HomeMy WebLinkAbout10202421 - PermitCity of Santa Ana PRq.lECT
ADORESS:611 N. BRISTOL ST
SUrrE*: oFFICE SUITE
RANGE:JOBTYPE: MULTI /AL
5t L-553AOORESS
RANGE:BUILOING #:ALTERNATURE
OF WORK:I NA
Blck:
LEGAL
OESCRImON: Lot
CONDO COMPLEXNO. OF EXISTING
EUILOINGS & UsEl
rnct 1c,8 5 L V-NTYPE OF
CONSTRUCTION:
BOCCUPANCY
GROUP:
s@5-oaL-23ASSESSOR',S
PARCEL il:
I h.cby etfim undsi prnalty of pcrjury that I am axempt ftom thc contracloG'
liccns law for thc folliling ,6aen:
_ Scction 7044A. l. as omer ot thc prcpcrty, or my cmployG with Mgcs as
thrir slc ffipGnstion, will do thc rcrk, and tha structuG is not intcnd6d or
offcrcd lor slc.
t
70448, l, as mcr thc with
@nskuc't
TENANI IMPROVEMENT
ANO / OR REMODEL AREA:
x-@FLOOO
ZONE:
owNER: SHADOW WOOD HOA
NEW / AOOL,
1st FLR. SQ. FT.:
NEW/ADOL.
OTHER SQ, FT.:
NEW / ADDL.
GARAGE M, FT,:
ADDRESS: %MANUEL SEPULVEDA NEW / ADOL.
2nd FLR. SQ. FT.:
511 N BRISTOL ST ZONING: R- 1 VALUATION:
SANTA ANA, CA PHONE:VCPLANNING
APPROVAL BY:DArE: @A / t1 / 99
CONTRACTOR:BLDG. SAFEW
PLAN CHECK BY:/,DATE:
HjE'J.", 6-aoN @8/L7/9eDATE:ADDRESS:rr .r rr-rv nnl:C\EIl\/nTll/.\NlJlvllvlul\l I
^F I tln I Af I r.\t\ I
I f f-f E\)l-l I vr-r I '\'zr !DIMPROVEMENTS
REOUIREO:
LANDSCAPING
REOUIRED:
i
I
I h.rcby atfim und.r pOnalty of p.riury one of thc tolliling O@laEtions:
I haE and will maintain a Ccrtificatc Ot Consont to S.lt-lnsurc tor WorkcB'ffi'pcnstion, as p@idcd ,or by SGction 37OO of the Labor Cod6, for thc
pcriormencc of thr rcIk tor which this Pemit is issucd.
_l haE and will maintain WorkcB' Compcnstion lnsunncc, as rcquired by
S6lion 37m ot the Labor Codc, for thc pcrfomancc of thc rcrk ,or wtrich thispomil is issucd. My Workc6' Compcnstion lnsuran@ caricr and policy numb€r
a16:
PolicvNury:fyF#f-"' :
that in the perrormance of the rcrk for which this prrmit is issued, I
any pe6on in any manner so as to brcome
WARNING: Failurc to surr WorkeE' Compansation coerage is unlaw'ul, and
shall subj6ct an cmployer lo criminal ponalties and civil rines up loonc hundred
thousand dollaE ($1m,0m), in addition to the cost of compcnsation, damaEcs as
prwidod for in Soction 3706 of ihe Labor Code, interest, and attorney's tees.
i]
subjacl
of
A
to the
and agree that if I
I shallof Scction 3700
thos
ADDRESS:
PHONE:
I hcrcby .ftim undcr penalty ol perjury that I am licen$d under prdisions of
Chaplu I (@mmcncing with &ction 7000) o, DMsion 3 ol thc Busincss and
Prclcssions Codc, and my lic.ns is in full torcc and cttccl.
Lionia Clas:_ Liccn$ No.
Datc: -Contraclor:LICENSE #:
INSTALL DRYWALL IN OFFICE
X'U BE /EHIFIED BY
FIELD INSPECTION
JOB DESCRIPTION:
f-/
Santa Ca.92701
BY/DAT
PER:
206 W. 4th. Street
2nd Floor
(714) 647-5800
City of Santa Ana
Building Safety Div. M-19
P.O. Box 1988
1
1
1
1
FEE TOTALPAID TO DATE
BALANCE DUE
FEES:PERMIT FEE
INVESTIGATION
PENALTY
ISSUANCE
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232 . OO
20
55135
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I hcroby atfirm undcr pGnatty of perjury that thcrc is a conslruction lcnding agcncy
for thc pcrlormancc of thG rcrk for which this pcrmit is issuod SGc. 3097, Civ. C.)
!-6nda,'s namc'
D.molition PormiB-AsbcstDs Notification Fsd.ral Rcgulations Oitlc 40, Part 6)
_Rcquircd Lctt r ol Notifietion.
_l crftty that thc lcdcEl rcAulations ragarding asb.st6 rcmffil arc not
appliabl. to thE prqrct
and County
I
Lcndc/s
cltv
r)
iooncct. I
rclating to
and County to
and Statc laE
P.rmittE namc (print):
jPPlient ot .g.nt
_l ccrtty that I h.E rc.d this
with all
OWNER.BUILDER DECLARATION
WO RKERS COM PET.ISATIOIi DE CI-A RATIOT{
LICENSED CONTRACTORS DECLARATION
CONSTRUCTION LENDING AGENCY
APPLICANT'S DECLARATION
Mailing Address Puhlic Counter
This permit shall expire by limilalion and b€come null and void if lhe work aulhodzed
by lhis permil is nol commenced wilhin 180 days from lhe date of lhis permil, or if the
work aulhorized by lhis permit is suspended or abandoned for 180 days, at any lime
aner work was commenced, ln such case a new permit shall first be oblained before
such work can be recommenced.
, 2-ro- 27
MBUILDING PERMIT PERMIT NO.LO20242L
Account No. 011-01-5911 - Pemit Validation CS-6os
?ty, r:s9mfr
eL
t{IscEL t2s2.m
,rvsPEcron coPY ->Avfl)
Address UniUSuite
BUILDING .-. INSPECTION RECORD
Notes, Remarks, etc.:
a
OWNER-BUILDER .TION
I hereby affirm undar penalty of perjury that I am exempl from the Conlraclors' Licenso Law for lhe follor,ring reaaon
(Sec. 7031.5 Business and Professions Code): Any City or County which requires a p€rmit to construct, alter,
improve, demolish, or repair any slruclure, prior to its issuance, also roquires lho applicant for such permil to lile a
signed statement that he or she is licensed pursuant to lhe provisions of lhe Conlrac-lors' Licensa Law (Chapler 9,
commoncing wilh Section 70fi) of Division 3 of lhe Business and Professions Code) or lhal he or she is exempl
lherefrom and lhe basis for lhe alleged oxemplion. Any violation of Seclion 7031.5 by any applicant for a permil
subjects the applicant to a civil penalty of nol mo,e lhan fiye hundred dollars (15fl)).
_1, as ourner of th€ prop€rty, or my employees wilh urages as their sole compensation, will do the uork, and the
struclur€ is not intended or ofrered for sale (Sec. 7(X4, Business and Professions Code: The Contractors' License
Law does nol apply to an ormer of the prop€rty wtto builds or improyea ther6on, and wtro does euch uork himself or
hersalf or lhrough his or her orvn employees, provided thal such improvemonls aie not intended or of,ered for sale. lf,
hoivever, the building or improvement is sold within one year of completion, lho O,vnor-Buildor will havo lh€ burden
of proving lhal he or she did nol build or improv€ for the purpoee of sale).
_1, as ovrrnor of tho prop€rty, am exclusively conlracting with licensed contraclors lo construcl the proiocl (Sec.
7(X4, Business and Professions Code: The Conkac{ors' Licenso Law does not apply lo an oymer of property who
builds or improves lhereon, and who conlracts fo. such projects with a Conlraclo,(s) liconsod pursuanl lo the
Contractors' License Law.).
I rm rxompt undor S€c{ion: , B. & P.C. forthis r6ason.
Site Work Remarks Date Signature t.D.
Setbacks
Forms/Steel /Holdowns
UFER Ground
Slab Floor
lr.J
Pool Fence
Masonry
Building Remarks Date Signature
Under Pinninq (floor ioistl
Foundation Ventilation
Roof Sheath
!nsulation / Enerqy
Dry Wall
Exterior Lath
TSar
Handicap Requirements
I t&6*,!:FRAMING I
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FINAL (Tenant lmorovementl t I '"1,, ,?13 fr -R-^r,T'J_
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Ownar:
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