701 W PROVENTIAL DRPermit Types
BLD ELE MEC PLM CITY OF ANAHEIM
X
BUILDING DIVISION
Permit Number. BLD2023-02121 200 S. ANAHEIM BLVD.
Issued: 05/02/2023 17141765 -5153
www.anaheim.net/building
(714)765.4626
Quarter Section: 74
------------------------------------------ ---
Address: 701 W PROVENTIAL DR, ANAHEIM, CA 92805
!i Legal Description: N TR 3492 BLK LOT 7
APN- 03618310
Project Description: Reroof: To remove existing and Install (14) sq. of over flat roof TPO over garage only
Living Area: Number of Stories: 1 Valuation: 91000.00
Garage Area: Constriction Types: NIA
Carport Area: Occupancy Groups:
Balcony I Deck Area: Fire Sprinldered:
Cool Roof. Total Foes paid for Permit: 341.52
People Associated with Project:
Contractor TG ROOFING AND ROOF REMOVAL 960 N ENTERPRISES ST200306111441359860 ORANGE, CA 92867
Permit Applicant Nicholas Carstensen
Owner LLOYD, JOHN DAVID JR TR J 4881 GEM LN
Type
Electrical Fixtures
City, Type
Plumbing Fixtures
Qty
Mechanical Fixtures Qty
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Cityof Anaheim D� io
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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 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 LisUBus. 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 foliwing applicable items have been
Building Final (714 765-5153) cAp0 r
Last Inspection -Final Only After Above Complete d-
D,�
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
PARTIAL INSPECTIONS
Building 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 Manedi
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
Mechanical Inspections
2nd FloqjAMar
R Sheathin • aphragm/Frame)
k1lasoirry (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., 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
Constructio
Exterior Plaster (Brown Coat)
T -Bar (Struct., Ele., or Mec.)
Grease Interceptor
Sewer
Water Engineering Backflow (Testable Only)
Water Service
Permit Types
BLD Permit
MEC PLM
X
Permit Number: OLD2023-02121
Issued: 05/02/2023
www.anaheim.net/building
(714)765.4626
Quarter Section: 74
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765-5153
Site Address: 701 W PROVENTIAL DR, ANAHEIM, CA 92805
Legal Description: N TR 3492 BLK LOT 7
APN: 03618310 '
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.
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. STATE COMPENSATION INSURANCE FUND Policy No.: 1976314 Expiration Date: 7/1/2023
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,shall forth th comply with those provisions.
Signature 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:
Lender's Address:
LICENSED CONTRACTOR'S DECLARATION:
I hereby affirm under the 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, and my licenses in full force and effect.
Contractor Signature
NUMBER EXPIRATION DATE LICENSE TYPE (SI
657689 12/31/2024 C39
S2 2 3
Date