HomeMy WebLinkAbout30137524 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, ;:,A 92702 Plumbing Permit#: 30137524
Permit Counte r: (714) 647-5800 In spection Requests: (714) 667-2738 Inspector Section: (714) 647-5853 Pin#: 32981
Project Address: 1715 W McEvoy Ln Unit: Bldg: Address Ra nge: Suite Range: ff
Assessor's Parcel: 101-531-04 Lot: 97 Block: NA Tract: 2887 Historic: No Zoning : R1
Owner: Thanh Vu
Address: 1715 McEvoy Ln
Santa Ana , CA 927061332
Phone: (714) 425-0852
Tenant Name:
Contractor: Owner-Builder
Address:
Phone:
State Lie#:
Lie Type:
Bus. Lie#:
Worke rs' Compensation Insurance:
Carri er:
Policy#:
Exp ires:
Bui lding Use:
Job Type:
Occupancy:
Constr Type:
R-3, U
VB
01116002 51602
0 11 16002 51602
01116002 51602
011 16002 51602
01116002 5 1602
01116002 51602
01116002 5 1602
01116002 5 1602
01 11 6002 5 1602
0 111 6002 51602
011 1 6002 51602
01116002 51600
01116002 5 1602
Fee Type Amount Qty Fee
Water Closet 13.24 2.00 $26.48
Shower 20.73 1.00 $20.73
Shower/Bathtub 20.73 1.00 $20.73
Whirlpool Tub/Foot Spa 20.73 1.00 $20.73
Sink 11.83 5.00 $59.15
Clothes Washer 13.01 1.00 $13 .01
Dishwasher 11 .16 1.00 $1 1.1 6
Garbage Disp 9.92 1.00 $9.92
Sewer A lter/Repair 41.46 1.00 $41.46
Gas Li ne alter/extend/ac 61.07 1.00 $61.07
Hose Bibb 14.41 2.00 $28.82
General Plan Update 20.56 1.00 $20.56
Issuance 1:•" i .~.-:.-. ,·:, .,. ~ _,. 5 1.26 1.00 ·$5U6 u ;:-. ,: -:· ~ 1• -rn~
r .. .. ·or ·
;-,ct ~ -t Uj_(,(:.,· :
: I ·t,,' ;,·1 !.: ;. ! ; . • ! l
I :, ~ •
-~"'•}i P.!i , , l t" Jt. ii Lh !],_ ! =~-•::
Nature of Work:
Single Family Dwelling
Addition
Remodel/Addition Code: CPC 2013 Notes: ConveW ('e)'kifbhen 'i'rit~1i2)'bathrooms. Relocate .
kitche'n !&·r~'JHcl ry coom. . .
Planning Conditions: All materials to match existing.
Planning Approval By: Date:
Pla n Checked By: Date:
Permit Issued By: Brodowski, Teri
Subject to Field:
Date: 12/01/2016
Account#
Bu ildin g Permit#: 10189377
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 180 days after its
issuance, or i f the work authorized on the site by such permit is suspended
or abandoned for a period of 180 days after the time the work is
commenced.
Inspector MID#: 2016-126212
01116002 51600
01116002 51602
Misc. Receipt:
Misc. Receipt :
Misc. Receipt:
Total
$20.56
$364.52
Fee Total:
Paid to Date :
Balance Due:
l_ll t J .::_\I !1) ~--~=.l .,'.1 ::_!_1 U '
$385.08
$0.00
$385.08
APPROVALS DATE ID/SIG.
UNDER GROUND
Waste & Vent ~, z, 1,7
Water-Under floor I i
Gas-Underfloor
Building Sewer
Area/Storm Drain
Interceptor/ Clarifier
TOP OUT
Waste & Vent
Water PipinQ
Gas PipinQ
Roof Drain I I
Tub/Shower Test
Rouah Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Pipina
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary Sewer/Cap
Back Flow Device
Rough Plumbing
Final Gas Test
Meter Release
FINAL
Notes, Remarks, Etc.
PLUMBING-INSPECTOR RECORD
COMMENTS OWNER BUILDER DllLCARATION .,
I hereby :1flir111 un der penall y of perjury 11ml I am exempt from 1hc Con1rac1ors · License Law for the foll owing r~:1so11 {Scc.7031.5
Business and Pro!Cssiu n Code): Any Ci ty or Count y wh ich requi res .i per mit to cnns!nH:I. allc r. im prn Yc. dcmoJi·;h or rcpaii any
structure. prior to ils issuance. a lso require s the applic.1111 for such permit lo tile ;.1 s ig.ncd st:11i.:mcn1 tlmt he or she is li L·cnst:d ,pur:!uant
to the rrovisio ns o r 1hc Con1rnctor's Licensed Law (C hap!cr 9. Commencing with Scc1 i o11 7(IOO of Divi sio n 3 o f the Husincst and
Profe ssions CodcJ or 1ha1 he or she is exempt l herefrom a nd 1hc ha si.s for the :1 lleged exempt io n. Any vio lat ion of Section 703 1.5 by any "11""' tor a pe rmi t subjects the applica11t to a civil pe11alty u f 1101 mor e tha11 live hu11dred dullars (5500),
\ I. us owner of1hc prope rt y. or 111ycmployccs wi1h wages as 1hc ir so le compcnsut ion. will do the work atKI the strncturc is not
i111cndcd or ortC red fn r sa le (Sec. 7044. Bu siness .1 11d Prufossions Code: The Crn 11ractnr's License Law docs 1101 apply tn ,111 owner of
lhe property who builds or impro\'CS thereon. and who docs such work him se lf or he rself o r 1hrough his or her own emp loyees.
provided thal such improvcme111s .ire not in tended or offered for sa le . If. ho\\'cvcr.1hc hu ild ing or irnpro\'cme111 is sold within one year
of comp lei in n. the Owner llui ldcr will h;.1 ve lhe burden of prm1ing lh:it he or she did 1101 build or improve the pmpe11y ro r the purpose of
s:Lle).
_I. as owner of the prope rly. :un exclusively cnn!rnct ing with li censed crn1 trac1ors lu conslrncl the proj ect (Sec . 7044. Business
a1Kl Pmfes~ion Code: The Conlrn ctor's License L.1w docs 11nl apply to an o\\111er nf properl y who huilds or i111 p rn,·es thcn:on.
and who cont racts for suc h projects wi1h a Contrn c1or(s> llcc11se d pursu,.1111 to the Contractor"s Lic en~e La w).
_I amcxcmpl under Sec li on, ________ . D. &~P-1/JYJlhis reaso n.
IJnlc: • \) -\ -/ (,,., Owner:_:i.., ~ _ _,,_,___~~~---WO~l-lK-E-,R-,+A(d'(~)~~,1~P-E_N_S_A_T_l(-IN _____________ _
DECLAl!ATION
I hereby affirm under pen:1l1y of perjury one of rhc following declara tions:
_I h:.1\'C and w ill ma intai11 a Ce rt ificalc nfCnnscnt In Self-Insu re for workers· t..·0111pcnsatirn1. as pro\'ided for hy Sect inn .HOO of1hc
L:1b<)r Cnde. for the pcrform:.uK"C oflhe wnrk for which the permit is issucll .
_I luwe and will mailllain workers' cot11pc nsa1 io n in sur;mcc. a.!I re<1ui red by See l io n 3700 of the Labor Code. for !he perfor mance of
the wmk fo r which I hi s pe rmi t is issued. My wo rker s· compcnsa rio11 insurnnce c;.1 rrier a nd po licy nu111 hc r arc:
C:1rr ie r: ___________________________ _
Po licy Numbcr: _____________________ Exp ires: __________ _
,di ccr1ify th,11 in the performan ce of the work for whic h I his permi l is issued . l shall not employ any person in :my 1m111 11cr
so as to become subject 10 th e wnrkcrs' cnm pcns,11inn laws o r Californ ia. ~md agree that if I slum Id hcrnmc suhjc:ct lo the
workers' compe nsation provisio ns of Sc:c1iun ]700 of the lahor Code. 1 shal l. for thwi th comply with those p nwisions ..
WAR NING: f-'a ilure to sec ure wor ke rs' compen s.i1ion covera~e•~1s unl:n f1 I. and shall suhject ai1 c111 plnycr lo crimi nal penalties ;md
civil lines up 10 one hundred lhousand do1\ars (SIOO.Uot)J. in addil i t e cos! n f co mpe11s.1l ion. damages as pmvich:cl for 1he
Seel inn 3076 o flhe Lahor Code. intercsl and al\orne y"s fees.
Date: • \'.L,-\ -l >? A1>1>lic:m1 :'1'-~---~~----------------
LI C EN SEI> CO NTRACTOR
lJECL ARATHlN
I here by aflirm under penalty of perjury I hat I am lice nsed under provision of Chapter 9 (co mme ncing with Sect io n 70UU) nf Di,,ision 3
of lh c Bu siness and Professions Code. and my license is in fu ll force and crtCe1.
License Class: ______________ License Num ber: _______________ _
0.-ite: ____________ Conlrnclor : _____________________ _
CONSTRUCTION LENDING AGENCY
I hereby affirm unde r pem1\t y o f perjury that I here is a co11s1111c1ion lending agency for the pe rformance of 1he wnrk for whic h this permit is
issued (Sec. ~097. Ci\'. C.).
l ender's Name: _________________________ _
l cnd er"s Add ress: _________________________ _
APPLICANT DECLARATION
I hcf'cby aninn under pc11ulty of perjury one of the follo wing declara tions:
Dcnmlition Permits-As bes tos Not ification Federal Rc gula1io ns (Title 40. Par1 6)
_Req uired Le11crof Notitica1 ion
_I ce11ify 1ha1 the federal regulations regardin g ashcslos remn\'al arc 1101 applicable 10 this projccl.
ordm.mce~ and St.tic Ll1ws rdttmg to hl1 ild1 n stn1c1 1on and hc1 ehy authom:c 1cp1e~cnra t1vcs of tlus C11 y a nd Counl) In en ter upon the
4 ~ ce111ty th ,H I h,1vc 1c,u..l !111s ,tpphc,t:i~1un ,111 state th.11 the alx1vc 111lonn.1tm 11 1s crnTect I agree to comp ly w1tl1 alt Ci ty ,111d Count y
t--------------------1-------+------l-------------------l ,tbovc mentioned p1o pe1ty lur 111,;pcctmn p I s
1--------------------11-------+------+------------------~ Ap plkanl or AJ.,:enl S 1J.,:11.1lure: \tl. Dute • I l.. -{ -{ h
Permitce name tprint):.~~~~--'~H:::A-t:1~~-tt=c+--\J~~----------------------