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City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Mechanical Permit#: 40130631
Permit Counter: (714) 647-5800 Inspection Requests: (714) 667-2738 Inspector Section: (714) 647-5853 Pin#:
Project Address: 321 5 Andres Pl
Assessor's Parcel:
Owner:
Address:
Phone :
Tenant Name:
Contractor:
Address:
Phone:
State Lie#:
Lie Type:
Bus . Lie#:
108-113-06 Lot: 28
Vesta Clarkson & Maynard
321 S Andres
Santa Ana, CA 92704
(714) 224-2170
Lightning Construction and
6047 Tampa Ave. #303
Tarzana, CA 91356
(818) 277-2043
951122
B
354082
Workers' Compensation Insurance:
Carrier: State Fund
Policy#: 9117672
Expires: 11/13/2017
Building Use: Single Family Dwelling Occupancy:
Job Type: Addition Constr Type:
Nature of Work: Addn/Remodel/Patio Cover/\Code:
Unit:
Block: NA
R-3, U
VB
CMC 2013
Bldg : Address Range: Suite Range:
Tract: 1550 Historic: No Zoning: R1
Fee Type Amount Qty Fee
0111600251604 Furnace/CompCombo 1 18.19 1.00 $118.19
01116002 51604 Clothes Dryer-Residen 37.57 1.00 $37.57
0111600251604 TypellHood 61.07 1.00 $61.07
01116002 51604 Bathroom Fan 28.42 2.00 $56.84
01116002 51600 General Plan Update 20.56 1.00 ,...i;, $20.56
0111600251604 lssuance Batch~ :'6531 -5 j _3/Ef1 ~~1~" 1~00 "-•_'-'~·-$-5·1 .26 0 ffice:c:n, f.~1i1ST•.v · t
Acc t~= Ref: T~-=~u~
Rc pt;:01684396 -12/6/2016 3:43 PM
Tr ansaction Total $1r747.49
Li shtnins Construction end Des
General Plan UPdate Fee
01 116002-51600000-
l'le c"an cal
01 116002-51604000-
I CL (:heck 0C708S
. ,-.-.
,..~.... • 7...J
$2,747 .49
Planning Conditions: All materials to match existing. FLOOD ELEVATION CERT REQ'D@
CONSTRUCTION & FINAL.
Notes: A/C unit on side property. Relocate laundry facilities &
water heater in garage. RemodeVconvert floor plan of
(e) kitchen.
Planning Approval By: Date:
Plan Checked By: Date:
Permit Issued By:
Subject to Field:
Chavez,Dave~
,;
Date: 12/06/2016
Account#
Building Permit #: 10189522
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 of 180 days after the time the work is
commenced.
Inspector MID#: 2016-128450
01116002 51600
01116002 51604
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
$20.56
$324.93
Fee Total:
Paid to Date:
Balance Due:
$345.49
$0.00
$345.49
MECHANICAL-INSPECTOR RECORD
APPROVALS DATE ID/SIG. COMMENTS Owner-Bui lder Decla ra tion
I hereby affirm under pe na lty of perjury that I am exempt form the Contractors· License Law for the following reaso n (f;c.70 3 1.5 Business-
Appliances and Professio n Code}: Any City or County which requires a pcnn it to construct. alter. im prove. demolish o r repair any struct Ure. µ;ic -~o its
issuance. also requires the a ppli cant for such permit to fi le a s ig n ed statement t hat he or she is licensed purs ua nt to the pro v isions o.o:-the
Metal Fire Place Co ntractor's Licensed Law (Cha pter 9. Commencing with Section 7000 of Division 3 of the Bus iness and Professions Co d e) o r that he or
she is exempt t he refrom and the basis for the a lleged exemption .Any vio la tion of Section 70 3 1.5 by a ny app licant fo r a pcn nit subjects lhc
Evap Cooler ap plica111 10 a civil penalt y of not more than fi ve hundred dollars ($5 00).
Furnace _I. as owne r of the propert y. o r my employees w ith wages as their sole comp ensat ion . will do the work and the s1ruc1 ure is not intend ed
or offered for sale ( Sec.7044. Bus iness a nd Pro fess ions Code: The Co ntra ctor 's License Law does not ap p ly to an owner of the property
Compressor who builds o r improves thereon. and who does suc h work himself o r h erself or through his o r her own e mplo yees. provided that such
im provements arc no t intended or offered for sale. If. however. t he bu ilding o r im provement is so ld w ithin o n e y ear o f c ompletion. the
Misc. Equipment Owner-Builder w ill ha ve the burden of proving that he or she no t b uild or improve fo r the purpose o f s a le).
_I, as owner o f the property. am exclusiv e ly contract ing with lic ens ed c ontractors to construct the project ( Sec . 7044. Business nod
Profess ion Code : T he Contractor's Lic en se Law d oes n ot apply to an owner of property who b uilds or improves t hereon . and who
Duct Work contracts for such projects w ith 3 Contractor(s) licensed p urs ua nl to the Contracto r's Lice nse Law .).
Pre-Insulation _I a m exe mpt under Section .B. & P.C. for this reason.
Insulation Date: Owner:
Smoke Detectors Installed WORKERS COMPENSATION DE!:;LARA TION
I hereby affirm under penall y o f perjury one of the fo llow ing declaratio ns:
Rough Ductwork _I have and will ma intain n Ce11ificate of Co ns e nt to Self-I nsure for workers ' compensatio n. as provided for by Sec t io n 3700 o f the
Labor Code. for the perfo rmance o f the work fo r whi ch the pennit is issued.
:::(11,we a nd wi ll maintain workers· compens atio n insu rance. as required by Se ction 3700 o f the La bor Cod e, fo r t he performa nce of the
work for which th is permit is issued . My worke rs· co mpensat ion in surance ca rrier and po li cy num ber are:
Vents Cl:ifficr: . ~k,,., r-vihJ
Toilet Room I Clothes Dryer Po licy Number: • ~ /j =, {.p_ ::J. 2 Expires: • °l l • J-3_,rJ
Re sidentia l Range (T his sect ion need not be completeJ ~ the permit is fo r One hundred d oll ars ~$1001 or less)
Other _I certify th at in the perfonnance o f the work fo r whic h this p ermit is issu ed, I shall not employ any person in a ny manner so as to
beca me s ubject to the wo rke rs' compen sat ion laws of Californ ia, and a gree tha t ifJ s ho uld become subject to the workers ·
compensation provis ions of Section 3700 o f t he Labor C ode. I sha ll, forthw it h co mpl y w i1h th ose provisio ns ..
Hood Da te : . I 2 , ~ . I ~ A pplicant: 'I-~ b-'"
Type I Hood WAR N I NG : Fa ilure 10 s ecure workers· compe nsa t ion c o,•erage is unlawful, a nd sha ll subject a n emplo ye r to crimina l pena lties nnd civ il
fi nes up to one hun dred thousand d ollars ($ 10 0.000).in additio n to t he cost o f compensa tion. da mages as prnv ided for the Section 3076 of
Type II Hood the Labo r Code. int erest and attorne y's fees
Grease Duct LIC ENSED C O NTR AC TORS DECL ARA TION
I hereby a rfinn under penall y o f perjur y that I am licensed under provis ion o f Chapter 9 (comme nc ing w i1h Sect ion 7000) o f Divis io n 3 of
the Busin ess and Pro fes s io ns Code • .md my license is in fu ll force and effect.
Fire Damper Licens e C lass: • f} Li cense N umber ~ g__t: 1/U-
; 2-. {;, L 0 -Openings Date : ' Co ntractor: ,C..
Installation CONSTRUCTION LENDING AGENCY
I here by a ffirm u nder pena lty of perjury t ha t there is a construction lendin g a gency fo r the perfonna nce of t he work for which this pennit is
F.D . Drop Test issued (Sec. 3097. C iv. C.).
Lende r·s Name:
Lender's Addre ss:
Above Hard Lid APPL IC A NT'S D F.C LARATION
Above T-Bar Demolitio n Pennits -Asbestos Notific ation Fed eral Regulatio ns (Title 40. Part 6 )
_ Requ ired Letter of Notificat ion
I I I ' _I certify that the fed eral reg ulatio ns regarding asbesto s removal are not ap pli ca ble to th is project.
Rough Mech. 1/ii/A mvr:Jt ~ ~rti fy that I have read this applicat io n a nd stat e t hat t he a bove infor mation is co1Tcct. I agree to comply w ith all City a nd County
Fina l Test I r/ ordinances a nd State Laws relating to b uilding constru ction. and here by authorize representatives o f this City a nd Coun ty to e nter upo n t he
I a bove m entioned property for inspec ti on purposes.
Meter Release \0..\\-Q ,V\~1114 Applicant or ngcnt sii;.: I(. i -Date: . /2-. &.1 G
FINAL I
Pe rmittee name (print): 0(.. EL ltvQ1= G-L \i'. c}j_ £ /2..,
M.\WP51\Perm1l-lnspect1on Fo rms\Mechanical-lnspector Record.doc 03.3 1 .0 6