HomeMy WebLinkAbout102102600 - PermitProject Address: 825 S Cypress Ave
Assessor's Parcel: 01 1-052-03 Lot: POR 8
Unit: A Bldg: Address Range:
Tract: PART OF MCFADDEI+WILBlock: NA Historic: No
Suite Range:
Zoning: R2
bity oi 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 #: 102102600
Pin #: 23111
Building Use.
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Single Family Dwelling
Demolition
Nru-Demo
SFD w/ no garage
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories:
R-3, U
VB
cBc 2016
x-0602320276J
1st FL Area
2nd FL Area
Other Areas:
Patio:
T.l.Area.
Yards Req'd
Valuation: $1 ,000.00Garage Area:
Totat
D6cription ot Work Demo unpsrmitted laudiy f.cilitytwslb in g.rege and revod back to odglnal use. Removo snclosad walla in carpoi aroa and r€tuh
back to orlglnal usa. Auth on fila.
Planning Conditions:Hs h i errr ,\ l t
Owner:
Address:
Phone:
Tenant
Nghiem Nguyen
54 Maywood
lrvine, CA 92602
(7141 492-2607
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation !nsurance:
Carrier:
Policy #:
Expires:
Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
Generol Plnn Updqte Fee
01 I l6t[J2- 5160rJurl0-
fll
d ins
6lrtr2- Sl6rJlLrlru-
Stds RevoIv i ng
6LtLr2- 516 1?rllr0-
c'f i Iril & Documen t
Bui
B
I'l t ct
frl I
L.r.t
2- 17771:tLilJrJ
***********x374S Aut
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd: No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Landscaping lnsp. Req'd: No
Gomez, Pedro
Zuniga, Allissa
Date: 1211712019
Date:
Date: 12118/2019
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002
07776002
07776002
07776002
07775002
07776002
57607
57770
51607
57672
57600
57507
Permit Fee
Microfilm Records
Penalty
Bldg. Stds. Revolving
General Plan Update
lssuance
$166.s3
$3.91
$252.69
$1.00
$22.95
$57.20Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 57770
Account#Total
Every pqrmitissued shall become invalid unless the work on the site authorized by
such permit is commenced within360 days afterits issuance,or if the work authorized
on the site by such permit rs suspended or abandoned for a period of 360 days after
the time the work is commenced.
lnspector MID#:201 9-156616
$22.e5
$476.42
$1.00
$3.91 Fee Totat
Paid to Date:
Balance Due:
$504.28
$0.00
$504.28
BUILDING. INSPECTOR RECORD
S!TE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION
I hocby affm undr pclalty of pcrjury that I m exmpt from thc Contraclos' Licere tlw for the following rwn (Se.7031.5
Busines md Profcssion Codc): Any City or County which requirc a pemh to coNtrucl, altq, imprcvc. dcmolish or rcpair my
structue. pnor to its issuacc, also rcquirc thc applicilt for such pctrrit to filc a signcd statmat thal h€ or slrc b licqscd plMt
to thc provisiom of thc Contractor's Liccnscd Law (Chspa 9. Commmcing with Setion 7000 of Division 3 of thc Buins 4d
Prcfsiom Cod€) or that hc or she is exempt thqefrom ud thc b6sis for the allcged cxmp(io[ Any violstion of Scrion 7031.5 by any
applicut for a pmil subjets thc applicant to a civil pcnalty of trot morc tha fivc hundrcd dollm ($500).
_1, s owna of thc property. or my cmployc with w8g6 s thcir $lc compcnsation. will do thc wd( ad thc struclrc is rcl
intqrded or offcrcd for slc (Sc.7044. BNins md Profeiom Codc: Thc Crntractor's Liccre lrw do6 not @ply to u ownq of
thc prcpsry *'ho builds or improvc tho@tr ud who do6 such wtt hiroclf or hwlf or thmugh his or hr om mploye,
provided that such inFovms rc not inandcd or offocd for glc. If. howdq. rhc building or improvqrcnt is sH whhin onc )qr
ofcompletioo, thc o\vn6 Buildq will have thc hrd6 of proving thd he or $e did rct hdld or inprovc thc prcpsty for thc purpo*of
ele).
-1,
r omq of the propqly, m qclBivcly contracting with licens€d contmctoc to @mtrucl thc projct (Sc. ?044, BEinG
ard Proftssbn Co&: Thc Contrctor's License Law do6 not applyto u own6 of propoty who builds or improvG thq6n,
md who ontrads for such projcls with 8 Contmcto(s) licas€d pu6uet to thc Contractor's Licre Law).
_ _! am exempt B.reas()n.
r'I hereby affrrm under penalty of perjury one followrng
_-_i have and will maintain a Certifrcate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the
labor Code. for the perfonnance of the work for which the permit is issued.
_l have and will maintain workers' compensation insurance. as required by Scction 3700 of thc Labor Codc. for the performance of
the work for which this permit is issued. My workers' comperuation insurance carrier and policy number are:
Carrier:
Policy Number:
--l certi& that in the performance of the work for which this permit is issued. I shall not employ any person in any manner
so as to become subjert to thc workers'compensation laws of California. and agree that if I should becorne subjcct to the
workcrs' compensation provisions of Section 3700 of the Labor Code. I shall. forthwilh comply with thosc provisions.
WARNING: Failure to secure workers' compcnsation coverage is unlawful, and shall subject an onployer to criminal pelrahies and
civil fines up to one hundred thousand dollars in addition to the cost of compensation. damages as provided for the
Section Code. interest(
I hereby alfirm under pcnalty of perjury that I am licensed undcr 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code, and my license is in full force and effect.
[.icense Numbcr:
Dete: Contrector:
W
I hreby aflim undo porahy of pcrjury that thoc is 8 construction lqding ag6cy for thc pcfotimcc of thc wo.k for which this pflnit is
issued (Se. 3097. Civ. C.).
Lcnder's Name:
I-cnder's Ad&ess:
APPLICANT DECLARA'TION
I hercby affrrn under penalty of perjury cne of the following declarations:
Dcmolition Perrnits-Asbestos Notilication Federal Regulations (Title 40, Pafl6)
-.Required
Letter of Notification
-
I cstify that thc fcdqal rcgulatioN rcgading obstos moval rc not applicablc to this prcjet.
W ,nn I have ud this application ard state rhal rhc above infonnation is coret. I agc to @mply with all City md County
ordinancB ad Stste tiws rclati[g to building constructiorL ad hscby authorirc rcprBmtalive of this City md County to ats upon thc
above mentioned property for inspection purposes.
Applicant or
llernritee
\
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bfloor/Ve nU I n s u latio n
Roof Sheathing
Shear Wall
Framing
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif.
/l --l
FINAL //ril ??o 24 %tr /
Certificate of Occu
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