869 S LEMON STPermit Types
BLD ELE MEC PLM
X
Permit Number: BLD2023-00934
Issued: 02/28/2023
www.anaheim.neUbuilding
(714)765-0626
Quarter Section: 85
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
Site Address: 869 S LEMON ST, ANAHEIM, CA 92805
Li+psl Dscription: S TWP 4 RGE 10 SEC 15 SEC 15 T 4 R 10 LOT 50 X 154
APN4 03707313
Project Description: Reroof: Remove existing to install (40) sq of composition shingles over entire house and detached garage
Living Area: Number of Stories: 1 Valuation: 20,000.00
Garage Area: Construction Types: NIA
Carport Area: occupancy Groups:
Balcony I Deck Area: Fire Spdnldemd:
Cool Roof: Total Fan paid for Permit: 363.60
People Associated with Project:
Contractor SUPERIOR ROOFING SYSTEMS INC 1601 S SINCLAIR ST UNIT C200512141114127140 ANAHEIM, CA 92780
Permit Applicant taylor jacks
Owner CALKINS MARK CHANDLER 21811 31ST DR SE
Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Mechanical Fixtures Qt)
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�Pt1ElAq CqC FINAL INSPECTIONS DATE INSPECTOR
Cityof Anaheim D� io All applicable items below must be signed before utilities are released
Building Division F i Final Gas Test
Electrical Final
Plumbing Final
DED ��y^ Mechanical Final
Cross Connection Control (714) 765-4280
Do not occupy this building until the final inspections have been made. Engineering Final (714) 765-5126
INSPECTION DATE I 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) 7664691
Electrical Ground Electrode/Ufer
Sub List/Bus. Lic. (714) 765-5194 (Allow 10 business days)
Setback/Forms/Trenches (Footings)
COA/M' sures
Do not install subfloor or pour floor slab until the follwing applicable items have been
signed:
k Building Final (7 765-5153)
al Only After Above C mpleted
2
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 e
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
Mechanical Inspections
2nd FI
po;ar(Sheathing/Dilhragm/Frame)
asonry (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 MEC PLM
X
Permit Number. BLD2023-00934
Issued: 02/28/2023
www.anaheim.net/building
(714)765-4626
Quarter Section: 85
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
1714) 765 - 5153
Site Address: 869 S LEMON ST, ANAHEIM, CA 92805
Legal Description: S TWP 4 RGE 10 SEC 15 SEC 15 T 4 R 10 LOT 50 X 154
APN:03707313
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 ATTORNEYS FEES.
I hereby affirm under penalty of pedury one of the following declarations:
I 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. STATE COMPENSATION INSURANCE FUND Policy No.:39 32093 Expiration Date: 1/2612024
Name of Agent: S)'a F-11 .N Phone No.:
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
worker's compensation laws of California, and agree that, it I should become subject to the worker's compensation provisions of Section 3700 of the
Labor Code, I shall forthwith comply with those provisions.
2. z?- 2.3
Signature of Applicant 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 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
NUMBER EXPIRATION DATE LICENSE TYPE (S)
865713 10/31/2023 C39
2,
Date
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