5624 E LA PALMA AVE (8)City of Anaheim
BUILDING DIVISION
POST THIS CARD WITH THE APPROVED PLANS
IN A CONSPICUOUS PLACE
ON THE JOB SITE
Inspection
INSPECTION RECORD
Date
SIGN PERMIT
ADDRESS:
5624 E LA PALMA AVE, ANAHEIM, CA 92807
OWNER:
ANAHEIM HILLS VILLAGE CENTER LP
PERMIT #:
SGN2021-00151
DATE ISSUED:
12/20/2021
DESCRIPTION:
Install (1) illuminated wall sign for'RalnBowls'.
POST THIS CARD WITH THE APPROVED PLANS
IN A CONSPICUOUS PLACE
ON THE JOB SITE
Inspection
Code
Date
Inspector
SET BACK, FORMS,
TRENCHES
602
UNDERGROUND
604
CONDUIT
MASONRY:
REINFORCEMENT,
606
PRE -GROUT
FINAL TRENCHES
699
3�
PARTIAL APPROVAL NOTES
INSPECTION DATE INSPECTOR
Inspectors can normally be reached between
7:30 - 8:00 A.M.
(714) 765.5153 + 0
signoard
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 https://aca.anaheim.net/CitizenAccess
To access your Inspection timeframe, please go to
www.anaheim.net/buffftAafter 7:30 am on the day of
your Inspection. Under Online Services, click on the
"Inspection Timeframes" link or call (714) 765-5153 + O.
Permit Number: SGN2021-00151
Issued: 12/20/2021
www.anaheim.net/building
(714)765-4626
Quarter Section: 184
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765-5153
Site Address: 5624 E LA PALMA AVE, ANAHEIM, CA 92807
Legal Description: A TR R RIVAS ALLOT 3RD CLASS LAND BLK R RIVAS ALLO
APN:34645123
Project Description: Install (1) illuminated wall sign for "RajnBowls".
People Associated with Project:
Contractor DIRECT SIGN 14865 DILLOW STREET WESTMINSTER, CA 92683
Permit Applicant Loc Nguyen
Owner ANAHEIM HILLS VILLAGE CENTER LP 8383 WILSHIRE BLVD 532
OWNER - BUILDER DECLARATION
I hereby affirm under penalty of perjury that l am exempt from the Contractors License State Law for the following reason(s) Indicated below by the
checkmarrk(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
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).
❑ I, as owner of property, or my employees with wages as their sole compensation, will do (_J 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 properly 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
❑ I, 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 Dursuant to the Contractors State License Law). I
I am exempt from licensure under the Contractors, State License Law for the following reason:
Date 12 / ) nl 1-M12 I Signature of Property Owner or Authorized Agent C -\/ wl�
I IWORKER'S COMPENSATION DECLARATION I
I hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a certificate of consent to selfdnsure 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.
0 1 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 carrier and policy are:
Carrier: Policy No.: Expiration Date:
This section need not be completed H the permit Is for one hundred dollars ($100) or less.
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
orkers compensation laws of California, and agree that, if I should become subject to the workers compensation provisions of Section 3700 of the
Labor Code. I shall forthwith comply with
Date
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 CONSTRUCTION LENDING AGENCY I LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of pedury 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
I hereby certify that I have read this application and state that the information above Is correct. I agree Professions Code.
to comply with all city ordinances and state laws relating building construction, and hereby authorize
represenfives of this city to enter upon the above mentioned property for inspection purposes. Date: 12/20/2021
Contractor: 1.7IF-ea Si o Y%
Number: SGN2021-00151 Expiration Date 2 128123
Date I Signature of 4plicant or Aaen TYPE: C45
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. I
Fees paid for Permit: $587.00