HomeMy WebLinkAbout101101709 - Permit1-
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA g?7o2 Building
Permit Counter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853 h\
Permit #:1011017O9
Pin #: 34698
Project Address: 3809 S Timber St Unit:Bldg: Address Range:Suite Range:
Zoning: RlAssessor's Parcel 4'10-062-19 Lot: 31 Block: NA Tract: 6433 Historic: No
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Use:
Single Family Dwelling
Alteration
Drywall
Sfd w/att garage
R.3, U
VB
cBc 2016
x-0602320278J
1st FL Area:
2nd FL Area:
Other Areas:
Garage
Total:
Patio:
T l.Area.
Yards Req'd:
Valuation: $5,000.00
Occupancy:
Constr Type
Code:
Flood Zone:
# of Stories:
Area
Description of Work: Replace drywall in kitchen.
Planning Conditions:
t.r, I r
Acc t
ttcpt
Tran
Owner:
Address
Phone:
Tenant:
DAVIDV&JOMINTZER
3809 S TIMBER ST
Santa Ana, CA 927074950
(7141812-8012
Contractor: GreenHomeDevelopment
Address: 6501 Sausalito Avenue
West Hills, CA 91307
Phone: (818) 941-0540
State Lic #: 1031586
Lic Type: B
Bus. Lic #: 374025
Workers' Compensation lnsurance:
Carrier: State Fund
Policy #: 9238'142
Expires: 0911312020
Engineer
Address
Phone:
License #
Architect /
Desioner:
Address:
Phone:
License #:
tenerOl l'lOn UP0nf
Jl I 16t-tLti- 516tlt:tLtLtti
iu i id ins
rI 1 I6[tt-t!- 51ait1t trtt"t
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
s\
Date:
Date:
Date:10/03/2019
Subject to Field:
Misc. Receipt
Misc. Receipt
Misc. Receipt
07775002 57607 Permit Fee
07776002 s7672 Bldg. Stds. Revolving
07776002 57600 General Plan Update
0L1-76002 5760L lssuance
Fee Total:
Paid to Date.
Balance Due:
$166.53
$1.00
$22.95
$57.20Verduzco, Violet
No
No
No
No
Account#Total
01 1 16002 51600
01 1 16002 51601
01116002 51612
$22.95
$223.73
$1.00
Every permit issued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days afrer 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.
$247.68
$0.00
$247.68
lnspector MID#: 2019-154876
I
i.rrerln HOfie UeVel
BUILDING- INSPEC ECORD
SITE.WORK DATE ID/SIG cpMMENTS
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bfloor/VenVl nsulation
Roof Sheathinq
Shear Wall
Framing -\.
lnsulation/Enerqy I tA ^? QAA
Drywall il ul lul llYuuutr . Lz ttStY
Ext./lnt. Lath I
Brown Coat
Ivlasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
FINAL /.bHW(LgY
Certificate of Occu pancy lrrl
Notes,, Remarks, Etg
)\rI
()WNI!R BUII,Di]R DEL(]ARA'I'IoN
I hoeby allirrn under penally ofpe{ury thal I an e\enlpt from lhe Contractors' l,icensc l,arv for the following reNn lss.70.'].5
Businas and Profssion (odc): Any Cit)'or County $hich requires a ponit to construcl, alts. irnprove. derlolish or relair nny
slruclure.priorloits issuance.alsorequirGtheapplicantftrrsuch;nrnittofileasignedstatsuent thatheorsheislicenscd pursuant
lo the pro\ isiof,s of th€ (.ontractor's Licensed [-arr (Chapter 9. (\)mnrencing $ ilh Sslion 7000 of Division 3 of the Business and
ProfessionsCode)orlhatheorsheisexempllhrcfrornantllhcbasisfortheallegedexernplion. AnyviolationofSrctionT0.ll.5hl.rury
applicant for a pennit srbjects the applicant to a civil penaltl. ofnol nnre than fir'e hundrcd dollnrs ($500). t
I. as osner oflhc |()peny. or rny employe$ *ith $ags as lhcir sole cornpeilsatiN. will do lhc \uk ild the slnrtue is nol
inlflded orolltrcdformle(Se.7044.BusinssandPnrlessions(irdcr TheConlractor'sl,iccnscl-a\vdosnotapply1oanowncrof
lhe prcpoly rvho huilcls or iruprovs thqmn. and *ho tlos such wtrk himselfor lrersclfor lhnrugh his or hcr orvn cnrpkryccs.
ofconrpldi()n. llr Ow'ncr lluilclet s'ill have the hmlm ol poving tlral he or she clid nol build or inrprove the propqly for the plrgrsc of
slc).
I. ru o\r ns oflhe propsly. am exclusively conlracting with licensed contracl06 lo constnrct the proist (Src. 7044. Busines
and hofGsion('odc: IheConlmclor'sLicense[.a\\'do6nolapplvloano\!nqofpropeny\hobuildsorimpro\eslhqsn.
and s'ho conlraclsforsuchfrojslssilha('ontraclo(s)licensedpursuanltotheContraclor'st.iccnseLaN).
I art erernpt under Setir,n Il. & l'.( for lhis reason.
l)ate: osilcr:
n'onrnns' trrlt t'iins,r'r'rox
t)Ii( l,Att^l toN
Iheretrl. afiirnunrlo pcnnll\ol'psiurloneofthclirlkrs'inSrlcclarrtions:
lhavemd\villmaintaina('enificateofCorNflltoSclf-lnsureforNorkos-conrpensation.o providedforbySetionlT00ofthe
labor Code. for the poformance ofthe rvork for rvhich the pmnil is isned.
- I ha\e and uill mnintarn \rlrrkers cornpensation insurancc. c
lhe \rork for shich lhis pqrnit is isued. My s orkaSrrrnpmsat
carier: - fttf tuh)
PoricyNumb6: ?y32Hz
re<;uiled by Satitrn -1700 of lhe libor Code, for the pslirnnuce of
ion insurance canic md Jnlicy nurnber ae:
lirpircs:q9 [!-+o
I ceilify lhal in lhc performnnce ofthe rvork for rvhich lhis pcrnit is issued. I shall not cnrpkry any pemon in any rnnnner
$ d to bffoue subject k) the w'orkfrs' composal ion laws of Califrrmia. and agre that if I should becotne subjet to the
uorkrs'cornpcnsationprovisionsofSdion.lT00oflhcl{ltr('ode. Ishall.forthsithcomply*iththo*prorisions.
\YARNING; [ailurc kr wure w'orkere'cornlxnsation co\sage is unlawful. and shall subid an orpkryer to oiminal fEnalti6 and
civil frnes up to onc hundred thouund dollars ($100.000). in addition lhe cost of conrpcnsation. donages as provided for the
Seclion -1076 of,(bdc. inlersl and atk,nrc) s ltr:.
Applic{nl:__
r)t,:( l.An,\'l toN
of the llusinss anrl llolcssions Code. and mv liccilsc is irr lirll firrce and effect
I-icense Classr
,,,"1o]o3\\L
l.iccnsc Numbcr:\ oRt<xG
( ontrnclor:
(:ONS'I'RU(]'I'ION LENDIN(; AGEN('I'
issued (Sec. .t097. ('iv. ('.).
l,cnder's Nanre:
Lendo's Addrqss:
APPLICANT DECLARATION
I hreby'affinn undcr penalty of perjury one ofthc follorting delarations:
Demolition Psmils-Asbeslos Nolification Fedsal Regulations (.l itle 40. Pan6)
-Raluircd l-cltcr of Nolifi calion
I colity lhal lhc fcdtral rcgulalions rcgarding asbcslos runoval are nol applicahlc lo lhis proiccl.
above mmtioned propeny for inspection purposs.
Applicflnt or Ageill Sigilatilrc:
I'ornlil* nsmr (priilt):
,,,," \ olrr\f 15
I
Ll5 4n- Lt {L-