HomeMy WebLinkAbout40134203 - Permitcity of Santa Ana 20 civic center Plaza (M-19), santa Ana, cA 92702
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Mechanical Permit #:4ll1342o,3
Pin #: 4098{W
Project Address: 1506 S Park Dr Unit:
Block: NA
Btdg:
Tract: '1498
Address Range:
Historic: No
Suite Range:
Zoning: Rl
Owner:
Address:
Phone.
Tenant Name:
Contractor:
Address:
Phone:
Melissa Galvez
1506 S Park Drive
Santa Ana, CA 92707
171419',14-2153
Ken Starr lnc dba Home Cor
3154 E La Palma #9
Anaheim, CA 92806
(888) 769-3009
01 I 16002 51604
01 1 16002 51600
01116002 51604
01116002 57770
Fee Type
Furnace
General Plan Update
lssuance
Microfilm Records
Amount
68.16
22.95
57.20
3.91
Qty
1.00
1.00
1.00
1.00
Fee
$68.1 6
$22.95
$57.20
$3.91
Botchi:53196 - Ll/27/2ttl9 ID:Office: CTYH TrsnEi: 49Accti: Ref*: 401
Rcpt*:02814858 - tl/27/2fit9 12
Tronsoction Totol tt52
State Lic #: 974908
Lic Type: C-2O
Bus. Lic #: 345086
Workers' Compensation lnsurance:Carrier: Traveler's lnsurance
Policy #: U82L7545771826c
Expires: 11lO1l2O2O
Ken Storr Inc dbn Hone Coofor
Building Use:
Job Type:
Nature of Work:
Notes:Change out furnace located in attic.
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within360 days after its
issuance, or if the work authorized on the site by such permit is suspended
or abandoned for a period o1360 days after the time the work is
commenced.
Single Family Dwelling
Miscellaneous
Furnace
Julie
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
R-3, U
VB
cMc 2016
11t2712019
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
01 1 't6002 5't600
01 1 16002 51604
o1116002 57770
$22.95
$125.36
$3.91
Fee Total:
Paid to Date:
Balance Due:
$152.22
$0.00
$152.22
lnspector MID#: 2019-156191
Assessor's Parcel: 013-213-02 Lot: 2
MECHANICAL.INSPECTOR RECORD
APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION
I hocby aflirm unda peralty of pcrjury that I iln excmpt film the CodracloN' LiccN law for the following rcen (Se.7031.5
Businss ud hofcsion Code): Any City or County which rcquira a pcrmit to construcl. alt6. improvq dmolish or rcpair any
structue. prior to ils isumcc. also rcquira the qplicant for such pcmil to file a signed statmmt that hc or shc b licsed pmumt
to the prcvisions of thc Contractor's Licensed Law (Chapto 9. Commencing wilh Setion 7000 of Division 3 of the Busincs and
PrcfcssionsCodc)orthathcorsheisexemptthdefromandthcb6isfortheallegedcrmption. AnyviolationofScctionT03l.5byany
applicantforapcrmitsubjectsthc applicantloacivilpflaltyofnotmorethanfivehundreddollars($500).
l.as otrflcrofthcprolErly.ormyemployeeswilhwasesaslhcilsolecotnpensation.uilldotheworkmdlheslruclueisnot
inlsrricrl orolTcredforsle(Sa.T044.BusincsandProfcssionsCodc:'l'hc(-ontraclor'sl.icenseLa\vdo6notapplytoanownerof
lheprcluly rvhohrilGorimgmrvethflq)n.ildwhodoqssuch\rrrkiimselforherselforthroughhisorherorvncnrploycs.
providedthalsuch irnJnovorentsuenolintodedoroffqedforrle.lf.hots'o.thebuildingorimprovenlmtiss)ldsilhinoncyd
ofconrpldion. the o$'ntr Buildq will ha\€ the txrrdm ofproving that hc or she did not huild or improve the prcFEty for thc puqFs of
sle).
l. s o\r ner ofthe prop€Tty. m exclusively contractin8 \r-ith licenssl conlracloE to construct lhe projst (Ss. 7014. B6inN
and l,mfqsionCode:TheContractor'sLicenseLawdo6ndapplvtoanorvnoofpropenyrvhobuildsorinrprovesthqmn.
and \\'ho conlmcts for such projets rvilh a ('onlraclo(s) licflscd pursuanl to lhe Contraclor's Licosc l-aN).
I atr eretnpl under Srlion- . B. & P-('. ftrr lhis reoon.
I)rlc
I hcrcby allirnr
0[ ncr:
\YORKURS' ('OIIPENSA iioN
Dtt( l,ARA',ilON
onc olthc folkxviug rlcclar ati(rns:undcr penalty ofpojury
l harc ancl \ ill nraintain a Cedificate ofConscnt lo Sclf-lnsurc lor $orkcTs compensation. as provirled fol by seclion lT00 oflhe
l.alx)r (i)dc. for the pofonnance ofthe $ork for which lhc po]nil is issucd.
lhc work for thh pflnit is ised. My rvorkm compdsation iNurance cmio md policy numba ue:
('arlicr:
Policy u Erpir6:a4
_l ccf,ify that in thc pcrformuce of thc work for which this pcmit is issued. I shall not mploy any ps$n in any mmns
s 6 to bccomc subjct to thc wor*m' compqsstion laws of Califomis. ud agre lhat if I should bccome subjat to thc
workm' compmation provisioD of Seclion 3700 of lhc Labor Code I shall. forlhrvith comply rvith lhos prcvisions..
IVARNING: Failurc to wuc rvorkss'compmslion covcmge is unlawfil. ud shall subjat il mployfi to siminal psultiG ud
civil fincs up to one hundred lhosud dollm ($100.000). in addition to lhe cost of compeNation. dmage u providcd for thc
Sectiut 3076 ol l-ahrr inttrGt and atlorney s fc$.
I hcrcby affirm under poahy of pedury that I am licosed unclq 9 (cornmocing rvith Scction 7000) ofDivision 3
of thc llusinss md Prefeiom Code. ad Iny licqsc is in full force ild ellst.
o 7z/?eOLiccNe
Drae:
Nunrhtr:
/t ( onlr{clor:
CONS'I'RU('TION I,ENDING AGENCY
I hcreby afllrn rnder lEnalty ofpqjury lhal lhtre is a conslnrcti()n lordirrg agmcy ftrr lhe poforrnance oflhe s'ork for shich this lunit is
issucd (Scc. .1097. Civ. C.).
lrndq's Nmc:
-
I-mder's Address:
APPI,I('AN'I' I)T]('I,ARA TION
I hor{ry allinn under penalty of perjury onc of the fcrlkru ing declarat ions:
I)cmrlition l'ermits-nststos Nolification Fcdcral RcSulati{)ils ( I itlc 40. l'arl6)
Rcqu ir cd t-cll$ of Notillcalion
_l cdiry thd the fedsal regulatiom regrding cbctos rmoval are not applicsblc lo this prcjcct.
- I cdify that I havc rad this application ed stalc lhal lhc ahotc infomation is corccl. I agre lo comply wilh all City and County
ordinancG md Statc tjws relating to building construclion. od h6cby authorize reprBmtativc of this City ud County to mtq upon lhe
above mmtioncd propcny for impcction
Applicant or Agent
z/_
Pflnite nanle (prinl):
Appliances
Metal Fire Place
Evaporative Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-lnsulation
lnsulation
Smoke Detectors lnstalled
Rouqh Ductwork
Vents
Toilet Room / Clothes Dryer
Residential Ranqe
Other
Hood
Type I Hood
Type ll Hood
Grease Duct
Fire Damper
Openinqs
lnstallation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rough Mech.
FinalTest
Meter Release I
FINAL z /z?/zrl -.t *{/.",1
Notes, Remarks, Etc.r--4 a