HomeMy WebLinkAbout10117034 - Permit City of Santa Ana BUILDING PERMIT ADOJ ss: PERMIT NO.
• • _ • • SUITEa SUITE JOB TYPE - -
RANGE
I hereby affirm under Penalty of perjury that I am eaempt from the contractors ADDRESS BUILDING a NATURE
license law for the following reason RANGE OF WORK
Section➢GaAA.I,as owner of Me properly.or my employees with wages as LEGAL NO OF EXISTING
then sole compensation,will do the work.and Me structure is not intended or DESCRIPTION Lot Block BUILDINGS&USE -
oflemd for sails - _ - - - _ - -. `
Sect on 1G44B,I,as owner,of Me property iKYconhacting mM CONSTRUCTION GROUP
g am eecusl Tract TYPE OF OCCUPANCY
)I<ensea consactors to construct the project _ —
ASSESSOR'S TENANT IMPROVEMENT .FLOOD
Date Owner PARCEL# -- AND I OR REMODEL AREA ZONE -
•- • • k • OWNER: . . , _. . NEW I ADOL NEW/ADOL
1st FLR SO FT OTHER SO FT
I hereby affirm under Penalty of Perjury one of the fallowing Declarations ADDRESS - NEW I ADDL NEW I ADDL
2nd FLR SO FT GARAGE SO FT
I ham and m11 Taman,a Cenihcate Of Consent to See Insure for Workers -- - -- -- -
f,ompen ton as pro,ded for by Section 3100 of the Labor Code.for the
pedor ce of the work for which this Permit s issued ZONING VALUATION
t�and will maintain Workers Compensa!on Insurance.as required by PLANNING _
Sectio,37W of the Labor Code for the performance of the work for which thin PHONE APPROVAL BY DATE
permit a issued My Workers Compensat on Insurance err er and policy number -- ---- -
are 1{( I CY CONTRACTOR .. . . SLID AI SAFELY
�/��v PLAN CHE IL DATE
Carnes
PObcY Numbel a �/4 I ADDRESS 65R[D B DATE -
(this section need not be completed of the permit is for One hundred dollars(S100) - — -- - - -- --- --
or less) - - - - r IMPROVEMENTS LANDSCAPING
REQUIRED REQUIRED
t certify that n the performance of ,he k f which this permit s issued I - - - --
s all not employ an,person n any man - s 1 P
become subject to the Workers _ I HONE JOB DESCRIPTION'
Compensation Laws of Cal loin a and ag that if I Should decome subject to the
Workers Com bensa on prIt'coulw s race of Se 1 37W of the Labor Code,I shall STATE
X O,eformw[ c�mpYPPlcanovsons t TTYPE
,tf--Ty/, LICENSE a
A vAl)''��'I / `� W✓✓ri s+i I�"✓
ANTA ANA
WARNING Failure to secure Workers Chmpensabon coverage is unlawful and BUSINESS LICENSE a
shall subject an employer to criminal penalties and civil does vp to One nundme
thousand dollars($100.000),in addition to me cost of compensation,damages as ENGINEER/ARCHITECT: ` l_
provided for in Section 3]O6 of the Labor Code.interest and attorneys lees LICENSED -
CONTRACTORS DECLARATION ADDRESS
I hereby affirm under penalty of perjury that I am licensed under proasons of
Chapter 9(commencing with Section 70X)of Dmsmn 3 of the Business and
Prolessions cod a 1 d semis m full tome and effect - -- - -
XLicense/Class I'• /y1 W v tiny No Lam.. I PHONE
Date It /h Contractor �e LICENSEY —
CONSTRUCTION LE • FEES: -
I hereby affirm under penalty of is a construction lending agency
for Me Performance of the work for which M s permit insured Sec 3091.Cn C) _
Lenders name
Lenders Address
APPLICANTS DECLARATION
Demolition Permits-ASbestos Notihcaron Federal Regulations(Tice 40,Pan 6 Mailing Address Public Counter
)
urtetl Leiter of Notification t City of Santa Ana
—V/equfy Mat Me federal regulations regamnng asbestos ramwal are not _ _.- - -I Buildins Safety Div. M-19 20G W. dlh. Street
apple le to this -._ -.... 2nd Floor
p'pj� P.O. Box 1988
cemty that I ham read this application and sate that the adow,information is Santa Ana, Ca. 92701 (714) 647-5800
correct I agree to comply with all City and Count,ordinances and State laws
of to building Ponst ct, jj onby inumorae represenathes of mis cnry Account No 011 01-5911 Penh Validation CS-605
and County to enter upon a t beret oned pmpedy for ,sped f es
Applicant or agent a g D a �u/V/- ME
4/16/98 8:,9AM -5911 $207.3 0
RSer �%QZiECC t -
�� Permmee name lPnnp
Address. Unit/Suite.
BUILDING --- INSPECTION RECORD
Site Work Remarks Date Signature I.D. Building Remarks Date Signature LD.
Setbacks Under Pruning (floor joist)
Forms I Steel I Holdowns Foundation Ventilation
UFER Ground Roof Sheath l8 �
Slab Floor - Insulation I Energy
Dry Wall
Steel
Exterior Lath
Pool Fence Brown Coat
Masonry _. T-Bar
Handicap Requirements
FRAMING
FINAL(Shell only) p /�
Notes, Remarks, etc.: FINAL Tenant Improvement)
OWNER-BUILDER DECLARATION
1 here by'thon under penalty of perprty that :no exempt Imm the Cunhactois'Licnnx Law 1nr the folbrw... nason
(So, 7031 5 3moness and PrOJ,,,s OT Code) Any City or County whirr requires a permit is co rslrucl alter
mpmve.demolish,re r,p.l, nny slnu for, purr bits isxoaec, also revtuues the apphcamt for suds per or In Ill. a
signed sretenrent trial he or she is licensed pusuant he the provisions of the Con lnrr.tors'License L.w iChophn 9.
n"ncmg with Section 7000 of Div, lot,3 u1 the Business and Professions Uncle)or that he of she is exempt
therefrom and the hasis for the alleged exemption. Any violation of Soclron 7031 5 by any applicant for a pemn:
subjects the applicant to a Civil Venally of not none than Irv,hundred dollars($500)
owner of the property,or my .r,ployeos with wages ac Oren sole compensalmn,will do the vmrk,and the
structure in nut intended or offered for sale(Soo 7044,Busmess and Professions Cod The Contractors License
Law does not apply to an no,of the rope.rly who builds or improves thereon,and who dons such wink himself or
herself or through his ce her own employees,pmvrded that such rmproverl are not...prond or offered for salo If,
however.the building or improvement is sold writer one year of complelwn the Owner-Builder will have the burden
of proving that he or she did not build or improve for the purpose of sale)
-- - -- - - - _I,as owner of Ole property,am exclusively contracting wrth licensed contmdors to construct the prompt(Sec
7044.Business and Professions Code The Contractors'License Law does nor apply to an owner of property who
- --'- - — builds or improves thereon,and who contracts for such projects with a Cor lraclor(s)licensed pursuant to the
Contractors'License Law)
_I am exempt under Section_ _ B.d P C for lhrs reason
Dale-. Owner: