578 S BROOKHURST STCity of Anaheim
0
BUILDING DIVISION
INSPECTION RECORD
SIGN PERMIT
ADDRESS:
578S BROOKHURST ST, ANAHEIM, CA 92804
OWNER:
SAI LEELA LLC
PERMIT#:
SGN2022-00079
DATE ISSUED:
06/24/2022
DESCRIPTION:
Installation of (1) illuminated wall sign for -Smoke &
Vape'.
POST THIS CARD WITH THE APPROVED PLANS
IN A CONSPICUOUS PLACE
ON THE JOB SITE
Inspection
Code
Date
Inspector
SET BACK, FORMS,
TRENCHES
602
UNDERGROUND
CONDUIT
604
PEi-;
MASONRY:
IP
REINFORCEMENT,
606
NO 1
PRE -GROUT
FINAL
Egg
PARTIAL APPROVAL NOTES
INSPECTION DATE INSPECTOR
Inspectors can normally be reached between
7:30 - 8:00 A.M.
(714) 765-5153 + 0
signcard
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-tP.,l ti(tpM//aca. anaheim. net/CitizenAccess
TION
3
To access your Inspection timeframe, please go to
www.anaheim.net/building after 7:30 am on the day of
your Inspection. Under Online Services, click on the
"Inspection Tlmeframes" link or call (714) 765-5153 + 0.
CITY OF ANAHEIM
Permit Number: SGN2022-00079
Issued: 06/24/2022
www.anaheim.net/bu ilding
(714)765.4626
Quarter Section: 40
Site Address: 578 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 for "Smoke & Vape".
People Associated with Project:
Contractor JUAN C OSPINA 4D01 W SEGERSTROM AVE SANTA ANA, CA
Permit Applicant JUAN COSPINA, OWNER 204 MURICA AISLE IRVINE, CA 92614
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 Slate 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, after, 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 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 ($500).
❑ I, as owner of property, or my employees with wages as their sole compensation, will do L__) all a (___) 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 pursuant to the Contractor's 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
1 hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a certificate of consent to seff4nsure for workers 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.
11 1 have and will maintain workers compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers Compensation insurance carrier and policy are:
Cartier: Policy No.: Expiration Date: —�
This section need not be completed k the permit Is for one hundred dollars I or less.
\� I certify That in the performs of the work to which ih rm' ' Its , I sh employ any person in any manner so as to become subject to the
workers compensation laws of California. and ree d I she a _workers compensation provisions of Section 3700 of the
Labor Code. I shall forthwith comoly with those Drovisions.
WARNING: FAILURE TO SECURE WORKERS' C�IPENSATION 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.
1 hereby affirm under penalty 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 informs on above is correct. I agree
to comply with all city ordinances and state laws relating building con ction, el authorize
representives of this city to enter upon the_abeve mention 'r JOT I h purposes.
— — 2 L %G
Daps S ce Agen
The premil shall expire by limitation and5b;�Mftdls void d the building or work has not passed
final Inspection 365 days from the date issua. A new permit is required to wmmenoe or
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 Business and
Professions Code.
Date: 06/24/2022
Contractor: 9 `i Li &5-7
Number: SGN2022-00079 Expiration Date
TYPE: C45 lo,0 '3�
continue work.
Foos psltl for Permit: $589.00