221 W KATELLA AVE (3)Permit Number: SGN2022.00073
Issued: 07/11/2022
www.anaheim.net/building
(714)7654626
Quarter Section: 87
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765-5153
Site Address: 221 W KATELLA AVE, ANAHEIM, CA 92802
Legal Description: P BK 10 PG 12 PAR 2 PM 10-12 PAR 2 -EXCEPT POR. IN
APN: 08243119
Project Description: Install (1) illuminated wall sign for'Hertz".
People Associated with Project:
Contractor MEDEARIS CONSTRUCTION COMPANY P O BOX 89-2110201503041918204240 TEMECULA, CA 92620
Permit Applicant Michael Dan
Permit Applicant Nhasha Gates
Owner DELAWARE HERTZ REALTY CORP 225 BRAE BLVD
OWNER - BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License State Law for the following reason(s) indicated below by the
checkmark(s) I have placed next to the applicable Item(s) (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 the permit to file a signed statement that he
or she Is licensed pursuant to the provisions of the Contractors' State License Law Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or the Is exempt from licensure 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 (4500).
❑ I, as owner of property, or my employees with wages as their sole compensation, will do (_) all or (_) portions of the work, and the structure Is not
intended or offered for sale (Sec. 7044 Business and Professions Code: The Contractors' Stele License Law does not apply to an owner of property who, through
employees' or personal efforts, builds or Improves the property, provided that the Improvements am not Intended or offered for sets. If, however, the building or
❑ 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' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed
Contractor oursuant to the Contractor's Stale License Law).
I am exempt from licensure under the Contractors, State License Law for the followinq reason:
Date Signature of Property Owner or Authorized Agent
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 seINnsure for worker's compensation, Issued by the Director of Industrial Relations as provided for by
ction 3700 of the Labor Code, for the performance of the work for which this permit is Issued.
r I have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code, for the pedonnance of the work for which this
permit is issued. My workers Compensation Insurance center and policy are:
Canter: EVEREST PREMIER INSURANCE COMPANY Policy No.: 7600023272221 Explretio
This section need not be completed H the permit Is for am hundred dollars ($100) or loss.
❑ I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the
worker's compensation laws of California, and agree that, H I should become subject to the workers compensation provisions of Section 3700 of the
La4Qr P94e. J i holUodhwBh comoly with thos0-orpvisions_
WARNING: FAILURE TO SECURE WORKERS' 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 OR THE LABOR CODE. INTEREST. AND ATTORNEYS FEES.
I hereby of fit, under penatty of perjury that there is a construction lending agency for the performance
Lenders Information:
I hereby certify that I have read this application and state that the information above is correct. I agree
to comply with all city ordinances and state laws relating building construction, and hereby authorize
representives of this city to enter upon the above mentioned property for Inspection purposes.
Date Signature of Applicant or Agen
The premlt shall expire by limitation and become null and void H the building or work has not passed
final inspection 365 days from the date of permit issuance. A new permit is required to commence or
continue work.
LICENSED CONTRACTORS DECLARATION I
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing with
Section 7000) of Division 3 of the mess and
Professions C Date: 07/1 IdI12
Contractor: MEDEARIS CONSTRUCTION COM
Number: SGN2022-00073 Expiraflon Date 519/202n
TYPE: B
Fees paid for Permit
City of Anaheim
BUILDING DIVISION
INSPECTION RECORD
SIGN PERMIT
ADDRESS:
221 W KATELLA AVE. ANAHEIM, CA 92802
OWNER:
DELAWARE HERTZ REALTY CORP
PERMIT#:
SGN2022-00073
DATE ISSUED:
07/11/2022
DESCRIPTION:
Install (1) illuminated wall sign for'Herz".
POST THIS CARD WITH THE APPROVED PLANS
IN A CONSPICUOUS PLACE
ON THE JOB SITE
Inspection
Code
Date
Inspector
SET BACK, FORMS,
TRENCHES
UNDERGROUND
CONDUIT
MASONRY:
REINFORCEMENT,
606
PRE -GROUT
DATE:
FINAL
699
PARTIAL APPROVAL NOTES
INSPECTION DATE INSPECTOR
Inspectors can normally be reached between
7:30 - 8:00 A.M.
(714) 765-5153 + 0
s 9n'am
INSPECTION REQUIREMENTS
A representative is required to be on the site to expose
any concealed wiring for final inspection.
INSPECTION REQUESTS
Inspection requests made prior to 5:00 pm
Monday - Friday will be scheduled on the
following workday.
To schedule your building inspection online, please
go to https://aca.anaheim.net/CitizenAccess
+�D
To access your inspection timeframe, please go to
www.ailaheim.net/buildiLiE after 7:30 am on the day of
your Inspection. Under Online Services, click on the
"Inspection Timeframes" link or call (714) 765-5153 + 0.