1275 N GROTON STr
Permit Types
BLD ELE MEC PLM
X
Permit Number: BLD2023-02112
Issued: 05/02/2023
www.anaheim.net/building
(714)765-0626
Quarter Section: 30
Site Address: 1275 N GROTON ST, ANAHEIM, CA 92801
Legal Description: N TR 3150 BLK LOT 32
APN:07137706
CITY OF ANAHEIM
BUILDING DMSION
200 S. ANAHEIM BLVD.
(714) 765 - S153
Project Description: Reroof: Remove existing material to install (1,800) sq ft of composition shingle over house and attached garage
Uving Area: Number of Stories: 1 Valuation: 61000.00
Garage Area: Construction Types: N/A
Carport Area: Occupancy Groups:
Balcony / Deck Area: Fire Sprinklered: No
Cool Roof: Total Fees paid for Perm@: 339.04
People Associated with Project:
Permit Applicant Dung Bui
Owner DUONG, SANG 1275 N GROTON ST
Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Mechanical Fixtures Qty
The permit shall expire by limitation and become null and vold 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�PHEiAt cq<
City of Anaheim D� io
Building Division F i
u a
�DGNDEC) �
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 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/MigaIN Measures
Do not install subfloor or pour floor slab until the follwing applicable items have been
Bu' �gFin 14 765-5153)
st I,:ion-Final Only Ager Above Completed
ro 1
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
been s*aned-
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
BUILDING DIVISION
CITY OF ANAHEIM
BUILDING DEPARTMENT 2016 CALIFORNIA CODES
CODE
200 S. Anaheim Blvd., Suite 145 CYCLE
Anaheim, CA 92805 01/001/201/20177
714 765-5153 EFFECTlVEDATE
www.anaheim.net/building
SMOKE DETECTORS AND CARBON MONOXIDE SELF CERTIFICATION
* Final inspection approval will require this completed form to be on site along with the job card.
Permit Number: e ad�°pj y ��//� _ Date:/
Project address: -gT- Al
Property Owner:
The undersigned dodg hereby ertify that I am khe property owner of the
property. I further certify that smoke alarms and carbon monoxide alarms
functional in all the following locations. All boxes must be checked below
above referenced
are present and
❑ Smoke Alarms and Carbon Monoxide Alarm: On the ceiling or wall outside of each separate
sleeping area in the immediate vicinity of bedroom/s or in each hallway outside of the rooms.
❑ Smoke Alarms: In each room used for sleeping purposes.
❑ Smoke Alarm and Carbon Monoxide Alarm: In each story, including any habitable basement;
(Note: in dwellings or dwelling units with split levels and without an intervening door between
the adjacent levels, a smoke alarm and a carbon monoxide detector installed on the upper level
shall suffice for the adjacent lower level provided that the lower level is less than one full story
below the upper level.)
All dwelling units -wit - a ed gar requi a carbon monoxide detectors.
Signature. .-- Date: r�
California Residential Code (Cection R314.6.2,CRC R315.2 states in part that existing dwellings be
"retrofitted with smoke detectors and carbon monoxide detectors when a building permit is issued for work on or
in a building that is valued at $1,000 or more." CRC Section R314.3, CRC R315.2 defines required locations as
indicted above.
NOTE: This certification is only used when normal access to the interior of the dwelling by the City of Anaheim
Inspector is not achieved during the course of project construction. It is normally used for exterior projects such
as re -roofing, re -siding, patio covers, solar photovoltaic installations, and similar exterior construction work.
200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax FEB 2018
www.anaheim.net/building B842
SMOKE/ CO ALARM REQUIRED LOCATIONS
Bedroom Bedroom
6
A.
C0
Kitchen
Living Room
Figure I
6
Bedroom
Living Room
Attic
6@5
Basement
Family Room Bedroom
Dining
Living Room
Kitchen
6 Gal
Bedroom Bedroom
Figure 2
6
Bedroom
Kitchen
Figure 3
REQUIRED SMOKE ALARM LOCATION
REQUIRED CARBON MONOXIDE ALARM LOCATION
V
Acceptable - Never -/Here Here
Top of Detector
Acceptable Here
Garage
Figure 4
4'
Wall
Permit Types
BLD ELE MEC PLM
X
Permit Number: BLD2023-02112
Issued: 05/02/2023
www.anaheim.net(building
(714)7654626
Quarter Section: 30
Site Address: 1275 N GROTON ST, ANAHEIM, CA 92801
Legal Description: N TR 3150 BLK LOT 32
APN:07137706
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
OWNER - BUILDER DECLARATION:
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's License State Law for the following reasons) indicated below by the
eheckmark(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, 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 g (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 then five hundred dollars ($500).
1, as owner of property, or my employees with wages as their sole compensation, will do L:_1 all or ( I 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 riot built or Improved 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' 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 Contractors State License Law).
I am exempt from licensure under the Contractors, State License Law for the following reason:
By my signature below I acknowledge 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 1 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:Nwww.leainfo.ca.eo-vlwlaw.html.
By my signature below, I certify to each of the following:
1 am the property owner or authorized to act on the property owner's behalf.
1 have read this application and the information I have provided is correct.
I agree to comply with all applicable city and coordinan s and state laws relating to building construction
I authorize represen�ve' f this city or county to a ter 6abo 'dentifled property for inspection purposes. pp''
�A�IV�9.�
Signature of -RE ertovirier or edlea"Agent Date . �^
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:
1 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:
Cartier: Policy No.: Expiration Date:
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
worker's compensation laws of California, and agree that, if 1 should become subject to the worker's compensation provisions of Section 3700 of the
Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant
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.C): r
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 Code, and my license is in full force and effect.
Contractor Signature Date
NUMBER EXPIRATION DATE LICENSE TYPE (S)
r
Permit Number: BLD2023-02112
Issued:
www.anaheim.net/building
(714)765-4626
Quarter Section: 30
Dear Property Owner:
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(7141 765 - 5153
OWNER -BUILDER ACKNOWLEDGEMENT AND INFORMATION VERIFICATION FORM
An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements
specified at 1275 N GROTON ST. ANAHEIM, CA 92801.
We are providing you with an Owner -Builder Acknowledgement and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder.
We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this
form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner,
obtain the prior approval of the permitting authority.
Directions: Read and initial each statement below to signify you understand or verify this information.
_ 1.1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building
9'3 permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an
Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully working as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to
2.1 understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
3.1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potential risk by hiring a licensed Contractor and having the permit filed in his or her name instead- of my own.
'g D 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
_� 5.1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers's compensation disability insurance, and contribute to unemployment
compensation for each "employee". I also understand my failure to abide by these laws may subject me to serious financial
risk.
7.1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
8.1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial
or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
j7 a 9.1 understand I may obtain more information regarding my obligations as an "employer" from the internal Revenue Service,
the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at
1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legally and financially responsible for proposed construction activity at the following address: 1275 N GROTON ST.
Permit Number: BL02023-02112
Issued:
wwmanaheim.net/building
(714)765-4626
Quarter Section: 30
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAMEIM BLVD.
(714) 765 - 5153
Permit Number: BLD2023-02112
11.1 agree that, as the party Legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
12.1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board may be unable to assist you with any
financialloss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil
court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is
injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and
wish to hire
Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of
their workers' compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the
agency responsible for issuing the permit.
Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required
to be presented when the permit is is o ve ' /the property owner's signature.
r°pe` J s Signet r _ Date: _
RECEIVED
CITY OF ANAHEIM
PLANNING DEPARTMENT MAY 0 2 2023
BUILDING DIVISION CITY OF ANAHEIM
PLANNING & BUILDING DEPARTMENT
AUTHORIZATION OF AGENT TO ACT ON BEHALF OF PROPERTY OWNER FORM
*Per California State Law, if you, the property owner, will be coming to our office to get a permit, we do not
require you to complete this form, however, if you are sending someone on your behalf (your agent), please
complete and sign the information below.
Also make sure that you have provided your agent with a signed Owner -Builder Acknowledgment and
Information Verification Form.
IScope of Construction Project (or Description of Work): / I
Project Location or Address:
Name of Authorized Agent:Cl��
Address of Authorized Agent:
,04401
'T
Phone Number of Authorized Agent:
,aSa ff&.5 042Z
Required Forms of Identification Attached: (Please check one of the forms of identification below in addition
to the required California State Issued ID)
Property Owner's California State Issued ID with:
Property Deed Property Tax Bill / Closed escrow document
Title Search Mortgage Bill ✓
I declare under penalty of perjury that I am the property owner for the address listed above and I
personally filled out the above information and certify its accuracy.
Property Owner's Signature: Date:
Office Use Only:
I D Verified
Ownership Verified
Documents �
Planning Info 9 -
Permit # �54r-> 2o-,7-3 - 0-2-112-
200
-2-ll2
200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax OCT 2013
www.anaheim.nettbuilding 8720
:
CITY OF ANAHEIM
PLANNING DEPARTMENT
BUILDING DIVISION
OWNER -BUILDER ACKNOWLEDGMENT AND INFORMATION VERIFICATION FORM
*Per California State Law, if you, the property owner, will be coming to our office to get a permit, we will provide
you with this form when you arrive. If you are sending your agent, please complete, initial, and sign the
information below. Also make sure that you have provided your agent with a signed Authorization to Act on
Behalf of the Property Owner Form with the required forms of identification.
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified at 17-1S. N, QtotO S- .
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to
make you aware of your responsibilities and possible risk you may incur by having this permit issued in
your name as the Owner -Builder.
We will not issue a building permit until you have read; initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot
execute this notice unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this
information.
06-A1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an
"Owner -Builder" building permit that erroneously implies that the property owner is providing his or her
own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious
financial risk for any injuries sustained by an unlicensed person and his or her employees while
working on my property. My homeowner's insurance may not provide coverage for those injuries. I am
willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to
workers on my property.
'3P 2. 1 understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not'hiring a licensed Contractor to assume this responsibility.
si 3. I understand as an "Owner -Builder' I am the responsible party of record on the permit. I
understand that I may protect myself from potential financial risk by hiring a licensed Contractor and
having the permit filed in his or her name instead of my own.
%y 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list
their license numbers on permits and contracts.
S 5. 1 understand if I employ or otherwise engage any persons, other than California licensed
Contractors, and the total value of my construction is at least five hundred dollars ($500), including
labor and materials, I may be considered an "employer" under state and federal law.
9 6. I understand if I am considered an "employer" under state and federal law, I must register with
MARCH 2009
200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)7654607 Fax B721
the state and federal government, withhold payroll taxes, provide workers' compensation disability
insurance, and contribute to unemployment compensation for each "employee." I also understand my
failure to abide by these laws may subject me to serious financial risk.
q 07.1 understand under California Contractors' State License Law, an Owner -Builder who builds
single-family residential structures cannot legally build them with the intent to offer them for sale,
unless all work is performed by licensed subcontractors and the number of structures does not exceed
four within any calendar year, or all of the work is performed under contract with a licensed general
building Contractor.
SL8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be
held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from
any latent construction defects in the workmanship or materials.
I understand I may obtain more information regarding my obligations as an "employer" from the
Internal Revenue Service, the United States Small Business Administration, the California Department
of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may
contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or
www.csib.ca.gov for more information about licensed contractors.
'S 11) 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and
understand that I am the party legally and financially responsible for proposed construction activity at
the following
address: 12 7LAI, C -e o l oM S'� AMA ": M , GA , 72 K -o I
11. 1 agree that, as the party legally and financially responsible for this proposed construction
activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as
employers.
-1 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to
any of the information I have provided on this form. Licensed contractors are regulated by laws
designed to protect the public. If you contract with someone who does not have a license, the
Contractors' State License Board may be unable to assist you with any financial loss you may sustain
as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is
also important for you to understand that if an unlicensed Contractor or employee of that individual or
firm is injured while working on your property, you may be held liable for damages. If you obtain a
permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or
not those Contractors are properly licensed and the status of their workers' compensation insurance
coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit.
Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable
to the agency is required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature:
PAGE 2 OF 2
200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax B721