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Home My WebLink About40130658 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 f Mechanical Permit#: 40130658 Permit Counter: (714) 647-5800 Inspection Requests: (714) 667-2738 Inspector Section: (714) 647-5853 Pin#: 54207 Project Address: 3101 S Deegan Dr Assessor's Parcel: Owner: Address: Phone: Tenant Name: Contractor: Address: Phone: State Lie#: Lie Type: Bus . Lie#: 412-152-31 Veronica Eggers 3101 S Deegan Dr Lot: 26 Santa Ana, CA 927046612 (949) 545-4100 Owner-Builder Workers' Compensation Insurance: Carrier: Policy#: Expires: Building Use: Job Type: Nature of Work: Single Family Dwelling Addition Addn ,. ' Occupancy: Constr Type: Code: Planning Conditions: All materials to match existing. Planning Approval By: Date: Plan Checked By : Date: Unit: Bldg: Address Range: Suite Range : Block: NA Tract: 7434 Historic: No Zon ing: A1 R-3, U VB CMC 2013 Misc. Receipt: Misc. Receipt: Fee Type 01116002 51604 Bathroom Fan 01 116002 51600 General Plan Update 01116002 51604 Issuance Amount 28.42 20.56 51.26 Qty 1.00 1 .00 1.00 Fee $28.42 $20 .56 $51 .26 Batcht:36526 -12/6/2016 ID: LROSALES Office: ClYH Tronst: 1 4 of 5 Acctt: ReH: 40130658 Rcptt:01684377 -12/6/2016 8:39 AM Transaction Total $777.64 Veronica Essers General Plo~ UPdate Fee $20.56 01116002-51600000- Mechonical $79.68 01116002-516Gi000- Master Cord $777.64 cco:************n2?~ Au ht•00&1 ~ Notes: Bathroom addition at rear of house. Owner-Builder form on file. Permit Issued By: Chavez, Dave Subject to Field: -p.C-- Date: 12/06/2016 Account# Misc. Receipt: Total Building Permit #: 10189183 Every permit issued shall be come 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#: 2016-128634 01116002 51600 01116002 51604 $20.56 $79.68 Fee Total : Paid to Date: Balance Due: $100.24 $0.00 $100.24 APPROVALS DATE Appliances Metal Fire Pla ce Evap Cooler ID/SIG. MECHANICAL-INSPECTOR RECORD COMMENTS Owner-Builder Declaration I hereby affirm under penalty of perju ry that I am exempt form the Contractors' L icen se L1w for t he followin g reason (sec. 7031.5 Bus inc~s . and Profession Code ): Any Cit y or County which requires a permit to construct. alter. improve. demolish or repair a ny struc-1 ure. prior to its issuance. also require s the applicant for such pennit to lile a signed statement that he or she is licensed pursuant to the pro visions o i the Contractor's Licensed Law (Chapter 9. Co mme ncing with Section 7000 of Division 3 of the Business and Professio ns Code) or that he o r she is e xempt therefro m and the basis for the alleged exemption ,Any v iolat ion of Section 703 1.5 by any a pplicant for a pennit subjec1s the applicant to a civ il penally o f not more than five hundred dollars ($500). Furn ace _I. as owner o f the propcny. or my employees with wages as their sole compensation. will do the work and the structure is no t inte nded or offered fo r sale ( Sec. 7044, Business and Profess ions Code: The Contractor's License Law does not apply to an owner of the prope11y C w ho builds or improves 1hereon. and who d oes such work himself o r herself or through his or her own e m p loyees. provided that such OmpreSSQr improvements are not intended or offered for sale. If. ho wever. the building or improveme nt is sold within one year of comp letion. the ._M __ is_c_._E_q---'-u_i__cp_m_e_n_t _________ ._ ______ _,_ _________________________ _,~r-Builder will have the burden of proving that he or she not build or improve for the purpose of sale). as owner of the p ropeny. am excl us ively contracting with licensed contractors to construct th e projecl ( Sec. 7044. Business a nd ~-------------------1---------l---------l------------------~ rofession Code: The Contractor's License Law does not a pply co an owner of property who builds or im proves thereon . a nd who Duct Work Pre-Insulation Insulation Smoke Detectors Installed Rough Ductwork contracts for such p roj ects with a Contractor(s) licensed p ursuant to the Contractor's License Law.) o.,:,•m i 2ltc1;,·:,1_ /----0,-vne-r -~~~~~L-~> ·o~ . l / •-r u WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one o f the follow ing declarat ions: _I have a nd w ill maintain a Certific ate of Consent to Self-Insu re fo r wotkers' compensa tion. as prov ided for by Sect ion 3700 o f t he Labor Code. fo r the performance of the work for which the permit is issued . _I ha ve and will maintain workers· compensation insurance. as required by Section 3700 of the Labor Code, for the performance of the work for which this permil is iss ued . My workers· com pensation insura nce carrier a nd policy number are : Vents r \ Carrier: __________________ _ Toilet Room I Clothes Dryer 4-t}'·--/; Jr<\.JiJ~ PolicyNumber E,pires: _____ _ Residential Range u ( '---7 ~cl ion need not be completed if the pennit is for One hundred dollars !SIOOi or less) ~Q--th_e_r -------=----------4---------1------+-------------------4 rtify,tlrnt in the perfonnance of the work for which this permit is issued. I shall not employ any person in any manner so as to ~--------------------1--------4--------1>---------------------1 subject 10 the workers· compensation laws o f Californ ia. and agree t ha t if I should become subject to the workers· Hood Type I Hood Type II Hood Grease Duct Fire Damper Openings Installation F.D. Drop Test Above Hard Lid Above T-Bar compen sation r;:ov¼•iji o ns of~~'; 3700 o f the Labor Code. I sl~~.:ply with th:se ~~ion~/ __ Date: /.Z./i ///.,,,,,, Applican1 :K/ A/"·c,,,,,, .,,,,,,,,_u, -J ~~ WARN;NG : l ilure ,{secure workers· compens:ition coverage is unlawful. and sha ll s ubject an employer to cr::O.na lties and civ il fi nes up to one hundred thousand dollars ($!00.000).in addit io n to the cost of compensation. d amages as provided for lhe Sect ion 3076 of t he Labor Code, interes1 and anorney·s fees LICENSED CONTRACTORS DEC L ARATION I hereby affirm under penalty of perjury that I am licensed under provision o f Chap ter 9 (commencing with Section 7000) of Division 3 of t he Bus iness and Pro fessions Code. and my license is in full force and e ffect. License C lass.: ______________ License Nu m ber _______________ _ Date: _____________ Contractor: ____________________ _ CONSTRUCTION LENDING AGENCY I here by a ffim1 u nder penally of perjury tha t th ere is a constrnction lending agency for the perfon nance o f the work for which this permit is issued (Sec. 3097. Civ. C.). Lender·s Name: _________________________ _ Lender's Address: _______________________ _ APPLICANT'S DEC LARATION Demolition Pennits-Asbestos Notification Federal Regulations (Title 40. Part 6) _ Required Letter o f Notification 1--------------------1--------4--------t-------------------,/_(iY ert ify lha t the federal regul ations regarding asbestos removal are not appl;cable to this project. ~R~o~u~g~h~~M~e~c~h~-----------.l-------L-----L----------------"::::11~¥-Lfj,'_I ccn1fy that I have rea d this appll ca11on and Slate that the above mformat 1on IS correct [ agree to comply w ith all City and County Final Test ordmances and State Laws rela~mg to 1ldmg conslnu:t1on. and hcr~thonze 1epresentalives ofth1s Ctty and Count to enter upon the above mentioned propeny fo r "ct1 pu oses ~ ...,.,...-: 7 .._ _ _ :;;> // ,I/ Meter Release A t0 Apphcantoragents,g. '><t'./4 ·rv,~v'?-tP 7'-X Date • I ~,,,¢/1/r.-.. FINAL (n....-'2--a ---\1 1~0_~'), ~ Pcrmittecname(print):"' //~ ~~ -~{ f V UU M:\WP51\Perm,Hnspect,on Forms\Mechanical-lnspector Rec ord.doc 0 3.31.06