HomeMy WebLinkAbout40135140 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Mechanical
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 4O135',4O
Pin #: 14146
Project Address: 3505 S Ross St Unit:
Block: NA
Bldg:
Tract: 7058
Address Range:
Historic: No
Suite Range:
Zoning: RlAssessor's Parcel 410-183-02 Lot 28
Owner:
Address:
Quang Luong
3505 S Ross Street
Santa Ana, CA 92707
(7'.t41 552-1417
01 1 16002 51604
01 1 16002 51600
01 1 16002 51604
01 1 16002 57770
Fee Type Amount
Furnace/Comp Combo 136.71
General Plan Update 23.79
lssuance 59.30
Microfilm Records 4.05
Qty
1.00
1.00
1.00
1.00
Fee
$136.71
$23.79
$5e.30
$4.05
Phone:
Tenant Name:
Contractor:
Address:
Phone:
Allcia Air Cond & Htg lnc
26824 Vista Terrace
Lake Forest, CA 92630
(949) 770-2495
State Lic #: 525314
Lic Type: C-20
Bus. Lic #: 129292
Workers' Compensation I nsurance:
Carrier: Employee Service Group
Policy #: WC022116942
Expires: 0710112021
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Building Use:
Job Type:
Nature of Work:
R-3
VB
cMc 2019 Notes: replacement
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Guevara, Jerry Date:
Date:
Date:
12t07t2020 Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Verduzco vor"t$12t07t2020
Account#
Every permitissued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
issuance, or if the work authorized on the site by such permit ts suspended
or abandoned for a period of 360 days after the time the work is
commenced.
01 1 16002 51600
01 1 16002 51604
01 1 16002 57770
$23.7e
$196.01
$4.05
Fee Total:
Paid to Date:
Balance Due:
$223.85
$0.00
$223.85
lnspector MID#: 2020-1 631 19
Single Family Dwelling OccuPancy:
Alteration Constr Type:
Fu rnace/Com pressor Com bPode :
MECHANICAL.I NSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I haehy affm undc panalty of pajury thd I m qmpt ftom the ContmctoE' Liccnsc Law for thc followitq twn (Sq.7031.5
Buins ud Prof6sion Codc): Any City or County which rcquiB a p6mit to @nstruct. dts, improvq rlanolish or rtpair my
stluc{uq prior to its iswca also rcquic thc qplicmt for such pqrnit to filc 8 signcd stdmot thd hc or shc is licoscd pmet
to thc prcvisioB of thc Conkactor's Liccnsed kw (Chaptq 9. Comacing with Sction 7000 of Division 3 of thc BBirN and
Profcsions Codc) or that he or shc is cxcmpt thqcfrom md thc bosis for thc allcged ampioc Any violation of Setbn 703 I .5 by uy
applicot for a pcrmit subjcts the applicut to a civil pcoalty of rot mor€ thfi fivc hundrcd dollm ($500).
-1.
as owner of the property, or my employees with wages as their sole compeosation. will do the work and tlrc stnEture b not
intended or offerd for sale (Sec.7044, Business and hofessioru Code: The Contractor's License l-aw does not apply to an owner of
the propcrty who builds or improvs tlrcreoru and who does such work himself or herself or through his or her own employees.
provided that such improvanents arie not intended orofftred for sah. II. howevcr. thc hlilding or irnprovcmcnt is sold within one )€ar
of complaion, the Ovner Builder will have the hrden of proving thd he or she did not build or impove the propcrty for the prposcof
s8h).
-1,
as owncr of the prop6ty. am exclusively contracting with licensed contractors to construct the project (Sec. 7M4, Business
and hof€ssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon.
and who contracts for such projeds with a Contraclo(s) licansed pursuant to the Contractor's Licetse l-aw).
-l
am exempt under Section-, B. & P.C. for this reason.
llolo.
WORKERS' COMPENSATION
DECLARATION
I hereby affrm under penalty of pcrjury one of the following declarations:
-l
have and will maintain a Certificate of Consent to Self-lnsure for workers' conrpensation, as provided for by Section 3700 of the
Code. for the performance of the work for which the perrnit is issued.
have and by Section 3700 of the l-abor Code. for the performance of
the carrier and policy number are:
fA4t-2--
Policy
_l certi& that in the performance of the work for which this permit is issued. I shall not employ any person in any manner
so as to bccome subject to the workcrs' compensation laws of California. and agree that if I should become subject to the
workers' compensation provisions of Section 3700 of thc Labor Code. I shall. forthrvith comply wilh thosc provisions..
WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an anploycr to criminal pcnalties and
civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the
Section 3076 Code. interest and attorney's */n
1 ^eb?/)
I ICT'NSED CONTRACTOR
DECI,ARATION
I hereby affrrm under penalty of perjury that I arrr licensed under provision of Chapter 9 (cotntnencing with Section 7000) of Division 3
of the Business and Professions Code. and my license is in full fcrrce and effect.
Nulnber:
i c-tq \a
W
I hcrcby alfim unda pqdty of psjury thd thc b a concructbn lcoding agacy for thc pcfot1me of thc mrl 6r which this Fmt b
iscd (Se. 3097, Civ. C.).
Lender's Name:
Lender's Address:
,r, ,.ANT ""c,I herdry affnm under penalty of perjury one of the follorving declarations:
Dernolition Permits-Asbcstos Notification Federal Regulations (Title 40. Part6)
-Required
Later of Notification
-l
certiff that the federal regulations regarding asbestos removal are not applicable to this project.
state that the above information is correct. I agree to comply with all City and County
to enter upon the
above mentioned properly for
Applicant or Agent
Permitee name ^e
and hereby authorize rep,resentatives of this City and
?12,c>
Appliances
Metal Fire Place
Evaporative Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-lnsulation
!nsulation
Smoke Detectors Installed
Rough Ductwork
Vents
Toilet Room / Clothes Dryer
Residential Range
Other
Hood
Type I Hood
Type II Hood
Grease Duct
Fire Damper
Openings
lnstallation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rough Mech.
Final Test
Meter Release ,l
FINAL '7-Dft,ft97(z
Notes, Remarks, Etc.
Owner:
as
1-l-z I
s&s 3l Ll
7-<)Contracto ,, kl