HomeMy WebLinkAbout101104959 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, Ct,92702 Building
PermitCounter: (7141647-5800 lnspectron Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: 1O1104959
Pin #: {5038
Proiect Address: 1830 E Nineteenth Sta
Assessor's Parcel. 396-352-19 Lot: 7
Unit:Bldg:Address Range: 1828-1834
Historic: No
Suite Range:
Zoning: A1Block: NA Tract: NA
Building Use:
Job Type:
Nature of Work:
Existing Bldg & Use:
Proposed Use:
Single Family Dwelling
Alteration
Bathroom Remodel
SFD
Occupancy:
Constr Type:
Code:
Flood Zone'
# of Stories.
R-3
VB
cBc 2019
x-0602320164J
1st FL Area
2nd FL Area
Other Areas:
Garage Area.
Totat
Patio:
T.l.Area:
Yards Req'd
Valuation: $S,500.00
Description of Work: Remodel existing guest bathroom
Planning Conditions:
Owrrer:\
Address:
Phone:
Tenant
John Johnson
1830 E 19th St
Santa Ana, CA 92705
(7141 483-1 217
Contractor: Pro Star Builders
Address: 17412 Ventura Ste 151
Encino, CA 91316
Phone: (866) 772-6161
State Lic #: 1053661
Lic Type: B
Bus. Lic #: 376410
Workers' Compensation lnsurance:
Carrier: State Fund
Policy #: 9266353
Expires'. 1213112021
Engineer:
Address:
Phone:
License #.
Architect /
Desiqner:
Address:
Phone:
License #:
Planning Approval By
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
o,,,rM
Date:
Date:
Date: 1011512020
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
Genera! Plan Update
I ssuance
Fee Totat
Paid to Date:
Balance Due:
0 77760 0 2
07776002
0 77750 0 2
07776002
07776002
57607
57770
57672
57600
57607
$172 64
$4 05
$1 00
$23 79
$59 30
Zuniga,
No
No
No
No
Fire lnsp. Req'd:
Police lnsp. Req'd:
Flood Zone Cert. Req'd: No
No
No Account#Total
Every permit issued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days afterifs issuance,or if the work authorized
on the site by such permitis suspended or abandoned for a period of 360 days after
the time the work is commenced.
01 1 1 6002 51 600
01116002 51601
01116002 51612
01116002 57770
$23 79
$231 94
$1 00
$4 0s $260 78
$0 00
$260.78
lnspector rMrD# 2020-1621 B0
\
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hcrcby affrm undcr lEnalty of pcrjury that I am excmpt fmm the ContrrctoN' Licensc lrw for lhc following r@sn (Stc.7031.5
Busincss anl Prcfcssion Crdc): Any City or County which rcquircs a Jrmil to conslnrt, sller, improve. dcmlish or lcIEir ey
stnrcturc, prior to its Lssuucc. sl$ rcquircs thc opplicant for such Frmil to filc a signcd stalcmnt that he or she is liccnsd pusilt
ro thc lmvisions of IIE Conlractor's Licenrd [:w (Chaptcr 9. Comrcing with S6tion 70m of Division 3 of the Busircss md
Pmfcssions Codc) or that he or shc is cxctrpt thercfrom and thc basis for lhc allegcd cxemption. Any violation ofscction 70.1 1.5 by ony ,
applicant for . pcrmit subjets thc Bpplicant to r civil pcmlty of not mrc thm fivc hurdrcd dollus ($500).
_1. as owner of thc prop,crty. or my cmployces with wagcs as thcir solc cornpcnsation. will do the work and the structurc ls not
intcnclcd <lr oll'crcd for salc (Sec.7044. Business and Profcssions Codc: Thc Contraclor's Liccnsc l-aw docs not apply to an owner of
thc proJrcrty who builds or intprovcs thcrccln, and who docs such work hirnsclf or hcrself or tfuough his or her own cmployees,
providcd that such improvcmcnt.s arc not intcndcd oroffcrod for sah. lf, howcvcr. thc building or inprovcnrcnt is rcld wilhin one ),uu
of complction, the Owncr Builder will havc thc burdcn of proving thd hc or shc did not build or improve thc proF,srty for thc purynse of
salc).
__1, as owncr of the property. am cxclusively contracting with licenscd contractors to construct thc project (Sec. 7W, Busincss
and Prrofcsskrn Code: 'l'hc Contractor's License Law does not apply lo an owner of propcrty who builds or improves lhcrcon.
and who conlracts for such projccts with a Contractor(s) licenscd pursuant to thc Contractor's License hw).
-IamcxenrptundcrSc'ction-.B.&P.C.forthisrcason.Date:_0wner:_
WORKERS' COM PEtr'{SATION
DECLARATION
I hcrcby affirrn undcr Jrcnalty of prjury one o[ thc folklwirtg dcrlarations:
_l havc and witl nraintain a Ccrtificatc of Conscnt to Sclf-lnsurc for workcrs' compcnsation. as provided for by Section 3700 of the
Labor Code, tbr thc pcrformancc of tlrc work for which the permit ls issucd.
_l havc and will maintain workers' compensation insurancc. as requircd by Section 3700 of thc l-abor Code, for thc pcrformance of
for which this pcrmit is issucd. My workcrs' cornlrcnsation insurancc carricr and policy number arc:\ <-fatz ' 'thc work
I)r>licy lL'Ll-24
-l
certify that in thc performance of the work for which this pcrmit is issued. I shall not employ any pcrson in lhy runncr
so as to bcconrc subjcct to thc workers'compcnsation laws of California, and agrcc that if I should bcconrc subjcct to thc
workcrs' cornpensation provisions of Section 3700 of the l-:bor Codc, I shall, forthwith comply with thonc pmvisions.
WARNING: I.hilure to sccurc workcrs' compcnsation coverage is unlawful. and shall subjcct an employer to criminal pcnaltics and
civil fines up to onc hundrcd thousand dollars ($100.000). in addition to the cost of comlrcnsation. damagcs as provided for thc
Scction 3076 of thc Lrbor Code. intcrcst and
ort", lO - lS'b
I hcrcby al'flrrn undcr Jrcnalty of pcrjury that I arn liccnscd of Chapter 9 (comrrcncing with Section 7000) of Division 3
of thc Busincss and hofcssions Codc, arxl rny licensc is in full forcc and effoct.
Liccnsc Nurnbcr:Io (
o^tu, ul O '15'b
W
I hcrcby afftrm undcr JEnally of Frjury thd rhcrc is a consruction lcnding agcrcy for the pcrformcc of thc rcrk for which this Ismit i$
issucd (Ss. 3097, Civ. C.).
Lcnrlcr's Nantc:
knder's Address:
APPLICANT NECLARATION
I hcrcby affirnr undcr pcnalty of pcrjury onc of thc following dcclarations:
Dcnrolition Pcrnrits-Asbestos Notification Fcdcral Rcgulations (Titlc 40. Part6)
_Rcquircd Lctter of Notification
_l ccrtity that thc fcderal rcgulations regarding asbcstos renxrvalarc not applicablc to this projcct.
-l
ccrtify that I have rcad this application and statc that with all City and County
and County to enter upon thcordinances and Statc Lrws rclating to
above nrcntioncd propcrty for
Applicnnt or Agenl
Pernritee name
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/VenVI nsu latio n
Roof Sheathinq
Shear Wall
Framinq
lnsulation/Energy
Drvwall
Ext./lnt. Lath
Brown Coat
JVlasonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Enoineer Final Report
Flood Zone Certif
I I .fr,
FINAL ul2zlw lllz,ild,7,,f,:)
Certificate of Occupancy I
Notes, Remarks, Etc.
Rev. 08-07 -201 5
,",.. to-lf -20