HomeMy WebLinkAbout40132208 - PermitCity of Santa Ana
Permit Counter: (714) 647-5800
20 Civic Center Plaza (M-19), Santa Ana, C492702
lnspection Requests: (714], 667-2738 lnspector Section: (714) 647-5853
Mechanical Permit #: 4lJ1322o4
Pin #: 90260
Project Address: 2109 S Park Dr
Assessor'sParcel: 015-201-03 Lol: '18
Unit:
Block: NA
Bldg:
Tract 1192
Address Range:
Historic: No
Suite Range:
Zoning: Rl
q
Ownerl
Address
Contraclor
Address:
DORINE PHILLIPS
2109 S, PARK DR
Santa Ana, CA 92707
(71415744275
lnter-City Energy Systems, I
1I75 N DEL PLACE
Ontario, CA 91764
(5621777-1142
Foe Type Amount
01'1'16002 51604 Wall Heater/Floor Furna 63.12
01'116002 5'1600 General Plan Update 21.25
01116002 516M lssuance 52.98
Fee
$63.12
$21 .25
$s2.98Phone
Tenant Name:
Phone
State Lic #: 587709
Lic Type: C-35, B, C-10, C-20, HIC
Bus. Lic #: 1999E1
Workers' Compensation lnsurance:Carrier: Zurlch Amerlcan lns Co
Policy #: WC038,t6460
Expires: O7lO1l2O1A
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Single Family Dwelling
Miscellaneous
Mechanical
Occupancyi
Constr Type
Code:
Notes: Mechanical
Dale:
Date:
Date:0611212018
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
web user
Every pennit issued shall bocome invalid unless the work on the site
authorizod by such pemit is commenced within 180 deys afler its
issuance, ot if the wo* authoized on the site by such permit is suspended
or abandoned fot a period of 1 80 days after the time the wo* is
conmenced
$137.35
$137.35
$0.00
lnspector MID#: 2018-144000
N/A - No Balance Fee Total:
Paid to Date:
Balance Oue:
Qty
1.00
1.00
1 .00
R-3
VB
cMc 2013
MECHANICAL-INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS
Appliances
Metal Fire Place
Evaporative Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-lnsulation
lnsulation /A*vt;6Smoke Detectors lnstalled N-lJ-/5
Rouqh Ductwork (/
Vents
Toilet Room / Clothes Dryer
Residential Ranoe
Other
Hood
Type I Hood
Type ll Hood
Grease Duct
Fire Damper
Openings
lnstallation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Bough Mech.
Final Test
Meter Release
FINAL tr-r3-{r D
Notes, Remarks, Etc.
OWNER EUILI'B DETTA&ATION
I hrnby affrn und.r pcm,ty of Fdury lhd I o cr.ryl fmn lh. Cor mclos Licsi$ Li* for lh€ folloDi.g E&en (Se.7oll5
Blsircss !,'d Prufcsior Codc): Any Chy or Counry qnich rcqlnes u I'€rmI Io on$Dcl' alrr, improrc, .lcmli3h or Bl,eir My
{o.t@, ,rio. ro irs Lssurrcc. !l$ Equies ric rp,,ltant for iuch pc.mir to th "
si8n d aIcftnl ihrl h. or sh. G lic.ns.d l'uNdt
lo rh. lolishns of tlr Co reror's Li.c.*d kD (Chlprd 9. Cormtuin! wnh Scdion 7000 of Divirion 3 of lhc Bulinss mn
PN&$ioN Codc) or rhdr hc or shc h cxcnpt rncBfiom Md th. b{ris lo, rlr dlce.d ercn{,lhi. Any viohliof, of Sdtion ?031.5 br rny
lpplicul lor a tcml subicck lnc lpplicanl lo a civil p.mly of Nr mrc Od fiw nundrd dolles (3500).
-1.
ar owtur of rhc r,!Fny. or ny.nphlrls with w.ge 6 rlEn $k onp.trsrio,L wul d. tlE eo* r,n ll'c sl.rt@ is ml
i,l.nd.n or o6.rd f6r sh (Se.7O4a. BNimle d ProLsrions Codc: TIE Conl@lols Ltcns Llw does nol alPly m a oeM of
rfi.rftFny slb hikts or inpna lltBr! dn qho dGs Mh hrt hinslf or herslf o, though hii d ha, ou employ.ca.
,mvi.hd lh.l such in{mwnrs @ mt inr.idcd trotu lor sL ll howcK. tlE huildiq c irytuEmnl k sld wilhin oE y@
oi sdrplcliotr ltE Owmr Buiu.r will h.w ff, budn oflmvinS thd tE .r :h. dil ml boild m in{mw nE !m|El, aor llE p'q,* of
-I.
{sowmrofrhc pbpcny. mcrctusivclyconr$ding wirh limr*d conrr.cror ro con(tucl rhc pmj.<r (56 7014. BLciE$
ad EoftrsionCodc: Thc Coflrrrrols Liccnse Lr$ des nor !t ly ro.n o*M of p,opcrry who blilds or inprovcs d.rm..
a.d who .6fl6ds fo, trh l,nF.l3 with r Conh.rods) lhen{d puNunr ro rh. Conrucrols Li$n$ L!w).
lrtrrcr. rtr utrdo Sccri{ .8.&P.C lnrrhLsnrn
WOR(EfS' CONIPENSATION
DECI.AAAII!}N
I n.rcby amirn Dndr ,.nshy of l'crjury onc ofth.l'ollowitrg dccleltions:
-l
hlvc !.d will @inllan a C4nifcrc ofcotr{nl ro Scll-ln$rc tor mrt6 otrp.ns{rio.. s lorid.d aor by Selbn l70O of fie
L,bo, Cod.. for rlE pdf.,lree of & e.l fo. wnhh rhe |im! b is.{.
t hdvc nnd will nuinrai. so,kcrs comFnsslion insuramc. as rcquncdbyScclion1700oflhsL{horGdc,forrhcptrforNnaoa
rh. wo.k ror ehich rh( p.rnil i( ksucd. My wortcrs cotrp.nsr io. insunncc oricr and Flicy nlnbd e:
-l
ccdiry thal in thc FcdorDtra oathc uorl for ahkt thh Frnit is irilca. l.h,ll noi cmploydny f.Mn in rny monkr
$ 6 ro b..rm subirl ro rhc srLdc con .nsalion hes of Cdlirornid, and aBE ltal if I itDuld t oft subi$ lo lL
workcm' co'np.n*ario. pmvhion* of setion l70i) of rnc Lihor Codc. I srtrll. fonnvirfi sq)ly *ilh IlnE Pdvisio.s..
WAnNING: F!il@ b sw workcs'.ompcnssdon .ovcE8c n unh{tuI. lnd sh{ll subjel s mploFr lo ainiId pcElls tnd
civil lincs up ro onc hundEd rhouMnd dolhrs (11m.000). in cddnk'n ro rlE @sr oI con !.nglio., dlmg.s &i pmvn.n for llt
Sdion 10?6 oatiE L.bor &q inlcEsl lnd lllomy s fei
D,le: Applimtl
LICENSID!.QNI&!.]OB
DIiCLTEAIIOtr
I hrchy rlltnrufttcr pcnllryof pdjury rh, l.d ln{i*l riJ.r prov,sn, olChnarct 9(.onrmn.in8 rirh Ssrirn 7([n) orDirisi(,n ]
ol rhc lturims\ ind Pdt$ion\ Codc.rnd mt licctrs i\ in lull nn.c rxl clft.r
iqi Liccns Nunb.r:
Conlrxdor:
AIIIICAUIDIICLAXAII!}N
I h*,,rmdundcr Icoalry ofr.{ury onc ofrhc lollowine dc.l rriotrr
Dcmhiotr Pcrnrik-Ashc{or Norifiolion Fcdcnl Rceularion{ (lilb.rt}. Pnn6)
-Rcquicd
tarrcr nr Norilirdior
_l.cnifyrhsi rhc lcd6n I Egu l,! ions rcB ding asbcsos rcnm!0|.r. nor qlltrbk ro lhh !roj.{I.
-l
c.nify rh l nlvc Ead rhis lpnlkaraon dn sr . rhar lh lboE inlomrbn n .oGl. I sgr lo otrtPly wilh aI C!, ad Coury
ordinoffi ord Srsr. t ws Ehin8 h hitsing co.irturhn ad hcEb, Nrhori4 GFcs.r{div8 of6is Cnydd County lo eme. upon llE
lbow Enrhmd pDFrry fG insperion pu4bei
Af,rli.nnr dr AE.nr Si!nrrurc
Pmire tum (rriiDr-
II
DfrTNI
caNuBtiqIloNIINIIN!3liIiNcr
I hcrchr or'ltr undcr Fillry of pqury rhtrIhcrc is d .\,,itudbn lcn nrS aecmy for thc rdonMr of ltc $ork fo, *hth rhn lf,nn is
hsucd (Scc 30r)7. Civ C.).
ttr'nJc'-. \,nr
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