215 E ELLSWORTH AVEPermit Types
w BLDG I ELE I MEC I PLM
X
Permit Number. OLD2022-05275
Issued: 11/07/2022
www.anaheim.nef/building
(714)765.4626
Quarter Section: 84
CITY OF ANAHEIM
Site Address: 215 E ELLSWORTH AVE, ANAHEIM, CA 92805
Legal Description: N TR 497 BLK LOT 40
APN: 26108112
Project Description: Electrical for 200amp subpanel
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
Uving Area: Number of Storlea: 1 Valuation: 0.00
Garage Area: Construction Types. N/A
Carport Area: Occupancy Groups:
Balcony I Deck Area: Fire SprlrWred:
Cool Root: Total Fns pald for Permit; 167.00
People Associated with Project:
Permit Applicant MODESTO MACIEL, OWNER 605 S CLAUDINA ST ANAHEIM, CA 92805 0000
Owner GILLISPIE JAMES H 15613 CHEYENNE ST
Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Mechanical Fixtures Qty
Sub PaneVremp Pwr - Under 600 V. up to 1
200 amps
The permit shall expire by Iimitatlon and become null and void N 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.
P�pHEIM Cq<
Cityof Anaheim o� �O
Building'Division
u >
DED %ah^
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 I 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 List/Bus. Lic. (714) 765-5194 (Allow 10 business days)
Setback/FormslTrenches (Footings)
COA/Migation Measures
Do not install subfloor or pour floor slab until the follwing applicable items have been
signed:
Building Final (714 765-5153)
Last Inspection -Final Only After Above Completed
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
PARTIAL INSPECTIONS
Building Inspections
IA R
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre -slab (Compaction/Membrane Reinf.)
Floor (Joist/Girders)��
Underfloor Insulation (Raised Foundation Only)
d �'
Floor Nailing (Raised Foundation Only)
_
2nd Floor (Floor Nailing)
Li I
Do not cover or conceal the work below until the following applicable items have
been shaned7
1st 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
Cons ructinn
Exterior Plaster (Brown Coat)
T -Bar (Struct., Ele., or Mec.)
Grease Interceptor
(Do no
Sewer
'
Water Engineering Backflow (Testable Only)
Water Service
Permit Types
BLD • ELE MEC PLM
'1 X
Permit Number. BLD2022-05275
Issued: 11/07/2022
www.anaheim.net(buiiding
(714)7654626
Quarter Section: 84
CITY OF ANAHEIM
Site Address: 215 E ELLSWORTH AVE, ANAHEIM, CA 92805
Legal Description: N TR 497 BLK LOT 40
APN: 25108112
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(7141765-5153
WORKER'S COMPENSATION DECLARATION:
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 Cade, 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 workers Compensation insurance carrier and policy are:
Carder. Policy No.: Expiration Date:
Name of Agent: Phone No.:
I certify that in thverformance 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�s9ompensation laws of California, and agree that, If 1 should become subject to the workers compensation provisions of Section 3700 of the
I shall fogi p comply with those provisions.
Date
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.Cy
Lender's Name:
Lender's Address:
LICENSED CONTRACTOR'S 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 nd my N nse is In full force and effect
NnuE-04595C - 67- Z.07 -?-
Contra Date
NUMBER EXPIRATION DATE LICENSE TYPE ISI
1047245 11/30/2022 C10