HomeMy WebLinkAbout101105395 - Permit^City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CAS27O2 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: {01105395
Pin #: 41873
Proiect Address: 271 3 N Olive Lna
Assessor's Parcel: 002-284-09 Lot: 38
Unit:Bldg: Address Range:Suite Range:
Zoning: RlBlock: NA Tract: 2089 Historic. No
Building Use: Single Family Dwelling Occupancy: R-3, U 1st FL Area
Job Type: Reroof Constr Type: V B 2nd FL Area
Nature of Work: Reroof Code: CBC 2019 Other Areas
Existing Bldg. & Use: SFD datt garage Flood Zone: X-0602320144J
Garage Area
Proposed Use: # of Stories:
Totaf
Description of Work: Reroof dt.o.-Remove and apply comp shingles/replace sheathing as req'd/handout given/auth on file
Planning Conditions:
Patio:
T.l.Area:
Yards Req'd
Valuation: $t 9,220.00
Owner:
Address:
Phone:
Tenant
Bibiano Rivera
2713 Olive Ln
Santa Ana, CA 927061130
(7141 836-8ee5
Contractor: Herman Roofing
Address: 4050-1 12 Brotherton St
Corona, CA 928791813
Phone: (951) 288-1328
State Lic #: 348265
Lic Type. C-39
Bus. Lic #: 187811
Workers' Compensation I nsurance:
Carrier: State Compensation lnsurance Fut
Policy #: 9030938
Expires: 1110112021
Engineer:
Address.
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
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
Orozco, lvan
Hernan dez, Kathy
Date: 1210812020
Date:
Date: 1210812020
Subject to Field:
Misc. Receipt:
Misc. Receipt.
Misc. Receipt:qY
07776002
07776002
07776002
07776002
07776002
57607
57770
57672
s760 0
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuance
Fee Totat
Paid to Date:
Balance Due:
$345.28
$4.05
$1.00
$23.79
$59.30
No
No
No
Fire !nsp. Req'd:
Police lnsp. Req'd
Flood Zone Cert. Req'd: No
No
No Account#Total
Every permit issued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days afterifs rssuance,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.
01 1 16002 51600
01 1 16002 51601
01116002 51612
01 1 16002 57770
$23.79
$404.58
$1.00
$4.05 $433.42
$0.00
$433.42
lnspector MID#: 2020-163144
't
BUILDING- INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUTLDER DELCARATION
I hcreby rlltrm undcr Fnalty of Frjury lhal I am cxcmpt hom lhc ConlracmN' Liccns Law litr lhc titlkrwhg rca$n (ScfiOJl.s
Busincss afil Profcssion Cirxlc): Atry City or County which rcquircs a [rcrmit to construc(. altcr. imprcvc. dcmolish or rcIBi, any
slructurc, prior to its issuancc, als(' rcquircs thc applicunt for such lEmil kr tilc a sigrcd statcmnt thal hc or shc is liccn$d Pursuani
to thc Jnrvisions of thc Contrackrr's Liccnrcd law (Chaptcr 9, Comnrcncing wilh Setbn 7000 of Division -l of thc Busircss and
PrufcssionsCodc)orthathcorshciscxcmptthdclnrmandthchasislbrthcalhgcdcxcmption. Anyviolationofsccti(D703l.5byany
applicant lbr a F mil subjels lhc applicanl to a civil pcnalty of trr)t morc th{n f ivc huilrcd dollars (5500).
_1, as owncr of the propcrty, or my cmployccs with wagcs as lheir solc compcnsalion, will do thc work atxl thc strur,*turc is nol
iltcnded orofl'crcd ftlr .sale (Scr-.7044. Busincss and Pnrfbssions CrxJc: Thc Contractor's Liccnsc [-aw drrcs ntlt apply to an owner of
thc propcrty who builds or impn)vcs thcrcon, and who d<rcs such work hintsclf or hcrself or thn)ugh his ttr her own cmployccs,
pnrvidcd that such improvcrncnts iuc not intcrdcd orollcrcd lilr salc. It, howcvcr, thc buikling or improvclncnt is sold withrn otlc ycar
ol'complction, thc Owncr tsuiLJer will have the burdcn ol'proving that hc or shc did not buill or improvc the pnrpcrty lbr thc purprsc of
salc).
_1. as ()wncr o[ the proJrcrty, am cxclusivcly contracting with liccnscd contractors to construct thc pro.iect (Scc. 7U4, Busiucss
and PnllbsskrnCotle:ThcContractrlr'sl-iccnscl-awdocsnotapplytoanowncrofprrtpcrtywhohuildstlrimprovcsthcreon.
and who contracls lirr such pro.iccts with a Contractor(s) liccnscd pursuant to thc Crtntractor's Liccnsc Law).
-l
am cxcmpl undcr Scction-, B. & P.C. for this rcas<ltt.
ll.,r^.
UOETEESSOMPINSAIIqN
DEC!.A8AIIAN
I hcrchy altirm undcr pcnaltyofJsjury ouc ofthe folhwinS deldalions:
_lhavcandwillmintainaCcnificatcofc(rnsnttoSclFlnsurcforworkss'compcnsalion,as prcvidqllorbySetiltn.lTfi)ofthc
Labor C(xlc, for tlE Frfirrmncc of lhc qrrt lbr shich thc Frmit is issucd.
all havc rnrl will mointain workc6' comlrcnsation insurancc, 8s requircd by Scct ion .1700 of thc tihor Codc, tbr thc 1Ertitrmret of
thc work for which this Frmil is issql. My workqs' smlrcnsalion insurancc cuier anl F)licy numbcr ec:
SA#e- FrnJ
poricy N"r',h"r, ?O 3 Oq 3 tr Expircs: .//- /-AL /
_l ccrtily lhat in thc pcrlirrmancc of thc wrlrk tirr which this Jrcrrnit is issucd, I shall not cntpkry any frcrson in any matlncr
so as to bccomc suhjcct to thc workcrs'comJrcnsation laws of Calitilrnia, and agrcc that if I should bcctlmc sub.icct to thc
workcrs' comJrcnsation provisions ot'scction 3700 of thc l-ahrr CrxJc, I shall, tilrthwith comply with thosc provisions.
WARNING: f;ailurc to sccurc workcrs' comJrcnsation c()vcragc is unlawt'ul, and shall subjcct an cmploycr to criminal Jrcnaltics and
eivil lincs up to onc hundrcd thousand dollars (S100,Uru), in adrlition to thc cost of comlrcnsation, damagcs as providcd tirr thc
Scction 3076 of thc l:txlr Ctxlc, intcrcst and atlorncy's l'ccs.4"COLO Annlicnnt: K
LI
DECLAR/ITION
I am licenscd under provision of Chaptcr 9 (commcncing with Scction 7firu) of Divisitln 3
my liccnsc is in tbll tirrcc anrJ ctI'cct.
I hcrcby allirrn undcr pcnalty ol'pcrjury lhat
ol' thc Busincss anrl Prcl'cssiorts Codc. arx,l
Licensc ,r^rr, C39 Liccnsc
tc/F26r
2ec Pz-o
W
I hcrcby allirm unrlcr Jrcnalty of Jrrjury that thsc is a coNtruclirn lcnding aSency tbr lhc Jrcrfirrmancc of lhc wtlrk hlr which thi\ JEmit is
issued (Se. -1097, Civ. C.).
lrnder's Namc:
APPLICANT DECLARATION
I hcrehy allirm untlcr pcnalty ol'Jrcrjury onc of thc lbllowing dcclaratiotts:
Dcmolition Permits-Asbcstos Notification Federal Regulations ('l'itlc 40, Part6)
-Requircd
lrttcr of Notitication
_l ccrtily that thc l'cdcralrcgulations regartling asbcstos rcn'xrvalarc not applicablc to this pr<tjcct.
_l ccrrily that I havc rcad this application and statc that thc alxrve intilrmatiotr is corrcct. I agrcc to comply with all City and County
ordinanccs and State l.aws rclating to building hcrcby authrlrizc rcprcscntatives of this City anrl County to entcr uJxln the
atxrvc nrcntioncd pro;rcrty lirr
Applicant or Agcnt
Penrritec nanre
,r^r" €e. Q zozo
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bf loor/VenUI rtsu Iatio n //
Roof Sheathino{r l7lrflrV frhlbDK,V
Shear Wall I
Framinq
lnsulation lEnerqy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
-ttl J\I //3
FINAL Itlt\ll]11,r0 t
Certificate of Occupancv I
Notes, Remarkq, Etc.I I ^ ,tt.^ro
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