HomeMy WebLinkAbout10196890 - PermitCity of Santa Ana
Permit Counter: (714) 647-5800
20 Civic Center Plaza (M-19), Santa Ana, CA 92702
!nspection Requests: (71 667-2738 lnspector Section: (714) 647-5853
t(Building Permit #: {O{96E9O
Pin #: 34177
Project Address: 1105 S Oak St
Assessor's Parcel: 011 -074-10 Lot. 10
Unit:Bldg: Address Range:Suite Range:
Zoning: RlBlock: D Tract: 466 Historic: No
Building Use: Singlo Family Dvrelling Occupancyt R3 1st FL Area Patio:
Job Type: Ahsration Conatr Type: vB 2nd FLArea: T.l.Area:
Nature of Work ssi8mic Rs&ofrt code: cBc 2016 ohe.Arqgsl ,. . yardqmu ig@p.
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Total: i O. " ""''
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De.crlption of Work: Volunl.ry 3.l3mlc retrcflt to sfd only. lnBtall (t) pu6h pler6 & polyurethane foam bslow siab
"nd
f.ornd"tiol;,.r, ,, ,. , ,
Planning Conditions: No exterior alterations or modifications Genennl F lnn Updqte Feefll I 1 AftftT- I I r,rifrfrfrfr-$??.IJB
Owner:
Address:
Phone:
Tenant:
Mr Jorgensen
1 105 S Oak Street
Santa Ana, CA 92701
(909) 957-9192
Contractor: A-1 Concrete & Constructiot
Address: 781 N Loren Avenue
Azusa, CA 91702
Phone: (626) 523-5222
State Lic #: 972625
Lic Type: B, C-8
Bus. Lic #: 370992
Workers' Compensation lnsurance:
Carrier: Everest Nat'l lns Co
Policy #. 7600018129181
Expires: 0912112019
tHelfrich ASsociatbs
Steven C }lelfrich
30640 XrlSUn Court
Redlands, CA 92373
(sos) 38917326
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner.
Address:
Phone:
License #:
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$215.29
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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
Fire lnsp. Req'd: No
Police Insp. Req'd: No
Flood Zone Cert. Req'd: No
No
No
No
No
Escamilla, Manny
Chehade, Nabil
Amsden, Julie
Date: 0612812018
Date: 1012212018
Date: 1110512018
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002
01776002
07776002
08907007
07776002
07776002
07776002
Permit Fee
Plan Check Fee
Microfilm Records
SMIP - Category 1
Bldg. Stds. Revolving
General Plan Update
lssuanceAccount#
71 188
Total
57607
s3600
57770
24000
57672
s7600
57607
Fee Total:
Paid to Date:
Balance Due:
$160.25
$222.16
$15.04
$2.34
$1 .00
$22.08
$5s.04
$477.91
$213.86
$264.05
Every permit rssued shall become invalid unless the work on the site authorized by
such permit is commenced within 180 days afterifs issuance,or if the work authorized
on the site by such permitis suspended or abandoned for a period of 180 days after
the time the work is commenced.
01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 53600
01 1 16002 57770
08901001 2400a
$22.08
$215.29
$1 .00
$8.30
$15 04
$2 34
lnspector MID#: 2018-144349
BU!LDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I haeby affirm undo penalty of perjury that I m excmpt from thc Contrsctors' License Law for thc followinS r@n (Se.7031.5
Busin6s and Profsion Code): Any City or County which rcquirc a pcmil to @ngrud, altq. improv€, donolish or repair uy
structurc. prior to its isuocc, also requirs thc spplicmt for such pamit to file a signcd statmmt that he or dE b licoscd pmuut
to thc provisiore of thc Contractor's Licensed [:w (Chapt6 9. Comncncing with Setion 7000 of Division 3 of thc Busincs adr Profsions Codc) or that hc or slre is oempt thqefrom ud thc basis for the allcgcd cxmption. Any violation of Scrion ?031.5 by ey
applicmt for a pnnit subjets thc applicmt to a civil penalty ofnot more thil live hundrcd dollm ($500).
-1.
as owner ofthe property, or my employecs with rvages as their sole conrpensation. willdo the work and the stnrcture b not
intended or offered for sale (Sec.7M4. Business and Professions Code: The Contractor's Licensc Law does not apply to an owner of
the propo'ty who builds or improves theron. and who does such work himself or herself or through his or her own employees.
provided that such impovanrcnts are not intendod or offered for sale. l[, hower/er. the building or improvement is sold within one ]rzr
of complaion. the Ourner Buildcr will have the burden of proving thd he or she did not build or improve the propot'y for the purpose of
sale).
-f
, as owner of the property. arn exclusively contracting with licensed contractors to construct the project (Sec. 7U4, Buiness
and hofession Code: The Contractor's License Law does not apply to an orvner of property who builds or improves thereon,
and rvho contracts for such projects with a Contracto(s) licensed pursuant to the Conlractor's License Law).
-l
am exernpt under Section-. B. & P.C. for this reason.
Date: Owner:
WORKERS' COMPENSATION
DECLARATION
I hereby affinn under penalty of perjury one of the following declarations:
_l have and will maintain a Certificate of Consent to Self-lnsure for workers' conrpensation, as provided for by Section 3700 of the
Labor Code. for the performance of the work for which the permit is issued.
_l have and rvill maintain 3700 of the Labor Code. for the performance of
rvork for rvhich this and policy number are:
E,v tryc4^y
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cerrify that in the performance of the work for w'hich this perrnit is issued. I shall not onploy any person in any manner
so as to become subject to the rvork€rs'compensation laws of California and agree that if I should become subje<t to the
norkers' compensation provisions of SEction 3700 of the Labor Code. I shall. forthwith comply rvith those provisions.
WARNING: Failure to secure workers' compensation coverage
civil fines up to one hundred thousand dollars ($100.000). in
is unlawful. and shall subject an ernployer to criminal panalties and
the cost of compensation. damages as provided for the
Section -3076 of the Labor Code, interest and attorney's
I
DECI { RATION
I hereby aflirrn under penalty of perjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3
of the lllusiness and Professions Code, and my license is in full force atd eflect.
\y'..*"C-Number:L5
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W
I hcreby affm undo p€nalty of perjury thar thac is a construcliotr knding agqcy for the pqfomce of the work for *'hich this pqnh b
isued (Se. 3097. Civ. C.).
Lender's Name:
Lender's Address:
APPLICANT NT'CI ^ RATION
I herety affrrm under penalty of perjury one of the follorving declarations:
Dernolition Perrnits-Asbestos Notification Federal Regulations (Title 40. Part6)
-Required
Letter of Notification
,r'cefli$/ that the federal regulations regarding asbestos removalare not applicable to this project.
is con'ect. I agree to cornply rvith all City and County
reprcsentatives of this City and County to entet' upon the
above mentioned prope(y fcrr
(ppli.",,t or Agent
,€Iermitee nnme 14 I )I
Set Backs
Forms/Steel/Holdowns -z/t-l
-lv--1
Erection Pads 7'"/ry ',T.A-{U
UFER Ground
SLAB Floor
Su bfloor/VenUI n su lation
Roof Sheathinq
Shear Wa!!
Framing
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif
,I
FINAL 3 /lo/aD <ry#ry-'.;n
Certificate of Occupancy 7 ru
Notes, Remarks, Etc.
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