HomeMy WebLinkAbout101103104 - Permitcity of santa Ana 20 civic center Plaza (M-19). santa Ana, c492702 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853 N
Permit #:1O11O31O4
Pin #: 28,473
Proiect Address: 5631 W Keelson Ave
Assessor's Parcel: 108-573-07 Lot: 39
Unit:Bldg: Address Range:Suite Range:
Zoning: RlBlock: NA Tract: 3821 Historic: No
Building Use:
Job Type.
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Single Family Dwelling
Reroof
Reroof
Occupancy:
Constr Type:
Code:
Flood Zone.
# of Stories:
R-3
VB
cBc 2016
A-0602320252J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Totat
Patio:
T.l.Area:
Yards Req'd
Valuation: $7,641.00
Description of Work: Tear off existing, install 27 squares of comp roofing
Planning Conditions
Owner:
Address:
Phone:
Tenant
Aguilera
5631 W Keelson Ave
Santa Ana, CA 92704
(714)'488-204s
Contractor: Mc Clain Roofing lnc.
Address: 12812Yalley View St #33
Garden Grove, CA 92845
Phone: (714) 897-1780
State Lic #: 625013
Lic Type: C-39
Bus. Lic #: 160402
Workers' Compensation lnsurance:
Carrier: State Compensation lns
Policy #: 1713760
Expires: 0110112021
Engineer
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp Req'd:
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:
Date:
Dale: 0211212O20
Subject to Field:
Misc. Receipt
Misc. Receipt
Misc. Receipt
07776002
07776002
07776002
07776002
07776002
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
57607
5777 0
57672
57600
57607
$333.06
$3.91
$1.00
$22.95
$57.20
web_user
No
No
No
No
Account#Total
N/A - No
N/A - No
N/A - No
Balance
Balance
BalanceEvery permit issued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days after its issuance,or if the work authorized
on the site by such permit is suspended or abandoned for a period of360 days after
the time the work is commenced.
Fee Totat
Paid to Date:
Balance Due:
$418.12
$418.12
$0.00
lnspector MID#: 2020-157712
BUILDING. !NSPECTOR RECORD
S!TE.WORK DATE ID/SIG.COMMENTS OWNI:R IIUII,I)ER I)I]I,CARA'TIoN
I hercby aflirnr under pcnalty of perjury that I am c\cn)pt frcnr thc (lontractos l-icensc ljw for the following rcasn (Scc.703 1.5
llusincss and Profession Codc): Any City or County which requircs a lErrnit to construct, altcr. irnprove. dcrmlish or rcpdir any
structure. pri()r rc its issuance. also requires the applicrilt fbr sucl Frnrit lo file a signed slatement that Ire or she is licansed pursuant
to rhc provisions ol lhc Conlractor's l-iccnscd liw (Chnpter 9, Comrncncing with Scclion 7(n) o, Division 3 ol the Busincss and
Protissions Codet or that lE or she is erenrpt therclil)m aDd the basis trrr tlE allcged exemptiotr. Any violation of Section 703 1 .5 hy any
rpplicrnlfornfEmilsuhjectsthe cpplicanltoacivilpeniltyofnolmorelhanfivehundreddollars($5(x)).
_1. as owncr o l'lhc prortny, or rny crnployees with wagcs as thcir solc compcnsllion, will do thc work and thc stnE(ure is m(
inteulerl orotferedforsle(56.TtN4,BusinessanrlPrufessionsCode:ThcConlractor'sLicenscLnwdcsnotDpplyloanowrcrof
th.pmFfly whobuildsorimprovesllEr$trurdw}x)dessuchwo*hinNelfortErselforthroughhisorherownenlployees.
prolidcd thnt srch irnprovcrrcnts re mt intcrdcd orollcred for salc. Il. howcver, lhc tNilding or ir{,rovcmil is sold within one }rar
ofcomplcri(nt. the Owncr Builder will Mvc th€ burd.n of proviDs lhat lE or she did not build or irprcvc the propery for lhe purposc of
sale).
_1. as owner ofthc p()pcdy, am exclusi!cly contrscling with licen$d con(raclors k) con\lrucl llt prcjccl (Sec. 7(N.1. Business
and PmtissinrCode:TheContractrr'sLicenseLawdoesnotapplytoanownerofproJrnywhobuildsorimproveslhercon.
and who conlracls lilr such preiccts with a Contractor(s) liccnsd pursumt to thc Conlracror's Liccnsc Law).
-Ianrc\emPlundersccti()n-.Il.&P.C,lilrthisrcason.
w()RKURS', ( ()NlPUNSA't I()N
t)ECLARAl'tON
l hcrchy alllrmundcr pcnahvof perjurv(,nc ol thc li)lk)win8 (lcclararit)ns:
_lhavciuxlwillnuinlainaCertificateofConsentloSelLlnsureforworlers'compensarion,ss pn)videdforhySaclion3T00ofrhc
Lshor C(xlc, for thc pcrformmc ol lhe work lbr which thc pcrmil ir i\sucd.
_l havc anrl will maintain workers' conrpensation ilsurance, as required by Secti(xr 3700 of the hbor Code, for thc perfomme of
thc work tar which thir lrrnit is isrucd. My workcrs' comltnsati()n insurance curicr el Nlicy ounltEr ue:
Policy
_l ccfliti that rn lhc pcrfbrnuncc of rlrc work for which this pcrnlit is issucd, I shall not enrpk)y any prson in any manncr
so as to hccorrc subjcct to the workcrs' compcnsatioil laws of Califon)id, and agrce lhnt if I should hccorrc subject to thc
workers'conrpensationprovisionsofSection3T00oftheLuborCbde,lshnll,fofihwithcomplywiththosprcvisioos.
WARNING: Failure to secure workcrs'compcNation covcftgc is unldwful, and shall subjecl nn cmployer to oiminal Fmlties aod
cilil fines up to onc huldrcd lhousand dollnrs (Sl(X).(XX]). in addilion to lhc cosl of compcnsation, damgcs !s providcd for lhc
Scction 1076 ofthe tllx)r (ixlc, ixcrest and a(toruy s fecs.
I)oacl-
I,I(:ENSFJD C0NTRACToR
T'ECLARATION
I hcrcby allinn undcr [Enall], of per.iurv rhal I am liccn$d undcr provision ol Chaflcr 9 (cr)rnmncing with Sccrirn 7fin) of Division 3
of thc Busrncss and Profc$sir,ns Codc. ffkl mv liccnsc is in ftll forcc md clfccl.
I-iccnsc C Nurnhcr'_
Ilrle'_
CONSTRUCTION T,I]NI)ING AGI.)NCY
I hcEhy atlirnr under lEnlltyof perjury tlul there is u cu$tnrclioil lerkllrg agerEy li)r thc fErfomarrec of the work ,br whkh lhis fEmit is
issued (Scc. :1097. Civ. C.).
l.cndcr's Naillc'
[.ndcr's Ad(lrcss:
APPLICANT T'ECLARATION
I hereby aflimr under penalty of perjury onc of the following declarations:
Denmlition Permits-Asbestos Notification Federal RcEularioos (Titlc 40, Pa(6)
-Rcquirctl
lrtter of Ndification
_l certily thlr the federal regulationx reguding asbesbs remval arc trot applicable b this prujet.
_l cenify that I havc rcad thir application and statc thal lhc abovc informlion is corccl. I agr@ lo clmply wilh all Cily and County
ordioanccs and Slntc liws relalilS lo bttilding coNtrudiul atul hercby auhorize reprcrcntatives ofthis Cily and County to enid uF)n thc
uhove mntioncd propeny lbr inspection puqp*s.
Appli@nt or Ag6t Signaturc: Dale:--
Pcmite Mme (prlnt):
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/VenVl nsulation
Roof Sheathing a-221-?o VFtt*{ la
Shear Wall
Framinq
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
ltrlasonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
FINAL 2-Ll'za u,rffttg
Certificate of Occupancy
Notes, Remarks, Etc
Bev. 08-07-20 1 5