HomeMy WebLinkAbout10196431 - Permit (2)City of Santa Ana
Permit Counter: (714) 647-5800
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20 Civic Center Plaza (M-19), Santa Ana, CA 92702 f Building
lnspection Requests: (7 1 4) 667 -27 38 I nspector Section: (7 I 4) 647 -5853
Permit #:1O196431
Pin #: 68338
Proj ect Address: 403 N Susan St
Assessor's Parcel:1 98-261 -23 Lot: NA
Unit Bldg: E Address Range: Buildings A-H
Historic: No
Suite Range:
Zoning: R2Block NA Tract: NA
Building Use: Other
Job Type: Alteration
Nature of Work. Ext. Doors
Existing Bldg. & Use: SFD w/ att garage
Proposed Use: Care Home (6 or less) w/no garage
Occupancy:
Constr Type:
Code:
Flood Zone.
# of Stories:
R-3.1
V B, SPK
cBc 2016
x-0602320256J
1
1st FL Area. 0
2nd FL Area: 0
Other Areas: 0
Garage Area:
Total: 0
Patio:
T.l.Area:
Yards Req'd:
Valuation: $6,000.00
Description of Work: Replace window with ext. door p/c fee waived per Jason Kwak
Planning Conditions
Owner:
Address:
Phone:
Tenant:
John Henry Foundation Care Facili Contractor
403 N Susan St Address:
Santa Ana, CA 927033433
(714)480-002s
John Henry Foundation Care Facil
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
ISE lnnovative Structural Engi
Shawn D Lothrop
29970 Technology Drive, Suite 108
Murrieta, CA 92563
(951) 600-0032
s5627
IDS Group
John Silber
1 Peters Canyon Road, #130
lrvine, CA 92605
(949) 387-8500
c1 5573
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
Fire lnsp. Req'd:
Police lnsp. Req'd:
Flood Zone Cert. Req'd:
*
McCann, Melanie
Kwak, Jason
Hernandez, Kathy
Date:05/15/2018
Date: 05/'15/2018
Date:05/15/2018
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002 57607 Permit Fee
01.776002 57672 Bldg. Stds Revolving
07775002 57600 General Plan Update
0L776002 57507 lssuance
Fee Total:
Paid to Date:
Balance Due:
$154.26
$1.00
$2',t.25
$52.98
$229.49
$0.00
$229.49
No
No
No
No
Yes
No
Account#Total
01 1 16002 51600
01 1 1 6002 5'l 601
01116002 516'12
$21.25
$207.24
$1.00Every permit issued shall become invalid unless lhe work on the site authorized by
such permit is commenced within 180 days after its issuance,or if the work authorized
on the site by such permit ls suspended o r abandoned for a period of 1 80 days after
the time the work is commenced.
lnspector MID#: 2016-126369
BU!LDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG COMMENTS OIVNER BUILDER DE],CARATIoN O
I hcrchy allirrn undcr l)cnrhy ol perjury lhat I anl cxctrrpl f()nl lhc Conlraclors Liccnsc Larv li)r Ihc folk)wing rcason (Scc.7031.5
Bu{incss lnd [,rofcsshn C(xlc): Atry Cily or Counly ivhich rcquires a pcrmil lo conslrucl. {llcr. inrprovc. dcrxrlish or rcpair anv
shrcturc. prior lo its issuarcc. also rcquires lhc applicant li)r slch lrcrnrit b lile a signcd slatcnlcnl lhrl he or shc is liccnsed pursuanl
to rhc proviqions of tlrc Contrack)r's Liccnsed Law (Chnplcr 9. Comnrcncing with Scction 7(XX) of [)ivision .1 of thc Busincsr and -
I,rolcssi('nsCodc)orthatlEorshciscxenlptthcrcliomandthcbasisli)rthcnllcgcdexcmfli(,n. AnyvioliilioilofScclioilT0ll.5byatry
ilpplicanlfornfcrnritsuhjcctsthc upplicrnlhccivilpcnaltyolnoln()rclhrnfivchundrcddolltrr(($5(X)).
_1. as o$ ncr of lhc p()lrrly. or my cmpkrlcc\ s'ilh wilgc\ as llrcir \()lc conrlrcn\rti()tl. u'ill d(, llrc lvork md lhc sltululc i\ nol
thcpK)ncf,y wh()buil(lsorirnprolcslhcrdnr.andwhodocssuchlvorkhitrlsclIorhcrsclforlhroughhisorhcrowncn4kryccs,
salc).
_1. rs otr ncr ()l thc l)ropcrly. anr cxclusivcly conlrilctiig wilh licct(c(l c()ntrrclors lo coDslrucl lhc frojcct (Scc. 704,1. Burittcs.
nnd [h)ltssi(n](i)dc:'[hcContrnclor'sLiccnscl-ilwdocsnolilpplyloilnowncrofpropenywhohuiklsorimprovcslhcrcoil.
nil(l $lnr contrncl\lbrsuchpruiccl\silha(i)rilrrclor(s)liccnscdpur{urnllolhc('oiltrlck)r'\LiccDsc[-as)-
I xilr cxrillot unJcr Sucli()il . B.li)r lhis
| )al e:in4 Yfls
I hcrchy atllrm undcr ltnilllyof pcrjuryonc ollhc 'lnrali()ns:
_l hrvc arxl will miiiililin il Cenilicalc ol Conscilt lo Scllilnsurc for workcrs compcnsation. rs providcd li)r by Scclion lT(x) ol lhc
Llh)r C(dc. lbr lhc lrcrtbrtnilncc of the work lbr which lhe pcrmil is issucd.
_l havc and will trriitrtrin workcrs compcnsatioD insurrncc. as rcquirc(l by Scction -1?0O ol lhc Lahor Codc. l-or lhc pcrfonnancc of
lhc work ti)r which lhis fcrnlil is issued. My wotkcrs' cornpcnsali(D insurrncc caricr urd policy nunrbcr arc:
Policy Nufirbcr: Expircs
_l ccrtili lhilt in thc pcrfornHrcc ol'lhr work for which lhis pcrnril is issucLl. I shall nol cntpkry any pcrson in any trlanncr
so rs t() hccotrrc suhiccl k) lhc workcrs conllcnsali()n lilws ol-Ctlilbnlir. ilnd rgrcc thrl if l shoul(l hLconrc suhjccl h lhc
r\()rkcr\'!oiltpcnsarionprorisionsolScction.lT(X)ofthc[-atx)r(ixlc.l\hnll.lbrlhwilhcon]t)lywilhlho\cfrovisi(ins.
WARNIN(;: fiailurc k) sccurc srrrkcrs'cortpcnsrlion covcragc is and shall stthicct rn cnpkrycr h (Tirililrnl lrcnrllics and
civil llncs np lo o[. hun(lrc(l thou\ilrtr| (k)llrrs ($l(X).(Xx)).
Sccliofi .1076 ol lhe l.alxI Co(lc- irrtcrcsl an(l xlkrrn.y s ltcs.
lo lhc ol ion. tlanragcs as pft)vi(lc(l IiI lhr
l)ilte:5-ttJ,K
I hercby rllir m rrrilcr l)cnrlty ()l pcr.itrry lhr( I ilnt provisiotr ()f ('hrplcr 9 (conriltrrcing s ilh Srclior 7(XX)) (,1 Divisir)n l
of thc Busincss and Profcssirrns Cotlc. antl rny licc[se lbrcc rn(l cl'lccl.
Liccnsc
Dn(e:
,iccn\c Nunlltr:
(i[(rnclor:
CONSTRUCTION LENDING AGENCY
I hcrcby rflirm under Frcnally o f pcrjury that thcrc is a c(nrst ruct ion lcndin8 agcncy for lhc l)c.forma[ce o[ I hc work for which lhis fErmil is
issucd (Sec. -1097. Civ. C.).
l-crxlcr'\ Nilnrc:
Lcndcr's Adtlrcss:
APPLICAN'I' DECLARA'IION
I hcrchy amrilr un(ler pcnrlty ol pcrjury onc of lhc lirllowing dcchrations:
Dcnrolition Pcrillits-Ashcstor Nolificrtio[ l;cdcral llcgulalions ( Iillc.10. Pflrl6)
-Rcquircd
[xllcr of Nolificali(nr
-l
ccrtify thal thc fcdcral rcgulations rcgarding asbcslos rcrnoval rrc not applicahle lo lhis piojecl.
_l cedify thnt I havc read this applicalion and slalc thal lhc iltnvc inli)nnation is corecl. I agre lo comply whh all Cily and Counly
orrlirrrnccs antl Slxtc Lru s rchting l()
rbo!c nlctrti()ncd prol)crly li)r inspccl
hcrchy xulh()ri7c rcl)rcscllalivcs of lhis ('ily nn(l County lo cntcr up(rl lhe
Apt)licnnl or AgcDl Signtluro
I'emrilee nanre (prinl):1(
u,r",5-lf-(tr
Set Backs
Forms/Steel/Holdowns 5-2jt4tr v.w)o
Erection Pads
UFER Ground
SLAB Floor
Subf loor/Vent/l nsu lation
Roof Sheathinq
Shear Wall
Framinq
lnsulation/Enerqv
Drywall
Ext./lnt. Lath
Brown Coat
lMasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
FINAL A-7-t/,,/ Z. 'L lN.5rq/m)
Certificate of Occupancv
Notes, Remarks, Etc.
( )$ [rr
Appliriltrl: