HomeMy WebLinkAbout10199067 - PermitI I
5 City of Santa Ana 20 Civic Center Pl , rta Ana, CA 92702
PermitCounter: (714)647-5800 lnspectior: Requ. .s: (714) 667-2738 lnspector
3r
Section: (7 1 4) 647-5853
Permit #: 1O{99067
Pin #: 34E5O
Building{
d
Project Address: 1129 ?2 S Van Ness Ave Unit:
Assessor's Parcel: 013-094-08 Lot 66 tslock: NA Tract: 648
Bldg: Address Range:Suite Range:
Zoning: R1Histonc: No
Building Use: Accessory Dwelling Unit-Convert Occupancy: R-3, U 1st FL Area:
Job Type: Conversion Constr Type: V B 2nd FL Area:
Nature of Work: ADU Code: CBC 2016 Other Areas:
Existing tsldg. & Use: SFD w/att garage & det porte coch, Flood Zone: X-0602320276J Garage Area:
Proposed Use: 2nd Dwelling Unit # of Stories:
Totat:
Description of Work: Convert 329 sf of att garage into ADU/remove patio between garage and sfd. SAUSD #3927
Planning Conditions:
Patio:
T l Area:
Yards Req'd:
Valuation: $S0,000.00
0
t
Owner.
Address:
Phone:
Tenant:
Roberta Rogers
1129 S Van Ness Ave
Santa Ana, CA 927071135
(7141 41s-98e8
Contractor
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier.
Policy #:
Expires:
Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone.
License #:
Peter Jeffrey Knowlton
Peter Knowlton
PO Box 3152
La Puente, CA 91744
c-44807
l n tr-.r'r-
v Lt r i u'-/ '.-
a1 l--. 1.,r.
Ll 4 , J. r-tt I
r'rr'l tl f-' I
Planning Approval By
Plan Checked By:
Permit lssued By:
NPDES lnsp Req'd:
PWA lnsp.
Gomez, Pedro
Scott Fazekas & Assoc.
Chavez, Dave
No
Date: 0210112019
Date: 0612412019
Date: 0710112019
Subject to Field:
Misc. Receipt
Misc. Receipt
Misc. Recerpt
72134
Total
07776002' 5,7f91 Permit Fee
07776002 53600 Plan Check Fee
0L776002 57770 Microfilm Records
',i37373002 s3300 Res Dev Fee - S/E
, .'ll :r ,
1
08901-007 24000 SMIP - Category 1
07776002 57'672 tsldg Stds. Revolving
07776002 57500 General Plan U pdate
07776002 57607 lssuance
Fee Total:
Paid to Date:
Balance Due:
$333 06
$444.32
$66 47
$3,461 .00
$6.s0
$2 00
$22 9s
$57 20
$4,393.50
$444.32
$3,949.18
Fire lnsp. Req'd:
Police lnsp. Req'd
No
No Account#
Flood Zone Cert. Req'd: No 01 1 16002 51600
Every permitissued shall become invalrd unless the workon the site authorized by
such permit is commenced within 360 days after tfs issuance,or if the work authorrzeci
on the site by such permitis suspended or abandoned for a period of 360 daysafter
the time the work is commenced
lnspector MID# 2019-149037
01116002 51601
01 1 16002 51612
01 1 16002 57770
08901 001 24000
31 31 3002 53300
$22.e5
$390 26
$2 00
$66 47
$6 50
$3,461 .00
lnsp. Req'd: Yes
ECORDItBU!LDIN
SITE.WORK DATE COMMENTS
Set Backs
ID/SIG.
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/Ve nt/l ns u I atio n
Roof Sheath
Shear Wall v+t4
Fram
lnsulation/Ene
Ext./lnt. Lath
Brown Coat
ltlaso
Pool Fence
T-Bar
Final R
En neer Final Re rt
Flood Zone Certif
FINAL
Certificate of
wtt-t--*z
at'lirnr untlc'r pnalty ot'pcrjury that I am L-xcnrpl lrrrnr thc- Contraclors' I-iccnsc l-aw lbr thc\lollowing rc:ison 6c.7g.l 1 .5
Bustrcss arxl P(rtbssiur Colc): Any Cily or County which rcquircs a Jrcrmit k) conslnrcl. nllcr. inrprolc. dcm)lish or enair tny
stnrchrrc. [rr)r lo ils issuance, also rcquircs thc rpplicant li)r srch lrrmit k) lilc a signcd slalcnrnl lhnt lE or shc is liccn*rl pursuatt
k) thc pn)visr rns of tlrc Contr{ck)r's Liccnscd 1.{w (Ch{plcr I, C()mnrncing wilh Scction 70()0 of Division .l of thc Busircss a,rt
Pnrfcssi(]nsCrdc)orthathcorshciscrcml]tthcrclh]nrandthchilsislbrthcallcgcdcxcmpti(rn. AnyviolationofSccti(]n70.ll.5hyany
applicantfornpcmilsuhjeclsthc applicnntk)acivilpcnaltyofm*m(rrcthnnlivchundrcddollars(5500).
_l,as owncrol'lhcpn)pcrly,ormyemplttvccswithwagcsaslhcirsolcconrpo'^ltsalion.rvilltklth**wrlrk:urdtlrcstructurcisntlt
inteptJed qr otl'crctl lirr salc (Scc.7044. Busincss anrl Prrl'cssions Ciile: 'l'hc- Colrtraclur's l-iccnsc Law docs not apply to an tlwncr ol'
thc pn)pcrty wtro huiltls or inrpnrvcs tlrcrcon. arrd who dr;*-s such work hirttscll' or hcrsc'lf or thntugh his or hc'r own cmpltlyccs.
salc).
pr()pcrty. anr cxclusivcly contracting with liccnscd t:onlrltckrrs lo constnlct thc prrljcct (Sc-c. 7(144. Iltrsilrc-ss
anrl
antl
C<tdc: J'hc Corrtraclrlr's l-iccnsc- Law drrcs lrot apply lo an owncr ol'prrtpe-rty wlro builtls ttr imprttvcs llrercon.
wlro contracts tilr such projccts with a Contraclrlr(s) liccnsctl pursuant kr tltc Conlracttlr's l-iccnsc Law;.
_l anrcxcnrpt undcr P.Cl. lirr this reason.y-*?t-/q
DECLARA'tION
I hcrchy ll'l'irnr untlcr 1--nalty ol'J^-rjurv olrc' ot'thc litlkrwing dcclaratiotts:
Lahlr Crxlc. lirr thc Jrcrlirrmancc of thc' work lilr whiclr thc- Jrcrnrit Ls issucd.
thc work lirr which this 1^.^^rntil is issucd. My wrlrkcrs' c()rnle-nsalion ittsuriutcc can'icr antl pllicy nunlh('r arc:
Policy Numbcr: Expires:
ily that in thc 1**rlirrnranec ot thc work lirr wlrich tlris pcrnrit is issucd. I shall nol cmpkry any pr'rsotl in any nlatlll!-r
so :is lo hcconrc suhjcct to lhc wrlrkcrs'compcnsation laws ol'Calilirrnirr. and acrL-c thal il'l shrluld r-bcomc suhjcct to lhc
workcrs' conrpnsation prrvisions ol'scctiorr J7(X) ol'tltc Lahlr Ctxlc. I shall. torrhwith comply with thosc prrlvisions.
IVARNlN(i: [;ailurc to sccurc wrtrkcrs'contpcnsalion covL-ragc is unlawlirl. and slrall subjcct ln entpkrycr lo criminal Jrcnaltics arlrl
civil lilrcs up to onc- hurrdrc.d th<lusand dollars ($tm.Uru). in addition to thc cost ol'contpcnsation. ttantagcs as providetl tirr lltc
Scction .]076 of thc Latxlr Code, intcrcsl and attorncy's I'ccs.,:4aa.al
I,ICENS F]I) ('0N'I'R,\C1'() R
I)I.]CI,ARA'TI0N
ol' thc- Busincss and Prol'cssions Codc. antl my liccttsc- is in lirll ftlrcr- attd cltccl.
Liccnsc Class: Liccnse Nunrbcr:
W
I hcrcby afnrm undcr Fnalry ol Frjury th.t thcrc is a construclion lcnding dgcncy lhr thc pcrli)mBtuc (rf thc work lirr which lhis tErmit i\
issucd (Scc. .1097. Civ. C.).
[xndcr's Namc:
[rndcr's Adtlrc'ss:
APPLTCANT DECLARATION
I lrcrclly allirnr undcr pcnalty ol'prjury onc o[ thc ltrlkrwing dcclarations:
Dcnxrlit ion Pcrnrits-Ashcstos Notification Fcdcral Rcgulat ions ('l'itle 40, Pan6)
_Rcqu ircd lrttcr ol' Notilication
ccrlily that thc l'cdcral rcgulations rcguding ashc'slos r(-m()val arc not ap;llicahlc lo lhis pnrjc-ct.*
ccrl il'y t hrrt Ituvc rcatl t his rrpplicul iott anrl sl ltlc that tllt-alxrvc'inlirrntation is corrccl.agrce lo crlnrply
ivcs ol'this City
with all City and Cottttly
and cOunty to cntcr ugrn tlrcandStatcLawsrclat ing lrt huiltlirrg cotrsl ntcl irttt.arrl hcrchy :tttl lxrriz.c
abovc nrcrrtioncd protru*rty lirr inspccti()n Eryf)scs.Luor Agent <XC,a
Penrrilet'nanle
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