HomeMy WebLinkAbout30141103 - Permit (2)llfu Cig of Santa Ana 20 Civic Center Plaza (M-1e), Santa Ana, CA s2702 Plumbinp Permit #: 30141{03
Pin #: 441{9
Proiect Address: 1129 112 S Van Ness Ave-a- -
Assessor's Parcel: 013-094-08 Lot: 66
Unit:
Block: NA
Bldg.
Tract: 648
Address Range:
Historic: No
Suite Range:
Zoning: Rl
Owner:
Address:
Phone:
Roberta Rogers
1129 S Van Ness Ave
Santa Ana, CA 927071135
(7141 41 s-98s8
01 1 16002 51602
01 1 16002 51602
01 1 16002 51602
01 1 16002 51602
01 1 16002 51602
01 1 16002 51602
01 1 16002 51602
01 1 16002 51602
01 1 16002 51600
01 1 16002 51602
Fee Type
Water Closet
Shower/Bathtub
Sink
Garbage Disp
Sewer Alter/Repair
Gas Line alter/extend/ar
General Plan Update
lssuance
Amount
14.78
23.12
13.20
11.08
46.25
68.1 4
68.1 4
46.25
22.95
57.20
Qty
100
1.00
2.OO
1.00
1.00
1.00
1.00
1 .00
1.00
1.00
Fee
$14 78
$23.12
$26.40
$11 08
$46.25
$68.1 4
$68.1 4
$46.2s
$22.95
$s7.20
d ",n oEi?4.& a , .-.
,
Tenant Name:
Contractor.
Address:
Owner-Builder
Phone.
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policv #:
Expires:
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Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Accessory Dwelling Unit-C Occupancy:
Conversion Constr Type
ADU Code:
Date:
Date:
Date:
R-3
VB
cPc 2016
a_f-EtrrnEat t rtt't rltatttr?a c.attrrgart t i.ta a altra v? irLllrL , st-
nt I I annn- qt afit'llll1tl-t'.1 a a|Ytrtra. rr' a !rrr'!'Vtr!'
Etl rrreh i nnI atrlrr aaalnt t r etlnn- Et (nnnntl-
rJ a a a t.tarrja- r.t a irtJLrr.t.rr.
l{err} an l'rr^i
r t Li -, l, Lt glat l,
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!.y, ..q.. tvrL.
Notes:
Fee Total:
Paid to Date:
Balance Due:
c?4, r ?r,.FL..t r a L..a,
c9(tL t
07 t0st2019
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt.
Total
Amsden, Julie
Building Permit #: 10199067
Every permitissued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
issuance , or if the work authorized on fhe site by such permit is suspe nded
or abandoned for a period of 360 days after the time the work is
commenced.
Inspector MID#: 2019-149037
01 1 16002 51600
01 1 16002 51602
$22.e5
$361 36
$384 31
$0 00
$384.31
PLUMBING.!NSPECTOR RECORD
COMMENTSAPPROVALSDATEID/SIG.
UNDER GROUND
Waste & Vent D ZL t7
Water-Under floor
Gas-Underfloor
Buildinq Sewer
ArealStorm Drain
I nterceptor/ CIa rifier /
TOP OUT .4.
Waste & Vent
Water Piping y 4;li)
Gas Pipinq U \)
Roof Drain
Tub/Shower Test 0-
Rough Water Heater
POOL/SPA
P-trap/Drain Line Y
Main Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary SewerlCap
Back Flow Device
Rough Plumbing
Final Gas Test
Meter Release ll ^l nA,?2
Etc.Notes Re
FINAL
t)t:1.('.\R,\'l'loN
I hcrcby affm unda panalty of perjury thd I m qmpt from thc ContnctoB' Lic€e l.rw for thc.folloling @n1Sc.7031.5
Buins 8nd Prcfsion Codc): Atry City or Courily which roquira a pcmt to onstruct. altE, improvq &molish or rcpair my
structurq prior to its isumcc. also rcquirc thc applicilt for such petrnit to filc a sigtrcd stdmmt thal hc or shc b lic63cd pNmt
ro thc provisions of thc Contnctor's Licms€d Lis (Chapts 9. Comcncing with Sction 7000 of Division 3 of thc Busins ud,
Prcfgions Codc) or that hc or shc L qopt thacfiom md thc bosis for lhc allcgcd cxmpion. Any violuion of Sc{ion 7031.5 by tny
applicaot for I pcmit subjcts thc applicsnt to a civil poslty of not morc thil fivc hundrcd dollm ($500).
-1.
s omo of thc Fop.rty. or my mployc with wag6 I thcir mlc ornpcnsation. will do thc wort and thc dnE{rc b rct
i[tqdGd or offacd for slc (56.7044. BEin* ud PtofcssioB Codq Thc Contraclor's Licdsc law do6 not apply to fi omc of
thc FoFty who hrilds or imprcrc thasn. ed who doB such wrt hiruclf or hcrclf or thrcugh his or ha om mployc.
provid.d that such imprcvffiB m mt irtodcd or olfmd for slc. lf, hosffi. thc building or imFovaml is sU wilhin one )@
of omplaion. rhc Ovna Buiklq wi[ haw rk hrd6 of pving tha hc or shc dil mt hrild or inerovc frc popa'ty for the prpos of
foperty. am exclusively contracting rvith licensed conlracton to construct the project (Sec. 7U4, Business
and [\ofission Code: The Contractor's License Larv does not apply to an owner of property rvho builds or improves thereon.
and rvho contracts for such projects rvith a Contracto(s) licensed pursuant to the Contractor's License Law).
-l
arn exempt under & P.C. for this
I hereby alTirnr under penalty of po'jury one of the follorving
- _ -l have and rvill rnaintain a Certificate of Consent to Self-lnsure for rvorkerc' compensation. as provided for by Section 3700 of the
I-alxrr Code. ftrr the perftrnnance of the s,ork frrr uhich the pernrit is issued.
_ - I havc and s'ill lnaintain s'orkers' compensation insurance. a.s rcquired by'section -1700 of the l-abor Code. for the perftrnnance of
the u'ork for rvhich this perrnit is issued. My s<rrkers' compensation insurance carrier and policy nutttber are:
( 'arr icr :
l r 1ti1 ("i '
cenify that ill the Frrfonnance of the rvork for rvltich this pernrit ts isstrccl.shall nol employ an\'person lll any nlanner I
s()as to become subject lo thc s'orkcrs'cornpensation laws of (-alifornia.and agree that
shall. forthrvith
ir r sltoulcl beconte subject to the
workers'compensalion provisions of Section -3700 of the Labor Code.comply s'ith those provisions..
WARNING: Failure to secure rvorkers' compensation coverage is unlarvful. and shall subject an anployer to crirninal penahies and
civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. datnages as provided for the
1076 of the Labor Code. interest and fecs.
b?4
I hereby a(Tirrn under penalty of perjury that I arn licensed provision of Chapter 9 (commencing rvith Serrion 7000) of Division -3
of the Business and Professions Code. and my license is in full force and effect.
License --[,icense
Number:
('ontraclor':
('()NS'l'ltLl("1'loN LENl)IN(;,\(;I1N('\'
I hrcby aflim unda pcnalty of psrjury that thq. is s constructior lcnding ag6cy for lhc prforrmcc of the \rcrk br *hich this Fmit b
issucd (Sec. 3097. Civ. C.).
Lcnder's Name:
I .crrtlcr 's Adth css:
APPLI('AN'I' DE(: LARA'I'ION
I herelr), aflinn under penaltv of perjury one of the follorvirtg cleclarat iotls:
Denrolition I'erntits-Asbestos Notification Federal Regulations (f itle 40. Pafl6)
_ -Rcquired l-ettet of Nolification
certify that the federal regulations regarding asbestos removal ale not applicable to this project.
s'ith all City and County
and County to enter upon the
above rnentioned property for inspection
A;lplicnnt or Agertt
I'ernrilee name ( print ):{tl Rd
3--/7
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Section
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