HomeMy WebLinkAbout40135034 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Mechanical
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 4O{35O3,4
Pin #: 7E354
Proiect Address: 3050 S Bristol Sta
Assessor's Parcel: 412-031-03 Lot: 1
Unit. 5-B
Block: NA
Bldg:
Tract: 10165
Address Range:
Historic: No
Suite Range:
Zoning: R4
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
lvan & Mayra Lozada
3050 S Bristol St, Unit 5-B
Santa Ana, GA 92704
(71416184845
QSP Corp dba QSP Constru
3401 Sirius Ave #3-322
Las Vegas, NV 89102
(562) 3714625
01 1 16002 51604
01 1 16002 51600
01 1 16002 51604
01 1 16002 s7770
Fee Type Amount
Furnace/Comp Combo 136.71
General Plan Update 23.79
lssuance 59.30
Microfilm Records 4.05
Qty
1.00
1.00
1.00
1.00
Fee
$136.71
$23.79
$se.30
$4.05
State Lic #: 1034-787
Lic Type: B, C-20
Bus. Lic #: 374/i5O
Workers' Compensation I nsurance:
t Carrier: Norguard lnsurance Company
Poliry #: eSWCi70594
' Expires: 0,1.12A2021
Bstch+ : 571110 l0/29/2tl2fi ID : oiors 1es15Office: CTYH Trsnsi: 20 3 of 3Acct*: Reft: 40135u3{
Rcpt*:031t12314 Ltt/28/2tt2tr I : tr{ PH
Tronsoct i on Totql 1580.81
QS[-' (:orp dbn ffSP (:onstruct ion
lnstall a/c compressor (153lbs) on balcony. OK to
issue per Anson.
$223.85
$0.00
$223.85
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Condominium
Alteration
HVAC
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
R-2
VB
cMc 2019
10119t2020
10t28t2020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total:
Paid to Date:
Balance Due:
Khang, Kathy
Chavez, Dave
Every permitissued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
issuance, or if the work authorized on the site by such permitis suspended
or abandoned for a peiod of 360 days after the time the work is
commenced.
-ZO
01 1 16002 s1600
01 1 1 6002 51 604
01 1 16002 s7770
$23.79
$196.01
$4.05
lnspector MID#: 2020-162230 4;6'//d:/i
M ECHANICAL.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hercby affirm undcr pcnslty of Frjury that I m cxctrtpt from the Contrrctos' Liens Lrw for the following rctwn (Scc.7031.5
Busiress and hofession Codc): Any City or County which rcquires a [Emh to @nstrucl, slts. itr{,rcre. &mlish or rcpah any
structurc. prior lo its issuare. dm rcquircs thc rpplicant for such pcmit to lilc I signcd stslemnt thal he or drc is liensd pusant
to thc prcvisions of the Contrrctor's Liccnsd llw (Chaptcr 9. Comcncing wilh Sstion 7000 of Division 3 of the Busircss and
Pmfcssions Codc) or thst hc or she ir cxempt th€rcfrom ard thc basis for the alhgcd crcmption. Any violation of Setbn 703 L5 by any
applicant for a pmit subjcls thc spplicrnt to 8 civil pcnalty of not mre lhsn ,ive hundrcd dollus ($50O).
_1. as owncr of the propcrty. or my employees with wages as their sole compensation. will do thc work and the stnrcture is not
intcndcd or offcrcd for salc (Scr.7o4a. Busincss and hofessions Code: Thc Contractor's License [:w docs not apply to an owncr of
thc propcrty who builds or in{rroves thcreon. and who does such work himself or hersclf or through his or her own cmployees.
providcd that such improrrcnrcnts are not intcrdod orofferpd for sah. lf. howcvcr. the building or irrrynoverrnt is sold within onc )ear
of complction. the Owner Builder will have thc burden of proving that he or shc did not build or improvc the propcrty for the pur;nsc of
sah).
_1. as owncr of'the propcrty. anr cxclusivcly contracting u'ith liccnsed conlruclors lo conslruct thc' projccl (Sec. 71A4. Busiltcss
arrtl PnrfcssklnCoclc: 'l'hcConlractor'sl,iccnsc[.awdocsnotapplyloanowncrofpropcrtywhohuildsorintprovcslhcrctttt.
and who contracts ftrr such projccts with a Clontraclor(s) liccnscd pursuanl to lhc Conlraclor's Liccnsc Law).
-l
arn exenrpl undcr Sccliort-. B. & P.C. tbr this rcason.
I)nle:
WORKERS' COMPENSATION
DECLARATTON
I hcrcby affirnr undcr pnalty of pcrjury onc of thc following dcclarations:
_lhavcamlwill rnainlainaCcrlilicatco[ConsclrlloSclf-lnsurclirrs'orkcrs'cont;rcnsalion.as provitlcdforhyScction-]7(X)o[thc
[;rtxrr Codc. f<rr thc pcrlbrnuncc of thc s,ork frrr u'hich thc Jrcrnrit is issucd.
_l havcandwill rnaintairrworkers'corrrpcnsatiorrirrsurancc.as rcquircdhy.Scction3T(DofthcLtllorCodc. lirrthcpcrforttnttceo[
thc work for pcrmit is issucd. My workcrs' conrfrcnsatiun insurancc carricr and gllicy numbcr arc:
D
t O tPolicy
Vlccrtify thar in the performance of the work for which this yrcrmit is issucd. I shall nor cmploy any lrcrson in any manncr
should hccomc subjcct to thcso as to bcconrc subjcct
workcrs' compcnsation
to thc workers' cornpensation laws of California. anrl agrcc that if I
provisions of Section 3700 of the Latnr Code. I shall. forthwith comply with thosc provisions.. a
WARNING: Failurc to sccurc workcrs'cornpcnsalion coveragc is shall artrl
tltccivil fines up to onc dollars ($100.000). in
and attorncy's fees.
cost of
Scclion 3076 of the intcrcst a
i o
LICENSED CONI'RA C'I'OR
DECLARA'I'ION
ol' tlrc Busincss anrl Prol'cssions Cotlc. :rtrl tny liccrtsc is in lirll tirrcc antl cl'ttct.
a C7 a +1 81Liccnsc
o x
W
I hcEby sffum urder penslty of perjury thst therc is 8 snstructk n hndirg 8gcrcy for thc pcrfoffic of the mrk for which thir tHmit is
issucd (36..30117. Civ. C.).
Lcnrlcr's Nanrc:
Lcndcr's Addrcss: . *"LIC -Nt t."cLA
I hcrcby affinn undcr pcnalty of prjury onc of thc f<rlkrwing declarations:
Dcrnolition Pcrrnits-Asbcstos Notification Ftderal Rcgulations ('Iitlc 40. Part6)
-Rcquircd
lrttcr of Nolificalion
-l
certify that the t'edcral rcgulations rcgading asbcstos rcnxrvalare applicublc lo lhis projcct.
$Arccrrify that I havc rcad rhis applicarion urd
abovc rncrrtionctl propcrly lirr ilts;lcctiort
Applicant or Agcnl
Pcrrnilce nurrrc
thc I agrce to comply with all City and County
Appliances
Metal Fire Place
Evaporative Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-lnsulation
lnsulation
Smoke Detectors lnstalled
Rough Ductwork
Vents
Toilet Room / Clothes Dryer
Residential Range
Other
Hood
Type I Hood
Type Il Hood
Grease Duct
Fire Darxper
Openinqs
lnstallation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rough Mech.
Fina! Test
Meter Release I ^l -tt \,l ^ t./
FINAL tli-w 4 '(ro urr.w6"l
-Tt t,I
{
Appliurnt:
Oate: r f
ordinanccs and Stalc Laws rclating to WI
of this City
- Datc: '
Notes, Remarks, Etc.