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10200877 - Permit
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10200877 - Permit
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Last modified
7/15/2022 8:41:18 AM
Creation date
7/15/2022 8:40:53 AM
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Permit
Permit Number
10200877
Full Address
611 N Bristol St
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PLUMBING <br />PERMIT <br />\ <br />PROJECT <br />ADDREES:611 N. BRISTOL ST <br />302@@877 <br />PERMIT NO.ez,l <br />sunE: * |FFte{SUTTE <br />RANGE:DESCRIPTION FEES <br />ADORESS <br />RANGE: 611-563 BUILDING <br />NUMBER: <br />ou\rNER: SHADOWWOOD HOME OWNERS ASSOC. <br />ADDRE$: Gll- N BRrsroL sr, *1 <br />I hcoby efina unda p.mlty ol pcrjury th.l I .m mmpt ftm th. conf.cbrs' <br />liccns lil ior th. iolbwing ffi: <br />_ Scfion 70.144, l, as mcr of lha propcrty, o{ my cmplo}ea with mg6 a3 <br />thcir sla compcmation, will do thc yyork, and thc structura is not inbndcd or <br />ofLlld ior l.la. <br />S*tion 70448, l, as mcr ot with <br />SANTA ANA, CA <br />PHONE: <br />CONTRACTOR: <br />Dtr <br />STA <br />t <br />+ <br />tn <br />srr.rlA eti- I L- v ! <br />BUSINESS LICENSETT <br />PERMIT SPECIFICATIONS: <br />JOBTYPE: MULTI /AL <br />NAN'RE <br />OF WORK:PIPING <br />I hcr.by.ffim und.r pGnatty ol pcrjury on. of thc frolliling O.clantions: <br />I hm rnd will m.int in r C.ft'fi€tr Ol Conrcnt to SclrJnsurc l,or Workc6' <br />Fmpcnetim, .s pBid.d br by Scction 37m of thc Labor Cod., for thc <br />pcttonnsno ot th. rc* b, which this P.rmit is iasucd. <br />_l hm .nd will mint in WorkcB Comp.nsation lnsunn6, aE rcquiGd byffim 3700 ol thc Labq tu., io, th. poriomano of thc mri ior which this' <br />pcrmit i. i$u.d. My WortcF Comp.nEtion lnsunn@ €ricr .nd policy numbcr <br />.nl: <br />Policy Numb.r_(thi.;e{on nccA <br />or lcrt). <br />in thc pGlfomancc of th6 rcrk for which this pcrmit is issucd, I <br />any pamn in any manncr I as tro becomc sub.iccl to thc Workcc' <br />of I should to thc <br />of thc <br />WARNING: Failurc to sccurc Work6E'cengc is unlawful, and <br />tho9 <br />shall rubi6{ an cmploy.r to <br />thous.nd dolla6 (S1@,O00), <br />pmidcd ior in Scction 3706 VN <br />TYPE OF <br />CONSTRUCTION:R-tOCCUPANCY <br />GROUP: <br />BUILOING <br />PERMIT f:x-oFLOOD <br />ZONE: <br />APPROVALS: <br />PLANNING <br />APPROVAL:OATE: <br />I hcmby alfm undGr pGnalv of pcrjury that I am lic.ns.d undcr provirionr of <br />Chaptcr I (commcrcing with Setion 7@) ol DMsion 3 ol thc B$inN .nd <br />Profr3sions Cod., .nd my liccns i3 in full br@ and cncct <br />Ucala Cla$:_ Licans. tlo.:_ <br />D.t!: Conbector <br />PLAN <br />CHECK BY:DATE: <br />BDNPERMIT <br />ISSUED BY:08/L7 /99OATE: <br />.-_-MAILING ADDRESS- <br />CITY OF SAI'TAANA <br />BUILDING SAFETY DTV. M.I9 <br />P.O. BOX l9t8 <br />SANTA ANA CA- 92?01 <br />_--PUBLICCOUNTER--- <br />206W.4rh STREET <br />2nd FL(rcR <br />PHONENUMBER <br />ol4) 64?-sEm <br />EEE TYPE AITIOUNT QTY FEE <br />1 <br />1 <br />1 <br />3 <br />18 <br />2L <br />TOTALPAID TO DATE <br />AMOUNT DUE <br />43 <br />@ <br />CAP FTXTURUIN FEE AD <br />ISSUANCE <br />.25.75 <br />.o@ <br />3 <br />18 <br />2L <br />25 <br />75 <br />Drrnolitioa P.rmiE-A3Mr tlotific.don Fcdcral R.gul.tions (rd. lo, Pen E) <br />_Rcquitrd L.tbr of llotifietion. <br />_l ortly th.t th. Hcnl rcgul.tions r.garding .sbGsto6 romml .rc not <br />.ppliebl. b lhis prcia;t <br />{pdient <br />6"-itt " <br />to <br />and to <br />L <br />thal I haa that thc aboo inlormation is <br />and Slatc laY6 <br />of this City <br />ot agcnt 3iO. <br />n.m (prino: <br />OWNER-BUILDER DECLARATION <br />WORI(ERS COMPENSATION DECLARATION <br />LICENSED CONTRACTORS DECLARATION <br />APPLICANT'S DECLARATION <br />This permit shall expire by limilation and become null and void if lhe work aulhorized <br />by lhis permit is nol commenced wilhin 180 days from lhe date of lhis permil, or if lhe <br />vyork aulhorized by lhis p€rmil is suspended or abandoned for 180 days, at any lime <br />aner vrork was commenced, ln such case a nevv permil shall lirsl be oblained before <br />such r^,o,k can be recommencsd.t?/w +rs9Plt Hnf,EL t+:1.00 <br />INSPECTOR COPY. <br />ACCOUNT NO. 011.01.5912 ... PERMIT VALIDATION u"L <br />cs-611 <br />I <br />IIa <br />I <br />_l <br />itorn
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