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1101 N MAGNOLIA AVE (6)1_ a Permit Number: SGN2022-00098 Issued: 09/15/2022 www.anaheim.netlbuilding (714)765-0626 Quarter Section: 17 CITY OF ANAHEIM Site Address: 1101 N.MAGNOLIA AVE, ANAHEIM, CA 92801 Legal Description: P BK 113 PG 21 PAR 1 APN: ;07076212 BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 766 - 6163 Project Description: Installation of (4) illuminated signs attached to gas dispenser canopy for "Chevron". People Associated with Project: Permit Applicant Brian D.Collins Owner BEYOND SERENITY AT ANAHEIM L P 1233 PARK ROW OWNER - BUILDER DECLARATION I hereby affirm under penalty of perjury that t 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 Items) (Sec. 7031.5 Business and Professions Code: any city or county which requires a permit to construct, atter, 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 taw 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). 13 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 0 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 pursuant to the Contractor's State License Law). I 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: Q 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. C ® 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 carrier and policy are: Cartier. TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Policy No.: UB7K6164 This section need not be completed r the permit 1s for one hundred dollars (1100) or less. Q 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, 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. 9/15122 Brian Collins _ Date Signatureof Applicant) 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 that there Is a construction lending agency for the performance Lenders Information: I hereby car* that 1 have read this application and state that the information above is correct. I agree 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. 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 hereby alum under penalty of pedury that I am licensed under provisions of chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. Brian Collins -- i Date: 09/15/2022 Contractor: CALCRAFT CORPORATION Number: SGN2022-00098 Expiration Date 3/26/2022 TYPE: B, C43, C33, C51, C10, HAZ, C45, C46 Fees paid for Permit: $1,050.00 Inspection City of Anaheim Date BUILDING DIVISION SET BACK, FORMS, INSPECTION RECORD SIGN PERMIT ADDRESS: 1101 N MAGNOLIA AVE, ANAHEIM, CA 92801 OWNER: BEYOND SERENITY AT ANAHEIM L P PERMIT #: SGN2022-00098 DATE ISSUED: 09/15/2022 DESCRIPTION: Installation of (4) illuminated signs attached to gas dispenser canopy for "Chevron". 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 PARTIAL APPROVAL NOTES INSPECTION I DATE I 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 https:Haca.anaheim.net/CitizenAccess To access your Inspection timeframe, please go to www.anaheim.netlbuildina 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. ?8 \q'lN (sLie NONf-S ------------------------ 9 J J 0 Z 3= CO) O LCI N N 2 CQ c W Z = LLJ a WN O Z U N O O �- : C��: a> N Oma\ i 'Z IL � CD IL ► V z LLJ [7 ZQ�.I� Z LU �� n U. Q >- uJ CL o m o Qw V V h � cI F]