HomeMy WebLinkAbout40134027 - Permitcity of Santa Ana 20 civic center Plaza (M-19), Santa Ana, cA 92702
Permit Counter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853 IR
Permit #:4fl1340.27
Pin #: 24980
Project Address: 3809 S Timber St
Assessor'sParcel: 410-062-19
Unit:
Block: NA
Bldg:
Tract:6433
Address Range:
Historic: No
Suite Range:
Zoning: Rl
Owner:
Address:
Phone
Tenant Name:
Contractor:
Address:
Phone
DAVIDV&JOMINTZER
3809 S TIMBER ST
Santa Ana, CA 927074950
(7141812-8012
Green Home Development
6501 Sausalito Avenue
West Hills, CA 91307
(818) 941-0s40
Fee Type
01 1 16002 51604 Range Fan
01116002 51600 GeneralPlan Update
01 1 16002 51604 lssuance
Amount
33.57
22.95
57.20
Qty
1.00
1.00
1.00
Fee
$33.57
$22.95
$57.20
$22,?rt
t?t1.77
t715.2r.1
( i0,04 )
State Lic #: 1031586
Lic Type: B
Bus. Lic #: 374025
Workers' Compensation Insurance:Carrier: State Fund
Policy #: 9238142
Expires: O9l13l2O2O
Botch*:52332 - lO/3/2019 I0: ELIZABETH
Office: CTYH Trons*: 6{ 5 of 5Acctl: Refi: 4013{027
Rcpti:02770345 - fi/3/2019 12;02 PIt
Tronsoct ion Totol t715.llt
Green Hone Developnent
for kitchen remodel
Building Use:
Job Type:
Nature of Work:
Single Family Dwelling
Alteration
Range Hood
d
Occupancy:
Constr Type
Code:
Date:
Date:
Date:
R.3, U
VB
cMc 2016 Notes:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By: Verduzco, Violet
Subject to Field:
Buirding Permit #: 101101709
10/03/2019
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
01 1 16002 5'1600
01 1 16002 51604
95
77
$22
$eo
Fee Total:
Paid to Date:
Balance Due:
$113.72
$0.00
$113.72
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
rssuance, or if the wo* authorized on the site by such permit is suspended
or abandoned for a period of 360 days after the time the work is
commenced.
lnspector MID#: 2019-154876
Mechanical
Lot: 31
MECHANICAL.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hcreby affm uoder pmalty of pcrjury that I m cxempt fiom the Contractors' Licens taw for lhe following rc@n (56.7031.5
Buinss md Profsion Code): Any City or Comty which require a pcmit to construct, altq. imp.ovq dmolish or tcpair oy
structuc, prior to its isuoce. also requirs the applicet for sucb p€nnit lo file a siSned ststmot thar hc or she is licfficd pwut
to the provisiom of rhe Cooraclor's Liccnscd law (Chapte 9, Comencing with S(tion 7000 of Division 3 of lhc Busincs ud
ProfesionsCode)orthatheorsheiscxmptthccfromodthe basisfortheallegcdermption. AnyviolaliooofSctionT03l.5bymy
applicant for a pmil subjets the applicst to a civil pmalty of oot more the fivc hundrcd dollss ($50O).
_1. a owns of the propeny. or my mployc with wag6 as their sle compcElion. will do the wo* md tlrc strudue b rct
intoded or offeed for sale (Sa.7044. Busins ed PrcfessioN Code: The ContGclot's Liccre law do6 not pply to m oma of
thc Fopcrty who tuilds or improve thqon rd who doc such wod< himself or hmelf or through his or hr om employe,
providcd that such improvm@a e not intodcd or offqcd for ele. lf, horvryq. thc tuilditrg or ihprcvmst is $ld within onc )qr
ofcomplction. the Owno Builds will hsvc thc budo ofprcving that he or she did not build or improvc the prcpqty for the purpos of
nle).
_1, o owno of the property. m exclusively contracting with licsed contractoE lo coNtrucl the project (Str. 7044. BBins
ed Prof6sionCode:TheConlrsctor'sLiccnscLawdo6nolapplytoanownsofprop€atywhobuildsorimprov6ths@n,
and who contncts for such projets with a ContEc'to(s) licmed puE@t lo thc Conlractor's Licrue tnw).
I m crmpt udq Sation-, B. & P.C. for this @tr.
I)Nlc:()\ ilcr
\\ ORKEIIS' ('ONIPI.]NS,\ I'ION
t)u( l,ARAt toN
I hrcby affim undr penalty of pejury onc of the follorving deloations:
_l havc ord will mainlain a Certillcatc of ('onsent to Self-lnsure for rvorkers' conrpensalion, as provided for by Sectfun .17(X) of lhe
l,abor ('ode. ftrr the pa fonnmce ol the rvork for which the pmit is issued.
_l havc and Nill maintain rvorkers coilipensalion insurance. a required by Scctirn 3700 ofthe l,abor Code, for lhe pciftrnnance of
lhe rvork for uhich this p6mit is iscd. ![workm' @mpqEdiotr insurscc wio ad policy numba ac:
<tl^Q 'k^f.,.>
Policy 1-
_l ceniry that ir the pslomce of the work for which this pemit is i$ued. I shall not mploy any pmon in uy muno
so otobccomcsubjetiothcwort6'compqEationlawsofCalifomia.mdsgrelhaliflshouldb€comcsubjcttothe
work6' compwtion prcvisiom of Sation 3700 of the Labor Code, I shall. forthwith comply with thos provisions..
WARNINC: Failure to sure workqs compcnsation covemge is unlarvful. ild shall subjst m mployer to oiminal pfislliG md
civil fine up to one hundred thoued dollN ($100,000), in addition to thc cost of compcnsation. damage u providcd for lhe
Setion of the code, intq6l ed anomey's fc..l
IJCENIfD.EANBACIAS
DECI,ARATION
I hoeby aflinn undo pmaky of psjury lhat I m liccnsed unde provision of Chapto 9 (comocing wilh Srction 7000) of Division 3
of the Busins ad PrcfGsios Code. md rny license is in full force ud effrt.
Liceue Numbo:
l)[l (:
CONSTRUCTION LENDINC ACENCY
I hereby aflirnr under penally of pcrjury lhat thse is a comtruction lending agocy for the pofomrance oflhe rvork for rvhich this ponit is
issucd (Sr. 3097. Civ. C.).
Lender's Name
Lender's Addrs:
AIXI.ICANLDECI.AMITON
I hotby affirm undq pcnalty ofpqjuy onc ofthc following dalaations:
Dcmolition Pmits-Asbetos Notification Fedqsl Rcgulatioos (Tirlc 40. Pan6)
-Rcquircd
Lelt6 of Notification
-l
cqti& thal the Iedqal regulatioN regsditrg rbotos rmoval re not applicablc to thie prcjGt.
_l cdiry thal I hsvc rad this application atrd statc that thc above infomalion is cor(t. I agrc to comply with Ell Cily ud County
ordinecG ed Statc laws Eldiry to builditrg coDmucriorl ad h6€by adhorizc rcprG$talivc of this City ud Couty to 6t6 upon thc
rbove mmtioncd property for iosp€liotr
Applicet or Agot
Pmite nme (priot):
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
,t I L
Rouqh Mech.tl l/',rep uzottyp U
Final Test I
Meter Release lt ,lzh
F!NAL ,v a-o )ftn/l '-f1.Yd I
Notes, Remarks, Etc.I ID
*," \,/lo\f lf