HomeMy WebLinkAbout40130565 - PermitCity of Santa Ana 2 0 Civ ic Center Plaza (M-19), Santa Ana , CA 9270 2 ~ Mechanical Permit #: 40130565
Permit C ounter: (714) 6 47-5800 In spect io n Re qu es ts: (714) 667-2738 In spector Sectio n: (7 14) 6 47-5853 Pin#: 24009
Project Address: 619 E Virginia Ave Unit: Bldg: Add ress Ran ge: S u ite Range :
Assessor's Parcel: 003-032-14 Lot: 18, PORS 19, 20, Bloc k : NA Tract: 70 5 Hi st ori c: No Zoning: R1
Own er:
A ddress:
Ph one:
Tenant Name:
Contractor :
A ddress:
Ph one:
State Li e #:
Lie Type:
Bus . Lie #:
Mauricio A & Gladys Martinez
619 E VIRGINIA AVE
Santa Ana , CA 927061741
(714) 702-9529
Owner-Builder
Workers' Compensatio n In surance:
Carri er :
Po licy #:
Ex pires:
Buildin g Use: Single Family Dwelling
J ob Type: Alteration
Occupancy:
Const r Type:
R-3, U
VB
Fee Type Amount Qty Fee
0 111 6002 5 1604 Range Fan 30.0 9 1.00 $30.09
0 111 6002 5 1604 Gas P iping In cid ental 20.84 1.00 $20.84
0 111 6002 5 1600 General Plan U pdate 20.56 1 .00 $20.56
0 111 6002 5 1604 I ssuan ce 51.26 1.00 $51 .26
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Natu re of Work: Interior remodel Code: CMC 2013 Not es: Interior kitchen remod el , new4 x 12 beam between
dining room a nd kitchen , new partition walls, new24"
x 36" opening.
Planning Conditions:
Pl anning Approv al By: Date:
Date: Plan Check ed B~:
Permit I ssu ed B. : A m sde n, Julie
S ubject to Field\
Dat e: 11 /02/2016
Account#
B uildin g Permit #: 10190953
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 if the work authorized on the site by such permit is suspended
or abandoned for a period of180 days after the time the work is
commenced.
Inspector MID#: 201 6-132046
0 11 16002 5 1600
0 11 16002 5 1604
Mi sc. Receipt:
Misc. Receipt:
Mi sc. Receipt:
Tota l
$20.56
$102.19
Fee Tot al:
Paid t o Date:
Balance Due:
$122.75
$0 .00
$122.75
I -
APPROVALS DATE I-CO MMENTS Owner-Builder Dec:laration . ' I hereby affirm under penalty of perj ury that I am exempt form the Contractors' License Law for the following reason (sec. 70.!.l .5 Busint'°.>~
MECHANICAL INSPECTOR RECO RD
Appliances • and Pro fess ion Code): Any City or Count y which requires a pennit to construct. alter. im prove. demolish or re9air any strui.:lure. prior to its
iss uance. also requ ires the applicant for such permit to file a signed statement tha t he or she is licensed pu rsuant tO the !,rov;:;ions of the
Meta l Fire Place Contr:ictor·s Licensed Law (Chapter 9, Commencing with Section 7000 o f Division 3 of the Business and Professions Code) or t hat he c. ..
she is exempt the refrom and the basis for the alleged exempt ion .Any violation of Sect ion 7031.5 by any applicant for a pen nit subj ects th e
Evap Coo le r applicant 10 a civil pena lty or not mo re than fi ve hundred dollars ($500). I>
Furna ce I. as owner of the property. o r m y employees with wages as their so le compensation. will d o the work and the structure is not intended •
~ffered for sale ( See.7044. Business and Profess ions Code: The Contractor·s License Law does not a p ply to an owner of the propert)-
Co mpressor who builds or imp roves thereon. and who docs such work himself or herself or through his or her own employees. provid ed tha t such
improvements are not intended or o ffered for sale. If. howe"er. the building or improvement is sold w ithi n one year of compl~~ion. the
Mi sc. Equi p me nt Owner-Builder will have th e burden of proving that he or she not build or impro\fe fo r 1he purpose of sale).
I I'(~· as owner of th e property. a m exclusively contracting w ith lic ensed contractors to construct the project ( Sec. 7044. Busini:ss and
ro ession Co de: The Contractor's Licens e Law does not ap ply to an owner o f property who builds o r improves thereon . and w ho
Duct Work contracts for such projects with a Contrnctor(s) licensed pursuan t to the Contractor's Lice nse Law.).
Pre -Ins ul atio n _I am exempt under Section .B. & P.C. for this reason. ~
Date II_ () :__ Jo I 6 <Avner: c;:/ac/4;5 ;ii CC. , ~ In sul ati o n
Smoke Detectors Insta ll ed WORKERS COMPENSATION DEC LARATION--
I hereby affirm under penalty of pe rj ury one of the fo llowin~ dec larat ions:
Ro ugh Du ctwo rk _I have and w ill mainta in a Certificate of Consent to Sclr-l nsu re fo r workers' compe nsation. as pro vided for by Sectio n 3700 or the
Labor Cod e. for the per formance of the work for which the permit is issued .
_I have and w ill mainta in workers' compensa tio n insurance, as required by Sect ion 3700 of the Labor Code, for t he performance of the
work for wh ich this permit is issued. My workers· compensation insurance carrier a nd po licy number are:
Vents Carrier:
To il et R oo m I Clothes Drye r Policy Number : Exp ires:
Res identi a l Ra n ge (This section need no t be completed if the pcn nit is for One hundred dollars iSIOO I or less)
Oth er ~Ml certify that in the perforlllance of the work for which this pcnnit is iss ued. I shall not employ any person in any manner so as 10
be ame subject to th e workers' co mpensation laws of Californ ia. and agree that if I should become subject to t he workers'
compensat ion provis ions of Section 3700 of th e Labor Code, I shall. forthwilh comply wil h 1hose provisions ..
Hood Date: I/_ 0 ~-,J-6) {,, Applicant: C: -,,,ik¾
T y pe I Hood WARNING: Failure to secure workers' compensation coverage is un lawful, and shall subject an employer to crim ina l pena lties and civil
lin es u p to one hundred thousand d ollars ($100.000).in addition to the cost o f compensation. damages ns provided for the Section 3076 o f
T ype II Hood the Labor Code. interest and attorncy·s fees
Grease Du ct LICENSED CO NTRACTORS D EC L AR AT ION
I hereby affirm under penally o f perjury tha t lam licensed under provis ion of Chapter 9 {commencing with Section 7000) of Division 3 of
the Business and Professions Code. and my l icense is in full force and effect.
Fire Damper License Class: Lice nse Number
Op e nings Drtte: Contractor:
In stallati o n C O NST RUC TION L ENDING AGE NCY
I hereby affirm under pe na lty of perjury that there is a construction lending agency for the pcrfonnance of the work for which this pennit is
F .D. Drop Test issued (Sec. 3097. C iv. C.).
Lender's Name:
Lender's Address:
Above Hard Lid A PPLICANT'S DECLA RATIO N
Above T-Ba r Demolition Pe rmits-Asbestos Notificat ion Federal Regulations (Title 40. Pait 6 )
_ Required Letter of Notific atio n
Ii/ ' _I cert ify that the federal regulat ions reg a rd ing asbestos removal are not applicable to this project.
Rough Mech. t v/1--u/ It I '1/)Rrl 1/ J ~ Jli1 certify that I have read this applicatio n and state that the abo,,e information is correct. I agree to comply with all City a nd Coun ty /l ~
Fina l Test I I I / I ,-..:..:. 1.../ ordinances and State Laws rela ting to building construction, and here by author ize rcprcscntalivcs o f this City and County to enter upon the
above ment io ned property for insp4 u'l)oses.,
Mete r Release . 1 I , A pplicant or agent sig.: <:::;'. ~ Date : //_ 0~-1 t.
FINAL 1t1 IL q /J v/ ;;;. ',,({£_/ Jc// Permitt ee name (print}: G'hJT ~<f'-4 he '2--
M:\W P51\Perm1t-lnspect1on Forms\Mechanical-lnspector Record.doc 03.31.06