HomeMy WebLinkAbout101103757 - PermitProject Address:1040 W Mac Arthur Blvd
Assessor's Parcel 937-383-48 Lot: 1,2, 3,4,5 Block: NA
unit: 52 Blds
Tracl: 10543
Address Range: 1000-1040
Historic: No
Suite Range:
Zoning: R4
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
Permit Counter: (714) 647-5800 lnspection Requesls: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 1O11O3757
Pin #: 13921
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Use:
Condominium
Alteration
Window c/o
Condominiums
R-2
VB
cBc 2019
x-0602320258J
Occupancy.
Constr Type
Code:
Flood Zone:
# of Stories:
1st FL Area:
2nd FL Area:
Other Areas;
Garage Area:
Total:
Patio:
T.l.Area:
Yards Req'd:
Valuation: S2,446.00
Oescription of Work: Window change out. 3 windows changed out. No size changes.
Planning Conditions:
Owner:
Address
Phone:
Tenant
Talita De Souza
1040 W, MacArthur Bouleva.d #52
Santa Ana, CA 92703
(s491 205-04',t7
Conlraclor: Home Depot U S A
Address: 12700 Stowe Drive, Suite 28
Poway, CA 92064
Phone: (858) 846-9700
State Lic #i 602331
Lic Type: B, C-39
Bus. Lic #: 365245
Workers' Compensation lnsurance;
Carrier: ACE AMERICAN INSURANCE COM
Policy #: C66922753
Expires: O3lO1l2O21
Engineer
Address
Architect /
Desiqner:
Address:
Phone:
License #
Planning Approval By;
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd; No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Landscaping lnsp. Req'd; No
Date: 05/1412020
Oate:
Date: 05/05/2020
Subject to Field:
0 77160 0 2
017 760 0 2
o77760 0 2
07776002
07776002
51601
57770
57572
57600
57607
Permit Fee
Microfllm Records
Bldg. Stds. Revolving
General Plan Updale
lssuance
Guevara. Jerry
Chavez, Dave
Fire lnsp. Req'd:
Police lnsp. Req'd
Flood Zone Cert. Req'd: No
Every pelmit issued shall becofie invalid unless lhe work on lhe sile authoized by
such pemit is commenced within 360 days aftet ils tssuance,ot it the wo authoized
on the sile by such pemtt is suspended ot abandoned tor a peiod ol 360 daysafler
lhe lime lhe work ts commenced.
lnspector MID#: 2020-1589'14
Misc. Receipt
Misc. Receipt
Misc. Receipt
$166.53
$3.91
$1.00
$57.20
No
No Account#Total
01 1 't6002 51600
01'116002 5160'l
01116002 51612
011',16002 57770
s22.95
s223.73
$1.00
$3.91 Fee Total:
Paid to Dale:
Balance Due
$251.59
$0.00
$251.59
Phone:
License #
I
SITE.WORK lD/slG. i COMMENTS OWNIR BUILDER DElr('ANATION
I hd.t y ,rm undd Fnslly of r.rrury lhn I o d.mP liom rh. Conra-loB l. ic.e L.s ld
'h.
foll,sirS .Nn (5(.7011 t
Ircin65 !.d Prcfsnrn Cod.): ny CiU or Cou y which r.{ut6 a FnI lo co.xtud, !1t6, introvc. .lqtulilh or EP.n dy
n'!c1u.. lnor r. irs Buan.., aLo r.qur6 th. .lplicMl lor sucfi Fmn lo filc ! lisftn nttod rlld h.or slt i li.sa.d pd@rl
h rh€ Eor6iont of rh. Conr*ld 3 Lkds.rl t $ lch,pld 9. Com'min( $ nh SalFn 7000 of Dirisi,n I of lh. Bsi.* ud
Itofsio.s Cod.l.r thr! lE or $. i! dcnpt rh6c&on od rhc b&sis lor th. dlqlcd .i60io. A., liol.rionofs.drcn 70.1I 5 brd,
!lDI'+ for a ,,cml .ubral! 'h. sprlicsnl to acililpoatlyofnol oocln n nv. hunrlr.d dollrsIl5O0).
- l. & o*nd otrh. FoFn], .,r rt .nDloy6 virh *0$6 s lhcn Fl. comp.saton. *ill do lh. \ t !d d. sME b tut
i.rdlcl d.lto.d ,or elc (S( 701.1, tlusirG dd Prolsns ( ck In. Co.r.d.rs I Em* Las &a ml .mly lo D o$E of
'h.F)r'd) uho hril&or nn0ror6rlE@tr ed sho &cifths! hims.lfor hdlfor rhouShhis o.ho ost.nploy.6.
trorid.d rnll ru.h mrmv...! s & ml d.nj.d d, olrsc! rlr sk ll, h.wd, rh. ttiuns ot rprorffi is $ld rthin orc 16
ol.on4Jl.1i).. rrE Os 6 thiLl, will h.Lt rh. hrb ol FlvinE rhd h. or sh. rtil d tlilll or imFov. tnc Flpdy tor llE purrr ot
l. s ou nd .lth. FoFrr.. M .rclBncly co,r.lcrins * irl' l'(cns.d contkkrB lo .oNlrucl lh. proldl lS{ 70{4. U6mN
aid ltor*ion ( od.: Th. C..lreclofr l-icos.l,a* do6 nor aFply ro M osn6 ofrrop.n, qho build!or 'mProl6 rhdo,,
lnd trls ed6ds for $ch Foj.ds snh o C.rnI6donel licoN.d ,{rsur tu (h. (}nhrdoii Li.@ t w}
I m.r@pl unJd sftrio.
D.re Orn.r _*oirKFrii' coitPENs rtoN
DTS,AAAIIO!
r hdcb nmm und6 p.n.ny of Fjuo rN olih. followln8 dccltralioN:
, I hrv. dxl rill rai.rdin r C.nilic{. olconmr h S.ll-lNuE fm edtd conFtsdio.. a F$ridcd lor by Scthn 1700 oltlE
l*or Co<lc aor rhc Ffo.iler oarh. $o,l id utich lh. pan ii isu.{
Ih.t a.d wiu moi.rain $ ork6 comFGarior idur&c. s r.auir.d urL Serio. 1?0o of lh. llbor Cod.. for lh. Ffoil@. ol
rh. tr.rl lor $h{h rhi! p.rn ir Bsugl. Mr wo'l6 'o p.Bd'on rBLrMc.cnid MdFlc) numba s.,-* . KE *@k(A/u . /
pu,rc1,{umbcr, L6Gt}-2V93,*,*- 7/r/A{
I .6t ily lhir in rhc pafotuc of rhc eor\ for $$th rhi. Fnn is ecd I shall ml ddoy tny pss. in o, odN
$ a ro b.{o6. $bjd lo thc md6' .omFGcion Lss of c.liiodi!. 4d ,aE lhal if I sholld beo,E 3ubict lo ttF
sorl6 coopcefio. prcvtioE of S6lior l?00 orlhc ldor ao&. I slEll fodh*ith 6n l, *nt rb* FolbbN.
WARi NG: Frjlur.lo sE $0116 comFsdion corqac. a uihwlul. .nd rh,ll $bj6t 6 dploF lo aihioll D6rXi3 tt4
.trll ntr.1 u! nr ok hun,I.n rnolsNl dollas (tll)o.0or)1. $ add'l t) rhc .oi ol ronrNnsrlon. &$a!.r ar plovJcd (tr rhr
Sebon:1076 olrh. ribr C rnts6r &d arorq-.- \ f6
I tdcby .rrn undd p.nant of poiury rhd I m ltdB.d unils F!! 6ion of( lupld 9 (comm.ins $ ith sc1iln 7000) of Divisior I
of rrE llrbs ed Pbrsiotu Co&. d mv li.e is in tuI for.. {rd .fi<1.
.".*.*, . -F I "n"v 6a2sj /
".', . S{: {{aaa <.'r-cr..x
callla!]cllaulEll)llc-dcrrcr
I hdlb.v.lfm und.r Frlry olFrrory lhd llE ir ! olEruclbn lddins.sdc, lor dE Flomrc oarh. *srl tor {lich lhi! p6tni i.
isu.d(56 1097. Cir. C ).
taUn r Nam.
ilI&l(ANLD&cLl8 Ixr!
I hd$y aifnn undd FnaX, of pcjuiy o.c ua rh. follo*in8 d(ldo! ions:
Don6hion PnnirlAstErd Nolifico!ron l.n6al R.rulalnin! (Tn h 40, Pd6)
R.{!tcrl trlr- ot Nonfieio.
I agen, (nnpl,'s hill(iryardC unr,
dir6 olrnisC y d ( ou.ry lo drd !po. rrr
ator mdroo.d plnFn, aor iNlErior
\pplic. r or.\gsr Sipn.tu'( )<
P.flnile Dnrtprt'l): *u ("tr-
-"'{tl@
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subfloor/VenUlnsulation
Roof Sheathing
Shear Wall
Framing
lnsulation/Energy
Drpvall
Ext./lnt. Lath
Brown Coal
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif.
I I r)
FINAL ll 470 WDt\Certificate of Occupancy
Notes, Remarks, Etc.
+
BUILDING- INSPECTOR RECORD
DATE
I I
I
I
i i
I
I
I
I
I I
LI\IITED POT\'ER OF ,\TTORT\-EY
I,Robert Ross (Namc of Home Dcpot Qualificr), Iiccnsc #
602331 , hereinafter rcfcrred to as the "Liccnsc Holdcr," the qualifoing agent of The
Home Depot, hereby appoint the lollowing persons as Anomey-in-Fact of the License Holder'/The Home
Dcpot, who shall act as my agent with rcspcct to only thc following mattcrs (a) signing and submitting
building permit applications, (b) obtaining building permits, and (c) obtaining the cenificate of occupanc."-
f-rom (pcrtinent city.icounty) on behalfolthe License Holder/The Home Depot
James Bucklin Kimberly Bucklin Jeffrey Peo
Roger Shafer Julie HezogCarmela Tayco Kevin Boyle
LICE\SE TIOI-DER:WITNESSES ( Iwo s i Enatures Teluired)
S ign a't )Sign
Print Namc: Robert Ross Print Name:
Date:
A"Nco5
Date
Titlc
o/ /o?/AaA,
4nl{- r4a /tlt!1t.1 D,'prr'
-- _)>
Company Namc: Home Oepot U.S.A. dba The Home Depol ----z u''-----
Ivtailing Addrcss: P O Box 105451 s ig,
C-1 1 Atlanta, GA 30348 Print Name t"l.o--9,12
Telephone No 770433-821't x 67741 Date: t,/11/ z<;7-7
Fax No.
Strte of:
lf I have designatcd more than one agent, the agents are permined to act scparately
( ) This powcr ofattomey and authorization shall expire on _ -
(r) This power of attomey and authorization shall continue in full force and effect until I deliver to you a
letter revoking the power or a new Limited Porver of Anomey tbrm replacing any previous authorization.
The foregoing instrument was acknowlcdged bclore me this _ day of Janvary 20_20,
by Robert Ross . rhc Service License Manager of Home Depot U.S.A, lnc.,a
Delaware corporation, on behalf of the corporatioo.
Notary Public
Commission Expires
Certif icate Attached for
California Notary Wording
Updated 3/9/2017
Countv ot
CALI FORN IA ALT.PURPOSE
CERTIFICATE OF ACKNOWLEDGM ENT
(cALTFORNIA CrvrL CODE 5 1189)
A notary public or other officer completing this certificate verifies only the identity of the
individual who signed the document to which this certificate is attached, and not the
truthfulness, accuracy, or validity of that document.
COUNTY OF (o
before me,Zavt CarrtoSo Swvero $a
lHerc lnsert Nome ond Title of the Officerl
?ober\ vtn.enil PoS(
On\fl4b\rc
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(sfi!/are
subscribed to the within instrument and acknowledged to me that@she/they executed the same
in 6/her/their authorized capacity(ies), and that b6yher/their signature(s) on the instrument
the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct
\Dotel
personally appeared
WITNESS m hand and fficial seal.
ZaRl .--IRDo9O BAAiEL1
xo(c.vPubl( Crl'lo.r'r
san ,tegoColnll
Corfirrton, 2 ?8 2l5l
ray Cotrn. Erprr6
^rdr
i1. l02l
Sign of Notory Public
AODITIONAL OPTIONAT INFORMATION
Description of Attached Document
Title or Type of Document:
Number of Pages: _ Signer(s) Other Than Named Above
Additional lnformation :
(Notary Seal)
Document Date
revrslon date 01/01/2015
STATE OF CALIFORNIA )
'.'.-,<_r )1.{#:
-,-\ "AC(}RI)'
THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO, EXTENO OR ALTER THE COVERAGE AFFORDEO BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONIRACT BETWEEN THE ISSUING INSURER{S). AUTHORIZED
REPRESENTATIVE OR PROOUCER. ANO THE CERTIFICATE HOLDER.
IMPORTANT: lI the c6nificato holder is an AOOITIONAL INSURE0, the policy(ios) must have ADOiTIONAL INSURE0 provisions or be endorsed.
lf SUBROGATION lS WAIVEO. subject to the terms and conditions of the policy, certain policios may requiro an endorse.nont. A stat6m6nt on
lhis certificate does not confEr rights to the certificate holdo. in lieu of such endorsom6nt(s).
MNRSH ]SA I
E'
C, xol
NSUiER B lle* Far shrro ns lo
BUILOING C
ATLANTA G
.?
CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE NUMBERCOVERAGES REVISION NUMBER: -'
THIS IS TO CERIIFY THAT THE POTICIES OF INSURANCE LISTEO AELOW HAVE BEEN ISSUED IO IHE INSURED NAMED ABOVE FOR IHE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REOUIREMENT TERM OR CCNDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECI IO ALL THE TERMS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOW\ MAY HAVE BEEN REDUCED BY PAID CLAIMS
POL CY EFF POTIC
IMMiOOIYYYYI IMMIOD
"o.'c" f--j fto;
t
i
MED ExP Any cne.erson, 5
Loc
E( ]LLJDED
GENERAT A6GRE64I E
OAMAGE TO RENIEO
PREMISES E. x:L.qn.6
GEN'L AGGREGAIE LIMII APPLIES PER
r I COIIIERCI LGEXERAL LT BlLlrY
' curus.uroe ' ]mcun
i-,'lsn-sr ooo ru
PERSONAT E AOV INJURY S
PROOUCIS, CO POPAGG t
Ll l ANY auro
I owNEo
T- F|RED
l__-.1 auros oNLY
AIJIOMOAILELIABILIft
BOOILY Ill]URY Ps ,ca 1€.I I scH€orJLEo
f---] NoN:dwNEo
L_.1 AUIos oNLY
EACHCCCURREi€E
EXCESS LIAB
OCCUR
CLAIMS.MAOE
B IwoRxERs coMPENsaIoN- Iero euproyens lregtrlrI : q'r'oqcpo erca p.erreo-e.e:.t
J CFFJCiR I'JEt.|aERE{'L]DE3'
(I.nd.rorY in xHl
rl r'6s d6.r be rnder
]ionrrnued co &dllronai Page
J-.,-
E L EACH ACCIOENI
,AC i
EL OISEASE,POLICY I. MIT I
EL OISEASE Ei EMPLOYEEi I
Excess Auto
Excess Gefterrl Lrab rtv
2971100110020m
MWZX 314580
n2 01,0! 20213
OESCRIPTION OF OPERATIOTIS TLOCATIONS I vExICLES IACORol0l Addlrlo..l R.mlrkt Sch.dul., m.y b. ltrrch.d il'@.!p.c. i.,.qun.d)
El,lIDENCE OF IISURNNCE
CERTIFICATE HOLOER CANCELLATION
HOME DEPOT USA INC
2455 PACES FERRY ROAD
BUILDING A
AIUNIA GA 30339
SHOULD ANY OF THE AAOVE OESCRIBEO POLICIES 6E CANCELLED BEFORE
THE EXPIRATION OATE THEREOF. NOTICE wlLL BE OELIVEREO IN
ACCOROANCE !YlrH THE POLICY PROVISIOI{S,
^UIHORIZE
O iEPRESEI{'^'IV E
Manash MukherJee -.!r(-a.vrror.j -!a,^..&-^r,.it ..
O 19EE-2016 ACORD CORPORATION. All righE r6servod
The ACORD namo and logo are registered marks of ACORDACORD 25 (2016/03)
II'SUiERIS) A'FOROING COVERAGE
prsuRER
^ )o eerlpr.c -sLra_ce . ,
AGENCY CUSTOMER IO
LOC #l
cN101642069
Atlanta---\ "A,CC)RI)'ADDITIONAL REMARKS SCHEDULE Page 2 of 3
ADOiTIONAL REMARKS
THIS ADOITIONAL REMARXS FORM IS A SCHEOULE TO ACORD FORM.
FORM NUMBERi
-?1-
rOnU nrle,Cenrficate of Liabilrty lnsurance
;arner .demnry nsu.aftre lompa.r )l |!cnn iren(a
Poxc,'rLrDer l,,i :6a-c2?:'a A! ri:! C A '(S,(
/ Lr VS \(] lE rri! \L l* :a SD r\
^/,
lv
EnE{rve lare -r: l], 2C2,
Erorrtoi lae C:3 0' 2l]21
rELrr-m 3t im lct
Camer iler Hen!6hrE ins!.ete Contoary
Porrcy [umD€r tlc 023C$m3 (CJC DEHI rrl ll0 ilN Ur NY Rll
Efecnve DaE 0301 20m
€tolabn oal8 03,01 2021
lELrlm,r S5 0m 000
Caner ACE Aflencan hsuGn e iomDany
PorEy r,Jumrer ',ta! a66922753 LQSI) raz :r LIC CR /a /lr ,
:leclve !.eP l3C' 2C2C
E${raloi 06re a3 0' 2c21
lELr LJrn I 54 000 oci
jrR 3! 000 C(S SIR ror he naes Dl Al :,r L fta OR # /ll
:aoer \aiora Jno.; re .surarEe:ohg*Jy
?rry rtumber {wc 45593$ oslr rcc:r f,r vE vl NY Jir ia JII
EfecNe laE 4301 2020
Erriaioc Dae 03.C1 2C21
ELrL,m[ S,l0(! JCC
51l000l[ SLR rorlta srales3l:0 UE n! Ul 0r. PA uI
5750 J00llR tor th€ lrae ol GA
S35l 100 SrR ,or fie nEEDI:T
Canar Naoo.d Jnon F e lnsu,anco CdntiJly
Poftr iilrnber IWC 6559357{OSD iUA)
Efectve DaE 0301 20m
ErfleEr' oale 03 01 z)21
(EL) u,i 54 500 000
srR s500 0m
Tx E ndoyeG xS ndenftrr
Camerllhros LJn6n h$ra,lce a,lnoaa,
Poi€y NumDer INS C66932315 lTx)
Enrove Dae 03'01 2020
Elp.aon Dale $ 0r m21
(€U Lrmi SI0m0000
srR s1 000 000
O 2008 ACORO CORPORATION. All .i9hts reserved.
The ACORO namo and logo are registered marks of ACORD
xALC CC0E
EFFECTIVE DA'E
ACORO r01 (2008/0J )
AGENCY CUSTOMER IO
LOC #:
cN 101642069
Atlanta
-,-i "ACORI)'ADDITIONAL REMARKS SCHEDULE Page 3 of 3
AODITIONAL REMARKS
THIS ADOITIONAL REMARKS FORM IS A SCHEDULE TO ACORO FORM,
FORM NUMBER: FORM TITLE Cenificate of Liabrlrty lnsurance
-' noME,.EPaT rrs,PE:S-'
For€ lec.t lSA n ll€ Tfe -r€,re leol
Hcnre Dead !l Puero qro lnc
some Jeoor nodl.l Auiionry LL:
norie D€tor Sbre Supfofl lna
ronc itpot J S,r ic jia
ganEn
"S -rck
Z p TechroQgcs
B 0 '/ r Hordmq:omorry .c
O 2008 ACORD CORPORATION. All rights reservod
The ACORO name and logo are registered marks of ACORO
AG€NCV
ACORO 101 (2008i 01)