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AUG I 2019 B715 200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax www.anaheim.net/building CITY OF ANAHEIM PLANNING DEPARTMENT BUILDING DIVISION BUILDING PERMIT APPLICATION DATE: PROJECT ADDRESS: DESCRIBE WORK TO BE DONE: VALUATION OF PROJECT APPLICANT: Name: I am the: Property Owner Contractor* Employee of*: Owner Contractor *Verification of Worker’s Comp. Required (including Carrier, Policy # and Expiration Date, Name and Phone Number of Agent) **PROPERTY OWNER: Name: Address: Phone Number: E-mail: CONTRACTOR/ARCHITECT/ENGINEER: Co. Name: Address: City: Phone Number: City License # : State License or Registration State, Zip: E-mail: WORKER’S COMPENSATION CERTIFICATE: Policy Carrier: Expiration Agent Name: Exempt, No Employees Policy Agent Phone Number: Minimum Permit Fee $167.00 Supplemental Permit Fee $53.00 Planning Plan Check Fee assessed when applicable Complete fee information is available at www.anaheim.net/building. (Continued Next Page) ---PAGE BREAK--- PAGE 2 OF 2 B715 200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax www.anaheim.net/building ROOM ADDITION BLOCKWALL / RETAINING WALL / PILASTERS Room Addition: Sq. ft. Garage: Sq. ft. Balcony: Sq. ft. Deck Area: Sq. ft. Covered Porch: Sq. ft. Carport: Sq. ft. Linear feet of Block wall < 6’ high Linear feet of Block wall > 6’ high Linear feet of Retaining Wall < 6’ high Linear feet of Retaining Wall > 6’ high Pilasters Detail plans are available at the Building Division counter for masonry garden walls, pilasters, and retaining walls up to 6’ high. Any design other than City plans require wet stamp and signature of licensed engineer/architect. Please note: Failure to supply all required information for your project may result in rejection of application. MAXIMUM CREDIT CARD TRANSACTION IS $5,000 *Depositors Trust Fund (DTF) for unique or complex items: The Building Official may require a specific amount into a Building Division Depositor's Trust Fund account in accordance with Resolution 2008-110. 1. Where plans are incomplete or changed so as to require additional plan checking, an additional plan check fee shall be charged at the rate established by the Building Official. 2. Express Plan Review Service is optional for applicant whose schedule will not allow the use of the normal plan check RE-ROOFING PATIO Proposed Roofing Material: ICBO/ICC Report of roofing material. Amount of Squares: Sq. ft. Structural analysis by a licensed architect/engineer required if material is 6 lbs. or over per sq. ft. Complete cool roof checklist on back side as required. Standard Design: Custom Design: Enclosed Patio: MISCELLANEOUS Demolition: Sq. ft. Skylight: Sq. ft. Fire place Factory Built Masonry Flag/Light Pole Height: Stucco Sq. ft. Drywall Sq. ft. Storage Racks: Linear feet of Storage Rack Window Replacements: ________Number of Windows CHECKLIST FOR SELF-EXEMPTION FROM NPDES RELATED STORM WATER INSPECTION REQUIREMENTS Please fill in the following boxes based on the activities that will be performed on site during the term of the building permit for which you are applying. There will be no: Soil Movement (i.e. earthwork, excavation, etc.). Uncovered materials (dirt, sand, fertilizer, etc.) that could be carried offsite by wind or rain. Exterior mixing of cementaceous products onsite (concrete, mortar, stucco, etc.). If all three boxes are checked, the applicant is exempt from NPDES related storm water inspection requirements.