HomeMy WebLinkAbout40130892 - Permit. , City of Santa Ana 20 Civic Center Plaza (M-19), Sa nta Ana, CA 92702 Mechanical Permit#: 40130892
Permit Counter: (714) 647-5800 Inspection Requests: (714) 667-2738 Inspector Section: (714) 647-5853
Project Address: 3417 S Timber St Unit: Bldg: Address Range:
Assessor's Parcel: 410-161-11 Lot: 23 Block: NA Tract: 7002 Historic: No
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
State Lie#:
Lie Type:
Bus. Lie#:
Tracy Tran
3417 S. Timber
Santa Ana, CA 92707
(714) 334-3170
Master Construction & Deve
1228 Village Way #A
Santa Ana, CA 92706
(714) 568-5444
532153
B
347001
Workers' Compensation Insurance:
Carrier: State Fund
Policy #: 1965180
Expires:
Building Use:
Job Type:
05/31/2017
Single Family Dwell ing
Alteration
Occupancy:
Constr Type:
R-3, U
VB
01116002 51604
01116002 51604
01116002 51604
01116002 51604
01116002 51604
01116002 51600
01116002 51604
Fee Type
Furnace/Comp Combo
Bathroom Fan
Laundry Fan Envir. Air
Range Fan
Gas Piping Incidental
General Plan Update
Issuance
Nature of Work: A/C & Fans & Addn Code: CMC 2016 Notes:
Planning Conditions: Neighbor's consent on file. A/Con side property.
Planning Approval By:
Plan Checked By:
Permit Issued By:
Subject to Field:
Date:
Date:
Date: 02/23/2017
Account#
Building Permit#: 01116002 51600
Every permit issued shall become invalid unless the work on the site 01116002 51604
authorized by such permit is commenced within 180 days after its
issuance, or if 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#: 2017-134578
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
$20.56
$338.09
Fee Total:
Paid to Date:
Balance Due:
Pin#: 78056
Suite Range:
Amount
118 .19
28.42
32.45
30 .09
20.84
20.56
51.26
Zoning: R1
Qty
1.00
3.00
1 .00
1 .00
1.00
1.00
1.00
Fee
$118 .19
$85.26
$32.45
$30.09
$20.84
$20.56
$51 .26
-2/2~/2017 _es15
rn1st: 102 w ,,er~. 40L~1 3
Ll:.!3/2017 4:1(
$1,01
$358 .65
$0.00
$358 .65
APPROVALS
Appliances
Metal Fire Place
Evaporative Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-Insulation
Insulation
Smoke Detectors Installed
RouQh Ductwork
Vents
Toilet Room I Clothes Dryer
Residential RanQe
Other
Hood
Type I Hood
Type II Hood
Grease Duct
Fire Damper
OpeninQs
Installation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rough Mech.
Final Test
Meter Release
FINAL
Notes, Remarks, Etc.
MECHANICAL-INSPECTOR RECORD
DATE ID/SIG. COMMENTS
.---
I '-I'• _...
V \../
OWNER BUILDER DELCA RATION ,
I hereby affirm uadcr penalty of perjury that I run exempt from the Contractors' License Law for the following reason (Sec.7.03 1.5
Business and Profession Code): Any City or Counly which requires a pcnnit 10 cons1n1c1. alter. impro ve. dcmpli sh or repair any
structure, prior to its issuance, also requires the applicant for such pennit to fil e a signed statement that he or she is licensed pursuant
to the provisions of the C ontractor's Licensed Law (Chapter 9 . Conunenci ng with Section 7000 of Div ision 3 of the Business and
Profossions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any
a pplicant for a penuit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
_l, as owner of th e propeny. or my employees with wages as their sole com pensat ion. wiJI do the work and the structure is not
intended or offered for sale (Sec. 7044. Business and Professions Code: l11e Contractor·s License Law does not apply to an owner of
the propeity who builds o r improves thereon. and who does such work himself or herself or through h is or her own e m ployees.
provided that such improvements are not intended o r offered fo r sale. If. however. the building or improvement is so ld within o ne year
of completion. the Owner Bu ilder will have the b1.1rdcn of proving that he or she did no! build or improve the propeity for the purpose of
,mle).
_1, as owner of1he property, am exclusively contracting with lice,tsed contrnctors to construct the project (Sec. 7044. Bu.sin~
and Profession Code: T he Contractor's License Law does not apply to an own er of property who builds or impro,'es thereon.
and who conlracts for such projects w ith a Contractor(s) licensed p ursuant 10 the Cont ractor's License Law).
_I am exempt under Section ________ • 8. & P.C. for this reason.
D~te: __________ Ow ncr:.~~-~~~--~-~-------------
WORKERS' COMPENSATI ON
DECLARATION
l hereby affirm under penalty of perjury one of the following declarations:
_.I have and will maintain a Certificate of Consent to Self-Insure for workers' compcnsntion. as pro vided for by Sectio n 3 700 of the
Labor Code, for the pcrfonmmce of the work for which the pennit is issued.
_l have and will mai ntain workers' compensation ins urance, as required by Section 3700 of the Labor Code. for the perfonnance of
the work for which this permit is issued. My workers ' compensation insurance carrier and policy number are:
Ca.Tier: __________________________ _
Policy Number: _____________________ E:<pires: __________ _
_I certify that in t he performance of the work for which this permit is issued. I shall not emplo y any perso n in any manner
so as to become subject to the workers' compensation laws of California. and agree that if I should beco me subject to the
workers' compensation provisions of Section 3700 of th e Labor Code, I shall. fo11hwith comply with those provisions ..
WARNING: Fai lure to secure workers' compensation covernge is unlawful. and shall subject an employer to aiminal penalties and
civil fines up to one hundred thousand dollars($\ 0.000). in addition to the cost of compensation. damages as provided for the
Section 3076 of the Lobo r Code, in terest nd alto ·s fees._//"')_____, /I /"J /'J
Date: ___________ A o ..-Y / / // / ~Yi
l hereby affinn und er penalty of perjury that I run licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code, and my license is in full force and effect.
L,ccnscClass ~
Date __________ -\➔/i ~~
I hereby affirm under penalty of pc,Ju,yt~is a construct,on len ding agency for the pe,fommnce of the work for winch th ,s permn is
,ssucd (Sec. 3097, Civ. C.) .
Lender's Name: _________________________ _
Lender's Address: _________________________ _
APPLI CANT DECLARATIO N
I hereby affinn under penalty of perjury one of the following dec larat ions:
Demolition Permits-Asbestos Notification Federal Regulations (Tit le 401 Pan6)
_Requ ired Letter of Notificatio n
_I certify that the federal regulations regarding asbestos removal are not applicable to this project.
-~t ify t I have read th ' lieation and state that the above infonuation is cmTecl. I agree to comply w i1h all City and County
ordin 1ces, State U relating to uild" c~nstruction. and 1ereby authorize representatives of this City and County to enter upon the
above 1 10ned p1 erty for inspc · s .
Applic 11 or A em ure: /') 'A ./1 Date: Z,. /2 Y, /4 .-,
,, ,, V -I --=t'----=-~
Pe,nn am (print):_~'"-'.,...,Y--,.--1(.....-4(.,_,,_ _____________________ _
/