HomeMy WebLinkAbout101103219 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702
PermitCounter: (714)647-580A lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Building
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Permit #: 1O{ 1o3219
Pin #: 66990
Project Address: 4004 W Fifth St
Lot: 5 Block: NA
unit: 101 Blds
Tract: 1 1894
Address Range: 3930-4006.
Historic: No
Suite Range:
Zoning: R2
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Condominium
Miscellaneous
Window Change out
Condominiums w/att Garages
R-3, U
VB
cBc 2019
A-0602320256J
$4,582.00
Retrofit. Contractor Letter of authorization on file. Handout given.
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r,..-r..l r r it'inrv i ;"'. '.i ,")ft t")it'iit 1 i : ;.1 ,
Occupancy:
Constr Type:
Code.
Flood Zone.
# of Stories:
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area.
Total:
Patio:
T l.Area:
Yards Req'd
Valuation:
Description of Work: Change out 5 windows
Planning Conditions:
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
Trcrnsnct ion Tot.nI
Venus Shttll$ell i
l{rineDepoLUSn
6erier'n1 F lnn Llpdnte F*e
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tiuilding
Lrl I 16[r:U- ::16uILil:r[r-
[t]dg 5t,ds Flevolv ing
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liicr0f i1m t D$cufients;
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1(:t. ihecfr 1r1149 7
t5r:r:i. I
Owner:
Address:
Phone:
Tenant
Ursula Ratri
4004 W. Fifth Street Unit 101
Santa Ana, CA 92703
(714) 366-3107
Contractor: Home DePot U S A
Address: 12700 Stowe Drive, Suite 28
Poway, CA 92064
Phone: (858) 846-9700
State Lic #: 602331
Lic Type: B, C-39
Bus. Lic #: 365245
Workers' Compensation lnsurance:
Carrier: Ace American
Policy #: WCUC65990586
Expires: 0310'112020
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd: No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Landscaping lnsp. Req'd: No
Graham, Jeffery Dale 02l2Ol2O2O Misc. Receipt:
Date: Misc. Receipt:
Chavez. Dave , Date: 02120t2020 Misc. Receipt:
=2" Subject to Field
No
No Account#
077L5002
07776002
07716002
07775002
07775002
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
57607
57770
57672
51600
57607
$166.53
$3.91
$1.00
$22.95
$57.20
Fire lnsp. Req'd:
Police lnsp. Req'd:
Flood Zone Cert. Req'd: No 011.t6002 51600
Every permit issued 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 rs suspended o r abandoned for a period of 360 days after
the time the work is commenced.
Total
01 1 16002 51601
01116002 516't2
01116002 57770
$22 95
$223.73
$1.00
$3.91 Fee Total:
Paid to Date:
Balance Due:
$251.59
$0.00
$251.s9
lnspector MID#: 2020-157930
Assessor's Parcel: 198-051-21
BU!LDING. INSPECTOR RECORD
S!TE.WORK DATE ID/SIG.COMMENTS owNER ltt,Il,l)Et{ t)ul.cARA't.toN
Iherebyaffirnrunderpenaltyofperi!rythatIamexcnrptfromthe(lontractors Licensc[-awforthefollowingreasoD(Sec.7031.5
ljusincss And Proltssion Codc): Any City or County which requires a pcnnit lo conslnlcl, nllcr, irnprovc, dcrnolish or (-Iair any
stnrcxrrc,priorloits issuance.alsorequirestheapplicrtrlfi)rsuchlErnlill)fileasiSnedslatenEnt lhatlrcorsheislicensed pursuant
to lhc provisionr ol lhc Conlraclor's l-iccnscd Iaw (Chaplcr 9. ComrncncinS wilh Scclion ?(fn of l)ivision J ol thc Busincss and
P()les\i()trsCodc)orthathcorsheiscremptlhcrefionrandtlEbasisti)rthcallcgedcrenrpti(tr1. Anyviolati(ilofSection703l.5byany
ilpplicaDrlbrapcflnilsubjeclslhe npplicanltoacivilpcDnhyofnot[]orethanl'ivehundrcddollars($5(X)).
_1, is owncr ol-lhc proFEnv, or my cmployccs with wagcs as lhcir solc' c()mpcnsalion. will do (hc wo* and thc structure is mt
iilculed orofferedforMlc(Sc.7{N.l.BusinessandPft)fcssionsC{xle:ThcConlractor's[-icenschwdoesnoltpplyloanownerof
the popcny wlxr boilds or improws lheron, iuld who d(Es such uork hinrselfor hcrselfor through his or lEr own employees.
providcd that such improvcrftnts de fl{ intcnded orolltrcd lor slc. II, howcvcr. lhc building or improvcmnl is sld wirhin onc ycar
of.onl)leli(r, llE OwDer Builder will hrve the burden of proving llut he or she rlitl not build r)r inrp()ve the propdy for lhe puqmse of
sale).
_1, as owner of lhe prcpeny, am cxclusivcly contrsclinS wilh lic€nsd conlraclors to cnnrlruct lhc prcjcct (Scc. 7(X4. Busincrs
arxl [trrflssinCirdcr'l'hcContnck)r'lLicenseLawdocsnotapplytoanownerofpropenywhobuildsorimproresthcreon.
and who conracts for such p()jccls with a Contrack,r(s) lice[*d pur\uant to thc Conlractor's Liccnsc kw).
-IlnlexemntUndersection-'B,&P,c,li,rlhisrea\oil,Dsle:_
woRKI.tRS' COM Pt:NSA'rION
DT]CLARATI0N
I hcrchy ltlirm undcr ncnrhy of pcrjury onc of thc l'olk)wing dcclnrnti()ns:
_l have ard will nBintairr a Cenilicate of Consent (r SelLlnsure for workers'compensrli(nr, al prcvided for hy Section J700 ofthe
tffi,for thc pcrformrcc of the work lbr which lh! pcrmit is issucd.
will nraintain workers' conrpensati)n irr\urnnce, as required hy Section 3700 ofthe llbor Codc, lbr lhe perf(,rnuilrce of
which lhis is issuc(l. My workcrs' c()nrl)cnsatiotr crtricr lxrlicy numhcr arc:
Policy
_l ccrtity lhat in thc Frtbrnuncc ()l'thc work for which lhis pcrnrit is rssucd, I shilll nrtr cnlploy rny lErson in
so as to hccorrc suhjcct lo lhc workcrs'conlpcnsalion laws ofCalifonria, nDd agrcc lhat if I should becorru suhjcct to thc
workcrs' contpensatioD provisions of Sectiotr 3700 of thc Labor Code, I shall. fonhwith conrply with thos provisioDs.
WARNING: Failure k, scure workcrs'compcnsilioo covcrdge is unlawful. dnd shall subjcct m (, (riminul pnaltrs und
civil fines up to one hundred t dollirs (Sl()0,(xX)). in
and atbmey s lce\.
additiil to the cost as providcd for ll.
Sectrr 1076 ofthe
I hcrcby al'firm under
DDCLARATION
ofperjury rhat I am licen$d undcr proyirion ol Chapter 9 (cornrroncing wirh Sccrion 70fi)) ofl)i!ision 3
ol rhc Rusincs\ fln(l l'rolcssir)ns C((lc. md nry liccnsc ir in lirll l'trrcc atrd cl'ti.cl.
[,iccnsc
3r
a
I herhy atlirnr under fEilaIy ofpcrjury tlut lhere
issucd (Scc. 3097, Ci!. C.).
trnddr's Nanrc:
r crnrstnlcliflr lendir8 a8ercy for thE pcrilrturce of lhe work tbr whicll this pemril is
lJn,lcr's Ad,lrcss:
APPLICANT DECI,ARATION
I tBrcby affmunder penahy of pcrjury one of the following delarations:
DenDlition Permils-Asbcrtos Notification Federal ReSulntions (Title.l0, Pan6)
_Rcquired lrttcr of Notificalion
renmval trc not applicable to this p()jerr.
with all City anrl County
and Courily to eoter uIxn the
atx)\'c mcntioncd propcny lilr inspccti()n
Applicnnl or AEcnt
I
,o*, ' Z-Zs-?
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/VenVl nsu lation
Roof Sheathino
Shear Wall
Framinq
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Jt/asonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
FINAL 6-?Za /L Cr.,.{€/As (Zr)
Certificate of Occupancy
Notes, Remarks, Etc.
D
Rev.0B-07-2015
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