918-922 N LEMON STPermit Types
BLD ELE MEC PLM
X
Permit Number: BLD2022-05492
Issued: 11/17/2022
www.anaheim.nettbuilding
(714)765-0626
Quarter Section: 71
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 51 53
Site Address; 918-922 N. LEMON ST, ANAHEIM, CA 92805
Legal DescriptioWe TR 143 BLK 'LOT.4 TR 143 LOT 4 & LOT 5 N 20 FT
APN:'03505318
Project Description: Reroof: Remove existing to install (33) sq of composition shingles over living area. and (13) sq of torch down over
attached garages
Living Area: Number of Stories: 1 valuation: 11,500.00
Garage Area: Construdon Types: NIA
CegM Area: Occupancy Groups:
Balcony I Deck Area: Fire Sprinklered:
Cool Roof Total Fees paid for Permit: 384.50
People Associated with Project:
Permit Applicant Tair Pivko
Owner JEW JUDY TR J H JEW 6901 SUERTE PINE
Type Electrical Fixtures Qty Type Plumbing Fixtures City Mechanical Fixtures City
e
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 comments or continue work.
P�PHEIIM C9< FINAL INSPECTIONS DATE INSPECTOR
Cityof Anaheim ��, All applicable items below must be signed before utilities are released
0 0
Building Division F y Final Gas Test
u > Electrical Final
Plumbing Final
IND 1) ��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 I 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) 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 _I __ __ _ _ ZZ 1 17f
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre -slab (Compaction/Membrane Reinf.)
Floor (Joist/Girders)
Underfloor Insulation (Raised Foundation
Floor Nailing (Raised Foundation Only)
2nd Floor (Floor Nailing)
Do not cover or conceal the work below until
1765 -5153) -
Only After Above Completed
Building Inspections
PARTIAL INSPECTIONS
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.) Mechanical Inspections
2nd F Shear
0o eathing/Diaphra /Frame)
Mason Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Duct (Mechanical)
Rough Mechanical
Rough Electrical
Rough COA/Mitagation Measures Plumbinq Inspections
Framing (Only after Plbg., Ele., Mac. & 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: BLD2022-05492
Issued: 11/17/2022
www.anaheim.net/building
(714)765-0626
Quarter Section: 71
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
She Address: 918-922 N LEMON ST, ANAHEIM, CA 92805
Legal Description: N TR 143 BLK LOT 4 TR 143 LOT 4 & LOT 5 N 20 FT
APN:03505318
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 perjury 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.
` e 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 workers Compensation insurance carrier and policy are:
Cartier. SOUTHERN INSURANCE COMPANY Policy No.: PANC000678 Expiration Date: 9/210023
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, l shall forthwith comply with those provisions.
-Z ' - 11 I Iii 2Z
Signature of Applig 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):
Lenders Name:
Lender's Address:
LICENSED CONTRACTOR'S DECLARATION:
I hereby affirm under the penalty of Perjury that 1 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)
1012285 03/310024 C39, C39, C39, B. 8, 8
it � 1 "LZ
Date