HomeMy WebLinkAbout10191507 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana , CA 92702 Building Permit #: 10191507
P ermit Counter: (7 14) 647-5800 Inspection Requests: (714) 667-2738 In spector Section: (714) 647-5853 Pin#: 44416
Project Address: 1526 Brookhollow Dr Unit: Bldg: Address Range: 1504-1528 Su it e Rang e:
Assessor's Parcel: 016-151-06
Building Use: Commercial
Job Type: Reroof
Nature of Work: Reroof
Ex isting Bldg. & Use: Commercial
Proposed Use: Offices
Lot: NA Block: NA
Occupancy:
Constr T ype:
Code:
Flood Zone:
# of Stories:
Tract: NA
B
VB
CBC 2013
X-0602320278J
Historic: No
1st FL Area:
2 nd F L Area:
Other Areas:
Garage Area:
Total: 0
Zoni ng : SD8
Patio:
T.I.Area:
Yards Req'd:
Valuation: $50,000.00
Description of Work: New layer of water-resistant roof coating applied over existing roof material. CRRC # 0656-0001. 19,000 sq . ft. Handout given.
Planning Conditions:
Owner: Duff E Watrous
Address : 341 Flint Ave
Long Beach , CA 908140000
Phone:
Tenant:
Planning Approval By: Ni, Ann
Plan Checked By:
Co ntra cto r : Owner-Builder
Address:
Phone :
State Lie#:
Li e Type:
Bus. Lie#:
Workers' Co mpensation In suran ce:
Ca rri er:
Policy#:
Expires :
Date: 12/01/2016
Date:
Permit Issued By: Chavez, Dave C:,,.
No -'9,
Date: 12/01/2016
Subject to Field: NPDES ln sp. Req'd:
Misc. Receipt:
Misc. Receipt:
Misc. Rece ipt:
PWA ln sp. Req'd : No
Planning ln sp. Req'd : No
Fire ln sp. Req'd: No
Police lnsp. Req'd: No Account#
Landscaping lnsp. Req 'd: No Flood Zone Cert. Req 'd : No
Every permit issued shall become invalid unless the work o n 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#: 2016-133232
0 111 6002 51600
0 111 6002 5 1601
0 111 6002 51612
Eng ineer:
Add ress:
Pho ne:
License#:
Architect/
DesiQne r:
Address:
Phone :
License#:
Tota l
$20.56
$797.51
$2 .00
ID; ELI i.Ai:-:_·-:_
: Gil~,;~ 6,!J ..:. --T
R,~r~" i!Jl 'ii '-;1)7
12/1/2016 li:50 ~M
1~1.-::': J.1 ; ~c1ri Jpdc•.t.e
~-~~6802 S_6QOGOG-
·Hii:n.i'~
01116002 51601'' P~r~t Fi£lj,, 7 f;t.,,: '~; ,:$"7~~-25
01116002 51612 Bld g. St ds. Revolving $2.00
0111 6002 51600 Gene ral Plan Update
01116002 51601 Iss uan ce
Fee Total:
Pa id to Date:
Balance Due:
$20.56
$51 .26
$820.07
$0.00
$820.07
BUI L DIN G-IN SPECTO R RE CO RD
SITE-WORK DATE ID/S IG. COMMENTS OWNER BU ILDER DELCARATIO N
I hereby affirm under penalty of perjury that I am exempt from the Contractors· License Law for the following reason (Sec.7031 .5
Set Backs Business and Profession Code): Any City or Cou nty which requires a peimit 10 construct. alter. improve. demolish or repair any
structure. prior to its issuance. also requires the appl icant for such pem1 it to fil e a signed statement that he or s he is licensed pursuant
Forms/Steel/Ho ld owns to the provisions o f the Contractor's Licensed La w (Chapter 9. Commencing w ith Section 7000 of Division 3 of the Business and
Erecti o n Pads Professions Code) or t hat he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031 .5 by any
applicant for a pem1it subjects the appli cant to a civil pen ally o r not more than five hundred dollars ($500).
UFER Grou n d _I. as owner of the property, or my employees with wages as their sole compensatio n. will do the work and the structure is not
S LA B Fl oor intended or orfered for sale (Sec.7044, Business and Professions Code: The Contractor·s License Law docs not apply to an owner of
the property who builds or improves thereon, and who does such work himself or herself or through his or her own emplo yees.
Su bfl oo r/Ve nt/lnsul ati o n provided that such improvements are not intended or orfered for sale. If. however. the building or improvement is sold within one year
Roof Sheathi nQ
o f completion. the Owner Builder will have the burden of proving that he or she did no t build or improve the property for th e purpose of
sale).
Shear Wall _I. as owner of the property. run ex.elusively contracting with li censed contractors to construct the project {Sec. 7044. Business
Fra minq and Profession Code: The Contractor·s License Law does not apply to an owner of property who bu ilds o r improves thereon.
and who contracts for such projects with a Contractor(s) licensed pursuant to the Contractor's License Law).
Insul ati o n/En e rgy _I am exempt under Section . B. & P .C. for this reason.
Drywa ll Date: Owner:
Ext.lint. Lath WQRKERS' !;;OM PENSA TIQN
DE !;;LARAT IO N
Brown Coat I hereby affirm under penalty of perj ury one of t he following declarat ions:
Maso nry ~' have and w ill maintain a Certificate of Consent to Self-Insure for workers' compensation. as provided for by Section 3700 of the
Poo l Fe nce Labor Code, for the perfonnancc o r the work for which the pcnnil is issued.
T-Ba r _I have and will maintain workers' compensation insurance. as required by Sect ion 3700 of the Labor Code. for the pcrfonnance of
the work for which this pennit is issued. My workers· compensation insurance carrier and policy number are:
Ha ndica p Req. Carrier:
. Aco<o.
De pu ty Fin a l Repo rt . /<Daooo (322-. ,'"2.i I I Z-1:>U; Po licy Number: Expires:
En g in eer Fin a l Re po rt
_I ce11ify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner
Fl ood Z one Ce rtif. so as to become subject to the workers' compensation laws of California. and agree that ifl should become subject to t he
workers' compensation provisions of Section 3700 of the LaOOr Code. I shall. forthwith comply with those provisions.
\VARNlNG: Fai lure to secure workers' compensation coverag e is unlawful. and shall subject an employer 10 criminal penalties a nd
c ivil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the -I .,... I, Section 3076 of the Labor Code. interest and attomey·s fees . -
F IN AL ~-r -16 ..J/~J~-, iz'("Yv/ . I '2.-! ! / Applicant:')(. ~ --::2-Date: I{,.
Certificat e of Occupancy I LIC E NSE~~
I DE!;;LARATIQN -I
Notes, Remark s, Etc . I hereby affinn under penalty of perjury that I am lic ensed under provision o f Chapter 9 {commencing with Section 7000) of Division 3
of the Business and Professions Code. ru1d my license is in full force ru1d cffcc1.
(_ -s1 c::-"3 i -65? S-S-1 -License C lass: I License Number:
.,.
l>atc: • r2.ft1Z::>/t:, Contract o r : )(.,, Hr,ti /qvid G~1:14.e.cc.[0 ~<>1frt
/I
" !,;01:!!STR!l!;;TIQC!i !,gNDING 1H,EN!;;Y
1 hereby affirm under penalty of perjury that there is a constmction lending agency for the perfonnance of the work for which this permit is
issued (Sec. 3097, Civ. C.).
Leudcr·s Name:
Lender's Address:
APPLICANT DECLARATION
I herebyaffinn under penalty o f perjury o ne of the following declarations:
Demolition Permits-Asbestos Notification Federal Regulations {Title 40, Pa1t6)
_Required Leiter of Not ificatio n
_I cenify that the federal regulations regarding asbestos removal are not applicable to t his project.
~ J:L-1 certify that I have read this a ppl.ica ti on and state that the above infonnation is correct. J agree to comply with all City and County
ordinances and State Laws relating to building construction. and hereby <mthorize represenlati\1CS of this City and County to enter upon the
above mentioned property for inspection~
J Applicant or Agent Signatu re: )' ~ .
Dale: • I 2.. L! !._ Z ;;.1~
7 ,
Permitce n ame (pri nt): ~ ~-r Lfrr?
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