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40132778 - Permit (2)
City of Santa Ana Permit Counter: (714) 647-5800 20 Civic Center Plaza (M-19), Santa Ana, C492702 lnspection Requests: (7 14, 667-2738 lnspector Section: (714) 647-5853 Mecha n ical Assessor'sParcel: 002-231-28 Lot: POR 17 Bldg: Address Range: Tract POTTS, BOROEN &Ilistoric: No Unit: B Block: NA Suite Range: Zoning: A1 q Owner: Address: Phone: Tenant Name: Contraclor Address: Thomas Pham 2941 N Hesperian way Santa Ana, CA 92706 (714) 890-22s0 Owner-Builder 01116002 51604 01116002 51604 0'1 1 16002 51600 01 116002 51604 Fee Type Amount Qty Fee Furnace 65.59 1.00 $65.59 Min Fee Adj 7.79 1.00 $7.79 General Plan Update 22.08 1 .00 $22.08 lssuance 55.04 1.00 $55.04gotEh+:4C6?l' _ \t-t/26. ),t.e tt,. , fi;rr:,.l, I,Off ice: ,. tY11 'rnni+ j t:'9 ' :; '. if tlAcct+r Fct +; ,,,,1J:179 ' ftrpti:0?421010 - !r-i .11.t rr-rii .a:ii F,'lransotL ion Totol. ,Ir| I - r.tfl Thonns ph am Phone State Lic #: Lic Type: Bus. Lic #: Workers' Compensation lnsurance: Carrier: Policy #: Expires: General Plon updote Fee01r16002- 51600000_ llechnn icsl 01116002- 51601000- V iso CC+: *r******xri*0107 $22.09 $128.42 t3(l ,00 Auth+:055118 Building Use: Job Type: Nature of Work: Planning Conditions Planning Approva Plan Checked By: Permit lssued By: Subject to Field: lBv Commercial Miscellaneous Furnace Occupancy: Constr Type Code: B, S-1 t B cMc 2016 Notes: Furnace Date: Date: Date: 1012612018 Account# Misc. Receipt: Misc. Receipt: Misc. Receipt: Total Amsden, Julie Buildins Permit #: 101 95932 Every pennit issued shall become invalid unless the wo* on the site authodzed by such porrnit is commenced within 180 days dftet its issuance, or iflhe wotk authoized on the site by such pemil is suspended or abandoned tgt a padod of 1 80 days aftet the time lhe wo* is commerrctd. 01116002 51600 $150.50 $0.00 $150.50 $22.08 $128.42 lnspector MID#: 2018-141110 01116002 51604 Permit #: 4O13277E Pin #: 42924 Project Address: 2941 N Hesperian Way Fee Total: Paid to Oate: Balanco Due: MECHANICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS oWNER ITUILI}ER DI]LCAR TION I hcrchy rlfirn undcr Nrilry ol pcrjury rh l n cxcmnr linm rl'd- C, rrrorJ l-i.cnsc t.rR lar rhc l'oll()win! rcr$i (Scc 70.115 " auiinc{\ rkl Piintsion C.nc): Any Ciry or Cortrr, *hich rc,tuncs d rr nr t' ..n(dcl. rl'cr. irnlrorc. 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Lh burdcn ofplrliia rlu lt ui nlc dil r huiltl or i'npn'vc rhc l[,rdy lnr rhc Puqr)t.l /Il.r",,nr(,'lrh.r,Drri!..n(!!lu\tr(h(trr.trrrnswithli&n\cJcotrcttr{h.onflrthcnmrc.r(Scc?(pr.BD\i't\\iil lh,rs{,nCuJc l'hc(i'ntx!rui\l (rn\.l x\ 'l.csnorrmlrtuoosncrof l]()ptny*tu huikl\ or nnpR,v.\ rh$con. rtrd sho .o r r\f.r {uch pn+crs *irh a Conrruclo( s) liscn\cd !u66nrbrhcc(, 'x.tr'r Li.c.\c trw) llgn-Brllll\ I hcrcby afaim uod* F.alr, rf Fljury o,E of lh. lolk wi.8 de!r.rio.s: -l nrtc &l I ill ruinrin r Ccdifi.ic of Cor\cnr tu s.lf ln\urc ror v ,lkcs oarpcnurion. $ prcvid.d i6r by sccrn)n lT0o orthc Uh.r Codc. ld rhc Fnbirnancc ol rhc so n, shich rhc pcrnrir is isx.d. -l hole ond will mainrain wort6 compcnsalion i.suoec, as nquied by S(tion 3?00 of rh. Libor Codc. lor lhc l,erftrnmc of rhc wort for *l ch rhn pcmi ar hsr!. My *orkcn omlc srio, iGtrl.re fftI ad policy numhd dc: ff*n'ryon*rr*p..r",nuRorrhc-o,*rmwhichfiiipcmirisis.d.lshlll.ot.trrploy.nypcrs.insnyMnturd 6 b b.com shjEr ro rhc wtrk6 omFrsrion IrH or C.liloDia. and aSIlc lh.l ir I shoukl lilom $birl lo lE sllda onw.stion prcvilion. of Sc.lio. 3'100 ol lh. tibor Cod.. I slEI. fonholth otlply wnh Oo* I,DvisioB.. WARNINC: Failurc ro surc workcn m'npcnsdbn covcBse is unl,wtul. 0.d shtrll subrrl on cmlto'lr lo dinind FrultiB lnd .iril fincs uI lo om hudrcd ltousrd dollars ($100.0t)0}. in addirio.lo lh. con ofconD.r$liotr. .km$s $ F,vidcd f.r lhc Crnc. inlcrc( ond allffrcr\ iccs. Z,O q /, IICIINIEILIONI&I(IUB DEELAM.IIAN I hcrchy aifin. unds FmlrtorIrljLry rh,r I nm ltin{d trndcr Irori\i.tr ol Chrfls 9 (conrnEo.ins {nh Sccri,n 7ffx)) oiDivnion 3 ol rhc Bulim\srM Pmri$ions Codc.orxi trrr liccn\c is in tullnncc Dd tffc.l : Lic.N Nuhttr: !;ONSIIJJIJI!}NII;NDINCAGEITT , hurch! rmntrund$ Fn,hyorp.rjDry rhnr rhcrc t ! coflslflctirn [ndine ugency Ibr rhc Frrornun.c orrhc *ork fn shi.h lhn Fnnir i\ ksued(Scc 1097,Civ C ) AIILICANLDEIIAAAIIAB I hs!-6y !trm ondcr Fnllryorp$jury onc olrhc rolkr*ing d..lmriotrs: Dcnroliio. Pcrmirs'Asbcsros Norificarion tjcdcrulResuh ion\ ( lirlc 40. Pd6r -kcquncd L.ncr of Norirrcdi[ 4 Lr,.n,ty rnn u* t",t*,t rcaul iaN Essnins a\hcsro\ rcnDral rrc dorrmli.rhlcro rhisrmjccr fA.-nnr,nn, *,, *"uun\ rrnhrrtr'n rkl {rrc rh rlt r&rvc inhnnrion i\c.qrcr.I xgN ro.rNpl, wirh rll cny rnd (bunry 'lfr,lnoncs mlSr ull*.r.urnsr.hd'ldnrc, rrtu trm. ld hcr cby.urhorizc rcrc$nllr iles or rhk Cir, ed counry r) ctrlLi uJn,r r,r rhrc Hnri{,ncd lrr,nony ntr Antlictrnr or Arcnr Signrllrc:^", py'e/zaT Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulalion lnsulation Smoke Detectors lnstalled Rouoh Ductwork Vents Toilet Room / Clothes Dryer t,/..11-19 Jc(M lv Residential Ranqe Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openings lnstallation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Meter Release FINAL I l\llq 1'tM)/.2 .?) Notes, Remarks, Etc.I I U Final Test lr '.i. \ \un,hu -l'\nnr\ - L.ftlel1 Nrm: - I