HomeMy WebLinkAbout101103312 - PermitProject Address:
Assessor's Parcel: 01 1-075-05
alen
Lot: 5 Block: E Tract: 466 Historic: No
Suite Range:
Zoning: Rl
Unit:Bldg: Address Range:
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: {O11O3312
Pin #: 37539
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use.
Proposed Use:
Single Family Dwelling
Reroof
SFD w/ att garage
SFD
Occupancy:
Constr Type:
Code.
Flood Zone'.
# of Stories:
R-3, U
VB
cBc 2019
x-0602320276J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Total
Oe6crlptlon of Work TrO existing roof end inslall new comp shingl6s like tor like to SFD with sttech.d g.reg€. Raplace sh.athingrplywood es needed.
Hand out given. Auth on file.
Planning Conditions:
Patio:
T.l.Area:
Yards Req'd
Valuation:$3,000.00
.t {f,
)
Owner:
Address:
Phone:
Tenant
Mahai Torok
1017 KILSON DR
Santa Ana, CA 927016049
(7141 624-3372
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 #:
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:
Police lnsp. Req'd
Flood Zone Cert. Req'd: No
Graham, Jeffery
Zuniga, Allissa
Date: 0212712020
Date:
Date: 0212712020
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
077760 02
077760 02
07776002
077760 02
077760 0 2
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuance
57607
57770
57572
s7600
57607
Fee Totat
Paid to Date:
Balance Due:
$333 06
$3.91
$1.00
$22.9s
$57.20
$418.12
$0 00
$41 8.12
No
No
No
No
No
No Account#Total
Every permit issued shall become invalid unless the work on the site authorized by
such permit is commenced within360 days afterifs issuance,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.
lnspector tvllD#: 201 1-100428
01116002 51600
01116002 51601
01116002 51612
01116002 57770
$22.9s
$390.26
$1 00
$3 91
a
a
BUILDING- INSPECTOR RECORD
SITE.WORK DATE ID/SIG COMMENTS
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/Ve nUl n su I atio n -l r
Roof Sheathinq ll ,0 Dq-*Y/
Shear Wall I
Framinq
lnsulatio nlEnerqv
Drvwall
Ext./lnt. Lath
Brown Coat
Nlasonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
tl \^t)4
(,/Ul{tdo,/FINAL
Certificate of Occupancy t
Notes, Remarks, Etc.
I hereby affirm undcr penalty of perjury that I am exempt from tlrc Cbntracton' License [-aw for the following reason (Sec.7031.5
Busincss and Profcssion Code): Any City or County which requires a pcrmit to construcl, aller, irnprove. dernolish or rcpair any
structure, prior to its issualrce. also requires the applicant fkrr such pernilt to file a signed staterrcnt that he or she is licenscd pursuant
to thc pmvisions of thc. Contractor's l,icensed l:w (Chapter 9. Commcncing with Section 7fiX) of l)ivision 3 of the Business and
Prot'essi<lns Code) or that he or she is exempt therefiom and tlre basis for tlre alleged exemption. Any violation of Section 703 I .5 by any
applicant for a pennit subjects thc applicant to a civil penalty o[ not more than llve hundred dollars ($5tXl1.
of thc propcrty, or my employecs r*,ith wages as thcir solc compcnsalion, will do the work and thc slructurc is rnt
or offeretl for sale (Sec.7M4. Business and Professions Code: The Contraclor's License Law does not apply to an owner of
the propcrty who builds or ingows therooq and wtxl does such w<lrk himself or hcrself or through his or her own employees,
provided that such irnprovernents are not intended or ollercd for salc. Il. however. the building or improvcment is sold within one )€ar
of conpletion, the Owner Builder will havc thc burden of proving ttut hc or she did not buikl or improvc thc p.perty for tlrc purporc of
sale).
_1. as owner of the prcperty, am cxclusively contracting with liccnsed conlracloni to conslruct thc pr,oject (Sec. 7044. Busincss
and Pnrtbssirxr Code: The Contractor's License Law does not apply to an owncr of progrcrty who builds or improves thereon.
and who contracrs for such projects with a Contractor(.s) licenrcd pursuant to thc Contractor's Licensc l-aw).
_l anr cxempt under B. & P.C.-21 -'?e
I hcreby aflirm undcr penalty of perjury one dcclarations:
_I have and will maintain a Certificatc of Consent to Self-lnsure for workers' comgrcnsation, as provided for by Section 3700 of the
Labor Code, lor the Jrerformance of the work lbr which thc permil is issucd.
_l havc and will maintain workers' conrpensation insurance, as required by Section 3700 of the Labor Code, for the performarrce of
the work for which this permit is issued. My workers' compcns:rtion insurancc carricr ad plicy number are:
Carrier:
Policy Numtrcr: lixpires:
_l ccrtity that in the pcrfbrmance of thc work for which this prmit is issucd, I shall not cmploy any pcrson in any manncr
so as to becomc subjcct to thc workers' cornpensation laws of California. and agrcc that if I should becomc subject to thc
workers' conrlrcnsation pmvisions of Section 3700 of the Labor Code, I shall, forthwith comply with those provisions.
WARNING: Failure to sccure workers' comgrcnsation covcrage Ls unlawful. and shall suhject an employcr to criminal pcnahirx and
civil lines up to one hundred thousand dollars ($100,UX), in addition to the of damages as provided for the
Section 3076 of the l-abor C'ode, interest and attorney's fees.
Iratc:2-2?:bL?t
I
I hercby aflirm undcr penalty of pcrjury that I am
I)NCI,ARA'I'I0N
under provision ol'Chapter 9 (cornmcncing with Section 7ffn) of l)ivision 3
of thc Busincss and Profcssions Codc. arxl my licensc is in full lirrce iurd etfcct.
l,icensc Numbcr:
I)ale:
CONSTRT.'CTION I,ENDING AGT:NCY
I hercby atfirnr under penalty of perjury that there is a construction lending agerrcy for the lrcrformarrce of the work for which this prmit is
issucd (.Sec. .3097, Civ. C.).
kndcr's Nantc:
f
[.cnder's Addrcss:
APPLICANT DECLARATION
I My affrnr under penalty of pcrjury one of the following declarations:
Demolition Permits-Asbestos Notification Fetlcral Regulatiorrs (Title 40. Part6)
-Required
[rtter of Notifrcation
_l certify that the federal regulations regarding asbestos renroval are not applicable to this project.
reatl this application and state that the above information is corrcct. I agree to comply with all City and County
representatives of this CitV3nd County to enter upon theand State l-aws relating to building constructiorta
atxn'e mcntioned pnrpcrty lirr
Applicanl or Agcnt
I)rrnritcr nanle
Purposcs.
atd autlxrrize
*r,, Z-21 -bZDt
Rev. 08-07-2015
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