1791 W ELM AVEPermit Types
BLD ELE MEC PLM
X
Permit Number: BLD2022-05148
Issued: 10/2812022
www.anaheim.net/building
(714)765.4626
Quarter Section: 47
Site Address: 1791 W, ELM AVE, ANAHEIM, CA 92804
Logi ii Deserlptlon: N. TR :1728 BLK LOT 19
JW: 12811307
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
Project Description: Plumbing to relocated and install new water heater located outside in rear of home.
LMng Area: Number of Stories: 1 Valuation:
Garage Area:
CarportArea:
Balcony I Deck Area:
Cool Roof:
Construction Types:
Occupancy Groups:
Fire Sprinldered:
Total Fees paid for Perm@:
People Associated with Project:
Permit Applicant CHRISTIAN FLORES, OWNER 509 W WHITING AVE FULLERTON, CA 92832 0000
Owner VU SIMON 1581 W CHATEAU AVE
0.00
NIA
213.00
Type Electrical Fixtures City Type Plumbing Fixtures City Mechanical Fixtures Oty
Water Heater 1
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.
P�PNEIM C9C
City of Anaheim D� �o
Building Division
u a
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
oElectricalDED al
ion Control (714) 765-4280
Engineering Final (714) 765-5126
INSPECTION I DATE 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/Forms/Trenches (Footings)
COA/Migation Measures
Do not install subfloor or pour floor slab until the follwing applicable items have been
sinned:
Building Final (714 765-5153)
Last Inspection-Final Only After Above Completed
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
PARTIAL INSPECTIONS
Building 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
e s' e :
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
Construction
Exterior Plaster (Brown Coat)
T-Bar (Struct., Ele., or Mec.)
Grease Interceptor
Sewer
Water Engineering Backflow (Testable Only)
Water Service
Permit Types
BLD ELE MECFLM
X
Permit Number: BLD2022-05148
IssAd: 10/28/2022
www.anaheim.net/building
(714)765-0626
Quarter Section: 47
Site Address: 1791 W ELM AVE, ANAHEIM, CA 92804
Legal Descriptloo: N TR 1728 BLK LOT 19
APN: 12811307
WORKER'S COMPENSATION DECLARATION:
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(7141 765 - 5153
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 self4nsure for worker's compensation, issued by the Director of Industrial Relations as provided for by
1n•Section 3700 of the labor Code, for the performance of the work for which this permit is issued.
{ I 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: PALOMAR SPECIALTY INSURANCE COMPANY Policy No.: PSIC0701207401 Expiration Date: 8/18/2023
Name of Agent: Phone No.:
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
workers compensation laws of California, and agree that, if I should become subject to the workers compensation provisions of Section 3700 of the
Lobo,
shall forthwith comply with those provisions.
Z
(� 22
Signature of Appli n 2Q�
Date
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY:
1 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 CONTRACTOR'S DECLARATION:
I hen acorn under the penalty of Perjury that t am licensed under provisions of chapter 9 (commencing with Section 7000) of Division 3 of the Business and
P es Code, and my license Is In full force and effect.
Io� 2� � 2o2Z
Contractor Signature Date
NUMBER EXPIRATION DATE LICENSE TYPE (Sl
1041460 07/31/2024 C36