3921 E MIRALOMA AVEPermit Types
BLD ELEMEC PLM
X
'Permit Number: BLD2023-00209
Issued: 01/17/2023
www.anaheim.net/building
(714)765-4626
Quarter Section: 153
CITY OF ANAHEIM
Site Address 3921,E MIRALOMA AVE, Anaheim, CA 92806
Legai D�esscrlotion: P BK 224 PG 17 PAR 5
APNc 34616448
BUILDING DIVISION
200 S. ANAHEIM BLVD.
1714) 785 - 5153
Project Description: Reroof: Remove existing to install (70) sq of flat roof capsheet
Living Area: Number of Stories: 1 Valuation: 28,000.00
Garage Area: Construction Types: NIA
Carport Area: Occupancy Groups:
Balcony I Deck Area: Fire SprinWered:
Cool Roof: Total Fees paid for Permit: 435.84
People Associated with Project:
Permit Applicant Brent McClain
Owner 3921 MIRALOMA LLC 5198 VISTA MONTANA
Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Mechanical Fixtures Qty
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.
City of Anaheim
Building Division
INSPECTION I DATE I INSPECTOR
Do not pour concrete until the following applicable items have been signed:
Plumbing (Ground/Underfloor Drain Waste)
Electrical Ground Electrode/Ufer
Setback/Forms/Trenches (Footings)
Do not install subfloor or pour floor slab until the follwing applicable items have been
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre -slab (Compaction/Membrane Reh
erfloor Insulation (Raised Foundation Or
r Nailing (Raised Foundation Only)
Floor (Floor Nailing)
not cover or conceal the work below until the
st Floor Shear
(Fire Dept.)
./Bond
Rough Duct (Meck
Rough Mechanical
Rouqh Electrical
applicable items have
gh COA/Mitagation Measures
ging (Only after Plbg., Ele., Mac. & Fire)
lation (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 Service Meter -(Meter will be set w
business days after approval) Excludes New
!xterior Plaster (Brown
.Bar (Struct., Ele., or N
crease Interceptor
Engineering Backflow (Testable Only)
Service
FINAL INSPECTIONS DATE I INSPECTOR
All applicable items below must be signed before utilities are released
Final Gas Test '
Electrical Final
Plumbing Final
Mechanical Final
Cross Connection Control (714) 765-4280
Engineering Final (714) 765-5126
Fire Sprinkler (ONLY) (714) 765-5041
Fire Dept. Final (714) 765-5041
Water Engineering (714) 765-4591
Sub List/Bus. Lic. (714) 765-5194 (Allow 10 business days)
Final (7 4765-5153)
qlp mal Only After Above Completei
PARTIAL INSPECTIONS
Buildinq Inspections
I
I
Mechanical Inspections
Plumbing Inspections
Electrical Inspections
I
Permit Types
BLD ELE MEC PLM
X
Permit Number: BLD2023-00209
Issued: 01/17/2023
www.anaheim.net/building
(714)765-0626
Quarter Section: 153
Site Address: 3921 E MIRALOMA AVE, Anaheim, CA 92806
Legal Description: P BK 224 PG 17 PAR 5
APN:34616448
WORKER'S COMPENSATION DECLARATION:
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
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:
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 Cade, for the performance of the work for which this permit is issued.
1 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:
Cartier: INSURANCE COMPANY OF THE WEST Policy No.: WSD506909100 Expiration Date: 1/1/2024
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 1hall forthwith comply with those provisions.
Signature of Applicant Datb V
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY:
I 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:
Lenders 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, end m licena,ls I full force and effect.
Contractor S' nature
NUMBER EXPIRATION DATE LICENSE TYPE (S)
625013 08/31/2023 C39
Date