATE:
BUS2006-02841 8/9/2013
TYPE: C10
TYPE: BUS
Quanity:
Electric Sign (Y/N): Y
PERMIT EXPIRED
INSPECTION
NOT COMPLETED
DATE: 431-4-f ( 3
Total:
ees paid r Permit:
367.35
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