HomeMy WebLinkAbout101102983 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 1O1102983
Pin #: 897E9
Proiect Address: 261 0 N Acacia PIa
Assessor's Parcel: 002-037-09 Lot: 9
Unit Bldg: Address Range.Suite Range:
Zoning: R1Block: NA Tract: 1471 Historic: No
Building Use. Single Family Dwelling Occupancy: R-3, U 1st FL Area: Patio:
Job Type: Reroof Constr Type: V B 2nd FL Area: T.l.Area:
Nature of work: Reroof code: cBc 2019 other Areas. yards Req,d:
Existing Bldg. & Use: Sfd w/det garage Flood Zone: X-0602320144J Garage Area: Valuation:
Proposed Use: # of Stories:
Total:
Description of Work: Reroof house & detatched garage - install comp shingles over existing (1) layer of comp.-tliT9,9!ttp,Slren.
F r r L r.- r i ., r ...{ ii .[ .-r .[ J. .' :-iU ,j ,l l:i: I]
Planning Conditions: Replace fascia boards and eaves as needed.
CIff ire! {:TYH Tr.nns+: ?Acct*: F:ef *:
$2,600.00
ID: }.IfiAI?{:IA
1 cr{' 1
I ul I r1??S3
Ftrrrl'r:t-rnQ Qq { /. O { /?fr l|}frlft Q r ?t A}'l
Engineer
Address:
Phone:
License #
Architect /
Desiqner:
Address:
Phone:
License #:
TrflnBor.-t, ion TotnI $41 8 . tit
t
Owner:
Address:
Phone:
Tenant:
Tom Avik
2610 N Acacia Pl
Santa Ana, CA 92706
(7141 543-5478
Contractor:
Address.
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #.
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires:
'f om Av ill
6errer'nI ['lnrr Llpdctte Fee
t:tl I t6uu?* 516ur-ullt0-
Bu i }d iris
Lrl I I6lJLr2- 5l6tJ1flLttr-
F'Idsr $t,dE RevoIvins
r:r1 I l6rJLr:?- 5t6l ?t-ttltt--
Il i c r. ci {" i .i 1y1 I\ Darunen t s
t-tl I 16[0? - 577 7t-tt]tlt-t-
Uisct
C(:+ I ************5?29
1,22,95
- $39tr -?6
$1.l:lu
'$3.?1
$41S.1?
Auth* : tt4253D
Planning Approval By:Guevara, Jerry
Plan Checked By:
Permit lssued By:
NPDES Insp Req'd
PWA lnsp Req'd:
, Julie
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No
Date: 0112912020
Date:
Date: 0113012020
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002
077L60 0 2
077760 02
0 7776002
07776002
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuance
57607
57770
57572
57600
57607
$333 06
$3 e1
$1 00
$22 95
$s7 20No
No
No
No
Account#Total
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within360 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
01116002 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
Inspector MtD#'. 2020-157418
)
BUILDING- INSPECTOR RECORD
SITE-WORK COMMENTSDATEID/SIG.
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bf loor/VenVl n s u lation
Roof Sheathinq
Shear Wall
Framing
lnsu lation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
[t/asonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
,
FINAL la,/;N '.W1ff€Zl|:rd
Certificate of Occupancy
Notes, Remarks, Etc.
\
I hcrchy aflirnr undcr Fnally of pcrjury lhat I am cxempt fror lhc ConlractoE' Licenrc liw for lhc following rcasn (Scc.70.]1.5
Busincss nnd Pftrfcssion Code): Atry Cily or County which rcquircs a Jrcrmil to conslrucl. .hcr. improlt. dcmlish or ftlxir any
struclurc. prior to ils issuancc. also rcquircs thc opplicant for such lrcrmil lo file o sigrcd strtcrrcnl lhal hc or she is liccnsd putsuill
to thc provisions of thc Contractor's Liccnrcd law (Chaptcr 9. Conmrcncing with Seclion 7000 of Division 3 of thc Busincss and
Codc) or that hc or shc is cxcnrpt thcrcfrom and thc hasis ltrr thc allcgcd cxcnrption. Any violation of Scction T03 l .-5 by arry
lirr a pcnnit subjccts thc applicunl lo a civilpcrralty<ll'rtot rttorc thatt fivc hurtdrcd tlollars ($5(X)).
()\!'1lcr of thc property. or rny cnrpkryccs with wages as thcir solc cornpensation. willdo lhc u'ork and thc stnrclurc is nol
intcndcd or offcrcd for salc (Scc.7044, Busincss and Profcssions Codc: Thc Conlractor's Liccnsc l-aw docs not apply lo an owtrcr of
the pn)pcrty who builds or intproves thcrcon. and whcr dcrcs such work himsclf or hcrself or through his or hcr own entployccs.
providcd that such improvenrnts arc xtt intcnclcd oroffcrcd for salc. ll. howcrcr. thc building or irnprovenrnl is sold within onc ycar
of corrphtion. thc Owner Buildcr will havc thc burden of proving that he or shc did not buikl or inprovc thc propcrty for thc purynsc of
salc).
_1. as owncr ol'the propcrty, anr cxclusivcly conlracting u,ith liccrrscd corrlractors to conslruct thc projcct (Scc. 7(M4. Busittcss
ancl l\rrli:ssion Codc: J'hc Contraclor's Liccnsc Law docs not apply lo iln owncr of propcrty who huilds or ilttprovcs tlrcreott.
and who conlracls fbr such projccts with a Contractor(s) liccnscd pursuant to thc Conlraclor's Liccttsc l-aw).
_l arn cxcrnt)l untlcr & P.C. lbr '"uh_
I):rtc:l(*,'lzo (_
OECLIR,ITION
I hcreby affirrn under penalty of pcrjury onc of thc following declarat ions:
-lhavcandwill
maintainaCertificatcofConsenttoSelf-lnsurclirrworkers'compcnsalion.as providcdfbrbySection3Tfi)ofthc
labor Codc. for the pcrformancc of thc work frrr which the perrnit is issued.
_l havc and will maintain workers' contpensation insurancc. as rcquircd hy Section 37ff) of thc l-abor Code. for thc Jrcrfonrrancc ttf
thc work for which this prmit is issucd. My workers' comfrcnsation insurancc carrier and plicy nuntbcr arc:
Number: Expires:
ccrtily that in thc perforrrrancc of thc work lirr which this pcrrrrit is issucd. I shall not crttpkry any pcrson in any nlanncr
so as to bc.conrc suhjcct to thc workcrs' conrpcnsation laws of Calilirrnia. and agrcc lhal if I should bccttnrc suhjcct to thc
workcrs' compcnsation provisions of Scclion 37fi) of the Lahor Codc. I shall. forthwith cornply with those provisions.
WARNING: Failurc to secure workers' comlrcnsation covcraec-llunlawful. and shall subject an enployer to criminal Jrcnalties and
civil fincs up to one hundred thousand dollars (Sl9I€6in adiftion to thc cost of comJrcnsation. damagcs as providcd for lhc
Scction 3076 of the l-atnr Code. inlercst and attorrrcy's fces. I -
oN", t/90 lto ^rr,,*'LICENSED CONTRACTOR
l)lrt'l,AlU\'l'lON
t hcrcby al'llrnr undcr pcnaltyol'pcr.iury lhat I ant liccnscd urrdcr provision ol'Chaptcr 9 (cotntncttcirrg with Scction 7fir) ot'l)ivisiorr 3
oI thc I]usirrcss and Profcssions Cotlc. and rny liccttsc is in l'ull lirrcc ard cll'ccl.
Licensc Class: Liccnsc Nunthcr:
Date:('onlraclor:
C( )NS'l'ltU("1'l( )N l,liN I)I NG,\(i IiNCY
I hcrcby allirnr urdcr JEnally ofperjury thal thcrc is a constructkil lcnding agcncy for lhc lErfornuncc of thc work for which this Jrctnrit is
issuecl (Scc. 3097. Civ. C.).
I-crrrlcr's Narrrc:
lrndcr's Addrcss:
APPLICANT DT'CI ARATION
I hcreby alllnn undcr penalty of prjury onc of thc following dcclarations:
Demolition Pcrmits-Asbcstos Notification Fcderal Rcgulations (l'itlc 40. Part6)
-Rcquircd
lrttcr of Notification
_l ccrlily that thc l'cdcral rcgulalions rcgardirrg asbcstos rcrrxrval arc nol aJlplicablc to this pr<rjcct.
ccrlily that I havc rcad this applicalion and statc thal thc ahrvc inlirrtnalittn is correct. I agrcc lo corrrply
rcprescntativcs of this City
u,ith all City artrl Counly
ancl County lo cnlcr ttlxrn l}r'ordinanccs antl Slatc laws rclaling to and hcrchy aulhorizc
abovc nrcntioncd proJrcrty for purF)scs.O.Applicant or Agenl /\-
Dare:-
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