HomeMy WebLinkAbout102103204 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
PermitCounter: (714)647-5800 lnspection Requests. (714)667-2738 lnspectorSection: (714)647-5853
Permit #:1O21O32O4
Pin #: 5E917
Project Address: 1005 N Fairlawn St
Assessor's Parcel: 405-1 14-07 Lot: 41
Unit:Bldg: Address Range:Suite Range:
Zoning: R1Block: NA Tract: 1899 Historic. No
Building [rse: Slngls F.mlly Dwolllng Occupancy: R-3, U lst FL Area Patio:
Job Type: Alter.tion ConstrType: V B 2nd FL Area: T.t-Area:
Nature of Workt NrV - OsmorRop.irrRe.tors Code: CBC m1 S Olher Areas: yards Req.d:
Existing Bldg. & Use: SFD wr.tt car.go Flood Zone: X{r602320144J
proposed use: # of stories: Garage Area: v'lualion: t1'000'oo
Tolal:
Oescrlptlon of Work: Osmo unpoamittgd Ehad attachod al roar oI racidenca, sgal oft unparmittad door opornittg at rrar and tinish with matodala that
Planning Conditions:
match existing, repair and finish damaged stucco with like materials and finishes, and repairlremodel kitchen and other interior
spaces as required per case. No change to windows or floor plan included as part of this proiect. Owner-Builder form on file.
Owner.
Address:
Phone:
Tenant:
Sankofa
1005 N. Fairlawn Ave.
Santa Ana, CA 92703
(310) 350-1 792
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation Insurance:
Carrier:
Policy #:
Expires:
Engineer:
Address:
Phone:
License #:
Archrtect /
Designer:
Address:
Phone:
License #:
a ,
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES Insp. Req'd. No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Landscaping lnsp. Req'd: No
Chavez, Dave
*
Fire Insp. Req'd:
Police lnsp. Req'd
Soto, Ricardo Date: 0211912020
Date:
Date: 0211912020
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
077760 02
07776002
077750 02
077760 02
0777600 2
07776002
0777600 2
Permit Fee
Microfilm Records
Investigation
Penalty
Bldg. Stds. Revolving
General Plan Update
lssuance
Fee Total:
Paid to Date:
Balance Due:
No
No Account#Total
57607
57770
s7507
57607
57672
57600
57607
$333.06
$3.e 1
$100.57
$252 6e
$1 00
$22.9s
$s7.20
$7t1 38
$0 00
$7t 1 .38
Flood Zone Cert. Req'd: No
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days afterifs issuance,or if the work authorized
on the site by such permitis suspended or abandoned for a period of 360 daysafter
the time the work is commenced
01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 57770
$22 95
$743 52
$1 00
$3 91
lnspector MID#: 2020-157561
SITE.WORK DATE ID/SIG.COMMENTS OWNER B UILDI.IR I)I.:LCA RATION
I hereby affirnr under penalty of perjury that I am exempt fr<lm the Contractors' License Law for the following reason (Sec.7031.5
Business and Prol'ession Code): Any City or County which requires a grermit to construct, aher, improve, demolish or repair any
structure, prior to its issuance. also requires the applicant for such permit to file a signed statemenl that lr or she is licenscd pursuanl
to thc. provisions of the Contractor's Licensed Iaw (Chapter 9, Commencing with .Section 7fi)0 of Division 3 ol'thc Business and
Prot'essions Code) or that he or she is exempt thereltom and ttre basis frrr the alleged exenrption. Any violation of Section 7031 .5 by any
iyfllanr for a pcnnit subjects rhc applicanl lo a civilpennltyof not more than llvc hundred dollars ($5Ott1.
W^f .}:il:li';i[[?3J;ffi:ff,?J:"':.:lHHilfli?il:$.':[fril1',:l;il:*:Lx,.,Hy,:Hffi[:J#,1.,",
the prcperty who builds or improws thcroru and wtn does such work himself or herself or through his or her own employees.
provided that such improvenrcnts arc mt intendcd or oll'cred for salc. Il. however. thc building or improvcrnent is sold within one ycar
of conpletion, lhc Owner Builtler will have thc burden of proving that lrc or she tlid not build or improve Ore propaty ftrr thc purposc of
sale).
_1, asownerof the properly, amexclusivelycontracting with licensed conlraclorstoconslruct the pmject (Scc.7M4. Business
alxl hofe;skrn Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon.
and who contracts for such projccts with a Contracto(s) liccnsed pursuant lo the Conlraclor's Liccnsc taw).
_l am under Secti.rn-,?-Owner: \t
woRKaRS'('OttP}:NS <
I hcreby allirm under grenalty of perjury onc of the tbllowing dcclarations:
-l
have and will nraintain a Certilicate of Consent to Selt'-Insure for workers' compensation, as provided for by Scction 3700 of the
Labor Code, for thc Jrerforrnarrce of thc work for which thc pcrmit Ls issued.
_l have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for lhe lrcrformance of
thc work tbr which this permit is issued. My workers' comJrcnsation insurancc carricr ard plicy numbcr are:
Policy Nunrber: Expires:
fur"^ity that in the prtbrnurncc of rhe work for which thi.s grcrmit is issucd, I shall not employ any person in any manncr
| # as to beconrc suhject to the workcrs' compensalion laws of Califionria. and agrcc that if I should bcconre subjcct to ttrc
workers' contlrcnsation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with thosc provisions.
WARNING: Failurc to secure workers'compensation coveragc is unlawful, and shall subject an cmploycr to criminal penalties and
civil lines up to one hundred thousand dollars ($Ifi),UXt). in addition to the cost of darnagcs as provided for thc
Seclion 3076 of [-atxlr interest and attorney's fees.
tl-oZc
I
t)t.t('t,.\ R,\1't( )N
I hercby aflirm undcr pcnalty of perjury that I am licensed under provision of Chapter 9 (cornmencing with Section 70m) of Division 3
of the Business and Professions Code, and my liccnse is in full force arxl effect. t
ll
Liccnse Class: Liccnse Number:
CONSTRI.ICTION I,ENDING AG}:NCY
I hereby atlirnr under penalty of perjury that there is a construction lending ager..,*y tor the performarrce of thc work tbr which this permit is
issued (.Sec. 3097, Civ. C.).
lrndcr's Namc:
[-cndcr's Atltlrcss:
APPLICANT DECLARATION
I trcreby affirm under pnalty of perjury onc of thc following doclarations:
Denrolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6)
_Required l-etter of Notification
_l certity that the federal regulations regarding asbe.slos removal are not applicable to thi.s proilct.
in[ormation is correcl. I agrec lo comply
,representatives of tNs City
with all City and County
and County to enter upon thcautlrorize
atxrvc mcnti()ncd property ltrr inspcction ,
Applicant or Agcnt
I)errnitce nanle
Datc: {
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf Ioor/VenUl ns u lati o n
Roof Sheathinq
Shear Wall
Framing
Insulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
Jt/asonrv
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif.
I tl-,/^
FINAL lr l(luo Dt{ v s/
Certificate of Occupancy
Notps, Bemarks, Etc.
Ir
BUILDING. INSPECTOR RECORD
t
Rev. 08-07-201 5
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