HomeMy WebLinkAbout101105246 - 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 #: 101105246
Pin #: 1o,479
t
Proiect Address: 3823 W Hazard Avea
Assessor's Parcel:198-01 1-21 Lot: NA
,r*[V'Bldg:Address Range. 3823-3901
Historic: No
Suite Range:
Zoning: R2Block: NA Tract: 1 1049
Building Use: Single Family Dwelling Occupancy: R-3 1st FL Area:
Job Type: Reroof Constr Type: V B 2nd FL Area:
Nature of Work: Reroof Code: CBC 2019 Other Areas:
Existing Bldg. & Use: Duptex w/garages Flood Zone: A-0602320143J Garage Area:
Proposed Use: # of Stories:
Totat:
Description of Work: Tear off BUR and apply BUR to flat portion of the roof, only on unit B. Handouts given.
Planning Conditions:
Patio:
T.l.Area:
Yards Req'd:
Valuation: $4,000.00
Owner:
Address:
Phone:
Tenant:
Lon Thi Nguyen
3823 W Hazard Avenue, Unit B
Santa Ana, CA 92703
(7141 e33-6746
Contractor: South West Sun Solar, lnc.
Address: 13752 Harbor Blvd
Garden Grove, CA 92843
Phone: (7141 582-3909
State Lic #: 1004667
Lic Type: B, C-10, C-20, C-38, C-39
Bus. Lic #: 350754
Workers' Compensation I nsurance:
Carrier: Starnet lnsurance Company
Policy #. BNUWC0151378
Expires: 06/01 12021
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
Planning Approval By.
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA Insp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd:
Graham, Jeffery Date: 1111912020
Date:
Date: 1111912020
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:Verduzco, Violet' l{
0777600 2
07776002
077760 02
07776002
07776002
57607
57770
57672
5760 0
s7507
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
!ssuance
$345.28
$4.05
$1.00
$23.79
$se.30No
No
No
No
Fire lnsp. Req'd.
Police lnsp. Req'd
Flood Zone Cert. Req'd: No
No
No Account#Total
Every permit issued shall become invalid unless the workon 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
01 1 16002 51612
01 1 16002 57770
$23.79
$404 58
$1 .00
$4.05 Fee Total:
Paid to Date:
Balance Due:
$433 42
$0 00
$433.42
lnspector MID#: 2020-162842
a
BUILDING- INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hcrcby offrm undcr pcnalty of Frjury that I m cxcopt from th€ ContractoN' Liccnsc [:w for lhG followirg romn (Sc.70313
Busincss ard Prcfcssion Code): Any City or County which rcquircs a lrcmit to mnstruL ahcr, improvc. dcmlish or rcIEir uy '
stnrturc, piln to its issumc, also rcquircs thc applicunt for such trrmil to lilc I signed staterent that hc or slE is liensd pusuel
to the Fovisions of tlE Contmctor's Licen$d bw (Chapter 9. Commrcing with Sstion 7000 of Division 3 of thc Busiress ild
Profcssbns Crde) or that hc or shc is cxctrpt thcrcfrom ard thc basis for thc allcged cxcmption. Any violation ofsectbn ?03 1.5 by any.
alplicant for a pcrmit subjEts thc applicant to a civil pcmlty of not mrc thu fivc hurdrcd dollrs ($500). I
_1. as owrrcr of the prof,crty. or my cmployccs with wagcs as their solc compcnsation, will do the work and the structurc is not
intcndcd or offcrcd for s:rlc (Scr.7044. Busincss and Prcl'cssions Codc: 'lhe Contractor's License [.aw does not apply to an owner of
thc proFrrty who builds or improvcs thercon. and who does such work himself or herself or through his or her own employees,
providcd that such improvcnrcnts are not interxlod oroffercd for sah. lf. howcrrcr. thc buiHing or inprovenrnt is sold within one )rcar
of comphtion, the Owner Buildcr will havc thc burdcn of proving that hc or shc did not build or improve the proSrty for tlrc purpose of
sale).
_1. as owncr of thc propcrty, am cxclusivcly conlracting with liccnscd contractors to conslruct thc proi'ct (Sec. 7044. Busincss
and Profcssion Codc: The Contractor's Liccnse Law docs nol apply lo an owncr of propcrty who builds or improves thercnn,
and who conlracts for such proicts with a Glntract<l(s) liccnsed pursuant to thc Contractor's License [aw).
-l
amexcmpt under Section-, B. & P.C. for thls rcason.
I)ale:( )w'lrcr:
WORKERS' COMPENSATION
Dr.CI ARATION
I hcreby affirm under pcnalty of grcrjury onc of thc following dctlarations:
-\por"
and will maintain a Cerrificatc of Consent to Sclf-lnsure for workcrs' compcnsation, as povidcd for by Scction 3700 of thc
Latrdr Code, for thc pcrfornurncc of thc work for which thc pcrrnit is issued.
_l have and will maintain workcrs' corrrpcnsation insurancc, as requircd by Scction 3700 of the Labor Code, for the perforlnatrce of
thc work for which this pcrmit is issucd. My workcrs' conrpcnsation insurancc carricr and policy number are:
J"-
Policy lt /2-)
_l certify that in thc pcrformarcc of thc work for which this pernrit is issucd. I shall not employ any person in any rnnncr
so as to bccome subict to the workcrs'compcnsation laws of California. and agrce that if I should beconrc subject to thc
workers' compensation provisions of Scction 3700 of thc [-atnr Codc. I shall. forthwith cnmply with those provisions.
WARNING: Failure to sccurc workcrs'
civil fines up to onc hundrcd thousand
comlrcnsation covcrage
dollars ($100.0fi)). in
ts shall subjcct an employcr to criminal pcnalties and
addit ion cost of comFrcnsation. danrages as providcd for thc
Scction 3076 of thc intcrcst arxl atlorncy's
,12
Applicant:
LICENSED CON'I'RACTOR
DI.'CLAItA'I]ON
I hcreby affirm under pcnalty of perjury thal I am liccnscd undcr provision of Chaptcr 9 (comnrcncing with Section 7000) of Division 3
of the Business and hofessions Code. alrd rny liccnse is in full forcc and effcrct.
L 1 lo o 67"
Liccnsc
('ontructrlr:
W
I hcrcby oflirm undcr Jrcnalty of lErjury lhat thcrc is I s)nsruction lcnding {gcrcy for thc lErforrucc of the work for which this ]rcrmit is
issucd (Sec. 3097. Civ. C.).
Lcndcr's Namc:
lrnder's Address:
APPI ICANT DECLARATION
I lrcrcby affirm undcr pcnalty of perjury onc of thc following dcclarations:
Dcrnolition Permits-Asbcstos Notification Fcdcral Rcgulatiorrs (Titlc 40, Part6)
-Requircd
[-ctter of Notification
_l certify that thc fcdcral rcgulations rcgarding asbcslos rcmovalare not applicablc to this projc',ct.
statc that thc ahrvc infornurtkrn is corrcct. I agrcc to comply with all City and County
and hcreby authorizc reprcsentatives of this City and County to enter upn the
above nrcntioned property for
Applicant or Agent t
Pernritee name (print):__
purposcs.
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/VenVI nsu Iatio n
Roof Sheathinq
Shear Wall qr.c.l .2d rL6 7A
Framinq
!nsulatio nlEnergy
Drywall
Ext./lnt. Lath
Brown Coat
J\Iasonrv
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif.
FINAL /Z-l-fr P CrS /,)etj ry4
Certificate of Occupancv J
Notes, Remarks, Etc.
Rev. 08-07 -201 5
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