HomeMy WebLinkAbout40130674 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Mechanical Permit#: 40130674
Permit Counter: (714) 647-5800 Inspection Requests: (714) 667-2738 Inspector Section: (714) 647-5853 Pin#: 62135
Project Address: 512 S Euclid St
Assessor's Parcel:
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
State Lie#:
Lie Type :
Bus. Lie#:
932-610-83
Diemmi Nguyen
512 S Euclid St
Lot:
Santa Ana, CA 927041054
(714) 705-3614
Owner-Builder
Workers' Compensation Insurance:
Carrier: "
Policy#:
Expires:
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
.. .
Single Family Dwelling
Addition
Addition/Patio Cover
...
, iJ ;, , ,h, '
•
1 I.
.ll
Occupancy:
Constr Type:
Code:
Date:
Date:
Bldg: Suite Range: Unit: •
Block: NA Tract: 13723
Address Range: 502-520
Historic: No Zoning: R1
R-3, U
VB
CMC 2013
Misc. Receipt:
Misc. Receipt:
01116002 51604
01116002 51604
01116002 51600
01116002 51604
Fee Type Amount Qty Fee
Alter Vent Sys 40.62 2.00 $81.24
Bathroom Fan 28.42 1.00 $28.42
General Plan Update 20.56 1.00 $20.56
Issuance 51 .26 1.00 $51 .26
Bat~ht:36008 -t-1.2 2016 ID: LROSALES
If _e: CTrH TranST• 63 4 of 4
Acd ~: Re I: .,.013 674
R ... Ptl:016J/6/_ 1-1~/~Clo 11:34 AM
Trarisadion Total 1,396.24
Ge,~ 1 Plan UpJo~
01116 w2-51'0 ·c
112 ... ha 1 ... al
01116G02-Ll~O• J
VIS
CCI: *~~********UJ,,
$_0.56
$16D.92
$1,396.24
Autt: :012493
Notes:
Permit Issued By: ¥Hernandez, Kathy Date:
Subject to Field:
12/12/2016
Account#
Misc. Receipt:
Total
Building Permit #: 10191244
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#: 2016-132571
01116002 51600
01116002 51604
$20.56
$160.92
Fee Total:
Paid to Date:
Balance Due:
$181.48
$0.00
$181.48
APPROVALS DATE ID/SIG.
Appliances
Metal Fire Place
Evap Cooler
Furnace
Compressor
M isc. Equipment
Duct Work
Pre-Insulation
Insulation
Smoke Detectors Installed
Rough Ductwork
Vents
Toilet Room / Clothes Dryer
Residential Range
Other
Hood
T ype I Hood
Type II Hood
Grease Du ct
Fire Damper
Openings
Installation
F .D. Drop Test
Above Hard Lid
Above T-Bar
1
Rough Mech . k/0111
Final Test I I I
Meter Release
' I
FINAL
' . I
M :\WP51\Perm,t-lnspeclion Forms\Mecharncal-lnspector Record.doc 03.31.06
MECHANICAL-INSPECTOR RECORD
COMMENTS Owner~Builder Declara tion •
l hcrd>y affirm under penalty o r perjury that I am exempt form the Contraaors ' License: Law for the following rason (s" 703 1.S ~usml!.s
•nd Profession Code). Any City or County which rcquin::s a ~nnit tu construct, alter, improvc, demulish or repair any structure, prior tu its
issuance, also rcquin:s thi: ilpplicant for such permit to file a signed s1a1cmcnt that hi;: or she is licensed pursuant to the provisioll"•O f the
Con~r11.c1or's Licensed Law (Chapter 9, Cumm..:nc ing with Section 7000 of Division 3 of the Business and Professions Cude) o r 1hat h~ 01
she lS exempt therefrom and the basis for the alleged exemption .Any violation ofSeaion 703 1 S by any applica nt for a permit liiubjccts th.:
applicant to a civil penally of not more than five hundrc::d dollars (SSOO). -
_I, as ownc:r ofthc: propc:ny, or my employc:~ with wages as t~ir ~k compc:nsatK>n, will do the work nJ th.! struaure is not 1111entled
o r oflCrc:d for sale ( Scc.7044, Busi~s and ProfessK>ns Code: Thi: Contractor's License Law does not apply to an owner of the: propeny
who builds or improv¢5 thereon, and who do.es such work himself or herself or through his or her own employees, proviJcJ that such
impro\lcmtnls are not intended or ofti:red tb r sale. lf, however, th e building or im provement is sold within one year of compl.:tion, the
Owner-Bui Idec will have: the burden of proving that he or she not build or improve for the purpo!tc: o f sale:).
_ _l, as owner of the propeny, am exclusively contracting with licerued contr1tclors to construct the project ( Sec. 7044, liusine.ss 1111J
Profession Code: The Comr.ictor 's License Law does not apply to an owner of property who builds o r improves 1hercon, and who
conU'3C:lS for such projects with a Contractor(s) lic:en5cd pursuant to the Contraaor's Licens e Law.)
u.,: ,Ull ~;·17/'i:_"o~ 1 h Owno, B. & P.C for lre~--:7--;2-=7, ~.
woiu,:A ~1PF.NSATION ni:ct.At\ATtON .,--
1 herc!by affirm under penalty of perjury one of the following declarations:
I have anJ will maintain a Ccnificate QfConsent to S1:lf-l1uurc for workers' compensation, as provided for by Section 3700 uflhe
Labor Code:, for the: pc1formancc oftlu: work for which lhc pcrmil ii i:isueJ.
I have and will maintain wurktu' comptnsatio n insurance, as required lJy Section 370U of the Labor Cud~, for the pc:rfonrn.111..:e ufthe
;;,,k for which this p.:rmit is issu1.:d My workers' compensation insuranO! carrier anJ rulicy number are:
Cu1il!r : ______________ _
Policy Number: ___ . --,--,-.,.,-,~------________ Expires _
(This .;cction need not be completed if the permit is for One hundrc.d dollars {SlOO) or lco}
--------·-
I certify that in the pc:rformanc:c of the work for which this permit is issut:d, I shall not employ any pc.rson III any manner si:i as tu
~me subject to the wo1kcrs • compensation laws o f California, and agree thal if should become subjecl tu the workc:rs '
compcnsa1 t tOn provisions ofScc;tion 3700 of the Labor Code, I shall, forth~jl compl with thos~ provisions,•
D•lc: / CJ (12 2 I,,) /~ Applica•ll:~~ _, -:7,--""y-, -·-··---~ •~ ~ -,I
WARN ING : Failure to sccurl! workers' compensation coverase i unlawful, and shall subji::c t an em~ycr to cri mimtl p~na ltics and i.:ivil
fines up to one hundred thousand dollars (SI 00,000),in addition to the cost of compensation, dam~ges as pruvide:d for 1hc .Secuon 3076 o f
the Labor Code. interest and auornc:y's fe~.
L.I C:KNSt;p CONTRACl'ORS IH:Cl,A llt\TION
I hereby 11.ffirm undc:1 penalty of pcrJury thilt I am licensed under provision of Chapter 9 (commencmg with Section 7000) of Oiv1s1on 3 i:if
the Businus and Professions Code, anJ my license is in full force and c.ffoc.1
License Class: __ ,.~----_______ License Numb~r _____________ _
Oa1e: _____________ Conuactor: _____________ _
,ONSTKll(7'ION U:NUING A(;f;NC:\'
I hereby affirm under penalty of perjury that thcte is a construc:uon lending agency for the performance o fllk: wurL for winch 1111$ permit ~
issuod (Soc. 3097, Civ. C.).
Lende1's Niuue: __________________________ _
Lend~'s Address. ________________________ _
A l'l'LIC:ANT'S Dt:Cl.i\RATION
Demolit ion Permits-Asbestos Notification Federal Regulations (Tnle 40, Part 6)
_ Rtquired Letter of Notificauon
_I ct:rtify thal the federa l rl!gulations rc:gardin~ t1libcli1os removal arc: not applicable: to lh is p1ojec1
-·_I ccmfy thal I have read this apphcauon and stale that the: above infounauon 1s correcL I agree to co1Hply with all C11y and Cuu111y
orrimances and State Laws relating to bu1~din • nstr ·uun, and he,eby authorl.ZI! rcprl!sentat1vcs uftlus C i1y and Coumy tu cnh:r upon the
above mentK>oc::d propc:rty for in~uon pyrpl) • •
Apphc.•n1or•••n• .. •·---//\ 1 / ,U----J~ ______ Uo10 1.c,_/4'2-2.o.1£.
l'c.-miu•e name(p11111). --12.t-(;;1L L.M~/~~ _____ ---·-__ _
~