HomeMy WebLinkAbout30141778 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA g27o2a --: -\ Plumbing
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 Inspector Section: (714) 647-5853 MY
Permit #:3O14177E
Pin #: 60'l{3
Project Address: 4501W Maurie Ave
Assessor's Parcel: 100424-14 Lot:10
Unit:
Block:NA
Btdg:
Tract: 2463
Address Range:
Historic: No
Owner:
Address:
Phone
Tenant Name:
Contractor:
Address:
Phone:
Henery Carrillo
4501 W MAURIE AVE
Santa Ana, CA 927031205
(71415s4-1274
Orange County Services db:
3801 Lenawee Avenue
Culver City, CA 90232
(310) 838-0408
0'l 1 16002 51602
01 1 16002 51600
01 1 16002 51602
01116002 57770
Fee Type Amount
Wtr Htr (Res up to 50 gi 23.12
General Plan Update 22.95
lssuance 57.20
Microfilm Records 3.91
Qty
1.00
1.00
1.00
1.00
Fee
$23.12
$22.95
$57.20
$3.91
$?2. ?5
t3. ?1
tStr.32
$107. ts
1is;6h|;i37+3 - ll6/2[2tt I0: omorflleslS
iif f ice: iT f ii Trurr:,}: 121 I of 1
cccti; Ref*l 3u1/rl77u
ii,:p ti : 02$-:iioi - L; 6/2lt2i-t 12 : 1:, Pf1
ironssct ion Totsl tlll7.18State Lic #: 765436
Lic Type: C-36, C-20
Bus. Lic #: 164117
Workers' Compensation lnsurance:Carrier: Cypress Ins Co
Policy #: MIWC022336
Expires: OllO'll202O
frrcnge iountc Scrviueg dbn Ili[l
Genersi Fion Update Fee
r"ri i iriu02- ii6tfi(iii0-iiicrofiir & Docurents
r.ri i iri002- 577;iio(iii-
F iurb i ns
r-ri i io0u2- iion;006-iil ihecir 0341{B
Notes: lnterior water heater change out. Same location.
,f
t
Building Use:
Job Type:
Nature of Work:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Single Family Dwelling
Miscellaneous
Water Heater change out
Occupancy:
Constr Type:
Code:
R.3, U
VB
cPc 2019
Planning Conditions:
Chavez, Dave
Date:
Date:
Date:
Every permit issued shall become invalid unless lhe work on the site
authorized by such permit is commenced within 360 days after its
lssuance, or it the work authorized on the site by such permit is suspended
or abandoned for a period of 360 days after the time the work is
commenced.
01t06t2020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
01 1 16002 51600
01 1 16002 51602
01116002 57770
$22.95
$80.32
$3.91
Fee Total:
Paid to Date:
Balance Due:
$1 07.1 I
$0.00
$107.18
lnspector MID#: 2020-156912
Suite Range:
Zoning: Rl
PLUMBING.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OlvNER BUn.t)ER l)8:L('ARA'l'loN
I hcrchy allirrn undcr pcnillty ol pcrjury thrt I anl cxctlf lionl thc Coilrrctor\' Licc[sc' l-xw l'()r thc followiig rcr{on (Scc70.11 5
llusincss ilrxl Prolbssirn (irdc): Any City or County $hich rcquirc\ a Frnlil lo con\lrucl. altcr. inrprovc. dcmolish or rcpiir ilily
\tructurc. pri(tr k) ils issurncc. also rc<luircs thc applicnnl for \uch lttiil lo lilc a sigicd slnlctrnl lhxt hc or shc is liccnscd pursurit
k) thc provisions ol thc Coillrxclor's l-icctrscd Law (Chapler 9. (\rtrrncncing with Scction 7(Xx) of Division .1 ol thc Bn\incss rnd
al)plicrtrlli)rrpcrnrilsilhjcct\lhc ilnplicanlhrcivilpcnilllyoftroltrx)rcthrlllvchun(lrcd(lollrrs($500).
-1.
as owrer of the fropcrty. or my cmplolees with wages Bs tlreir sle compensation. will do the work ud the slutw is rel
inlcrdcd oroffsed for sh (Sc.7(X4, Busiress and Profcsshns Codc: The Contractor's Licens hw does not spply lo an owner of
tlEfmperty whohuiktroritrprosthemn.urdwhodmshm*himselforhcrslforlhmughhisorherosnemployees.
providcd thst such imprcwrils e mt interded or offered for sh. lf. howew. the boiHing or ir{,mrcrcnt is rcld sithin orc }etr
of corpletion. tlr Owrer Buiklo will hrw tlE burdcn of Foving that hc or she dil ret buiu or irprevc 0E pmperty for thc purJns of
uh).
_1. us owner ofthe prcpefly. am exclusively contracting with liccnscd conlraclors to conslruct lhc prejcct (Sec. 7044. Busincss
and Prcfcssbn Codc: Thc Contractor's Liccnse Lsw does not apply lo an owner ofpropcrly who builds or improves thercon.
and who conlracls for such preFcls wilh a Conlrtrclo(s) liccnscd pursuant to the Contracbr's Liccnse Law).
-l
am cxcmpl under B. & P.C. for this reason.
WORKFRS' CoIIIPENSATION
DECI ARATION
I hcrchy aflirm under penalty of pcrjury onc of lhc following dalarutions:
l.rh(n-(ixlc.lorlhcpcrli)rntilnccollhcworklorwhichlhcpcrilril i\is\lrc(l.
_l have and will mainl0in workcrs' compcosation insurancc. as rcquircd by l
thc work for which this pcrmit is iss€d. My worktrs' conr[rcnsation insurarcc
Setion3700ofthct bor
cmier ed lblicy numhcrFr-^a-s\
Codc. for lhc pcrfornuncc of
ore:
a \I z\Policy
_l ccmify lhat in thc pcrformancc of thc work for which this pcrmit is issucd. I shall not cmploy any pcrson in any manncr
so as lo hccom subjcct lo I hc workers' compcnsation laws r:f Calilornia, and agrcc lhrl if I should hccorc subjcct to lhc
workcrs' compcnsation provisions ofScction 3700 ofthc Latnr G)dc. I shrll. fofthwilh comply with thore provisions..
WARNING: Failurc to scurc workcrs'compensalion covcmgc is unlawful. and shall suhjccl an cmploycr lo ffiminal Fmltics and
civil frncs up lo onc hundrcd thousand dollrs ($100.fix)). in addilion to of compensation. damges as providcd for thc
Sstion 3076 thc labor Codc. irletcsl and altomy's fccs.
,b u t
()l thc Ilu\incss xn(l llrrlcssiorrs (ixlc. antl nry liccnrc ir in l'ull lirrcc rn(l cllcct.l'il '
0-s tLiccnsc Numbcr: r r6s+3 4
e
CONS'TRUCTION I FNDINC AGENCY
I hcrchy s[firil undcr frnalty of pcrjury thal thcre is a constructirn hnding agc[cy for lhc pcrti)rmencc ofthc work for q'hich this lErrnit is
issucd (Scc. 3097. Civ. C.).
[rntlcr'r Narrc:
hodcr's Addrcss:
APPT,ICANT I)T]CI ARATION
I lm$y alnni undcr Nnrlty of pcrjury onc of thc lirllouing tlcclarrthns:
[)rrnoliti(rn Pcrilrits-A\hcstos Notiticrtion Fcdcral Rcgulali(xrs ('I itlc {0. Parl6)
-Rcquircd
t{ltcr of Nolificntion
|
-l
.crtity thilt thc lbdcrll rcgulrttrrs rc8ilrding ashcsk)s rcrmrvrl rrc nol applicablc lo lhis proiocl.t-
lE ."nify rl"r I havc rcJ(l thi{ ilpplicxlion and sttrtc lhrt lhc atx)vc inli)rnrxlion is conccl. I ngrcc to cr)trrply wilh all City aril County
above mnlioncd pmperty for
Applicant or Agenl .t
Pemlte name (prinl):(
zo
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underfloor
Buildinq Sewer
Area/Storm Drain
I nterceptor/ Clarif ier
TOP OUT
Waste & Vent
Water Pipinq
Gas Piping
Roof Drain
Tub/Shower Test
Rouqh Water Heater
POOL/SPA
P-trap/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
Rouqh Plumbing
Final Gas Test
Meter Release
FINAL 94-7fi hr.i -i(l ?ru1irk+ Ufrfla- r.rrrrtfroc
Notes, Remarks, Etc.
9<arsr! fo) t-?A-2n
--D
l)illr ()silrr
csniar. t \nasurar.ce Cot\tutv^ # Ih.a
Dale:
Confrsctor:(
/