210 W SIMMONS AVE (5)Permit Types
BLD ELE MEC PLM
X X
Permit Number: BLD2022-04888
Issued: 10/14/2022
www.anaheim.neUbuilding
(714)765-0626
Quarter Section: 89
CITY OF ANAHEIM
Site Address:.:210 W SIMMONS AVE B, ANAHEIM, CA 92802
Legal DAcRption: N TR 2520 BLK LOT 84
APN: 233094%
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(7141765-5153
f low
Project Description: Photovoltaic with Micro -Inverters: Install roof mounted solar with (8) modules, (8) mircro-inverters and 100 amp
subpanel. REF: BLD2022-02170
Living Area: Number of Stories: 0 Valuation: 10,000.00
Garage Area: Construction Types: VB
Carport Area: Occupancy Groups:
Balcony I Deck Area: Fire Sprinklered:
Cool Roof: Total Fees paid for Permit: 257.30
People Associated with Project:
Permit Applicant Paul Le
Owner CHAVEZ LUIS 210 W SIMMONS AVE
Type Electrical Fixtures Qty Type Plumbing Fixtures Qty Mechanical Fixtures Qty
Microinverter 8
Sub PaneUTemp Pwr - Under 600 V, up to 1
200 amps
The permit shall expire by [Imitation 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�PHEIM cq<
City of Anaheim D� �O
Building Division i
u a
�DUNDED �$h^
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 ' V4-
Plumbing Final
Mechanical Final
Cross Connection Control (714) 765-4280
Engineering Final (714) 765-5126
INSPECTION DATE 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
s"ane .
Building Final (714 765-5153)
Last Inspection-Final Only After Above Completed
Z
Plumbing (Ground/Underfloor Water)
Underfloor Rough Gas
PARTIAL INSPECTIONS
Building Inspections
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Floor (Joist/Girdem)
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 Mane&
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. & 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
Construction
Exterior Plaster (Brown Coat)
T-Bar (Strutt., Ele., or Mec.)
Grease Interceptor
(Do not backfill unless sioned nfl)
Sewer
Water Engineering Backflow (Testable Only)
Water Service
Permit Types
BLD ELE MEC PLM
X X'
Permit Number: BLD2022-04888
Issued: 10/14/2022
www.anaheim.net/building
(714)765.4626
Quarter Section: 89
CITY OF ANAHEIM
Site Address: 210 W SIMMONS AVE B, ANAHEIM, CA 92802
Legal Description: N TR 2520 BLK LOT 84
APN:23309416
WORKER'S COMPENSATION DECLARATION:
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 self4nsure 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 workers compensation insurance, as required by Section 3700 of the tabor Code, for the performance of the work for which
this permit is issued. My workers Compensation insurance carrier and policy are:
Cartier: STARNET INSURANCE COMPANY Policy No.: BNUWC0154185 Expiration Date: 6119023
Name of Agent Phone No.:
I certify that in the performance of the work for which this permit Is issued, l shall not employ any person in any manner so as to become subject to the
workers co pensation laws of California, and agree that, If I should become subject to the workers compensation provisions of Section 3700 of the
Labor , I shall forthwith comply with those provisions.
Signature of Applicant/ ZILL4
:�
Date
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY:
1 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 th 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, my license is in full force and effect.
164iy rl,
Contractor Signature Date ,
NUMBER EXPIRATION DATE LICENSE TYPE (S1
1004667 06/30/2023 C10, C39