HomeMy WebLinkAbout101103220 - PermitCity gf Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
PermitCounter. (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: {Oi 1O322O 1
Pin #:gsegtt
Project Address: 1209 S Broadway
Assessor's Parcel: 013-153-03 Lot:16
Unit:Bldg: Address Range:Suite Range:
Zoning: RlBlock: NA Tract: 579 Historlc. No
Building Use:
Job Type:
Nature of Work:
Existing Bldg & Use
Proposed Use:
Single Family Dwelling
Alteration
Patio Door c/o
SFD
R-3
VB
cBc 2019
x-0602320276J
1st FL Area.
2nd FL Area:
Other Areas:
Garage Area.
Total:
Patio:
T.l.Area
Yards Req'd:
Valuation: $2,388.00
Occupancy.
Constr Type
Code:
Flood Zone
# of Stories:
Description of Work: Change out one patio door. No size changes
Planning Conditions:Bnbch* ti++-/9 - ?l jt-t/2t-|1[r ID;: llijAi,:i:r;i
Owner:
Address:
Phone:
Tenant:
Rafael G&EmmaArroyo
1209 S Broadway
Santa Ana, CA 927071207
(714).2OO-7642
Contractor: Home Depot U S A
Address: 12700 Stowe Drive, Suite 28
Poway, CA 92064
Phone: (858) 846-9700
State Lic #: 602331
Lic Type: B, C-39
Bus. Lic #: 365245
Workers' Compensation lnsurance:
Carrier: Ace American
Policy #: WCUC65990586
Expires: 0310112020
Engineer:
Address.
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #.
0lIice: CTYH Tr$nsi! 71Accti: Rel*: lLrl
h:,]pLirt-t289fi435 - 2/2tt/2it?tt Iil'lr'cnsnct ion Totcrl tlilll
Vs:rru5 Shukoslt i
HoneDepotUSA
6enercrl frlctn Ltpdnte Fee
Lrl I 161102- 51 6lil:il:rriLr-
P'u i Id ing
r:rl I I6LrU2- 516r:rlr:rUr:r-
[,1ds 5t,ds Revolv ins
r-r1 1 l6ttU2- ::i161?LrUir-
fi rc.rtif-' i Irrr & [ocuments,
Ll1 I 1{iLil:t?.- I777l:il:[]Lt-
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
Chavez, O"ugg2
Dale: 0212012020
Date:
Date: 0212012020
Subject to Field:
Misc. Receipt:
Misc Receipt:
Misc. Receipt:
07775002
01776002
07776002
07776002
o7116002
57607
57770
5L672
s7600
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
$166 53
$3.91
$1.00
$22.95
$57.20
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 01 1 16002 51600
01116002 51601
01 1 16002 51612
01116002 57770
Account#Total
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.
$22.95
$223.73
$1.00
$3 91 $251 59
$0.00
$251.59
lnspector MID#: 2020-157929
Fee Total:
Paid to Date:
Balance Due:
BUILD!NG. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER IiUILI)EI{ t)lll,CARA'I ION
I hereby aflrnl under penalty of perjury thal I am exenrpl from lhe Contra.lo^' Licensc kw for rhc followiDg reasoD (Ss.7031.-5
Busincss and Prolcssion Cfirc): Any City or County which requircs a lErrnit lo conslrucl. alter. irnprove. dermlish or rcpair any
stnlcture. prior tr) ils issuance. also rcqutes the applicanl li)r such pemil rc fil€ a sigDed slalemnt lhat hc or sha i$ licenrd pursuant
to thc provisions of the Conlractor's l,icenscd liw (Chaptcr 9, CornrncncinS wilh Scclion ?(X)0 ol l)ivi$ion J of thc Business and
Profcssi()nsCode)orthalhdorrheiserempttherefiomandthebasislortlEallc8edcxenlpti(tr1. AnyviolationofSection?03l.5byany
{pplicnnr for a IEnnit rubjects the applicant to i civil penxlty oI not rmre lhan Ilvd hundrcd dollars ($5(x)).
_I. as owncr ol'lhc propcny, or my employecs with wagcr as thcir elc compcnsation, will do lhe work and thc slreture is mt
iNeftlcd oroffcrcdforslc(Sa-.7(X4.BusinesssndPrcfessionsCode:T|EContrachfsLicen*Lawdoesnotapplytoanowncrof
lhepropeny wkrbuildsorinl|)rorslhcre[uldwlpdGssuchwo(khimselforlErselforlhroughhisorhcrownemployees,
providcd that such impmvcrrcn(s ile ool intcnded orollcrcd lbr salc. Il, howcvcr, lhc building or improvcrrent is sold within one ycd
ofconpleti)[ the Owrcr Buil&r will lurvc lhc bunJcn ofpnrvirrg tlul lrc or she did not build or impreve lh. pmpqty for tlE purln$ of
sle).
_1, rs owner oflhe propedy. am cxclusively conlractinS wilh licensed conlrack)rs lo conslrucl the preject (Sec. 7(M4. Busincss
arxl PnrllsstnCodc:ThcConrractor'sLiceDseLawdcsnorapplytoanowDcrofpropenywhohuildsorinprovestheredr.
and who codrnctsforsuchprojcclswithaConrracto(s)liccn*dpursuanlrorhcCoilrador'sLicensct w).
_l an) exempt under Sectiur-, B. & P.C. tirr this reasor.
WoR Kl:lLS' CoM PI.INSA'I I( )N
DI]CI-ARATI()N
I hcrcby affirm undcr pcnalry of pcrjury one of lhc ti)llowing dcclararions:
_lhaveandwill nuintainuCe(ificateofConsenttoSell.lnsurefi)rworliers'conrpensation,as prcvidedforbyScctionST00ofttre
ffiti,r
for thc perforrorcc of thc work for which thc pcrmit is irsucd.
will nliliilai,l w(,rkers' con)pensali(xl insurance. as required by Seclion 3700 oflhe Labor Ci)de, tbr the perftrrnrance of
whiclr is issucd.insurancc cadcr and F)licy numbcr [c:
a aPolicy
_l ccrlity lhrt i0 rhc pcrlirrnunce of tlrc work fi)r which this l)crnlil is issuc(|. I shilll not cn{)loy ilny pcrson in
so as lo hccom suhjccl lo (hc workcrs' conrpctrsal ion laws ol'Calilbrnfu, and aSrcc lhnt if I should becorre to thc
worlicrs'.ompensdtionprovisioNofSection3T00ofthebborCodc,lslull,fonhwithcomplywith
\{ARNING: Failurc to securc workcrs'compcnsilion covcragc is uohwful, and shall suhjact nn to criminal Fna[ics dd
civil fircs up to one hundrcd thousnnd dollArs ($100.{Xx)). iD iddition lo thc cost o[
Secliixr irilerest and atk)fty's fces.
I herchy allirm urdcr pcnalty of pcrjury lhat I am liccn*d undcr provision ol'Chaplcr 9 (comrrcncing with Scction 7(fi)) ol l)ivision l
()f thc Busincss iln(l Prolissir)ns C(xlc. aod nly liccnsc is in ttll lbrcc and cltcct.6 o
[-iccnsc
I heEby atfirm under Fnahyofperjury that lhere
issued (Scc. 109?. Civ. C.).
Lendcr's Name:
a conslRrcttD lendir)g agercy li)r the perfomarce of rhc work li)r which this pemit is
[Jndcr's Address:
APPLICANT DECl,ARATIoN
I tEreby affm under penalty of perjury onc of the following rle larationr:
Demolition Permits-Asbeslos Notification Fedcral ReSulationr (Title.l0, Pan6)
_Reqrired [iler of Ndification
pfi)ject.
t ug* ro -.pty Jif, ull City anrl County
ofrhis Cny and $funryro entd u[Dn tlE
Applicant or Agcnt
I'rmlilc( nanre
^,",'
2*)D t'A
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/VenVl nsu lation
Roof Sheathinq
Shear Wall
Framinq
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
lt/asonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif.
,
I I
FINAL -a//'l/?f, -<44,1-L )
Certificate of
Notes, Remarks, Etc.L
Rev.0B-07-2015
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