HomeMy WebLinkAbout101104762 - Permit (2)City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
PermitCounter: (714)647-5800 lnspection Requests. (714)667-2738 lnspectorSection: (714)647-5853
Permit #: {O1104762
Pin #: 74647
Project Address: 1246 S Arapaho Dr
Assessor's Parcel: 109-664-53 Lot: 135
Unit:Bldg: Address Range:Suite Range:
Zoning: R1Block: NA Tract: 3855 Historic: No
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Single Family Dwelling
Reroof
Reroof
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories.
R-3
VB
cBc 2019
x-06023202s6J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Totat
Patio:
T.l.Area:
Yards Req'd
Valuation:$4,732.00
Description of Work: lnstall 28 squares of comp roofing over existing one layer of roofing
Planning Conditions:
Owner:
Address:
Phone:
Tenant
Santa Ana
1246 S. Arapaho Dr.
Santa Ana, CA 92704
(7141 4s5-s4s3
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Engineer:
Address:
Phone.
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
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:
web_user
No
No
No
No
Date:
Date:
Date. 0912712020
Subject to Field:
Misc. Receipt
Misc. Receipt
Misc. Receipt
077760 02
07776002
07776002
07776002
07776002
57607
57770
57672
57500
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
$345.28
$4.05
$1.00
$23.79
$59 30
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No
Account#Total
N/A - No
N/A - No
N/A - No
Balance
Balance
BalanceEvery permitissued shall become invalid unless the workon the site authorized by
such permit is commenced within360 days afterifs issuance,or if the work authorized
on the site by such permitis suspended or abandoned for a period of 360 days after
the time the work is commenced.
Fee Totat
Paid to Date:
Balance Due:
$433.42
$433 42
$0.00
lnspector MID#'2020-1 61771
BUILEING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hercby ailirm undcr FDally of Frjury lhal I am cxcmpt fiom thc Conlrackrrs' Lrccr$c Law firr thc folktwing rcasrn (Scc.7)-11.5
BusiDcss ail Prolbssi(rn C(xlc): Any City or County which rcquircs a lErmit to construct. allcr. improvc. dcmrlish or rcpair any
structurc, pri)r b its issuancc, also rcquires thc applicant for such lErmit to lilc a siSncd statcmnl lhat hc or shc is liccnsd pusuant
k) thc provrsiurs ()f lhc c(rntractor's Liccnscd llw (Chaptcr 9, Commcncing wilh SR-lion 7000 r,f Division .l of thc Busincss and
Ptulcssions Codc) or that hc or shc is cxcmpt thcrcliom !trd thc basis for thc allcgcd cxcmltion. Any viol.lion of Sethn 701 1.5 by any
applic0nt tbr a pcrmit subjccts thc 0pplicalt lo a civil pcnalty of Dot m)rc lhatr five hundrcd dollus (.$5fi)).
_1. as owncr ot'thc propcrty. or my cmployces with wagcs as thcir solc compcnsation, will do thc work arxJ lhc strtrr*lurc is nol
intcndcd or ()ll'crcd firr salc (Scc. 7044, Busincss and Prct'cssions Ctxlc: Thc Contract()r's Liccnsc Law docs not apply lo att owncr of
thc pn)pcrty who huilds or itnprovcs lhcrcon. arxl who drrcs such work himsell'or hcrsclf or thfl)ugh his or hcr own cmployccs,
providcd that such impnrvcrncnts arc not ilrtexled or ollbrcd ltlr salc. It, howevcr, thc buikling or imprlvcrrcnt is sold within ()nc ycar
ol'complction, thc Owncr Buildcr will havc the hurdcn ol'prlving that hc or shc did not build rlr improvc thc pruJrcrty for the purJnsc of
salc).
_1, as owncr ol'thc pn)perty, am exclusivcly contracting with liccrrsctl conlractors to cottsttuct the pro.icct (Scc. 7044, Busincss
and hufcsskrn Codc: Thc Contraclor's l-iccnsc [-aw rkrcs not apply to an owncr of proJrcrty who builds or improves thcreon,
and who contracts tirr such projccts with a Contractrlr(s) liccnscd pursuant to thc Contractor's Liccnsc [-aw).
-l
am cxempt undcr Scction-, B. & P.C. tbr this rcason.
ft..r^,
WORKERS' COI\IPENSATION
DECLARATION
I hcrcby alllrm undcr Jrcnalty ol'1^-rjury onc of thc tirllowing dcclarations:
_l have arrd will maintain a Ccrtificatc of Conscnt to Scll'-lrrsurc lirr workcrs' comgrcnsation, as pnlvirlcd fbr by Scctitln -i700 of thc
l-atxrr Ctxlc, lor thc Jrcrtbrmancc of thc work lirr which thc grcrmit is issucd.
_l havc arrd will maintailr workcrs' comJrcnsation insurancc, as rct;uircd by Scct ion -1700 ot'thc Lahor Codc. lirr thc Jrcrlirrmatrcc tlf
the work lirr which this Jrcrmit is issucd. My workcrs' comlrcnsation insurancc carricr and Jxllicy nunrhcr arc:
Policy
_l ccrtity that in thc Jrcrlirrmancc of thc work tirr which this Jrcrmit is issucd, I shall not cmploy any pcrson in any manncr
so as lo bcconrc subjcct to thc workcrs' comJrcnsation laws of Calitbrnia. and agrcc lhal if I should bccomc subjcct to thc
workcrs' comJrcnsation pnrvisions o[ Scction 3700 of thc Lahlr Crxlc, I shall, lbrthwith comply with thosc pnrvisiotts.
WARNTNG: Failurc to liccure workcrs' comgrcnsati()n c()vcragc is unlawl'ul, and shall subjcct an cmploycr t() criminal Jrcnaltics and
civil linc-s up to onc hundrcd thousand dollars (Sl00,Un), in additir)n lo the cost o[ comgrcnsatiott, damages as providcd for the
Scction 3076 of the latnr C<xlc. intcrcst and atlorncy's l'ccs.
LICENSED CONTRACTOR
DECLARATION
I hcrcby atlirm under Jrcnalty of pcrjury that I am liccn:icd undcr provision of Chaptcr 9 (comnrcncing with Scction 7UX)) of Division -]
of thc Busincss and Pnllbsskrns Codc, and my liccnsc is in full tilrcc and cft'cct.
Liccnsc Class: Liccnsc Numbcr:
W
I hcrcby atfum undcr lEnalty of lrcrjury rhat th@ is a construction lcnding agcrey for thc Jrcrfomc of lhc vork tbr which lhis JEmit is
issucd (Ss. 3097, Civ. C.).
[,cndcr's Name:
lrnder's Address:
_l ccrtily lhat thc f'cdcralrcgulations rcgurling ashcstos rcmovalarc not applicablc to lhis projcct.
_l ccrtily that I havc rcad this applicnti(rn afil statc thal lhc ah)vc irformation is corect. I {!rc to comply with all City and County
orditraNcs and State kws rclating k, building construction, .ur, hcrcby auth(rrirc rcltrcscilativcs ofthis City {[d County lo cntq u[[n thc
at[vc mtrtioncd JrroJEny for insJEctioD puqr)scs.
Applicant or Agent Signaturc: Date:-
I'enrrilcc nanre I nrirrl lr
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/VenUI nsu Iatio n
Roof Sheathinq
Shear Wall ,uil% n tt^44d '?7)
Framinq t I 04
lnsu lation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
[\Iasonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif.
///
FINAL t//e6/,u,A z/l
Certificate of Occupancy '/f (//
Notes, Remarks, Etc.
Flnrr
APPLICANT DECLARATION
I lrcr,-by allirm undcr pnalty ot'Jrcrjury one of the lblklwing rlcclarations:
Dcnxrlition Permits-Asbcstos Notification Fedcral Rcgulations ('Iitle 40, Part6)
_Rcquircd Lrttcr of Notilication