HomeMy WebLinkAbout30113124 - PermitCity of Santa Ana
20 Civic Center Plaza (M-19), Santa Ana, CA 92702
Plumbing Permit #: 3O{ 13'124
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 {\
Proj ect Address: 820 S Van Ness Ave
Assessor'sParcel: 010-243-13 Lot: 12
Suite:
Block: 17
Bldg: Address Range:
Tract:POLYTECHNIC Historic:No
Suite Range:
Zoning: SD40
Owner:
Address:
Maria Montes
820 S Van Ness Ave
Santa Ana, CA 927015507
(714) s41-5ee8
Fee Type
Water Closet
Shower/Bathtub
Sink
lssuance
Fee Total:
Paid to Date:
Balance Due:
Amount
7.25
7.25
7.25
23.50
Qty
1.00
1.00
1.00
1.00
Fee
$7.25
$7.25
$7.25
$23.50
$4s.2s
$0.00
$45.2s
Phone:
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
IJU+I UUU
I RAHSACTI
Buildins
(:K
CHANGE
Building Use:
Type of Work:
Nature of Work:
Planning Conditions
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Single Family Dwelling - De Constr Type
Miscellaneous Occupancy:
Dir C/O Code:
Brodowski, Teri
Date:
Date:
Date:
VN
R3
cPG 2001
Notes: Direct change-out of plumbing fixtures. Letter of auth
on file.
01/31/2003
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Building Permit
This permit shall expire by limitation and become null and void if the work authorized by this permit
is not commenced within 180 days from the date of this permit, or if the work authorized by this
permit ls suspended or abandoned at any time after the work is commenced for a period of 180 days.
Before such work can be recommenced, a new permit shall be first obtained to do so.
Account #: 01 1 -01 -591 2 lnspector
(flre
4r,*\+
PLUMBING.INSPEGTOR RECORD
APPROVALS DATE rD/srG.COMMENTS Owner-Buildcr Dccluation
I hcreby affim undcr pcnalry of pcrj ury that I m cxcmpt fm thc Conracton' Licensc Law for thc following rcoon (scc 703 I 5 Busincss
md Profcsion or County which rcquirca a pcmit to construct, altq,improvc, dcmolish or repair my structurc, prior to itr
or shc is liccnscd puruut to thc provilions ofthcisguuc, also
Contactor's
thc for such pcmit to filc a signcd shtcmat $d hc
Law (Chspa 9, Comocing with Srction 7000 of Division 3 of thc Busincss md Profcssions Codc) or that hc or
thc bais fo thc allcgcd cxmption .Any violation of Secdon 7031 5 by ay applicut fo a pemit subjccs thcshc is ud
a civil pcnalty ofnot moc thu fivc hundrcd doll6 (S500).
c owncr of thc popcrty, or my mploye with wage 6 0lcir solc composation, will do thc work md thc structuc is not irtmdcd
or offacd fc ralc ( Scc.7044, Bwitrcss ed Prcfcssiotr Codc: Thc Cof,trrctor's Licruc Law dq not apply to m omcr of thc propcrty
who builds or improve thm, ud who dq guch wok hiruclf or hmclf u through his o hq om cmploycs, povidcd that such
improvmmB u€ not inrmded or offscd fo salc. If, howcva, thc building or improvmmt is sold within onc yca of complction, thc
Ownq-Buildo will havc $c budo ofprcving that hc or shc not build or improvc for thc purpmc ofsalc)
_I, r oma of thc property, m cxcluively cmrding with licmscd conrrcbm to consmct thc prcjcct ( Scc ?044, Bwinas od
Profcssion Codc: Thc Contractor's Licolc Law
contrrcts |or such projcctl with 8 Contrrcro(s) I
docs not apply to m ownr of propcrty who builds or improvcs thcrcon , od who
rLaw)licmsed pumuut to thc Conrrctor's
-I,
Dstc:
&P,
I hrcby undq ofpcrjury onc
_I havc ud vill minuin a Ccttificatc of Coruat to Sclf-lnrw for wckm' compmratio, u providcd fo by Scction 3700 of thc
Labor Codc, for the pcrfmcc of thc work for which the pmit is issucd.
_I havc md will maintain wckm' comlmsation insuucc, u rcquircd by Scction 3700 of rhc Labor Codc, for rhc pcafommcc of thc
work fu which this pqflit is isucd. lv!y,ror*m' cmpcnsatim insumce cmia ud ;nlicy nmber ecl
Poliry Nmbtr .,/ Expirs: _
tmirr*9 00) sl*)
that in $c pcf{mcc of thc work for which this pcmit
of Califmiq ad
is issucd, I shall not in uy munc so c to
laws that if I thc workers'
Labor Codc. I provisions.
Failuc to compcnsation sd shrll subjcct il mploycr to ciminal pcnaltics ud civil
fincs up to otrc hundrcd ($100,000),in addition to thc cost ofcompcnsation, dmagcs I providcd for rhc Scdion 3076 of
thc Labor Codc, inrscst md anomcy's fccs
LICENSED CONTRACTOFS DECLARATION
I hcrcby aflim undcr psalty of pcrjury th6t I m licoscd undcr provision of Chaptcr 9 (commcncing with Scction 7000) of Division 3 of
thc Bwincss md Profcssions Codc, md my liccnsc is in full forcc ud cffcct.
Licmsc Cl6s:_ Liccnsc Numbcr
Datc: Cont etor:
CONSTRUCTION LENDING AGENCY
I heby affim unda pcnslty of psjury thst thm is a construdion lading agmcy fq thc tErfomecc of rhc work for which rhis pcmir is
issucd (Scc. 309?, Civ, C.).
Lends's Nmcr
Lmdcr's Addrcssl
Dcmolition
APPLICANT'S DECLARATION
Notification Fcdcral RcgulatioN (Titlc 40, Part 6)
_ Rcquircd ofNotification
_t thc fcdcral rcgulations rcSdding abcatos rcmoval uc not applicablc to this projcct
that I havc rcad this application statc that thc abovc infomation is corcct. I agrcc to
ordinuca md
abovc
Laws to md hocby authorizc rcprcscnativc
with City md County
thc
UNDER GROUND
Waste & Vent
Water-Underfloor
Gas-Underfloor
Building Sewer
Area/Storm Drain
I nterceptor/ Clarifier
TOP OUT
Waste & Vent
Water Piping
Gas Pipeing
Roof Drain
Tub/Shower Test
Rough Water Heater
POOL/SPA
P{rap/Drain Line
Main Drain/Pool Piping
Fill Line/Back Flow
Pool Heater/Gas Line
Misc
Gas Service
Water Service
Lawn Sprinkler ^oSanitary Sewer/Cap ny't A,U
Back Flow Device N frIT 4r ,a-1
(L rA,az
Rough Plumbing I/^N w
Final Gas Test V I l - -'- ,'L
Meter Release \,-^J' ,{1" -zY.'11
F!NAL -
Notes, Remarks, Etc.
I
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