HomeMy WebLinkAbout30113839 - PermitCity of Santa Ana
20 Civic Center Plaza (M-19), Santa Ana, CA 92702
\(\Plumbing Permit #: 3O{ { 3839
Permit Counter: (714) 647-5800 lnspection Requests: (714)667-2738
Project Address: 1925 E Kemper Ave
Assessor'sParcel: 390-542-14 Lot: 33
Suite:
Block: NA
Bldg:
Tract:6530
Address Range:
Historic: No
Suite Range:
Zoning: Rl
Owner:
Address
Phone:
Tenant Name:
Contractor:
Address:
Phone:
Jim & Dixie Bosley
1925 E KemperAve
Santa Ana, CA 927056831
(714) 633-6256
Aqua Scapes Pools & Spas
321 Calle Felicidad
San Clemente, CA 92672
(949) 492-7664
Fee Type
Extend Gas Line
lssuance
Notes:
Fee Total:
Paid to Date:
Balance Due:
Amount
21.25
23.50
Qty
1.00
1.00
Fee
$21.25
$23.50
$44.75
$0.00
$44.75
State Lic #: 754.729
Lic Type: C-53, HIC
Bus. Lic #: 0003689
Workers' Compensation lnsurance:Carrier: Exempt
Policy #:
Expires:
Building Use:
Type of Work:
Nature of Work
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Single Family Dwelling - Dr Constr Type:
Alteration Occupancy:
Exterior BBe Code:
Morales, Janet
Date:
Date:
Date:
VN
R3/U1
cPc 2001
06/03/2003
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
lot?no LLBuilding Permit #:
This permit shall expire by limitation and become null and void if the work authorized by this permit
is not commenced within 180 days from the date of this permit, or if the work authorized by this
permit is suspended or abandoned at any time after the work is commenced for a period of 180 days.
Before such work can be recommenced, a new permit shall be first obtained to do so.
Account #: 01 1 -01 -591 2 lnspector
PLUMBING.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS
UNDER GROUND
Waste & Vent \
Water-Underfloor \
Gas-Undeffiosr Q ro,**/) -E-a)/YR-\)--
Building Sewer tt
Area/Storm Drain
lnterceptor/ Clarifler
TOP OUT
Waste & Vent
Water Piping
Gas Pipeing
Roof Drain
Tub/Shower Test
Rough Water Heater
(
POOUSPA R.-
P-trap/Drain Line ^l -Eas V2/U <t--
Main Drain/Pool Piping l)T4).LYk)*
Fill Line/Back Flow 7+7-6 <rqD <(>-
Pool Heater/Gas Line )et)b ),)fu-2L-
LV
Misc
Gas Service
Water Service
Lawn Sprinkler
Sanitary Sewer/Cap
Back Flow Device
Rough Plumbing t/
Final Gas Test / b7/03 .h//lD (z-
Meter Release lt V
F!NAL 9-lo- 2o *hD)o>
Notes, Remarks, Etc.
Owncr-Buildcr Dalration
I hrcby aftim unda padty of pcdury thst I m cxmp fm thc Cmtrrctotr' Liccruc Law for thc following rcsotr (!cc.r0315 Buinas
sd Profc$ion Codc): Any City or Couty *hich rcquircs a pcmit to consruct, altcr, improve, dcmolish or rcpair my structw, prior ro it!
issuucc, also rcquire thc applicut fc such pmit to filc a rigf,cd statcmmt thEt hc or rhc is liccnscd pursuut to th€ proviliw of thc
Contractor's Licmcd Law (Chaptr 9, Comacing with Scction 7000 of Division 3 of thc Buincas ud Prof6siom Codc) or that hc or
shc is cxmpt thcrcfiom md thc bris fc thc allcgcd cxmptim .Any violation of Scction 7031.5 by ey applicilt fu a pmit subjccts thc
applicmt to a civil pa,alty ofnot morc the livc hmdrcd dollm ($500).
_I, u ownc of thc propcrty, o my mployc with wage u thcir iolc cmpmsedon, will do thc work md thc structre i! not intmdcd
or ofrmd fc salc ( Scc.7044, Buitres md Profasions Codc: Thc Contr@tor'! Licosc Law dm not apply to m owna of thc prcpcrty
who builds u impovs th@n, ud who dG such work hiruclf or hmclf u thrcugh his r hcr own mployce, providcd that such
improvmmts e not intodcd or offacd fq s8lc. If, hwcvq, thc building or improvmat is sold within onc ycu of complaion, thc
Owns-Builda will have tlrc budo ofprcving that hc or shc trot build or improvc for thc purposc ofsslc).
_I, s omc of thc propcrty, m cxcluivcly contrrcting with licorcd conrrcton to cwtruct thc prcjcct ( Scc 7044, Buine ud
Profasim Codc: Thc Cmrrctq's Limc Law dm not apply ro e oms of propcrty who builds r improvc thacon , md who
conracts for such proj€rs wilh a Cor&ro(s) licmscd pBuet to thc ConEactor's Lictrc Law.).
_l m cxcrnpt uada S@ti@
-B.
& P.C. ftr thi! ttam.
Darc: Owra
WORKERS COMPENSATION DECLARATION
I hscby affim udr pcnalty of pajury onc of thc following delmtiou:
_I havc md will mintain a Catificarc of Coroat to Sclf-lNuc ftr wtrkm' compcnsstim, I providld fs by Sstion 3700 of thc
Labor Codc, for thc pcrfmcc of thc wort fm which thc pcrmit is issucd.
_lhavcadwillminuinwckm'cmpcasatimimmcc,c rcquircdbySction3T00ofthcLabqCodc,forthcpcrfomeccofthc
work for which this pcmit is isucd My workc' composation insuucc cmic md policy numbcr uc
Policy Numba, Expiro,
(This lcctim nccdnotb"-.pta"a ittnffioo) o t$)
1, ^u
rn
^c
pcfmcc of thc wok fu
bemc subjcr to thc wor*s ' comps[atim lawg
which this is issucd, I
agrcc that
shall not cmploy uy pcnon
ifl should bccomc subjcct to
in my mmncr so r to
theof
3700 ofthc Labor Codc,forthwith comply with thosc provisions..
Datc:
WARNING: Failuc to sccurc workm' compmsation covcragc is unlawful, md shall s cmploycr to criminal pcnaltics md civil
fincs up to onc hundrcd thouod dollm (t100,000),in addition to the cost ofcompcnsation, damagcs u providcd for thc Scction 30?6 of
thc Labor Codc, inrcrcst ud attomcy's fc6.
Ihgcby8mmundcrpmaltyofpcdurythaffincingwithScction7000)ofDivision3of
thc BBin6s ud Profcssions Codc, ild my licensc is in full forcc md cffcct
Licme ClmsJ i - Li-n..[r-b., t,",QwYbw
CoNSTRUCTIoN LENDIT{G AGEN6I/
I hmby aftim udcr pcnalty of pqjury that th6c b a consmcdon lcnding ag6cy for thc pcrfommcc of thc work for which ttris pcrmit is
issued (Scc. 3097, Civ. C.).
Lodr's Nmc:
Lodq's Addres:
APPLICANT'S DECLARATION
Doolition PmiB-Albqts NotifiBtion Fcds8l RcSulations (Titlc 40, Part 6)
_ Rcquircd Lmd of Notification
_l ccrtiry that thc fcdml rcSulalions rcSdding sb6t6 rmoval dc not applicablc to this trojcct.
lft ccrtiry ttat t lavc rcad this appliation md statc that tic abovc infomation is concct. I agrcc to comply pith all City ed county
ordinsce md Sdc kws to building consmction, md hcrcby
abovc motioncd
Applic\g^dmt sis.
Prmffrzrffie@1nt)
purposcs.
rcprccntstivca of this City to mt6 upon thc