1515 S HARBOR BLVD 202 (15)Permit Types
BLD I ELE I MEC I PLM
X
Permit Number: BLD2021-03973
Issued: 09/09/2021
INSPECTION REQUEST LINE:
(714) 765 - 4626
Quarter Section: 76
C
Site Address: 1515 S HARBOR BLVD 202 (WEST MAIN ENTRANCE COMPLEX)
Legal Description:
200 S�-I_ S4HEIM�BLVD.
(714) 765 - 5153
EIM
Project Description: DCA - Kingswell Shop/BLDG 202 - Electrical to relocate power and data to new locations. REF:
BLD2021-03571
Valuation:
Construcion Types: N/A, ,
Total Fees paid for Permit: 167.00
People Associated with Project:
Contractor MORROW MEADOWS CORPORATION 800 SOUTH HARBOR BLVD 120 ANAHEIM CA 91789 0000
Permit Applicant KATY BRANAM
Type Electrical Fixtures
Receptacle, switches, lights
Qty Type
26
Plumbing Fixtures Qty Type Mechanical Fixtures Qty
The permit shall expire by limitation and become null and void if 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. fbld_permit_combo
P�PµEIM c9t
City of Anaheim o� �o
Building Division i
U D
�tjNOED
Do not occupy this building until the final inspections have been made.
FINAL INSPECTIONS DATE INSPECTOR
All applicable items below must be signed before utilities are released
Final Gas Test
Electrical Final
Plumbing Final
Mechanical Final
Cross Connection Control (714) 765-4280
Engineering Final (714) 765-5126
INSPECTION DATE I INSPECTOR
Fire Sprinkler (ONLY) (714) 765-5041
Do not pour concrete until the following applicable items have been signed:
Fire Dept. Final (714) 765-5041
Plumbing (Ground/Underfloor Drain Waste)
Water Engineering (714) 765-4591
Electrical Ground Electrode/Ufer
Sub LISUBus. Lic. (714) 765-5194 (Allow 10 business days)
Setback/Forms/Trenches (Footings)
COA/Migation Measures
Do not install subfloor or pour floor slab until the follwing applicable items have been
i
Building Final (714 765-5153)
Last Inspection -Final Only After Above Completed
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
PARTIAL INSPECTIONS
Buildinq Inspections
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre -slab (Compaction/Membrane Reinf.)
Floor (Joist/Girders)
Underfloor Insulation (Raised Foundation Only)
Floor Nailing (Raised Foundation Only)
2nd Floor (Floor Nailing)
Do not cover or conceal the work below until the following applicable items have
been ine•
1 st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
Mechanical Inspections
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Duct (Mechanical)
Rough Mechanical
Rough Electrical
Rough COA/Mitagation Measures
Plumbing Inspections
Framing (Only after Plbg., Ele., Mec. & Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable items have been signed:
Drywall
Drywall Penetrations (Ele, Mec & Plbg)
Interior Lath
Exterior Lath
Electrical Inspections
Electrical Service Meter -(Meter will be set within 2-3
business days after approval) Excludes New
Construction
Exterior Plaster (Brown Coat)
T -Bar (Strutt., Ele., or Mec.)
Grease Interceptor
(Do not backfill unless sinned off)
Sewer
UATP
Water Engineering Backflow (Testable Only)
Water Service
• P&mit Types
BLD I ELE I MEC PLM
X
Permit Number: BLD2021-03973
Issued: 09/09/2021
INSPECTION REQUEST LINE:
(714) 765 - 4626
Quarter Section: 76
C17, HAANA' �}� E I M
BUILDING,DIVIISION
200 S� & OW"dLVD.
(714) 765 - 5153
Site Address: 1515 S HARBOR BLVD 202 (WEST MAIN ENTRANCE COMPLEX)
Legal Description:
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 she 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 ($500).
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' 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 improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved 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' 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:
By my signature below I ackonowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the
improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed
contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application
is submitted or at the following Web site: htto://www.Ieoinfo.ca.gov/Galaw.htm1.
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owner's behalf.
I have read this application and the information I have provided is correct.
I agree to comply with all applicable city and county ordinances and state laws relating to building construction
I authorize representatives of this city or county to enter the above -identified property for inspection purposes.
Signature of Property Owner or Authorized Agent
WORKER'S COMPENSATION DECLARATION:
Date
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 ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -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.
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
permit is issued. My worker's Compensation insurance carrier and policy are:
Carrier: TRAVELERS PROPERTY CASUALTY CO
Name of Agent:
Phone No.:
Policy No.: UB1N2297462125K
Expiration Date: 7/1/2022
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the
worker's compensation laws of California, and agree that, if I should become subject to the worker's compensation provisions of Section 3700 of the
Labor Code, I shall forthwith comply with those provisions.
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Signature of Applicant Date
Permit Number: BLD2021-03973
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY:
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):
Lender's Name:
Lender's Address:
LICENSED CONTRACTORS DECLARATION:
I hereby affirm under the 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, and my license is in full force and effect.
Contractor Signature Date
NUMBER EXPIRATION DATE LICENSE TYPE (S)
230813 6/30/2022 B C10
The permit shall expire by limitation and become null and void if 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.
fbld permit combo declare