HomeMy WebLinkAbout30241951 - PermitProject Address: 1005 N Fairlawn St
Assessor's Parcel: 405-1 14-07 Lot: 41
Unit:
Block: NA
Bldg:
Tract: 1899
Address Range:
Historic: No
Suite Range:
Zoning: Rl
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Plumbing
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #: 30.24{95{
Pin #: 37E36
Owner:
Address:
Sankofa
1005 N. Fairlawn Ave.
Santa Ana, CA 92703
(310) 350-1792
Fee Type Amount
Water Closet 14.78
Shower 23.12
Sink 13.20
Clothes Washer 14.52
Wtr Htr (Res up to 50 gi 23.,,12
Repipe Res (Each 100' 46.25
General Plan Update 22.9s
lssuance 57.20
Microfilm Records 3.91
Qty
2.00
2.00
2.OO
1.00
1.00
1.00
1.00
1.00
1.00
Fee
$29.56
$46.24
$26.40
$14.s2
$23.12
$46.2s
$22.e5
$57 20
$3.e1
Phone:
Tenant Name:
Contractor
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier.
Policy #:
Expires:
01 1 16002 51602
01 1 16002 51602
01 1 16002 s1602
01 1 16002 51602
01 1 16002 51602
01 1 16002 51602
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
t, Building Use:
I Job Type:
" Nature of Work:
Single Family Dwelling OccuPancy:
Alteration Constr Type
N/V - Demo/Repair/Restore Code:
Date:
Date:
Date:
R-3, U
VB
cPc 2019
Notes: Plumbing fixtures. Owner-Builder form on file.
st'r lit & uofum€nu
Planning Conditions:
Planning Approval By
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Chavez, Dave
102103204
02t19t2020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
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 the site by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
Inspector MID#: 2020-1 57561
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
$22.95
$243.29
$3.91
Fee Total:
Paid to Date:
Balance Due:
$270 1 5
$0 00
$270.15
Lliu'/ su
3r'ftt t
16LtLt2
PLUMBING-INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS otvNlitt lr t I I l.DI|R I)l,ll.('A RA'l'l( )N
t hercby sffum undcr Fnslty of pedury thal I m cxen?t from lhc ContrcloB' LLw Lrw for thc following mwn (Sc.7031.5
Busin$s rrd Profcssion Codc): Any City or County which requircs s pcmil lo onstruct. 8116. itr{rrcrc, dcmlish or qdr my
structurc, prhr to its issure. sls rcquircs thc spplicmt for such ;rmit to lile 8 signed strtercnl lft8t hc or stE is liensd Pusant
ro the ,f,ovisiotrs of t|! Conlrctor's Lictnsd Lrw (C-haprcr 9, Commrcing vilh Sation 7000 of Divisbn 3 of lhc Busircss od
Pmfcssions Code) or thsi hE or shc fu crcmpt th@frcm rnd thc bosis for thc Ellcggd excmplion. Any violstion of Scclion 703 I .5 by 8ny
tDplic8nt for 8 permil subjlrts the applicant to s civil penslty of not mrc than live hundrcd dollrs ($500).
ffi u on* orrhc prcFny. or my emph)rcts with wagcs ss their rclc ompsrsslion, uill do the wt utd thc stndrc b Dt
l'ln-.tendcd or ofrcrcd for sle (Sc.7O44. Busincss md Professions Codc: The Conlraclor's Liccns lrw docs not spply ]o 8n owner of
tlE lrclraty who builds tr in$m6 thcpn. rnd wl[ dc sh rc* himsclf or herslf or lhrcugh his or hcr own cmplolrccs.
prcvkledrhrtsEh imFowGnlsNmtintqrdedffollcEdftrslc. lf.howcg.tlEhriHirgmitrTtrecnrissldwhhhorc)r
of @trpbliotr the Owrcr Builtcr will h8rc the burdcn of Foving thd hc or shc dil mt boiH or itrptoE thc trclqty for tlE PulIs of
sle).
_L as owns of the propcrty. am exclusiwly @ntlactiog wilh liensd contGlor to o[ttruct lhc prc]r-l (Sa. 7044. Busircss
rnd Ptofssi,n Code: The Contrrctor's License kw dos not apply to m owner of prcpcrty who buildr or imPrcvcs thqeoft
rnd who contmts fd iuch pmixts with s Contrscto(s) liensd puEut to thc Coilnctor's Lhcos [5w).
_l,am cxcrnpt B.&
()r'ner: *
I hcreby affirrn under Fnalty of Jrcrjury onc of the following
_l havc and will tnaintain u Ccrtillcatc of Consclrt to .Sclt-tnsurc li)r workcrs'conq)ensillion. as pn)vidcd lbr by Sccliott 37fi) ol'thc
t-abor Ctxlc. t'orthc pcrlirrrrurrrcc oIthc work for which thc pcntrit is issucd.
_l havc 1n<l witl nlaintain workcrs'cotnpcnsation insurancc. as rcquircd hy.sccliott -17(X) of thc l,ahor Codc. for thc pcrf'ortnancc of
thc work ltrr u,hich this pcrnrit is issucd. My workcrs' corlrpcnsution insurancc can'icr alxl policy nutnhcr iuc:
in thc pcrfr)rmanceo[thc work for which this pernrit is issucd. I shall not cmploy any person in any manncr
if I should bccomc subjcct to thc
conrply with thosc provisions..
subject to thc workers'compensation laws of Califcrrnia. and agrcc that
workers' compensation provisions of Sc.ction 3700 of thc L.rrhr Codc. I shall. forthwith
WARNING: Faiturc to securc workcrs'corrrpcnsation covcragc is unlawful. and shall subject sn cmployer to criminu! Jrenalties and
civil fincs up to onc hundrcd thousand dollars ($l00.un). in addition to oI damages as provided for the
Scclion 1076 of Codc. intercst and attorney's fecs.
o 2{2o o
I
I hcreby affirm undcr pcnalty of perjury lhat I am licensed under provision Chaptcr 9 (cornmencing with.Scclion 7000t of Dlvision 3
of thc Business and Professions Code. and my license is in full force and cffcct.
t,
l)lrlt'. ('tlltlritclttr.
CONSTRUCTION LENDTN(: AGENCY
I hcrchy nllirn undcr lrcnllly ot pcrjury rhar therc is a construcrion lcndirg a8cncy lbr lhc p(rfornuncc oflhc work for whhh lhis trcnnil is
issucd (Scc. 1097. Civ. C.).
Lcndcr's Addrcss:
APPLICA NT DIICLARATION
I h'rcby itflinrt undcr ;rcnalty of Jrcrjury onc of thc following dcclarations:
Dcmolition Pcrntits-Ashcstos Notification Fcdcral Rcgulations (Titlc 40. Part6)
-Rcquircd
Lrttcr of Notilication
_t ccrtify that thc fcdcralrcgulations rcgarding asbcslos rcrnoval urc nol applicablc to lhis project.
f?Accnify that I havc rcad this application arxl statc rhar thc atnve infirrmatiolt is correct. I agrcrc to comply
%rdinances ancl State l.aws rclating to builcling conslruction. and hcrcby aulhorizc rcprcscntatives of this City
with all City and County
antl
atxrvc rrrcnliorrcd propcrty for irrspcction
Applicanl or Agent
l)t nrrilee nirnre
t --
cnlcr
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underf !oor
Buildino Sewer
ArealStorm Drain
I nterceptor/ Clarif ier
TOP OUT
Waste & Vent
Water Pipino
Gas Pipinq
Roof Drain
Tub/Shower Test
Rouqh Water Heater
POOL/SPA
P-trap/Drain Line
Itlain Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heaterlcas Line
Miscellaneous
Gas Service
Water Service
Lawn Sorinkler
Sanitarv SewerlCao
Back Flow Device
Rouqh Plumbinq
Final Gas Test
Meter Release rl D.
FINAL ll 11l-h)T*W,,"1
Notes, Remarks, Etc.- I
ll 11 l'?,0 Fro %a L€Altrv t> L'K1r1r'69 ,
ffiW\/61 I =-DI+J+W-L
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Date: J
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