570 S BROOKHURST ST (4)0 City of Anaheim
BUILDING DIVISION
INSPECTION RECORD
SIGN PERMI''
ADDRESS:
570 S BROOKHURST ST, ANAHEIM, CA 92804
OWNER:
SAI LEELA LLC
PERMIT p:
SGN2022-00012
DATE ISSUED:
01/27/2022
DESCRIPTION:
Installation of (1) illuminated wall sign reads "AI
Amira Jewelry"
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
AT]:
-L
FINAL TRENCHES
699
PARTIAL APPROVAL NOTES
INSPECTION DATE INSPECTOR
Inspectors can normally be reached between
7:30 - 8:00 A.M.
(714) 765-5153 + 0
signcara
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.neUCitizenAccess
To access your inspection timeframe, please go to
www.anaheim.nct/buildinu 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.
CITY OF ANAHEIM
Permit Number: SGN2022-00012
Issued: 01/27/2022
www.ana heim.neVbu ilding
(714)765-4626
Quarter Section: 40
Site Address: 570 S BROOKHURST ST, ANAHEIM, CA 92804
Legal Description: P BK 35 PG 42 PAR 1
APN: 12817134
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
Project Description: Installation of (1) illuminated wall sign reads "AI Amira Jewelry"
People Associated with Project:
Contractor
MY SIGN DESIGN INC 4821 LANKERSHIM BLVD III NORTH HOLLYWOOD, CA 91601
Permit Applicant
Angel Leon
Owner
SAI LEELA LLC 2312 BENTLEY RIDGE DR
OWNER - BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors License State Law for the following reason(s) Indicated below by the
checkmark(s) I have placed next to the applicable items) (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 requ lies 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 she is exempt from Ilcensure 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 ($5001.
❑ I, as owner of property, or my employees with wages as their sole compensation, will do L__) all or (_) portions of the work, and the structure Is not
Intended or offered for sale (Sec. 7044 Business and Professions Code: The Contractors' State 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 are not intended or offered for sale. 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 Dursuant to the Contractors State License Law).
I am exempt from licensure under the Contractors, State License Law for the following 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:
❑ I have and will maintain a certificate of consent to sell -insure for worker's compensation, issued by the Director of Industrial Relations as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
s 'he t I have and will maintain worker's compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this
ti Is Issued. My workers Compensation Insurance carrier and policy are:
Carrier. STATE COMPENSATION INSURANCE FUND Policy No.: 9265538 Expiration Date:
This section need not be completed If the perms Is for one h area dollars ($100) or leas.
❑ I certffy that in the performance of the work for whit his 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 the ecome subject to the workers compensation provisions of Section 3700 of the
LTfJ*I b with mmoly with those ono
WARNING: FAILURE TO SECURE WORKERS'COYIENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,ODO). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES
AS PROVIDED FOR IN SECTION 3706 OR THE LABOR CODE. INTEREST. AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY LICENSED CONTRACTORS DECLARATION
I hereby affirm under penetty, of perjury Nherat there is a construction lending agency for the performance 1 eby efMn under penalty of perjury that I am
Lenders Information:
I hereby certify that i have read this application and
to comply with all city ordinances and state laws rel
representives of this city to enter upon the above m
The premit shall expire by limitation and
final inspection 365 days from the date i
that the information above is correct. I agree
building construction, and hereby authorize
led prg2prerl6rInspection purposes.
and void ff the building or work has not passed
mce. A new permit is required to commence or
licensed under provisions of chapter 9 (commencing with
Section 7000) of Division 3 of the Business and
Professions Code.
Date: 01/27/2022
Contractor:
Number. SGN2022-00012
TYPE: C45
Expiration Date 12/10/2022
continue work.
Fees paid for Permit: $587.00