171 N PASEO RIO BLANCO (2)Permit Types
,BLD ELE MEC PLM CITY OF ANAHEIM
X
BUILDING DIVISION
Permit Number: OLD2022-04509 200 S. ANAHEIM BLVD.
Issued: 09/21/2022 (7141765.5153
www.anaheim.net/building
(714)765-0626
Quarter Section: 190
Site Address: 171 N PASEO RIO BLANCOANAHEIM, CA 92807
Legal pescrlption: N TR`7787 BLK LOT 12
APN:35813122
Project Description: Residential EV Charger Level 2
Living Area: Number of Stories: Valuation: 0.00
Garage Area: Construction Types:
Carport Area: Occupancy Groups:
Balcony / Deck Area: Fire Sprinldered:
Cool Roof: Total Fees paid for Permit: 0.00
People Associated with Project:
Permit Applicant Marco Vazquez 1336 E. Covina Blvd Covina, CA 91724
Type Electrical Fixtures Qty Type Plumbing Fixtures Qly, Mechanical Fixtures Qty
EV Charger 1
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�PNEIM cq<
City of Anaheim D� �O
Building Division F i
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�DVNDED %a�^
Do not occupy this building until the final inspections have been made.
FINAL INSPECTIONS DATE 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
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
sinned:
Building Final (714 765-5153)
Last Inspection-Final Only After Above Completed
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{I
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
PARTIAL INSPECTIONS
Buildinq 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 sinned7
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
Mechanical Inspections
2nd Floor Shear t
Roof (Sheathing/Diaphragm/Frame)
Masonry (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
Constructep
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: BLD2022-04509
Issued: 09/21/2022
www.anaheim.net/building
(714)765-0626
Quarter Section: 190
CITY OF ANAHEIM
Site Address: 171 N PASEO RIO BLANCOANAHEIM, CA 92807
Legal Description: N TR 7787 BLK LOT 12
APN:35813122
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(7141 765 - 5153
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 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 selfdnsure 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.
MV
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. CLEAR SPRING PROPERTY AND CASUALTY COMPANY Policy No.: CWC00030701 Expiration Date: 7IM023
Name of Agent. 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
workers 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 those provisions.
Marco Vazquez 9/21/2022
Signature of Applicant
Date
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):
Lenders Name:
Lenders 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.
INCEPTION ELECTRIC INC
Contractor Signature
NUMBER
1053258
EXPIRATION DATE
05/31/2023
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9/21/2022
Date