HomeMy WebLinkAbout101104728 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (7141647-5853
Permit #: {0110,4728
Pin #: 457fi4
Proiect Address: 2326 N Poinsettia Sta
Assessor's Parcel:003-082-36 Lot: 4
Unit:Bldg: Address Range:Suite Range:
Zoning: R1Block: NA Tract: 1365 Historic: No
Building Use: Single Fafilly Dwelllng Occupancy: R.3, U lsl FL Area: Palio:
Job Type: RerooI Constr Type: V B 2nd FL Area: T.l.Area:
Narure of work: Rerool code: cBc 201 9 other Areas: yards Reqd:
Existing Bldg. & uee: sfd wrdot gar.ge Flood zone: x{602320163J Garage Area: vatuation: gl2,oqt.oo
Proposed Use: # of Stodes:
Toht:
Deacrlptlon ot Work: Tcar ofi comp and apply comp to std and datachgd gaaago, Roplaco BUR on Ilat po.tion of root H.ndout! given.
Planning Conditions:r_u
Owner:
Address:
Phone:
Tenant:
JoeyR&LindaPerez
2326 POINSETTIA ST
Santa Ana, CA 927062050
(7141 401-6e83
Contractor: Premium Roofing Systems
Address: 2054 Continental Ave.
Costa Mesa, CA 92627
Phone: (7141 884-5108
State Lic #: 1042214
Lic Type: C-39
Bus. Lic #. 370747
Workers' Compensation Insurance.
Carrier. State Compensation lnsurance Fur
Policy #: 9233137
Expires: 0611312021
Engineer:
Address:
Phone:
License #:
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
Graham, Jeffery Date: 0912312020
Date:
Date: 0912312020
Subject to Field:
Verduzco, Viotetal-J
Misc. Receipt:
Misc. Receipt.
Misc. Receipt:
0 77760 0 2
07776002
07775002
07776002
07776002
57607
57770
57672
57600
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuance
$345.28
$4 05
$1.00
$23 79
$5e 30
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 01 1 16002 51600
01116002 51601
01 1 16002 51612
01 1 16002 57770
Account#Total
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days after ifs issua nce,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.
$23 7e
$404 58
$1 .00
$4 05 Fee Total:
Paid to Date.
Balance Due:
$433 42
$0.00
$433.42
lnspector MID#: 2020-1 61676
BUILDING. INSPECTOR RECORD
SITE.WORK DATE !D/SIG.COMMENTS OWNER BUILDER DELCARATION
I hcrchy atlirm undcr pcnalty of Frju]y that I am cxcmpt hom thc Grnlraclors' Liccn* law li)r lhe foll(rwing rcasrn (Se.703].5
Busincss ail Profcssion Gxlc): Atry City or County which rcqutcs a Frmit k) construcl. altcr. improvc. dcmolish or rcpair any
structurc. pri)r to its i$suancc, also rcquircs lhc applicant for such lErmit k, filc a signcd statcmnl that hc or shc is lictnsd pusunl
to thc provisions of thc Gnrlractor's Liccnscd Law (Chaptcr 9, Commcncing with Setion ?0U) of Division -1 of thc Busincss and
Prufcssions Codc) or thdt lE or shc is cxcmpt thcrcfrom and thc hasis for thc allcgcd cxcmptiul Any violalion of Setion 70.1 1.5 byt any
applicant li)r a lEmit suhjccts thc applicant to a civil pcnalty of not n$rc than livc hundrcd dollrs (5500).
_1, as owncr of thc propcrty, or my cmployccs with wagcs as thcir solc comfrcnsalion, will do thc work arxl thc slructurc is nol
intendcd or ol'fcred filr salc (Scc.7044, Busincss and Prol'cssions Crxlc: The Contractor's Licensc l-aw docs not apply to an owncr of
thc pnrJrcrty wlro builds or improvcs thcrcrrn, and who drrcs such wrlrk himsclf or hcrscll or thr)ugh his or hcr own cmpk)yccs,
provided that such improvcrncnts arc not intcrxletl or ollbrctl tilr sah. Il, howevcr. thc huikling or improvemcnt is sokl wilhin one ycar
of comphtion, thc Owncr Builrlcr will havc thc burdcn ol'proving that hc or she did not buikl or improve the pnrpcrty lirr thc purprsc o[
salc).
_1, as ()wncr of thc pn)pcrty, am cxclusivcly contracting with liccnscd contractors to conslruct thc pnrject (Scc. 7044, Busincss
and Pnllbssion Code: 'fhc Contractor's Liccnse Law tlocs not apply lo an owncr of propcrty who builds or imprtlvcs thcrcon,
and who conlracts lirr such projccls with a Contractrlr(s) liccnsctl pursuant to thc Contract()r's Liccnse Law).
-IamcxcnlptundcrScctitln-'B.&P.C.lilrthisrcasrln'f \..a ^.
WORKERS' COTII PENSATION
DECLARATION
I hcrcby alTirm undcr Jrcnalty of prjury onc of thc lblkrwing dcclarations:
_l have arxl will maintain a Certiticatc of Consent to Sclf-lnsurc lbr workcrs' comSrcnsation, as providcd tirr by Scction 37fi) of thc
l^V, Crxlc. lbr thc pcrlirrmance of thc work for which thc pcrmit ls issucd./
{t luu" and will maintain wrlrkcrs' comJrcnsation insurance, as rcquircd by Scctiort 3700 of thc Labor Cotlc, lilr thc perlirrmancc of
ill work tilr which this Jrcrmit is issucd. My workcrs' conrfrcnsation insurancc carricr and pllicy numbcr are:
3-2o.:. 1\3Policy
_l ccrtity that in thc Jrcrlilrmancc of thc work tirr which this Jrcrmit is issucd, I shall not empkry any pcrson in any manncr
so as lo hccomc subjcct to thc workcrs' compensation laws of Calilirrnia, and agree that if I shoukl become subject to thc
workcrs' comJrcnsation provisions of Scction 3700 of thc Latxrr Crxlc, I shall, forthwith comply with ttxlsc pnlvisions.
WARNIN(i: Irailurc to sr'curc workcrs' crtmpcnsation covcragc
civil lincs up to onc hurttlrcd thousantl dollars ($1fi),Ot)O), in
is unlawful, anrl shall sub.jcct an cmploycr trt criminal Jrclraltics and
addition t<l thc cosl ol'compcnsation, damagcs as providcd lirr thc
Scction .t07(r ol'thc Lahrr Ctilc.zrq intcrcst and attonrcy's t'ccs.
2
I hcrcby at'tirm under Jrcnalty of Jrcrjury that I am liccnscd undcr Chaplcr 9 (comnrcncing with Scctkrn 7m0) of Division 3
of thc Busincss and Prol'cssions Crxle. arxl my liccnsc is in full tirrcc arxl etl'cct.
Liccnsc C-Numbcr:tOr-{ zZ\\-(
Date: 1- o-* Z\e t
W
I hcrcby afftrm undcr lEnalty of lErjury thot thcre is a constructi)n lcnditrS agerey for thc lErfomrec of lhc uork for which this lrcmit is
issucd (Ss. 1097, Civ. C.).
[,cndcr's Namc:
lrndcr's Address:
APPLICANT DECLARATION
I hcrcby atlirm undcr penalty of perjury onc of thc folkrwing dcclarations:
Dcmolition Permits-Asbcstos Notification Federal Rcgulations (Titlc 40, Part6)
_Rcquircd l,ctter of Notilication
/ Lcrtity that thc l'ctlcral regulations rcgartling asbcslos rcmoval arc not applicablc to this projcct.
/ t certifythat I have rcarl this application arxl statc that the above intormation is corrcct. I agrcc ro comply wirh all City and Counry
ordinanccs and State laws rclating to hcrcby authorize rcprcscntativcs of this City and County to entcr upln the
ahrvc mcntulncd pmJrcrty lilr
Applicant or Agent
Pcnrritee nanre
construclion, aml
3 rd 2ci.r
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bf loor/Ve nVl n s u Iatio n
Roof Sheathinq t tl Lol1,0 Dft*31
Shear Wall
Framinq
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
[Vlasonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif.
I l--,
FINAL // /t z/ao - t,l-\t(Certificate of Occupancy
Notes, Remarks, Etc.
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