417 E ADELE STPermit Types CITY OF ANAHEIMPLMBLDELEMEC
X X X
BUILDING DIVISION
200 S.ANAHEIM BLVD.
(7141765-5153
Permit Number;BLD2023-02181
Issued;05/05/2023
www.anaheim.net/buiiding
(714)765-4626
Quarter Section:83
Site Address:417 E ADELE ST,Anaheim,CA 92805
Legal Description:N TR 152 BLK LOT 4
APN:03517111
Project Description:Residential Remodel:Replace (1)shower with re-tile,and Electrical for fixture upgrade
5,000.001Valuation:Number of Stories;Living Area:
Garage Area:
Carport Area:
Baicony /Deck Area:
Cool Roof:
N/AConstructionTypes:
Occupancy Groups:
Fire Sprinkiered:
Total Fees paid for Permit:215.65
People Associated with Project:
11801 PIERCE STREET STE 200201707241628000208 RIVERSIDE,CA 91709Contractor
Permit Applicant
Owner
YBARRA PROFESSIONAL BUILDERS
Danielle Shalom
OREGEL,JAMES ANDREW 417 E ADELE ST
QlyQtyMechanicalFixturesQtyTypePlumbingFixturesTypeElectricalFixtures
Receptacle,switches,lights 1 Shower
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.
DATE INSPECTORFINALINSPECTIONS
City of Anaheim
Building Division
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
Do not occupy this building utUil the final inspections have been made.Engineering Final (714)765-5126
DATE INSPECTOR Fire Sprinkler (ONLY)(714)765-5041INSPECTION
Do not pour concrete until the following applicable items have been signed Fire Dept.Final (714)765-5041
Water Engineering (714)765-4591Plumbing(Ground/Underfloor Drain Waste)
Sub List/Bus.Lie.(714)765-5194 (Allow 10 business days)Electrical Ground Electrode/Ufer
Setback/Forms/Trenches (Footings)COA/Migation Measures
Do not install subfloor or pour floor slab until the follwing applicable items have been
sinnofi Building Final (714 765-5153)
Last Inspection-Final Only After Above CompletedPlumbing(Ground/Underfloor Water)
/Underfloor Rough Gas
PARTIAL INSPECTIONSMechanical(Groundwork)
Building InspectionsElectrical(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
bet"ii sii'iiioi'l
1st Floor Shear
Mechanical InspectionsFiresprinkler(Rough)(Fire Dept.)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Duct (Mechanical)
Rough Mechanical
Rough Electrical
Plumbing InspectionsRoughCOA/Mitagation Measures
Framing (Only after Plbg..E!e..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
Electrical InspectionsExteriorLath
Electrical Service Meter-(Meter will be set within 2-3
business days after approval)Excludes New
Construction
Exterior Plaster (Brown Coat)
T-Bar (Struct.,Ele.,or Mec.)
Grease Interceptor
-‘01 back
Sewer
Water Engineering Backflow (Testable Only)
Water Service
Permit Types
BLD ELE MEC PLM
X X X
Permit Number. BLD2023-02181
Issued: 05/05/2023
www.anaheim.net/building
(714)7654626
Quarter Section: 83
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(7141765-5153
Site Address: 417 E ADELE ST, Anaheim, CA 92805
Legal. Description: N TR 152 BLK LOT 4 ry
APN:03517111
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 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.
�S
Ll 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. STATE COMPENSATION INSURANCE FUND Policy No.: 9158762 Expiration Date: 1111012024
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
workers compensation laws of California, and agree that, if I should become subject to the workers compensation provisions of Section 3700 of the
Labor ode, I shall forthwith comply with those provisions.
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):
Lender's Name:
Lender's 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.
Contractor Signature
NUMBER EXPIRATION DATE LICENSE TYPE (S)
334090 01/31/2022
S �5 /2 3 .
Date