HomeMy WebLinkAbout101103488 - Permitcity of santa Ana 20 civic center Plaza (M-19), Santa Ana, CA 92702 '-' Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (7'14)647-5853
Permit #: {O1103488
Pin #: 39112
Proiect Address: 1021 112 W Chestnut Avea
Assessor's Parcel: 008-212-34 Lot. POR 11, POR 12 Block: A
Unit Bldg: Address Range:
TTAct: BUCKINGHAM Historic: No
Suite Range:
Zoning: R2
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Use:
Accessory Dwelling Unit-Detacheo Occupancy:
New Constr TYPe:
New ADU Code:
SFD Flood Zone.
SFD w/det ADU # of Stories:
R-3
VB
cBc 2019
x-0602320257J
1st FL Area. 1053
Znd FL Area:
Other Areas:
Garage Area:
Total: 1053
Patio:
T.l.Area:
Yards Req'd:
Valuation: $e0,000.00
Description of Work: Addition of (21bedrooms, (2) bathrooms, den and utitity room. ADU unit is a HUD approved manufactured home; State approved
foundation system. SAUSD #4000
Planning Conditions:
Owner:
Address:
Phone:
Tenant:
Mike Mattingley
1021 112 W. Chestnut
Santa Ana, CA 92703
(7141 325-6230
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
Soto, Ricardo
Le, Tung
Verduz.l, ,,or"N{
No
Date: 0711512020
Date: 0711412020
Date: 0712112020
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002 57607
07776002 53600
07776002 57770
37473002 53300
08907007 24000
07776002 51672
07776002 s1600
07776A02 57607
Permit Fee
Plan Check Fee
Microfilm Records
Res. Dev. Fee - SA//
SMIP - Category 1
Bldg. Stds. Revolving
General Plan Update
lssuance/New Structu
$345.28
$478.68
$64.80
$4,781.00
$7.80
$3.00
$23.7e
$1 s8.1 5
$5,862.50
$461 .74
$5,400.76
74359
PWA lnsp. Req'd: No Fire lnsp. Req'd: No
Planning lnsp. Req'd: Jgg- Police lnsp. Req'd: Jes,
Landscaping lnsp. Req'd: No Flood Zone Cert. Req'd: No
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days afterifs issua nce,or if the work authorized
on the site by such permitis suspended or abandoned for a period of 360 days after
the time the work is commenced.
Account#Total
01 1 16002 51600 $23.79
01 1 16002 51601 $503.43
01 1 16002 51612 $3.00
01 1 16002 53600 $16.94
01116002 s7770 $64.80
08901 001 24000 $7.80
3141 3002 53300 $4,781.00
Fee Total:
Paid to Date:
Balance Due:
Inspector rutD# 2020-1 58554
t
BUILDING. INSPECTOR RECORD
SITE-WORK DATE ID/SIG.,,COMMENTS OWNER BUILDER DELCARATION t
I hereby atlirm under pcnalty of perjury that I am exempt from the Contractors' License [:w for thc following rcason (Scc.7031.5
Busincss and Profcssion Codc): Any City or County which requircs a pcrnrit to construct. alter, improvc. dcnrolish or rcpair any
structure, prior to its issuance, also rcquircs thc applicant for such pcrrnit to filc a signed statenrcnt that hc or shc ls liccnscd pursuiult
to thc provisions of the Contractor's Licensed [:w (Chaptcr 9. Commencing with Section 7000 of Division 3 of the Busincss and
Profcssions Codc) or that hc or she is excmpt thcrefrom and thc basis for thc allcged exemption. Any violation of Section 7031 .5 by any
applicant lbr a permit subjccts the applicant to a civil pcnalty of not more than fivc hundrcd dolkus (5500).
-1,
as owncr of thc proF,crty. or my cmployces with wagcs as thcir solc compcnsation. will do thc work and tltc stnrcturc is not
intendcd or offered for salc (Sec.7OC+, Business and hofessions Code: The Contraclor's License l,aw docs not apply to an owncr of
the pnrpcrty who builds or improvcs thcrcrrn. and who docs such work hirnself or herself or through his or her own entployccs.
providcd that such improvenrcnts arc not intcndod oroffcred for sah. If, howerar. thc building or inprovcnEnt is sold wilhin one )ryu
of cornpletion. thc Owncr Buildcr will havc thc burden of proving that he or she did not buih or irnprove tlrc prcprty for thc purynsc of
sale).
V\W as owncr of thc proFrcrry. amcxclusivcly conrracting with licensed contracrors lo conslruct thc protrt (Scc. 7O14, Business
and Profcssion Codc: Thc Contractor's Liccnse Law does not apply to an owncr of property who builds or improvcs thcrcon,
and who contracts for such;nojccts with a Contracto(s) liccnscd pursuant lo thc Contraclor's Licensc Law).
_l am excmpt undcr Section_, B. & P.C. for thls reason.
WORKERS' COMPENSATTON
DFCLARAT']ON
I hcrcby atlirrn undcr pcnalty of prjury onc of thc following dc.clarations:
_l have and will nuintain a Ccrtificate of Conscnt to Self-lnsurc for workcrs' compensation, as povidcd for by Scction 3700 of the
[:bor Codc. for thc pcrformance of the work for which thc permit ls issued.
_l havc and will maintain workers' comJrcnsation insurance. as rcquirct by Scction 3700 of thc labor Codc. for the pcrformance of
thc work for which this pcrmit is issucd. My workers' compcnsation insurance carricr and plicy numbcr arc:
Carricr:
Policv Numbcr: Exoires:
lrbt""rtify thar in thc pcrformarrce of thc work for which this permit is issued. I shall not cmploy any pcrson in any tnanner
so as to bcconrc subjcct to thc workcrs'compensation laws of California. and agrcc that if I slxluld bccornc subjcct to thc
workcrs' compensation provisions of Section 37fi) of thc latnr Codc. I s]rall. forthwith comply with thosc provisions.
WARNING: Failure lo liccurc workcrs' compcnsation coverage is unlawful. and shall subjcct an employer to crirninal pcnaltics and
civil fines up to onc hundrcd lhousand dollars (S100.O00). in addition to thc cosl of compcnsation. danragcs as provided for thc
a
Section 3076 of thc Latxrr Code. intcrest and altorney's fces.
Dare:
-7 ( ?u I to Applicarrt:
LICENSED CONTRACTOR
DECI ARATI(IN
I hercby affirrn undcr pcnalty of grerjury thal I am licenscd under provision of Chaptcr 9 (comnrncing with Scction 7000) of Division 3
of thc Busincss and Professions Code, ard my licensc is in full force and cffect.
Liccnsc Class: Liccnsc Nurnbcr:
Date:--
CONSTRUCTION LENDING AGENCY
I hcrcbyaflirmurdcrlEnaltyof lrcrjurythal thcrcisaconstruction lcndingagercyforthepcrfomcof thcrcrkforwhichthisFrmit b
issucd (Se. 3097, Civ. C.).
Lrndcr's Nanrc:
Lcndcr's Adtlrcss:
APPLICANT DF'CLARATION
I trcrcby aflirnr undcr penalty of pcrjury onc of the lbllowing dcclarations:
Dcmolition Pcrnrits-Asbcstos Notification Federal Regulations (Titlc 40. Part6)
'--Rcquircd [.cttcr of Notifrcation
-l
ccrtify thal thc fedcral rcgulations rcgarding asbcstos rcnrovalare not applicablc to this projcct.
E\ ccrtify that I havc rcad this application and statc that thc atnvc inforrrution is correct. I agee to comply
ordinanccs and Statc [:ws rclating to building construction, and hcrcby authorizc rcprcscntatives of this City
with all City and County
and County to cnter upon thc
above nrentioncd propcrty for purr)ses.
Applicant or Agent
Itcrrttilu. rranrr)/)
,r^r^.?( L\\ z-D
Set Backs \ln -G r)n ^Uai 1
Forms/Steel/Holdowns ?ltl - | L,v lJr \.,,, f t
Erection Pads
UFER Ground
SLAB Floor
S u bf loor/VenVI ns u I atio n
Roof Sheathinq
Shear Wall
Framing
lnsulatio nlEnergy
Drywall
Ext./lnt. Lath
Brown Coat
lt/asonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif
I I ,./-a
FINAL tt/wl -{/W,illra 7.62
Certificate of Occupancy
Notes, Remarks, Etc.
Rev. 08-07-201 5
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