HomeMy WebLinkAbout101103045 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
Permit Counter: (714) 647-5800 inspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: {O{ {O3O45
Pin #: e4571!
Project Address: 1005 N Fairlawn St Unit:Bldg: Address Range:Suite Range:
Zoning: RlAssessor's Parcel: 405-'114-07 Lot: 41 Block: NA Tract 1899 Historic: No
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Single Family Dwelling
Reroof
Reroof
Sfd w/att garage
Occupancy:
Constr Type:
Code:
Flood Zone:
# of Stories:
R-3, U
VB
cBc 2019
x-0602320144J
I
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Total
Patio:
T.l.Area:
Yards Req'd
Valuation: $8,500.00
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Description of Work: Tear-off & apply comp shingles. Handout given
Planning Conditions:
Owner:
Address:
Phone:
Tenant
NANA V
12931 Palm St.
Garden Grove, CA 92840
(310) 350-1792
Contractor: Baja Roofing & Coatings
Address: 2563 Kurt Avenue
Los Angeles, CA 90040
Phone: (562) 669-5598
State Lic #: 992760
Lic Type: C-39
Bus. Lic #: 373787
Workers' Compensation lnsurance:
Carrier: State Fund
Policy #: 9168264
Expires: 1011812020
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:
Date: 02/05/2020 Misc. Receipt:
Date: Misc. Receipt:
Date: 02t05t2020 Misc. Receipt:
Subject to Field:
01 1 16002 51601
01 1 16002 51612
01116002 57770
07776002
07776002
07776002
07776002
07776002
s7607
57770
s7672
57600
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
$333.06
$3.91
$1.00
$22.95
$57.20
ki, Teri
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
Fire lnsp. Req'd: No
Police lnsp. Req'd: No Account#
Flood Zone Cert. Req'd: No 01116002 51600
Every permit issued shall become invalid unless lhe 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 or abandoned for a period of360 days after
the time the work is commenced.
No
No
No
No
Total
$22.95
$390.26
$1.00
$3.91 Fee Total
Paid to Date:
Balance Due
$418.12
$0.OCt
$418.12
lnspector MID#: 2020-157561
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNT]R BUILDER DELCARATION
I hocbl al'lirm undo peralty of pqjury lhat I an erempt ,iom th€ Contraclo6' Licmse Law for the following re@n (Ss.703 1.5
tsusincss anC Profesion Codclr Any City or County which requires a pmnit to constnrct, alta, improve, dmolish or rcpair any
struclure. prior lo ils i$uece. alco rcquirE thc applicmt for such pemit to file a signed statcmol lhal he or she is licmoJ pusumt
to lhc plovisions ol the Contractor's l,icenscd taw (Chaptq 9, Commencing rvith Strtion 7000 of Divisioli -1 of the Busines md
ProfcssiorsCode)orlhatheorsheisexemplthqefromildthcb6isfortheallcgedcxmptjon. AnyviolalionofsstionT03l.5byany
applicinlforapmnilsubjstslhe applicanttoacivilpenaltyofnotmorelhanlivehundreddollos($500).
I, o o$no of lhc prolEdy. or rny employeG wilh wags 6 their sle compwtion. will do lhe work md lhe srruduc 6 nol
intodsl or offsed for slc (Sa.7044. Busins md Professions Codc: The Contractor's Licme larv do6 not apply to u oMs of
thcpmpeny whobuil&orimprovelhtron.mdwhodo6suchworkhirnselforherselforthroughhisorherownemploycs.
provided that such improvmtrls uc ft)r intmdcd or offtrcd for sle. ll. hou'*s. the building or improvonst is $ld within on. tqr
ofcornpldion. the Gvns Buildg will have the hrd6 ofproving lhd he or she did not boild or improve the prc1ry for the purpos of
sale).
-1,
o ownq of the propay. m cxclusivcly contracting *ith licfficd contractos to construct the prejcct (Sec. 7044, Buines
md Prcf6sicnCode:TheContractor'sLicenseLawdo6notapplylomownsofpropertywhobuildsorimproveslhsmn.
md who contrads for such projecrs with a Contmcto(s) licffied p[su@t lo lhe Contractor's Licmsc Lau1.
_i an exempt un.ls Sction__. B. & P.C. firr lhis rruon.
Dale:Owtrer:_
WORKERS'COMPENSATION
DECLARATION
I hqcby affirm under poalty of pqjury one of the following dcclaatioN:
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have md will maintain a Cenificate of Consent to Sclf-lmure for workqs' compqrsation. as provided for by Setion 3700 of th€
labor Code. for the psfomacc of the work for which the pmnit is issued.
flhaveandwrllmaintainworkers compemationinsurance.m requiredbySectionlTO0ofthcLaborCodc,forthepofonnmceof
0re *ork for which this pmit is isuql. My workm' compmulion irourace cmier md policy numba re:
c**,,-Slatr9 6qafD
PolicyNumbs: qlV (}2-bq Expires: _\a - t€4' 2b
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cenify that in the perforrnance of the work for shich lhis pemlil is issued. I shall not anploy any pmon in my mmna
so 6 to becomc subjecl to thc work6'compemation larvs ofCalifomia. md agree that ifl should b€comc subjcct to the
workss' comlremlion provisions of Setion ]700 of the Labor Code. I shall. forthwith comply with thos provisiom.
WARNING: Failure to wue workm'compwtion covera8e is unlawful. aod shall subjet m anployo to oiminal penaltic md
civil lines up to onc hundrcd thousand dollars ($100.000).addition to thc cosl of danages a provided fot the
Section l0?6 of thc t-a[{r Codc. intcrLst md fea.
DECLARA'TTON
I hocby affirrn undo poalty of psjury that I an licerued undr provision of Chapto 9 (comencidg wilh Scction 7000) of Division 3
of the Busirlcs ild Profmicrro Codc. ad rny licosc is in full force dd effet.
L- vq q c{2-1(aO
Licensc Clas:
CONSTRUCTION LENDINC AGENCY
I hereby affinn under Frf,alty of perjury lhat th6e is a comtruclion lending aSmcy for the psfonnmce of lhe work for rvhich this pemit is
issued (Se. 3097, Civ. C.).
lrndq's Nme:
-
tsdq's Addrs:
APPLICANT DECLARATION
I hscby aflinn undtr poahy of perjury one of the following deldatrcns:
Demolition Permits-Asbestos Notification Fcdoal Regulations (Title 40, Pm6)
_Requirqi Lcner of Notilicalion
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cqtify lhat lhe fcdgal rcgulatioN reguding oLslos renoval ae not applicable lo this prejEt.
md slale lh.l the ah)ve infornation is corect. I agrL! to comply wilh all Cily and Counly
conslruction, dd hqeby authorDc reprGtrlativ6 of this Cily ild County to mlq upon the
Applicrnt or,\gent *5( \
I'crmilce \\\) \-L\(-A.{
2-lElzD
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subfloor/VenUl nsulation Ir a-
Roof Sheathinq / /P/ /aP h/l?t/Jo,6[-
Shear Wall lt
Framing
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
ltllasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report \
Flood Zone Certif
I -t h1
FINAL t.,wI
Certificate of Occupancy I I
Note arks Etc
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