HomeMy WebLinkAbout101103131 - PermitProject Address: 718 S Townsend St Unit:Bldg: Address Range:Suite Range:
Zoning: R3Assessor's Parcel:109-612-03 Block: NA Tract: 3391 Historic: No
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA g27OZ Building
Permit Counter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #:1O1{03{3{
Pin #: s8{1]J
Building Use: Itlulti-Famlly (5 or more unlts) Occupancy: R-2 'lst FL Area: Patio:
Job Type: Reroof Constr Type: V B 2nd FL Area: T.t.Area:
Natureofworh Reroof Code: CBC20i9 Other Areas: yards Req,d:
Existing Bldg. & Use: 8-unit apartment Flood Zone: X46O232O257J
proposed user #ofstories: Ga'age Area valuation: lll'00000
Total:
Do6crlptlon o, Wo&: T..r off exbting roof materiel and install n6w comp 3hingla matarial. Ropair aheathing as ne.dad. 38 squaroa. Handout givsn.
Planning Conditions:
Owner:
Address:
Phone:
Tenant:
CHUNG & YVONNE LAU
315 E MAIN ST
Alhambra, CA 918013958
(626)379-4375
Contractor: Tesla Roofing, lnc
Address: 1467 W. Washington Blvd.
Los Angeles, CA 90007
Phone: (213) 640-0906
State Lic #: 1046651
Lic Type: C-39
Bus. Lic #: 375109
Workers' Compensation lnsurance:
Carrier: State Compensation lnsurance Fur
Policy #: 9229688
Expires: 041'1412020
Engineer:
Address:
Phone:
License #.
Architect /
Desiqner:
Address:
Phone:
License #:
a
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
Fire lnsp. Req'd:
Police lnsp. Req'd
Graham, Jeffery
Chavez, Dave
22
Dale: O211312020
Date:
Dale: 0211312020
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002
077L6002
07776002
07775002
07776002
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
57607
5777 0
57672
57600
57607
$333.06
$3.91
$1.00
$22.95
$57.20
No
No Account#Total
Flood Zone Cert. Req'd: No 01116002 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 is suspended or abandoned for a period of 360 days after
the time the work is commenced.
lnspector
01't16002 51601
01 1 16002 51612
01116002 57770
$22.95
$390.26
$1.00
$3.91 Fee Total:
Paid to Date:
Balance Due:
$418.12
$0.00
$418.12
Lot: 3
MID#: 2020-157754
L
BUILDING- INSPECTOR RECORD
Rev.0B-07-2015
SITE.WORK DATE ID/SIG COMMENTS owNuR Bt rILI)ER t)t]t.cARAT()N
I hereby affirnr under penalty of perjury that I m) etcmpt from the Contraclo6' l,icense [;rw for the following reafn (Sc.7031-5
llusincss and l,rolcssion Codc): Any City or Countv which rcquircs a pcrmil o consnuct, altcr, irnprovc, dcmolish or rnair any
stnrcture.priort()its issuancc.alsorequireslheapplicatrtfirrsuchpernit()fileasignedslnlcmnt lhatlEorshaislice[Ed pursuanl
lo lhc nrovisions of lhc Contractor's l,iccnscd l-aw (Chaptcr 9, Cornrnencing wilh Scction 7(XX) ol l)ivirion 3 ol lhc Business and
Pr()ftssi()osCode)orthatlEorrhcisc\cnrpllhcreftonlandllEbasislirrtltrlle8edexenrptiul. Ailyvi()latiurofScctiorT03l.5byany
applicrnrforapcnnitsubjecrsthc {pplicanrtoncivilpennltyofnotrnorethrnfivehundreddollars($5U)).
_1. as owncr ol'thc propfly. or my cmplovecs with wages as lheir slc compcnsalion, willdo lhe work ard thc slMture is m(
irilendcd orofferadforNule(5*.7044.BusincssandPmfessionsCodc:TheCuilruclor'sLiccnscLawrloesnolapplybflnowncrof
th€pfi)pcdy wh)buildsorimprovestlHsilafilwhodocssuchworkhinrselforlErsclforthmu8hhisorherownemployees,
prol idcd lhat such impmvcrrcnts e mt intefilcd or ollered for sle. ll, howcvcr. the blilding or itrprovcrrent is soH wilhin onc }til
ofconuleliol, the Owncr Buildcr will hsve the burden ofprcving lhd hc or shc dirl not build or improve thc prc[Eny for llE purfnse of
$le).
_1, as owner of thc pmpcrly, am cxclusively contractinS wilh liccnFi conlraclon to conslruct lh. pmject (S4. 7014. Businc\s
arrl PnrtksbnCode:TheConlraclor'iLicenscLawd(EsnolapplyloanownerofproJrnywhobuildsorimproveslher6n.
and who conlracts for such prcjecli with a Coilraclor(s) liccnsed pursuill lo thc Conlractor's Liccnse Law).
_l anlexempl under Section_, B. & P.C. lbr this reason-
n----
EA8IE&ISOIIIENSAIIQN
DECLARATION
I hcrchy aftirm under f'enahy ofpc.jury one ofthe following dcclMarions:
_l havc and will Mintain a Ccnilicatc of Conscnt to Sclf-lnsurc for workers' contpcnsalion, as pmvided for by Scction J700 of tha
Lahor Codc, for the performmc of lhc work for which thc permit is i-ssued.
$flave a$ wrll maintain workcrs' compcnsalion insuramc, as rcquircd by Scclion l70O of thc tibor Codc, for thc IErfomrce of! thc work frrr whie h rhis plrmit is issued. My workers' compensstion ins$rilcc cmier aftl lmlicy numbcr dc:
Polic)z
_l ccrity thlt in thc prlbrnunce ofthc work for which this pcrmit is issucrl, I shull not en]pby any pcrson in any manncr
so as lo hccorE subject to the workers' compcnsation laws of California. and aSrcc that i[ I slnuld bccorre subject to thc
workers' comlrcnsrtion provisions of Section 3700 of the Lah)r Code, I shdll, fonhwith comply with thos prcvisions.
WARNING: Irailure lo sccure workcrs'compnsalion covcruEc is unlawfirl. nnd shall subjcct u employcr t) fiinrinal Fmlties and
civil fincs up h one hundred thousand dollnrs (Sl(x),(xru). in addition to lhe cost of co$pcnsalion, damrgcs ns provided fo. thc
Seclion 1076 ofthe titx)r Cbdc, ineresl and atbrcy's fees.
?D
I hcreby al'lirm undcr pcnahy of pcrjury lhat I arn licenscd undcr ptovision ol Chapter 9 (cornrrcncing wilh Scction 7iln) oI Division 3
of thc Busincss and Pmfcssiom Codc. ill my licenrc is in full forcc arrl clltct.
l-iccnsc Nurnher'/ o (61s/
CONSTRUCTION I,ENDING AGENCY
I hceby attirm uilder fEnalty of periury thal there is a constructiur hudirg agcE-y fbr the perfomarce ofthe work for which this lEmit i9
issued (Scc. 3097, Civ. C.).
kndcr's Nanre:
[lndcr's Addrcss:
APPLICANT DECLARATION
I hdcby affmundcr pcnalty of pcrjury onc of (hc followinS dslarations:
Derolition Permits-Asbcstos Notification Fcdcral RcSulations (Titlc 40, Pa.t6)
-Rcquired
[.tter of Notification
_l cediry thit th€ fcdcral regulations rcgarding asbcslos rcnDval aE nol applicablc to this pmFct.
Uwgify ,tnl havc rarJ rhis applicalion all statc thal thc abovc infomalion is corcct. I aSre to @mply with all City an<l Counry
6dinailccs rnd Statc liws r€latinS to buildinS coNtructiotr ilxl hcreby outhorizc rcprcsntativcs of this City and County lo eotcr ulDn tha
rh()vc nrcolir)nc(l lnl)pcrty k,r insl)ccti()n lurIx)ses.
Aptllicant or Agcnt
I'( rnrilrr name(nrrnr):D( sE/* G Z1
^," t y'tl/zo
---.----r------7-_
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/VenVl nsu lation tl I
Roof Sheathing //t6/%v 4rI
Shear Wall tl
Framinq
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
[t/asonry
Pool Fence
T-Bar (
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif.
I I t,
F!NAL '/honoY d6
Certificate of Occupancy I
Notes, Remarks, Etc.
-
,,,**,, c 157hre. a^4/ -T,tts ,4tAt)
arrnrn*t*-, f ( - =
*;SNTA
NA,"ffi
Planning & Building Agency
20 Civic Center Ptaza Rogs ,qnnex
P.O. Box 1988 (M-19)
Santa Ana, CA92702
(714) 647-5800
ww,v.santa-ana_ oro
This document mdy be found ot..,
201 3 CRC
SA
(Please use a black or blue ink batt-point pen)
state of california requires that smoke and carbon monoxide (co) al
buildings.
ms are installed in residential
california Residentialcode (cRC) section R314.1and R31.5.2 states in that existing dwellings be
"retrofitted with smoke alarms and carbon monoxide alarms. cRC se
the required locations.
f\eo,h boxes betow must be checked:
ion R314.3 and R314.3.3 define
(caruon monoxide alarms: Are instailed outside of each sleeping a
bedrooms and also on each level of the dwelling. Alarms are required
appliances (i.e, hot water heater, cooktop, furnace) or a fireplace.
in the immediate vicinity of
n bedrooms with gas-fired
psmot e alarms: Are installed in each room used for sleeping, in hallway outside of a sleeping
room, and on each level of the dwelling.
Retrofitted detectors may be battery-operated for buildings where interior alterations are
performed. combination smoke/co alarms must comply with all appli
by the State Fire Marshall (SFM). Battery life must be 10 years.
ble standards and be approved
I hereby certify that I am the contractor or the property owner of the bove project. I further certify
that smoke alarms and carbon monoxide alarms have been installed i compliance with the governing
codes and have been tested to be functional. l, also, hereby certify I will retest the alarms per the
ma nufactu rer's instructions
lcheck onel et Licensed Contractor P ner
NorE: This self'certification is only used for projects that affea the of the structure. This
process is applicable oNLY to projects where dccess to the interior of
lnspector is not required.
dwelling by o Santa Ana
AI
oke & CO
rm Affidavit
Project Address:7rB s Toc*D@a gr
Permit Number:- ,-1713/
Property Owner:t-+c/
Gontractor:1- t F6a2t't6z License I t: /ct (66-e/
Signature:ootl:2O -o
Have this completed form and the job-card readily ava on final inspection!
tr
*,$NTA
NA,W
Planning & Building Agency
2A Clvic Center Plaza Ross Annex
P.O. Box 1988 (M-19)
Santa Ana, CA92702
(714) 647-s800
ww/v. santa-ana. oro
This document may be found at...
INSP{2
(Please use a black or blue ink ball-point pen)
state of california requires that smoke and carbon monoxide (co) al
buildings.
california Residentiat code (cRC) section R314.i. and R315.2 states in that existing dwellings be"retrofitted with smoke alarms and carbon monoxide alarms. cRC se
the required locations.
ion R314.3 and R314.3.3 define
'ms are installed in residential
n bedrooms with gas-fired
ABoth boxes betow must be checked:
S'caruon monoxide alarms: Are installed outside of each sleeping a
bedrooms and also on each level of the dweiling. Alarms are required
appliances (i.e. hot water heater, cooktop, furnace) or a fireplace.
in the immediate vicinity of
p Smof.e alarms: Are installed in each room used for sleeping, in
room, and on each level of the dwelling.
hallway outside of a sleeping
Retrofitted detectors may be battery-operated for buildings where no interior alterations are
performed. combination smoke/co alarms must comply with alt appl
by the State Fire Marshall (SFM). Battery life must be 10 years.
ble standards and be approved
I hereby certify that I am the contractor or the property owner of the
that smoke alarms and carbon monoxide alarms have been installed i
project. I further certify
compliance with the governing
codes and have been tested to be functional. l, also, hereby certify
man ufactu rer's instructions.
I will retest the alarms per the
lcheck onel Li cense d tr P er
NorE: This self-certification is only used for projects that offect the of the structure. This
process is applicable oNLY to projects where dccess to the interior ol
lnspector is not required.
dwelling by a Santa Ana
AI
oke & CO
rm Affidavit
Project Address:z0s fu\Y -%rt2
Permit Number:/o' ^3 /s 1
Property Owner:LbA
Contractor:7a4 ,?4oftAh License I l: .'4:669
Signature:Z.-,1 z4-oatl:9u,/p
Have this completed form and the job-card readily on final inspection!
*,,SNTA
A},[AJ'ffi
Planning & Building Agency
20 Civic Center Plaza Rots Annex
P.O. Box 1988 (M-19)
Santa Ana, CA92702
(714) 647.s800
wwl,v.santa-ana. oro
This document mdy be found ot,.,
(Please use a black or blue ink balt-point pen)
state of california requires that smoke and carbon monoxide (co)
buildings.
california Residentialcode (CRC) section R314.1 and R315.2 states in
"retrofitted with smoke alarms and carbon monoxide alarms. cRC
the required locations.
ABoth boxes below must be checked:
p caruon monoxide alarms: Are instailed outside of each sleeping a
bedrooms and also on each level of the dwelling. Alarms are required
appliances (i.e. hot water heater, cooktop, furnace) or a fireplace.
2013
s are installed in residential
rt that existing dwellings be
n R314.3 and R314.3.3 define
a in the immediate vicinity of
r bedrooms with gas-firedn
flSmot<e alarms: Are installed in each room used for sleeping, in e
ioom, and on each level of the dwelling.
hallway outside of a sleeping
Retrofitted detectors may be battery-operated for buildings where or alterations are
performed. combination smoke/co alarms must comply with all appl
by the State Fire Marshall (SFM). Battery life must be 1.0 years.
I hereby certify that I am the contractor or the property owner of the
e standards and be approved
bove project. I further certify
that smoke alarms and carbon monoxide alarrns have been installed compliance with the governing
codes and have been tested to be functional. l, also, hereby certify th I will retest the alarms per the
ma nufactu rer's instructions.
lcheck onel ,8 Licensed Contra tr erty
NorE: This self-certification is onty used for projects that affect the of the structure. This
process is applicable oNLY to projects where dccess to the interior of
lnspector is not required.
dwelling by a Santd And
AI
oke & CO
rm Affidavit
Project Address:7tB s 7oai%-tYt :7 *3
Permit Number:/o//n 3tz/
Property Owner:t4u
Contractor:76(4 72s62)h License r t:1o461il
Signature P4 ,/*,/--
Have this completed form and the job-card readily availa on final inspection!
*;SNTA
.NA,,ffi
Planning & Building Agency
20 Civic Center Plaza Rocs Annex
P.O. Box 1988 (M-19)
Santa Ana, CA92702
(714) 647.5800
wwiv. Sa n ta-an a_ oro
This document mdy be found at...a
rNSP-02 201
are installed in residential
on R314.3 and R314.3.3 define
e standards and be approved
bove project. I further certify
compliance with the governing
I will retest the alarms per the
(Please use a black or blue ink bail-point pen)
state of california requires that smoke and carbon monoxide (co) a
buildings.
california Residential code (cRC) section R3i.4.1and R315.2 states in rt that existing dwellings be"retrofitted with smoke alarms and carbon monoxide alarms. cRC
the required locations.
ABoth boxes below must be checkedr
fr crruon monoxide atarms: Are installed outside of each sleeping a
bedrooms and also on each level of the dwelling, Alarms are required
appliances (i.e. hot water heater, cooktop, furnace) or a fireplace.
a in the immediate vicinity of
bed rooms with gas-fired
flsmot<e alarms: Are installed in each room used for sleeping, in e
foom, and on each level of the dwelling.
hallway outside of a sleeping
Retrofitted detectors may be battery-operated for buildings where no or alterations are
performed. combination smoke/co alarms must comply with all appl
by the State Fire Marshall (SFM). Battery life must be 1.0 years.
I hereby certify that I am the contractor or the property owner of the
that smoke alarms and carbon monoxide alarms have been installed
codes and have been tested to be functional, l, also, hereby certify th
man ufactu rer's instructions.
lcheck onel P License Owner
NorE: This self-certification is only used for projects thot affect the of the structure. This
process is applicable ONLY to projects where dccess to the interior of
lnspector is not required.
dwelling by a Santa Ana
Contractor tr P
AI
oke & CO
rm Affidavit
Project Address:J-1z 'ft(
Permit Number:
Property Owner:t-*u
Contractor:TRLA tzob,A^J h License I t: l2/66s/
Signature -'l Ooti,:,/*7d
Have this completed form and the iob-card readily on final inspection!
ilSNTA
NA,'ffi
Planning & Building Agency
20 Civic Cente r Plaza Ross Annex
P.O. Box 1988 (M-19)
Santa Ana, CA92702
(714) 647-s800
WWrv.Santa-ana. oro
This document mdy be found at...san
(Please use a black or blue ink ball-point pen)
state of california requires that smoke and carbon monoxide (co)
buildings.
california Residentialcode (cRC) section R314.1 and R315.2 states in
"retrofitted with smoke alarms and carbon monoxide alarms. cRC
the required locations.
ABoth boxes betow must be checked:
fi.caruon monoxide alarms: Are installed outside of each sleeping a
bedrooms and also on each level of the dwelling. Alarms are required
2013 CRC
are installed in residential
rt that existing dwellings be
,n R31.4.3 and R314.3.3 define
a in the immediate vicinity of
bedrooms with gas-fired
appliances (i.e. hot water heater, cooktop, furnace) or a fireplace.
f,smore alarms: Are installed in each room used for sleeping, in e
room, and on each level of the dwelling.
Retrofitted detectors may be battery-operated for buildings where
hallway outside of a sleeping
or alterations are
performed. combination smoke/co alarms must comply with all appl
by the State Fire Marshall (SFM). Battery life must be 10 years.
I hereby certify that I am the contractor or the property owner of the
ble standards and be approved
bove project. I further certify
that srnoke alarms and carbon monoxide alarms have been installed compliance with the governing
Codes and have been tested to be functional. l, also, hereby certify th I will retest the alarms per the
man ufacturer's instructions
lcheck onel F Licensed tr Owner
NorE: This self-certification is only used for projects that affect the of the structure. This
process is applicable oNLY to projects where occess to the interior of
lnspector is not required.
dwelling by o Santa Ana
P
AI
oke & CO
rm Affidavit
Project Address:fu)D,seroP .;7a(B ,J-#r
Permit Number:10/ / b,7 /s/
Property Owner:LftU
Contractor:T6(4 RoortAh License I t: /o(€6sa
Signoture:oatl:4u /,a
Have this completed form and the job-card readily availab on final inspection!
+
*,SNTA
NA,ffi
Planning & Building Agency
20 Civic Center Plaza Ross Annex
P.O. Box 1988 (M-19)
Santa Ana, CA927A2
(714) 647-5800
ww,v. santa-ana. oro
This document moy be lound at...
201 3 CRC
san
(Please use a black or blue ink bail-point pen)
state of california requires that smoke and carbon monoxide (co)
buildings.
california Residential code (cRC) section R314.1and R315.2 states in
"retrofitted with smoke alarms and carbon monoxide alarms. cRC
the required locations.
6\eoar, boxes betow must be checked:
A carbon monoxide atarms: Are instailed outside of each sleeping a
bedrooms and also on each level of the dweiling, Alarms are required
appliances (i.e. hot water heater, cooktop, furnace) or a fireplace.
a in the immediate vicinity of
bedrooms with gas-fired
,fr.s-or" alarms: Are installed in each room used for sreeping, in ea hallway outside of a sleeping
room, and on each level of the dwelling.
Retrofitted detectors may be battery-operated for buildings where n
s are installed in residential
rt that existing dwellings be
n R314.3 and R314.3.3 define
interior alterations are
performed. combination smoke/co alarms must comply with all appl
by the State Fire Marshall (SFM). Battery life must be 10 years.
I hereby certify that I am the contractor or the property owner of the
that smoke alarms and carbon monoxide alarms have been installed ir
e standards and be approved
bove project. I further certify
compliance with the governing
codes and have been tested to be functional. l, also, hereby certify I will retest the alarms per the
ma n ufactu rer's instructions
lcheck onel Contractor ner
NorE: This self-certification is only used for projects that offect the of the structure. This
process is applicable oNLY to projects where occess to the interior of
lnspector is not required.
dwelling by a Santa Ana
AI
oke & CO
rm Affidavit
Project Address:7rB fia,J*envr >=ef(
Permit Number:/O/ lo 3 /.,9 /
Property Owner:-l-+UContractor:Ttrsct R2yRDA License r ', lo(669
Signature:z oatl:
=/z-n /-,
Have this completed form and the job-card readily avai on final inspection!
N"''SANTA
NA,'ffi
Planning & Building Agency
20 Civic Center Pleza Roas Annex
P.O. Box 1988 (M-19)
Santa Ana, CA92702
(714) 6.t7-5800
wwJv.santa-ana. oro
This document moy be lound at.,.
(Please use a black or blue ink ball-point pen)
state of california requires that smoke and carbon monoxide (co) al
buildings.
california Residential code (cRC)section R3l.4.1and R315.2 states in that existing dwellings be
"retrofitted with smoke alarms and carbon monoxide alarms. cRC se
the required locations.
ABoth boxes betow must be checked:
in the immediate vicinity of
n bedrooms with gas-fired
SSmoke atarms: Are installed in each room used for sleeping, in
room, and on each level of the dwelling.
hallway outside of a sleeping
Retrofitted detectors may be battery-operated for buildings where no interior alterations are
performed. combination smoke/co alarms must comply with all appl
by the State Fire Marshall (SFM). Battery life must be L0 years.
ble standards and be approved
I hereby certify that I am the contractor or the property owner of the
that smoke alarms and carbon monoxide alarms have been installed i
project. I further certify
compliance with the governing
codes and have been tested to be functional. l, atso, hereby certify
man ufactu rer's instructions.
I will retest the alarms per the
{check onel Licensed tr P
NorE: This self-certification is only used for projects that affect the ol the structure. This
process is applicable oNLY to projects where occess to the interior of
lnspector is not required.
dwelling by o Santa Ana
'ms are installed in residential
ion R314.3 and R314.3.3 define
E caruon monoxide alarms: Are instailed outside of each sleeping a
bedrooms and also on each level of the dwelling. Alarms are required
appliances (i.e. hot water heater, cooktop, furnace) or a fireplace.
er
AI
oke & CO
rm Affidavit
Project Address:6Disa,to _f,Ae .s.dZ
Permit Number:/
Property Owner:L+u
Contractor:-r6ti Footr(rJh License I tla466s7
Signature:1./oatl:,/*/r*
Have this completed form and the job-card readily on final inspection!
I
ilSNTA
ANA,"ffi
Planning & Building Agency
20 Civic Center Plaza Ross Annex
P.O. Box 1988 (M-19)
Santa Ana, CA92702
(714) 647-5800
WW,V. Santa-a n a- oro
This document moy be found at...
INSP.O2
n
(Please use a black or blue ink ball-point pen)
state of california requires that smoke and carbon monoxide (co) al
buildings.
california Residentialcode (CRC) section R314.1and R315.2 states in that existing dwelltngs be
ms are installed in residential
ion R314.3 and R314.3.3 define"retrofitted with smoke alarms and carbon monoxide alarms. cRC se
the required locations.
f\eoah boxes betow must be checked:
p caruon monoxide atarms: Are instailed outside of each sleeping a
bedrooms and also on each level of the dweiling, Alarms are required
appliances (i.e, hot water heater, cooktop, furnace) or a fireplace.
r in the immediate vicinity of
bed rooms with gas-firedn
Froo
Smoke alarms: Are installed in each room used for sleeping, in
m, and on each level of the dwelling.
hallway outside of a sleeping
Retrofitted detectors may be battery-operated for buildings where no interior alterations are
performed. combination smoke/co alarms must comply with all appl
by the State Fire Marshall (SFM). Battery life must be 10 years.
ble standards and be approved
I hereby certify that I am the contractor or the property owner of the
that smoke alarms and carbon monoxide alarms have been installed i
project. I further certify
compliance with the governing
codes and have been tested to be functional. l, also, hereby certify t
man ufactu rer's instructions.
I will retest the alarms per the-
lcheck onel p censed ctor tr P ner
NorE: This self-certification is onty used for projects that affect the of the structure. This
process is applicable oNLY to projects where dccess to the interior ol
lnspector is not required.
dwelling by a Santa Ana
AI
oke & CO
rm Affidavit
Project Address:7/8 5- /aAil,&Az -97 z tB
Permit Number:o,/
Property Owner:L*u
Contractor:7zs(4 R4afttJ6 License i |-loqdLel
Signoture:-Z/ootl:4-/r^
Have this completed form and the job-card readily avaitab on final inspection!
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