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501 E JULIANNA ST (2)Permit Types BLD ELE MEC PLM X Permit Number: BLD2023-01481 Issued: 04/11/2023 www.anaheim.net/building (714)765-4626 Quarter Section: 81 CITY OF ANAHEIM BUILDING DIVISION 200 S. ANAHEIM BLVD. (7141765-5153 Site Address: 501 E JULIANNA ST, ANAHEIM, CA 92801 Legal Description: S TWP 4 RGE 10 SEC 3 SEC 3 T 4 R 10 POR W1/2 SE1/4 , APN:03502055 OWNER - BUILDER DECLARATION: I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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, 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 9 (commencing with Section 7000) of Division 3 of the Ej,usiness 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 Iicent for a permit subjects the applicant to a civil penalty of not more then five hundred dollars ($500). I, as owner of property, or my employees with wages as their sole compensation, will do () 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 Improvement Is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not 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 Lew 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 Contractor's 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 I 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:/Mrww.leainfo.co.00v/calaw.html. By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner's behalf. I have read application and the information I have provided is correct. I agree to co pl wdh all applicable city and county ordinances and state laws relating to building construction I authorize re res nt4bves of this city or county to enter the above -identified property for inspection purposes. AW—IL',I 1 207-55 or Authorized Agent Date WORKER3`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: Carrier: 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 I 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 pedury 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 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 fS1 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 -$7o/ E. L rAja ,d Sr A,,- 1441st 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. Wewill 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 sig nj ~„vry Vr nvruKMAT1uN information. signify you understand or verify this 101. 1 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. S 2.1 understand building permits are not required to be signed by property owners unless the y are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. �0&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 financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. V-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. 15.1 understand if I employ or otherwise engage any persons, other than Caljfomia licensed ractors, 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. VA6. I understand if I am considered an "employer" under state and federal law, 1 must register ' g with 200 S. Anaheim Blvd., Suite 145 Anaheim. California 82605 (714)765-5153 Phone (714)765.4607 Fax ( MARCH 20o9 ��. - -� -.At-- 8721 .'?gin'`"' ... `'• .. :.. • ,'- , • • m . - ;3! the state and federal..governmenf;wathhoid payroll taxes, provide workers' compensa"tion drsabilr Insurance;�and contribute: to unem to tY P yment compensation forreach "e=mployee " I also understand m,''. failure fo, abide b these laws: m Y Y a su b'ect• •.. ..... ...• •- . ' .. . :.:.Y. , ..J., .rne;toaeraous�financial:nskb, .. •' , � .. nunderstantl under Caldornra'Contractors' State. Lcense.'Law an :O ' single family residenfial structures cannot legally build them with;the intent t offer tl 67717"4 hem for sale lds unless all work rs peiforrned by licensed subcontractors and the -number of structures does not excee foul within any calendar year, or all of tfe, work•.fs.perforrried under 0ntra0t;vinth a ;licensed general - v building Contractor.. ::. 8 hyunderstand as an Owner Budder if l seN the: roe for held liable for anyfinanciaf or personal rn�unes susta ned byy any subsequentownier(s) tha#dresu front any latent construction defects ¢in the..workmanshrp oc:matenals .. _ l9 C understand I mryay obtain.more information regarding my obligations as an "em to er" from`thE hildifalRevenue SerVrce, the UnitedYStatesSmall Business Administration, the California Department of Benefit Payments, and the Cahfomra Division of Industrial Accidents ;I alsounderstand'I?ma` • F I .rf6 WOW the Calrfomra Contractors. State Ucense Boardk(CSLB) at 1 80:0 32,1 CSLB (2752)'or Y' www cslbca gov for more nforma on.-, bout IrcQnsed; coritictors, x 10 f maw'.' of antl consent to an Owner Builder buldrn ermit:a '~' r , R g P pphed for rn my name, antl understand that `! am the parry legally and finanorally responsrble:for proposed'construcbon, activi at thefollowmg . .. tY . ,rJ add`r'ess T ✓ �11 I agree that, as the a Illy ll .and `financrall res nsible'for this ro osed construction ac vitt', f wily abide b a!I a y Y°.0.P ,,P Y Pp ble laws and requirements Ghat governwiie=Bwldes ' employers:,as ,well as 12 I agree. to notify the`issuer of this form immediately of any°additions, deletions a y ofrthe infor Y 4 �� , or changes to: b matron I have providP.-K9111dhis form Ucensed, contractors are regulated bylaws designed�toprotect the.publrc If,you'contract with someone who, j A xL_ h' r does not have a J►cense, the Contractors' State License Board may bekunable to assist you`with any financ�a! loss you may sustain . as a result of amplamt Your only. remedy again"st unlicensed Contactors maybe m avil'oo�k" also irnportantfor�you ,to understand that rf a nunlrcensed�Contractor or emplo` 00"of thats r y ' art it rs frm rs intu�edwtile workrn on our ro ert� Y; Y" ndirntlual or =yN g Y p p 4 y,�you ma be held Irable for damages If you obtain a pemiit�asOwner :Budder and wish°to hire Contractors you will be responsible for ve in .wheth °« nat those C;ontra`ctors are properly licensed, and the status of their :worke'r ' cor`pen rt on rnsurarir oc coven e .',ter .tg... - ...'. ••.. ...,�• •..: `,' r• .. i yBefore axburld'ing permit cantbe rssuetl,'thrs form:mu •_,.r;: F st be completed and signed`, by'the property owner "and retained '01tfe agency responsible for issuing the;permrt::.. ' ;Note ;A,coPY the ro owner' of p party s,. nver's4license, form notarization, or;other.yerrfcation acre `to�the`ragency is r`equlred to be presented whentthe permit rs:issued to vei-ifjrthe;propert ownersble ' signature- Y . ' � •Property Owner's Signature_ ;: _ . • • • .. ', E, Date =2�ale E7200 Sm Anaheim Blvd=, Suite 1,45 Anaheim, Calr[omia 928Q5 µ: (7,14)765-5153 Phone: (714)785-4807 Fox PAGE 2 of 2 -. •' .. . • : ...', .a. • ' , ... : .. .. ..