HomeMy WebLinkAbout30140240 - Permitt 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 AV Plumbing
lnspection Requests: (7 14) 667-2738 lnspector Section: (7 14) 647-5853
Permit #:3O14O24O
Pin #: 97638
Gity of Santa Ana
Permit Counter: (714) 647-5800
Project Address: 1106 N Concord St
Assessor's Parcel: 400-284-12 Lot: 107
Unit:
Block: NA
Bldg:
Tract: 2648
Address Range:
Historic: No
Suite Range:
Zoning: Rl
Owner:
Address
Phone
Tenant Name:
Contractor:
Address:
Phone
Jowala Persand
1105 Concord St
Santa Ana, CA 927013212
(714) 972-9680
Safe Step Walk-in Tub Coml
15262 Pipeline Lane
Huntington Beach, CA 9264
(714) 373-8545
Fee Type
01116002 5'1602 Bathtub
01116002 5160C General Plan Update
01 'l 16002 51 602 lssuance
Amount
22.25
22.08
55.04
Qty
1.00
1.00
1.00
Fee
$22.25
$22.08
$55.04
State Lic #: 983603
Lic Type: B
Bus. Lic #: 365881
Workers' Compensation lnsurance:Carrier: State Compensation lnsurance Fund
Policy #: 9002477
Expires: OllO'll2O19
inlp Stpr lub Corpnnv
Updote Fee
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020rJ0-
$
*rI*1080 Authi:021t4
t/7/2ilt8
ronsf:62
Ref*:- tt/?/201
IO! CCUELLA2ol 3
30140240
2!3{ Ptl
14{1. l0
$99.37
$0.00
$99.37
Generol
(r1 t 1600
Plurb i n
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V iso
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Plon
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Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Single Family Dwelling
Miscellaneous
Remodel Bathroom
Zuniga,Aili..V
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
R.3, U
VB
cPc 2016
11tO7t2018
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes: Replacement
Fee Totat
Paid to Date:
Balance Due:
Buirdins Permit #: 10198292
Every permit issued shall become invalid unless fhe work on the site
authorized by such permit is commenced within 180 days after its
lssuance, or if the work authorized on the site by such permit ls suspended
or abandoned for a period of 1 80 days after the time the work is
commenced.
01 1 1 6002 51 600
01 1 1 6002 51 602
$22.08
$77.29
lnspector MID#: 2018-147511
PLUMBING.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I herehy affrm undcr pcEhy of pcrjury that I m excmpt ftom the Contracto6' Licg,se l,aw fordrc following re&n (Sa.?031.5
Buincss and Profcssion Code): Any City or County which requircs a ;rmit to construct, alts, improve, dcmolish or rrpair any
structure, prhr lo itr issmc, als .equir* thc applicanl for such Jrmit to lilc a signed stalcwnt that hc or shc iq licc[rd purunt
to thc pmvisions of th€ Contractor's Liccnsed Law (Chaptcr 9, Commencing with Section 7000 of Division 3 of thc Busincss and
PmfcsionsCode)orthath.orsheiscxcmptthcrcfromardthcbaqisfortheallegcdcxemption. AryviolalionofsetionT03l.5byany
applicantforapcmitsubjcctsthe applicanttoscivilpcmltyofretmorclhanfivehundrcddollars($500).
-1,
as owncr of thc prcJrcny, or my emplo)Eca with wages as thcir $l€ omprnstion, will do th. sork ard thc atrctw is mt
intended orofferedforslc(Ss.T044,BusinessandPmfcssionsCode:'l'hcConlraclor'sLiccnsLawdocinotapplytoanowncrof
thc pmlErty wln builds or impmw the@r\ ard who dc och work himself or hcRlf or thmuSh hii or hcr own cmploym,
provided that such impmv€rcnts N mt interdcd orofftrcd for sle. l[ howwo, the building or impmvercnt is sold within onc ,!ar
of @rpldioq the crwmr Builder will hsvc ttE burdo of pmvinS lhot h€ or she did ml buiH or imprcw the pmpcrty for thc puIns of
sle).
-1,
asowrcr of the pmpeny, am cxclusively contmcting with licensed contracloB to onsrud thc pmjet (Src. 7M4. Busires
and PmfcssionCodc:'[heConlractor'sLicenseLawdoesnotapplyloanownerofpropertywhobuildsorimprevesthcrmn,
and who mnlmds for such pmjeas with a ContEcto(s) liccNed purrunt to thc Conlrsctor's Licc[E Law).
_l sm excmpt undcr Setion_, B, & P.C. for this ltmn.
l)nlc
IVORKf, RS' COMPENSATION
DECLARATION
I hcrcby affirm undcr pemlty of pqjury onc of thc followiog delmtions:
_l have ancl will nrainlain n Certilicale of Conscnt tr Scll:lnsure for workers' conpensalion, as providerl lbr by Section 1700 of the
l-.h)r Codc. lhr the pcrfoilnance ofthe qtrrk for rvlrich thc pernrit is issucd.
-l
have S@tion 1700 of lhe lrbor Code, for the pofomrcc of
the work carier and Fnlicy number rc:
Policy
/ aoo"-\7 7 ,I
-l
ccnify lh.t in thc performnce of the work for qhich this permit is issed. I shall not cmploy any pcrson in any manrcr
m as to beom ruhjat to lhc wori(ss' mmpenstion laws of Califomia, and agrc that if I slDuld trcome subjet to thc
workers'compensationprovisionsofSection3T00ofthcLatnrCode,lshall,forthwithcomplywiththo*pmvisions..
WARNINC: l;ailure to secure workers'compensnlion/rk)veragc rs unlawful. and sholl suhjrct an employer to criminal pemltics and
civil lines upre one hundred thousand dollaF (Sl91000). in addilion ro the cost ofcompensation. damgcs as provided for the
S(ti(rn 107(r oflhe Lahor (-ode, intereil nnd attornq/s fees.
u,,", rrl-r/t8 "I tct'Nsf,D coNl RAC',t OR
Df,CLARA'TION
I herehy affirm under penalty ofperjury that I aft licenKl under pmvision ofChapter 9 (connreming with Section 7000) of Division l
of Ihc Business aml Pnrfessions Crrde, nrri my license is in full force and effsl.
,-E 473/,o3LicenscNumber:
\\1 z.
C(TNSTRUCl]ON Lf, NDIN(] ACf, NCY
I hereby alirm umler penalty ofpcrjury thu there is a construclt)n lencling agency for the performance oflhe work for which this pemit is
isrued (Sec. .1097, ('iv C.).
Lendcr's Name:
Lender's Ad&css:
APPI ICANT Nf,CI AITA'I'ION
I hsEby affm under pcnalty ofperjury onc ofthe following declaralions:
Dcmlition Pcrmits-AstBtoi Noti,icdion l:edtral ReSulatioos ('l'itle 40, Part6)
-Required
Letler of Noliliqlion
-l
certify that lhc federal regulations rcgarding sbcstos removal are not applicable to this prcjst.
-l
ccrti& thot I have read this application and state thal ihc atnve infomtion is corffl. I agre to smplywilh all City and Counly
ordimrccs ard State Laws building constructioq ard hcrcbyautlnrizc rcprentativca of thii City and Countyro ors upon thc
above mentioncd preperty for purposcs.
Applicatrt or Agent
Pcmriaee trame ue/
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underfloor
Building Sewer
Area/Storm Drain
I nterceptor/ Clarifier
TOP OUT
Waste & Vent
Water Pipinq
Gas Piping
Roof Drain
Tub/Shower Test
Rough Water Heater
POOUSPA
Ptrap/Drain Line
Main Drain/Pool Piping
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary Sewer/Cap
Back Flow Device
Rough Plumbing
Final Gas Test
Meter Release t /))/1 /)/ //
FINAL Fr)
Notes, Remarks, Etc. '"
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