HomeMy WebLinkAbout101104742 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #: {O110,4742
Pin #: 11450
Proiect Address: 231 9 W Russell Avea
Assessor's Parcel: 109-081-10 Lot: 8
Unit:Bldg: Address Range:Suite Range:
Zoning: RlBlock: NA Tract: 3354 Historic: No
Building Use Singl. F.mily Dwelling Occupancy: R.3 1st FL Area: Patio:
Job Type: Roroof Constr Type: V B 2nd FL Area: T.t.Area
Nature oI work Reroof code: cBc 2019 ofter Areas: yards Req'd:
Existing Bldg. & Use: SFo Flood Zoner x{r602320252J
proposed ua€: # of stodes: Garage Area: v'lu'tion: t4'q'0'00
Tolat
D.ac.lption of wo.k Tsar ofi exlsting rcof m.tori.l.nd install nowcompshinglo roof material. 19aqu.r6. Ownor.Buildor fo,m on fi|.. Handout givon.
Planning Conditions:
Owner:
Address:
Phone:
Tenant:
Carlos Tobias
2319 W. Russell Ave.
Santa Ana, CA 927043235
(7141 7274e82
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier.
Policy #:
Expires:
Engineer
Address:
Phone:
License #.
Architect /
Desiqner:
Address:
Phone:
License #:
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
Fire Insp. 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
Gomez, Pedro
Chavez, Dave
Date: 0912412020
Date:
Date: 0912412020
Subject to Field:
Misc. Receipt:
Misc. Receipt.
Misc. Receipt:
07776002
07776002
07775002
07776002
07776002
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
57607
57770
57672
s7600
57607
$34s.28
$4.05
$1.00
$23.79
$5e.30
Account#Total
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 days after
the time the work is commenced
$23 7e
$404.58
$1 .00
$4 0s Fee Total:
Paid to Date:
Balance Due:
$433 42
$0 00
$433.42
lnspector MID#:2020-1 61736
BUILDING- INSPECTOR RECORD
SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION .
I trcrcby alfirm under pcnalty of pcrjury that I amexcmpt from thc Contraclors' Liccnse law for thc following reason (Sec.7031.5
Busincss and Prof'cssion Codc): Any City or County which rcquircs a pcrmit to construct, alter, irnprovc. dcmolish or rc;xrir any
structurc. prior to its issuancc. also rcquircs thc applicant for such pcrmit to filc a signcd statcmcnt that he or shc ls liccnscd pursuant
to thc provisions of tlre Contractor's Liccnsed l-aw (Chapter 9, Commencing with Section 7000 of Division 3 of the Business and
Profcssions Code) or that he or shc is cxcmpt thcrcfrom and the basis for the allcged cxemption. Any violation of Scction 7031 .5 by any
applicant for a permit subjcrcts thc applicant to a civil pcnalty of not more than five hundred dollars ($500).
_1. as owncr of the will do thc work and thc structue is not
License [:w dtlcs not apply to an owner of
the pnrpcrty who builds or improves thcrcnn. and who does such work hirnsclf or hcrsclf or through his or her own crnployccs.
providcd that such improvenrcnls arc not intendod or offcrcd for sale. lf. howcrar. thc buiHing or inryrrovcnrent is mld within one yqrr
of conrphtio[ thc Owncr Buildcr willhavc thc burdcn of proving thal hc or shc did not buib or inqlrove thc propcrty for ttrc purposcof
salc).
_1, as owncr of thc pn)pcrty. am cxclusivcly contracting with liccnscd conlractors to construct the pro.icrt (Scc. 7W, Busincss
and Prnfession Code: Thc Contractor's Liccnse Law docs not apply to an owncr of propcrty who builds or improves thercon,
and who contracls for such projects with a C-ontractor(s) licenscd pursuant to thc Contractor's License kw).
-l
anr cxcrnpt undcr Scction-, B. & P.C. for this rcason.
Date:
IVOIIKIiILS' C( TIII PENSATION
DI'CLARATION
I hcrcby affirm undcr pcnalty of prjury onc of thc following doclaralions:
_l havc and will maintain a Cerrificatc of Conscnt lo Sclf-lnsurc for workcrs'compensation. as provided for bySection 3700 of thc
L:bor C-ode. for thc perfornrancc of thc work for which thc perrnit is issued.
_l havc and will maintain workers' compcnsation insurarrcc. as rcquircd by Section 3700 of the [:bor Code, for the performancc of
the work fttr which this prmit is issucd. My workcrs' comgrcnsation insurance carricr and plicy numbcr are:
Carricr:
Policy Numbcr: Expires:
_l ccrtify that in the pcrformance of thc work for which this pcrmit is issucd. I shall not crnploy any pcrson in any rnnncr
so as to bccomc subjccl to thc workcrs'compensation laws of California, and agree that if I should bcconr subject to thc
workers' compcnsation provisions of Section 3700 of the hbor Code. I shall, forthwith comply with thosc provisions.
WARNING: Failurc to sccurc workers' conpnliation covcragc is unlawful. and shall subict an employer to criminal penaltics and
civil fincs up to onc hundrcd thousand dollars ($100,0m), in addition to the cost of comlrcnsation, danragcs as providcd for the
Section 3076 of the latnr Codc, intercst and attorney's fccs.
Applicant:
LICENSED CONTRACTOR
DF'CI-ARATION
I hcrcby affirrn undcr pcnalty of perjury that I am liccnscd under provision of Chaptcr 9 (comnnrcing with Section 7000) of Division 3
of thc Busincss and hofes.sions Code. and my liccnse is in full force atd cffcct.
Liccnse Class: Licensc Numbcr:
W
I hcrcby .ffirm undcr JEnalty of ]rcrjury that thcrc is a consructk n lcnding agcrEy for thc performcc of lhe work for which this lsmil is
issucd (Se. 3097, Civ. C.).
lrndcr's Nanrc:
l*tds's Addrcss:
AIELICAITLDECI.A8AtrON
I Hy aFm under pcnalty of pcrjury orc of thc folbwing dElsntions:
Demlition Pcrmits-Asbestos Notification Fed€ral ReSulations (Title 40, Psn6)
_Required lrtlcr of Ndiliclrbn
-l
c.rlify that the fcdcnl rcgul8tions rcgardinS asbcslos rcmval rc ml applicable to this pDlxt.
_lrenify thrt I have rcad this application and statc thst the sbove infortrEtion is corecl. I agrc to cor{,ly with 8ll Cily and County
ordinires qrd Statc trws rctaring to building comtnrctiotr atd hercby authorire rcDre$ntatiws of lhis City utd Couty to cnt6 upon 0E
sborc mntbrcd prcpcny ftr inspcction pupos.
Applml or Ag6t Slgnalure: Drlc:-
PcmlaE namc (Drinl):
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bf loo r/VenUI ns u latio n ^l I ,"/
Roof Sheathino il','1.0 Uru1ry6 ?y0
Shear Wall
Framino
Insulatio nlEnergy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req.
Deputv Final Reoort
Engineer Final Report
Flood Zone Certif
I I ^/.a
FINAL Eil?f)UUltu n{0
Certificate of Occupancy I
Notes, Remarks, Etc.
Rev. 08-07 -201 5
Date:_
Date:_ Contractor:-
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