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1515 S HARBOR BLVD (362)Permit Number: SGN2023.00002 Issued: 01/17/2023 www.anaheim.net/building (714)765-4626 Quarter Section: 76 CITY OF ANAHEIM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 Site Address: 1515 S HARBOR BLVD 120-205, Anaheim, CA 92802 Legal Description: S TWP 4 RGE 10 SEC 22 T4 R10 SEC 22 POR OF W 1/2 APN:08219027 Project Description: DLR - Confidential project; see correspondence for scope People Associated with Project: Permit Applicant Joshua Richards Owner WALT DISNEY PARKS AND RESORTS US INC PO BOX 313 OWNER - BUILDER DECLARATION 1 hereby affirm under penalty of perjury that 1 am exempt from the Contractors 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, after, 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 (commenting 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). 13 I, as owner of property, or my employees with wages as their sole compensation, will do U) 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 0 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 Lawl. 1 am exempt from licensure under the Contractors, State License Law for the following reason: Date Signature of Property Owner or Authorized Agent WORKER'S COMPENSATION DECLARATION 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 workers 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 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 carder and policy are: Cartier. INSURANCE COMPANY OF THE WEST Policy No.: WSD503618805 Expiration Date This section need not be completed if the permit is for one hundred dollars ($100) or less. ❑ 1 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 1 should become subject to the workers compensation provisions of Section 3700 of the Labor Code. I shall forthwith comply withe p 1 'tib Za2 Date ature of Applicant WARNING: FAILURE TO SE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP T 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 CONSTRUCTION LENDING AGENCY LICENSED CONTRACTORS DECLARATION 1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance I hereby affirm under penalty of perjury that I am Lenders Information: licensed under provisions of chapter 9 (commencing with Section 7000) of Division 3 of the Business and 1 hereby certify that I have read this application and state that the information above is correct. I agree Professionssode. to comply with all city ordinances and state laws relating building construction, and hereby authorize representives of this city to enter upon the above mentioned property for inspection purposes. Date: 0 Contractor: ON RICHARDS COMPANY Date Signature of Applicant or Agen The premit 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. Number: SGN2023-00002 TYPE: B, B Fees paid for Permit: Expiration Date 3/23/2023 $1,393.50 City of Anaheim BUILDING DIVISION INSPECTION RECORD 0 SIGN PERMIT ADDRESS: 1515 S HARBOR BLVD 120.205, Anaheim, CA 92802 OWNER: WALT DISNEY PARKS AND RESORTS US INC PERMIT #: SGN2023-00002 DATE ISSUED: 01/17/2023 DESCRIPTION: DLR - Confiden0al project; see correspondence for scope POST THIS CARD WITH THE APPROVED PLANS IN A CONSPICUOUS PLACE ON THE JOB SITE Inspection Code Date Inspector SET BACK, FORMS, 602 TRENCHES UNDERGROUND 604 CONDUIT MASONRY: REINFORCEMENT, 606 PRE -GROUT FINAL 699 31 a3 J ,5G PARTIAL APPROVAL NOTES INSPECTION DATE INSPECTOR Inspectors can normally be reached between 7:30.8:00 A.M. (714) 765.5153 + 0 signcard INSPECTION REQUIREMENTS A representative is required to be on the site to expose any concealed wiring for final inspection. INSPECTION REQUESTS Inspection requests made prior to 5:00 pm Monday - Friday will be scheduled on the following workday. To schedule your building inspection online, please go to haps:Haca.anaheim.net/CitizenAccess To access your Inspection timeframe, please go to www.anaheim.neUbuildinla after 7:30 am on the day of your inspection. Under Online Services, click on the "Inspection Timeframes" link or call (714) 765-5153 + 0.