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Home My WebLink About10191506 - PermitCity of Sa nta A na 20 C iv ic Cente r Plaza (M-19), Santa A na, C A 9270 2 Building Permit #: 10191506 Pe rmit Counte r : (7 14) 6 4 7-5800 Inspectio n Re quests: (714) 667-2738 Inspect o r Section: (7 14) 64 7-5853 Pin#: 69831 Project Address: 1520 Brookhollow Dr Assessor's Pa rcel: 016-151-06 Lot: NA Block: NA Build ing U se: Commercial Occupancy: J o b T yp e: Reroof Constr T ype: Na ture o f W o rk: Reroof Code: Unit: Bldg: Tract: NA B VB CBC 2013 Ad dress Ra nge: 1504-1528 Hi st oric: No 1s t F L A rea: 2 nd FL A rea: Other A reas: Suite Ra nge: Zoning : S08 P atio: T .I.Area: Yards R eq'd: E xisting Bldg. & U se: Commercial Flood Zon e: X-0602320278J G arage A rea: Valuation : $50,000.00 Pro posed U se: Offices # of S t o ri es: T o t a l: O Description of Work: New layer of water-resistant roof coating applied over existing roof material. CRRC # 0 §§§;:_9,qQ!v 1.~,9-.ooo.~Sl i A~o!r'8 ndcHJt glY.~Ehf..__: Planning Conditions: Owner : Brookhollow Office Park Associati , Contractor: Highland Commerci al Roofi1 5105 Heintz Street Address: 11 Ma di son Ave 26 Ad dress: New York, NY 100103643 Baldwin Park, CA 91706 (626) 856-2076 Phone: Ten a nt: Pl anning Approva l By: Plan Checked By: Pe rmit Issu ed By: NPDES lnsp. Req'd: No PWA lnsp. Req 'd: No Pla nn ing ln sp. Req'd: No Land scapin g lnsp. Req'd : No Ni , Ann Phone: Stat e Li e #: 632551 Li e Type: C-39 Bu s. Li e #: 341422 Worke rs' Com pe nsa tion In surance: Carrier: Starr Indemnity & Liab ility Po li cy #: 1000001322 Exp ires: 12/31/2016 Date: 12/01/2016 Date: Mi sc . Receipt: Misc. Rece ipt: Cha vez, Dave C- --;;? Da t e: 1 2/01/2 016 Subject to Field: Misc. Rece ipt: Fire lnsp. Req 'd : No Police lnsp. Req 'd: No Account# Flood Zone Ce rt. Re q'd: No 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. 0 111 6002 5 1600 0 111 6002 5 1601 0 111 6002 5 16 1 2 Inspector MID#: 2016-133 23 1 Engineer : Ad dress: Phone: License #: Architect/ Des iQne r: Address: Phone: License #: T o ta l $20.56 $797.5 1 $2.00 urr. :ei ,_~"fll iL,.:i~:,_. ~runs~~ 66 3 of _ Ref~; 10:l?1'.50,; · 12/1/2016 11:50 AM flishlctn d Co1,u,1er,~ial Roof"ins Ge~2ra1 flan Update Fee ,).i. i 16002-516000(10· 2,...., .1.C in::; Ciili6002-_,i60J.0(11} Blds Stds Revoivins 011!6002-:1612000- 01116002 51601 Permit Fee 0111 6 002 5 1 6 1 2 Bl dg. Stds . Revo lving 01116002 5 1 600 Gene ral Plan Update 011 16002 5 1 601 Iss uance Fee Tot al: Paid t o Dat e: Balanc e Du e: $74 6.25 $2.00 $20.56 $51.26 $820.07 $0 .00 $820.07 SITE-WORK DATE ID/SIG. Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor SubfloorNent/1 nsulation Roof Sheathing Shear Wall IV '-' Framinq Insulation/Energy E xt.JI nt. Lath Brown Coat Ma sonry Pool Fence T-Bar Ha ndicap Req . Deputy Final Report Enoineer Final Report Flood Zone Certif. FINAL Certificate of Occupancy Notes, Remarks, Etc. BUILDING-INSPEC TOR RECORD COMMENTS O WNER BUILDER DELCARATION I hereby affirm under penalty of perjury that I am cxempl from the Contractors' L icense Law for the followiug reason (Sec.7031 .5 Business and Profession Code): Any City or Cou nty which requires a permi t to construct. alter. impro ve. demolish o r repair any stmcturc. prior to its issuance. also requires the appl icant for such pennit to file a signed statement that he o r she is licensed pursuant to the provisions of the Contractor's Li censed Law (Clrnpter 9 , Commencing w ith Sect ion 7000 of Divisio n 3 of the Business .ind Proressions Code) or that he or she is exempt therefrom and the basis for the alleged exemption . Any violation o f Sectio n 7031.5 by a ny applicant for a pennit subjects the applicant 10 a civil penalty of not mo re than five hundred dollars ($500). _I, as owner o flhe propert y, or my employees with wages as their sole compensat io n. wil l do the work and the structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor·s License Law docs not a pp ly to an o wner or the property who bu ilds or improves thereon. and who does such work himself or herself o r through his or her o wn employees. prov ided that such improvements are not intended o r offered for sale. If. however, the building or improvement is sokt within one year o r completion. the Owner Builder will have the burden of proving that he o r she did not build or improve the pro perty for the pu'l)OSC o f sale). _I. as owner o f the property, run exclusively contracting with licensed contractors to construct the project (Sec. 7044. Bus iness and Profession Code: The Contractor's License Law does not app ly to an owner of property who builds or im pro ves thereo n. and who contracts for such projects with a Contractor(s) licensed pursuant to the Contractor's LicCnse Law). _1 am exempl under Section, ________ • 8. & P.C. fo r this reason . Da ce.: ___________ Owncr:-::==========o------------- WORKERS' C OM PENSATION OECLARATI ON I hereby a ffirm under penalty of perjury o ne of the fo llowing declaratio ns: _I have and will maintain a Certificate of Consent to Self-Insure for workers· compens ation. as pro vided for by Section 370 0 of the Labor Code, for the performance o f the work for which the pen nit is issued. _I have and will mo intoin workers' compensatio n insurance, ns required by Section 3700 of the Labor Code, fo r the per formance of the work for which this permit is issued. My workers' compensat ion insurance carrier and pol icy number are: Carrier: __ •_-~A __ ·C.._o __ f'_d _________________ _ Policy Numbcr:_• __ (,_00.:...__D_D __ D __ l_>--""---2_..:2 _____ ,Expires; _• __ l _2~/_•_l _2--_o_l _"-_ _1 certifytha1 in the performance o f the work for which this permit is issued. I shall nol employ any perso n in any manner so as to become subject to the workers ' compensation laws of California. and agree that if I should become subject 10 the workers' compensation pro,1isions of Section 3 700 of the Labor Code. I shall. fo11h with comply w ith those p rovisio ns. W A RNING: Fail ure to secure workers' compensation coverage is unlawful. and shall subject an employe r to criminal penalties and civil fin es up to o ne hundred thousand dollars ($100 ,000). in addition to the cost of compensation, damages as provided for the Section 3076 oflhe La bor Code, interest and attorney"s fees. n Date: , { L{ I / z.., (-(, A p p lh:ant, ..,.._ "~ ~ -r LICENSED~N ____IOR ,._ DECLARATION • I hereby amnn under penally of p erjury that 1 am licensed under provis io n o f Chapter 9 (commencing w ith Section 7000 ) of Division 3 of the Business and Professions Code. and my license is in fu ll force and effect. U cense Class: • L -3 ( License Number ; ' C-5 ( -6 S, 2 ~S-/ • ------=---'------ D a I e .. · _ -•-t~L=+/_,_1+...,,z~;;,'-'-'( (;,,_,__ Contraclor ~ l:-\\'5l¼\/\d ('-'~l,,\uCo~( /(""<)+-(Vt r - CONSTRUCTION L EN DING AGENCY I hereby affirm under penalty of pc1jury that there is a construct io n lending agency for the perfonnance o f th e work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: __________________________ _ Lender's Address: _________________________ _ APPLICANT DECLARATION I hereby affinn under penalty of perjury one o f the following declarat ions: Demolition Permits-Asbestos Notifica1ioll Federal Regulatio ns (T itle 40. Part6) _Required Letter of Notification _I ce11ify that lhe federal regulat ions regarding acibestos removal are no! applicable to th is project. ~ _,J"L;..ceitify that I have read this a pplication and s tate that the above infonnation is correct. I agree to comply w ith a ll City and County i-----------------------------------------------------1 ordinances and State Laws relating to building constmction, and hereby autho rize representatives of th is City and County 10 enter upon the above mentioned p roperty for inspect ion purposes. _.,,,.,----; _ Applicanl orAgcntSigna lure:-,...._ 4 ~ .. ___..,c-.--Dale: • / 2-,/1/ < .:>t.C.. Permitee na me(1lrinl): )(_.,_ .. Tcf£ L tt v-v'\, =