221 S ANAHEIM BLVD (8)SIGN PERMIT NO. SGN2021-00024 BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
TYPE OF PERMIT INSPECTION REQUEST LINE:
Alter Attached to Structure Sign CITY OF A N A H E I NI (714) 765 - 4626
DATE: 3/2/2021
JOB ADDRESS: 221 S ANAHEIM BLVD
LEGAL DESCRIPTION:
PERMIT APPLICANT: ROGER DEFRERAS
OWNER INFORMATION: CONTRACTOR INFORMATION:
R SIGN SERVICES INC
' 530 ESPLANADE ST 501
REDONDO BEACH, 90277 CA
JOB DESCRIPTION: Installation of illuminated wall sign "Parini Kabob Grill"
VALUATION: 4,500.00
LDER DECLARATION
QUARTER SECTION: 83
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: CMN
, nereoy am" under penalty or perjury mar 1 am exeMPI Trom me Uontraciors License Law tor me rollowing reason (bec. /ll31.b business and Professors code: any city I
county which requires a permit to construct, after, improve, demolish or repair any structure, pdor 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 Profe
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).
❑ [,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. ff, 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 Contractors
El
License Law).
u I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
WORKER'S COMPENSATION DECLARATU
1 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 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. STATE COMPENSATION INSURANCE Policy Number: 9204301
This section need not be completed If t he permit is for one hundred dollars ($100) or less.
I 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
become subject to the workers compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: 3/2/2021 Applicant:
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE 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.
LENDING
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance
work for which this permit is issued (Sec.3097.Civ.C):
Lenders Information:
I certify that I have read this application and t hat the above information is correct. I agree to comply with
all city ordinances and state laws relating to di g construction, and hereby authorize representives of this
city to enter upon the abo ro r inspey(ion purposes.
' Date: 3/2/2021
Sig lure of Applicant or Agent
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.
1 nereoy amrm under penalty or perjury that 1 am licensed
under provisions of chapter 9 (commencing with Section 7000)
of Division 3 of the Business and Professions Code.
Date: 3/2/2021
NUMBER:
BUS2021.00453
TYPE: C45
TYPE: BUS
Total:
Contractor:
EXPIRATION DATE:
3/1/2022
eas pa r ern t:
591.00