123 E ELLSWORTH AVE (4)Pennrt lypes _ _
.'- BLD ELE MEC r.M Li t Y OF ANAHEIM
! X -- X BUILDING DIVISION
Permit Number: BLD2023-02440 200 S. ANAHEIM BLVD.
Issued: 05/18/2023 (714) 765 - 5153
www.anaheim.neUbuilding
(714)7654626--
Quarter Section: 84
Site Address: 123 E ELLSWORTH AVE, ANAHEIM, CA 92805
Legal Description: N TR 497 BLK LOT 7 TR 497 LOT 7 POR OF LOT AND LOT
APN: 25108414
Project Description: Site Work: Construct 17 In it X 8ft high block wall to match existing, relocate 8 It high swing gate, install (4) light
poles, new concrete slab for water treatment equipment. REF: BLD2022-05244
LMng Area: Number or Stones: 0 Valuatio,
Garage Area: Construction Types:
Carport Area: Occupancy Groups:
Balcony I Deck Area: Fire Sprinklered.
Cool Root Total Fees paid for Parma:
3,774,720A0
VB
No
2,662,92
People Associated with Project:
Contractor C D M CONSTRUCTORS INC 555 17TH STREET STE 500 DENVER, CO 80202
Permit Applicant Nona Jesmani
Owner CITY OF ANAHEIM 201 S ANAHEIM BLVD 7TH FL
Type Electrical Fixtures Oty Type Plumbing Fixtures Oty Mechanical Fixtures Oty
Pole Light 4
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�N"EIM cq` FINAL INSPECTIONS
City of Anaheim i� All applicable items below must be signed before utilities are released
D O
Building Division f z
u a
�DUNDED tsh^
Do not occupy this building until the final inspections have been made.
Final Gas Test
Electrical Final
Plumbing Final
Mechanical Final
iioa
Cross Connection Control (714) 765-4280
Engineering Final (714) 766-5126
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 11
Sub List/Bus. Lic. (714) 765.5194 (Allow 10 business days)
Setback/Forms/Trenches (Footing
COA/Migation Measures
Do not install subfloor or pour floor slab until the follwing applicable items have been
sioned
Building Final (714 765-5153)
Last Inspection -Final Only After Above Completed
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
PARTIAL INSPECTIONS
Building Inspections 7N
(J\,L S \_Qa7_/— 8 v
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 sioned
1st Floor Shear
Firesprinkler (Rough) (Fire Dept.)
Mechanical Inspections
2nd Floor Shear
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. 8 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
'co Ag,
Electrical Service Meter -(Meter will be set within 2-3
business days after approval) Excludes New
S
Exterior Plaster (Brown Coat)
,1
a&6A,2q D°V
T-Bar (Struct., Ele., or Mec.)
J
Grease Interceptor
(no nor hankfid unless sinned offl
Sewer
Water Engineering Backflow (Testable Only)
Water Service
Permit Types
BLD ELE MEC PLM
X X
Permit Number: OLD2023-02440
Issued: 05/18/2023
www.anaheim.net/buiiding
(714)765-0626
Quarter Section: 84
CITY OF ANAHEIM
BUILDING DIVISION
100 S. ANAHEIM BLVD.
(714) 765.5153
Site Address: 123 E ELLSWORTH AVE, ANAHEIM, CA 92805
Legal Description: N TR 497 BLK LOT 7 TR 497 LOT 7 POR OF LOT AND LOT
APN:25108414
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 cedificate of consent to selfansure 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.
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:
Carrier. LM INSURANCE CORPORATION Policy No.: WA561DBBTSZ6013 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
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, l shall forthwith comply with those provisions.
n � ,
Signature of Ap , icant
�
LOS
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:
1 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, and my license Is in full force and effect.
i/
14,0
ntractor NgnVure
NUMBER EXPIRATION DATE LICENSE TYPE is)
671513 05/31/2023 A, C10, B, HAZ
&'9ZLL
Date