925 S EUCLID ST (5)SIGN PERMIT NO. SGN2020-00133 pMrira BUILDING DIVISION
200 S. ANAHEIM BLVD.
o° (714) 765 - 5153
TYPE OF PERMIT
New Attached to Structure Sign C I TY
DATE: 11/4/2020
JOB ADDRESS: 925 S EUCLID ST
LEGAL DESCRIPTION:
PERMIT APPLICANT: RYAN YBARRA
OWNER INFORMATION: CONTRACTOR INFORMATION:
BALL EUCLID PLAZA LLC MACHAN SIGN COMPANY INC
P O BOX 5272 1209 EUCLID AVE
BEVERLY HILLS, CA 90209-5272 LONG BEACH, 90804 0000 CA
JOB DESCRIPTION: Installation of (1) illuminated wall sign for "OPTUM".
VALUATION: 2,500.00
E I M INSPECTION REQUEST LINE:
(714) 765 - 4626
QUARTER SECTION: 48
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: MAL
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perl'ury that I am exempt from the Contractors License Law for the following reason (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 such permit to file a signed
statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9)(commencing with Section 7000 of Division 3 of the Business and Professions
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).
❑ I, 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 Contractors 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. If, 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).
❑ 1, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions Code: The Contractors
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
License Law).
❑ 1 am exempt under Sec. B & P.C. for this reason:
Date: Owner:
WORKER'S COMPENSATION DECLARATION LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: I hereby affirm under penalty of pedury that I am licensed
❑ I have and will maintain a certificate of consent to self -insure for workers compensation, as provided for under provisions of chapter 9 (commencing with Section 7000)
by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. of Divsion 3 of the Business and Profespioas F,e .
C ave and will maintain workers compensation insurance, as required by Section 3700 of the Labor Code,
or tNe performance of the work for which this permit is issued. My workers Compensation insurance carrier
and policy are:
Carrier: MIDWEST EMPLOYERS CASUALTY CO. Policy Number. BNUWC0150417
Date: 11/4/2020 r—
NUMBER: EXPIRA
This section need not be completed if t he permit Is for one hundred dollars ($100) or less. BUS2002-04449
TYPE: C45
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in TYPE: BUS
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 tabor Code, I shall forthwith
comply with those provisions. Q -- ,._._.
Date: 11/4/2020 `Applicant4
WARNING: FAILURE TO SECURE WORKER'S OMPENS
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
THOUSAND DOLLARS ($100,000), IN ADDITION TO THE C
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE
41COVERAGE IS UNLAWFUL, AND:
FINES UP TO ONE HUNDRED
OF COMPENSATIoN, DAMAGES AS
:REST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of pedury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec.3097.Civ.C):
Lenders Information:
I certify that I have read this application and state that the above information is correct. I agree to comply with
all city ordinances and state laws relating t ding construction, and hereby authorize representives of this
city to enter upon the above mentioned pl6peo for inspection purposes.
n /
Date: 11/4/2020
�Signat _o_f plicantor-Agent- --�
The permit shall expir by mitation and become null and void if the building or work has
not passed final insp c in 365 days from the date of permit issunace. A new permit is
required to comment or continue work.
Quanity.
I"MI" /T)T
912/2021
EXPIRED
INSPECTION
NOT COMPLETED
DATE: �2
Fees paid for Permit:
Total:
587.75