HomeMy WebLinkAbout101103385 - Permit?City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 927A2 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section. (714) 647-5853
Permit #: {O1103385
Pin #: E6499
Proiect Address: 1016 W Pine Sta
Assessor's Parcel. 008-212-10 Lot: POR 11
Unit:BIdg: Address Range: 1014-1016
Tract: BUCKINGHAM Historic: No
Suite Range.
Zoning: R2Block: A
Building Use: Slngle Family Dw€lling Occupancy: R.3 1st FL Area: Patio:
Job Type: Raroof Constr Type: V B 2nd FL Area: T.l.Area:
Nature ot Work Raroof Code: cBc 2019 Other Areas: yards Reqd:
Existing Bldg & u3e: sfd Flood zone x{402320257J
carage Area: v.tu. on: t5,25o.oo
Proposed Use: # of Slories:
Totat:
Deacription ot Work Rsrcof . lsmove axisting, leplace any damaged lhaathing, inrtall new roofing lystem - GAF Tlmberllne, color la sagowood
HandouB glvan.
Plannlng Conditions:Rapala all damagod oavas, refre.! & fa!ci..
Owner:
Address.
Phone:
Tenant:
KENT HARRIS
1014 W Pine St
Santa Ana, CA 92703
(ss1 ) 830-e387
Contractor. Crown Reconstruction Serv
Address: 45 Vantis Dr
Aliso Viejo, CA 92656
Phone: (949) 357-6274
State Lic #: 1051230
Lic Type: B
Bus. Lic #: 375292
Workers' Compensation lnsurance:
Carrier: State Fund
Policy #: 9224420
Expires: 0313012020
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
Planning Approval By:Khang, Kathy
Plan Checked By.
Permit lssued By:Amsden, Julie
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Date: 0310512020
Date:
Date: 0310512020
Subject to Field:
Misc. Receipt:
Misc. Receipt.
Misc. Receipt:
07776002
07776002
07776002
0!775002
0 77760 02
s7607
57770
57572
57600
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuance
$333.06
$3.e1
$1.00
$22.95
$s7.20No
No
No
No
Fire lnsp. Req'd:
Police lnsp. Req'd:
No
No Account#Total
Planning lnsp. Req'd.
Landscaping lnsp. Req'd:Flood Zone Cert. Req'd: No
Every permit issued 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 days after
the time the work is commenced.
01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 57770
$22 95
$3e0.26
$1.00
$3 91 Fee Total:
Paid to Date:
Balance Due:
$418 12
$0 00
$41 8.12
lnspector MID#: 2OZC-158278
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/Ve nVl nsu latio n
Roof Sheathinq Lta-2D fXZ*e lol
Shear Wall
Framing
Insulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Jt/asonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif
FINAL l r-/ .z.c)l- CB lefta> *2n
Certificate of Occupancv
Notes, Remarks, Etc.
\
/
I
I hereby affirnr under penalty of perjury that I am exempt fronr the Cbntraclors' License law for the following reason (Scc.7031.5
Busincss and Prolbssion Code): Any City or County which requircs a pcrmit to construct, altcr, irnprove, dernolish or repair any
structure. prior to its issuance. also requires the applicant tbr such Jrrntit to file a signed slaternent that lr or she is licensed pursuanl
to thc provisions oI thc Conlractor's l,icensed law (Chaptcr 9. Commcncing with .Scction 70fi) of Division 3 of the Business and
Prot'essions Cotle) or that he or she is exempl therefiom and the basis tbr tlrc alleged exemption. Any violation of Section 7031 .5 by any
applicant for a lrrmit subjects the applicant to n civil penalty of not more than five hundred dollars ($5tXl1.
_1. as owner ol'thc property. or my employees with wages as thcir snlc compcnsation, willdo the work and the stnrclure is not
intended or offered for sale (Sec.7(X4, Business and Professions Code: Thc Contractor's Licenrc Law does not apply lo an owner of
the property wlxr builds or improves therurn, arxl who does such work himself or hrself or through his or her own employees,
provided that such irnprovemnts are not intended or ollered for salc. Il. howcvcr, thc building or funpnrverrcnt is sold within onc year
of conplctiorl thc Owncr Builder will have the burden of proving ttrat lre or she did not buikl or impnovc ttrc propcrty for thc purp;sc of
sale).
-1.
as owner of the property, am exclusively contracting with liccn.sed conlractors to construct the pnoject (Sec. 7044, Business
and holbssbn Code: The Contraclor's License Law does not apply to an owner of proprty who builds or improves thereon.
and who contracts lor such projects wilh a Contractor(s) licensed pursuant to the Contractor's License l-aw).
-IanrexemptunderSection-'B.&P.C.forthisreason.Date: Owner:
WORKI,IRS' COM PI,INSATION
DECLARATION
I hcreby aUirm under penalty of pcrjury onc of thc following dcclarations:
_l have and will mainlain a Certilicate of Consent to Self-lnsure for workers' compensation, as provided for hy Section 3700 of the
Lahor Code, for the pcrformance of the work lbr which the Jrermil is issued.
f,rrurrand will maintain workers' conrpensation insurance, as required by Section 3700 of the labor Code, for lhe Jrerfornunce of
( the work fbr which thi.s permit is issued. My workers' comlrcnsation insurance carrier antl plicy number arc:
_1,L^ l- .C . .a -a
_l ccrtity that in thc prfornurncc of thc work for which this pernrit is issucd, I shall not employ any frcrson in any manner
so aslobccorncsuhjccttothcworkcrs'conrperrsationlawsofCalifornia,andagrccthatiflshouldbccomcsubjccttothc
workers' comJrcnsation provisions of Section 37fi) of the Labor Codc, I shall, f<rrthwith c'onrply with thosc provisions.
WARNING: Failurc to secure workers'c<lmpcnsation covcr.lge ls unlawful, and shall subjcct an cmploycr to criminal Jrenalties and
civil fines up to one hundrcd thousand dollars ($l(X).(Xru). in addition to the cost of conrlrcn.sation, damages as provided for the
Section
hcrcby
of thc Busincss and Professions Co<Ie, ard my liccnsc is in full tbrce arxl ctfcct.
L-z'\Nurnhcr:3-5'L
CONSTRI.'CTION I,ENDING AGENCY
I hercby aflirm under penalty of perjury that there is a construction lending agercy tbr the performancc of the work for which this pcrmit is
issucd (Scc. 3097, Civ. C.).
[-cnder's Name:
[.cnder's Address:
APPLICANT DECLARATION
I lrrcby affrm under penalty of perjury one of the following declarations:
Denrolition Permils-Asbestos Notification Federal Regulations (Title 40, Part6)
-Required
l.ctter of Notifrcation
-l
certity that the federal regulations regading ashstos renroval arc nol applicable to this pro.ject.
certify that I havc rcad this applicalion arxl state that the above information is correct. I agrcc to oomply with all City and County
ordinances antl State Laws relating lo huilding constrctiorl and herehy autlxrrize representalives of thi.s City and County lo enter ug>n the
atxrvc mcntioncd propcrty
L
or Agcnt
nalue
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