HomeMy WebLinkAbout101103161 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA92702 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853 P\Y
Permit #: {O11O316{
Pin #: 1451 6
Project Address: 922 W Park Ln
Assessor's Parcel: 001 -244-10 Lot: 55
Unit:BIdg: Address Range:Suite Range:
Zoning: RlBlock: NA Tract: 1824 Historic: No
Building UBe: Singlo F.mily Dwolling Occupancy: R-3, U 1st FL Area Patio
Job Type R.rcof Constr Type V B 2nd FL Area T.l.Area:
Nature ot work Reroof code: cBc 20t9 other Areas yads Reqd
Existing Bldg. & uss sFDwr.tteer.eo Flood zone: x46a232014J carage Area vatu.tion: gts,ooo.oo
Proposed Use: # of Stodes:
Totat
Doscriptlon of Work TrO oxi.ting roof and in.tall now comp ahlnglo llko for llketo SFD.nd .tt.chod grrage. Roplace lhoathinElplywood a. n.od.d.
Auth on flle. H.nd out glvon.
Planning Conditions:
owner: Joelconzrlez contraclor: cwner-Eu der Engineer: ,,'..,.1 '' " . i
Address: 922 w PARK Ltt Addrcss: Address: ' " - - :
Santa An., CA 927031513)
Phone: F14l 376-9542
Tenant
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier.
Policy #:
Expires:
Phone:
License #:
Architect /
Designer:
Address:
Phone.
License #.
-loe I 6on rn I ei:
Gerr ern I F'lnn Updnt e Fee
t:tl 1 16[u2- 5160rlt:[Jt]*
Building
t:rl 1 I 6r-it-]2- 51 6r-r 10011-
Blds Stds Revo1v i ns
r:tl 1 l6r.rrr2- 516120t:rlr-
11 icrol i lrn & Documents
Lr1 1 I 61ilJ2- 3777tul[rr-r-
$22.95
$3?0 .2&
$1,[r[r
$3. 91
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
Gomez, Pedro ./'
Zuniga, nff,.r[
Date: 0211412020
Date:
Date: 0211412020
Subject to Field:
Misc. Receipt
Misc. Receipt
Misc. Receipt
i::.., ..1...1 .,ti'ii
077760A2 5'76Oe' :Fermit FEe, i ' _, . ;i ,.- ;, . . $333.06
07776002 57770 Microfilm Records $3.91
07776002 s7672 Bldg. Stds. Revolving $1.00
07776002 s7600 General Plan Update $22.9s
07776002 57607 lssuance $57.20
Fire Insp. Req'd:
Police Insp. Req'd:
No
No Account#Total
Flood Zone Cert. Req'd: No
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within360 days afterifs rssuance,or if the work authorized
on the site by such permit rs suspe nded or abandoned for a period of 360 days after
the time the work is commenced.
01 1 16002 s1600
01 1 16002 51601
01 1 16002 51612
01 1 16002 57770
$22.95
$390.26
$1 00
$3.91 Fee Total
Paid to Date:
Balance Due:
$418.12
$0.00
$41 8.12
lnspector MID#: 2020-1 57814
BUILDING- INSPECTOR RECORD
SITE.WORK DATE !D/SIG.COMMENTS OWNI.]R II I.' I I,T)T'R DI.:I,CA RATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' License law for thc following reason (Sec'.7031.5
Business and Prol'ession Codc): Any City or County which rcquircs a permit lo conslruct, altcr. improve, demolish or repair any
stntcture, prior to its issuance. also requires the applicant for such pernrit to file a signed slatemenl that he or she is licensed pursuant
to the provisions of ttr. Conlractor's l.iccnsed taw (Chapter 9. Commcncing with Scction 7fiX) ol'Division 3 of the Busincss and
Prof'essions Code) or that he or she is exempt therefiom and tlrc basis lbr the alleged exemption. Any violation of Section 7031 .5 by any
applicant for a pcnnit subjects the npplicant to a civil penllty o[ not more than five hundred dollars ($500).
Za'. ^t owner of thc proflcnv. or rny ernptoyees with wagcs as their sole compcnsation. witldo the work ard the shrcture is not
irrtentletl or offeretl for salc (Sec'.7(X4. Business and Pnrlessions Cule: The Contractor's License l-aw docs not apply to an owncr of
the prugrerty who builds or improrrts thcreon, and whcr does such work himself or herself or through his or her own employees,
provided that such irnprovcrrcnts are not intended or ollertd [or salc. Il. hnwever, thc building or inprovennnt is sold within one year
of conrpletkrn, thc Owner Buikler will have the burtlen of proving that hc or she did not buikl or improvc Ore property for the purporc of
sah).
_1. as owner of the properly, am exclusively contracting with licensetl contraclors to conslrucl thc pnrject (Scc. 7044. Business
and Protbssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves there<ut.
antl who contracts for such pro.iccts with a Contractor(s) liccnscd pursuanl to thc Conlraclor's License Law).
-l
am excmpt under B. & P.C.this
rrate, ,:-itvlll<,
I hcreby alf irm under Jrcnalty of perjury one of the tbllowing
_l have and will maintain a Certificate of Consent to Selt'-lnsure for workers' comprcnsation, as provided for by Section 3700 of the
Lahor Code, for the pcrformancc of thc work for which the permit is issued.
_l have and will maintain workers' compensation insurancc, as required by Seclion 3700 of the krbor Code, for the perfornunce of
thc work tbr which this Jrcrmit is issued. My workers' comJrcnsation insurancc carricr ancl policy numhcr are:
Carrier:
Policv Numbcr: E,xoires:
-l
ccrriff thar in thc perfirrmancc of the work for which this prmit is issuetl, I shall not employ any person in any manner
so as to bcconre subjcct to thc workers' compensation laws of California. and agree that if I stnuld bccome subject to the .
workers' compensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with tlrosc provisions.
WARNING: Failure to secure workers'compensation coverage ls unlawful, and shall subjcct an employer to criminal grcnalties and
civil ftnes up to one hundred thousand dollars ($l00,UX)). in adtlition cost of conrpensation, damages as providcd for the
Seclion 3076 of the Lahrr Code, inlerest and
l"l '7.,{)
I hercby allirm undcr pcnalty of Jrcrjury that I arn licenricd 9 (cornrncncing with Section 7000) of Division 3
of thc Business and Profcssions Codc, and my license is in full forcc arxl elfcct.
Liccnsc Class: Liccnse Numbcr:
CONSTRI,'CTION I,I.:NI)TNG AGENCY
I hercby athrm under Jrenalty of perjury that there is a constructiorr lending agerrcy for the Jrcrformance of the work tbr which this Srerntit is
issucd (.Scc. 3097, Civ. C.).
[-cnder's Name:
lcnder's Address:
APPLICANT DECLARATION
I hcrcby affirm under penalty of perjury one of the following declarations:
f)entolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6)
_Required l-etter of Notification
_l certity that thc federal regulations regarding asbestos rcnpval are not applicable to lhis pmix't.7r
,Yl*ify that I travc rcad this application arxl stare that thc abovc information is correc't. I agrec to comply with all City and County
and County to enter upon lheordinances and State Laws relating construct iorr, anJ herehy authorizc representatives
atxlvc mcntioncd property for
Applicunt or Agcnt
l'rnrritee nanle
purposcs.
L
of this City
(1 U)
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/VenVl nsu lation I
Roof Sheathinq 7- 2llolo \0
Shear Wall
Framino
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Nlasonry
Pool Fence
T-Bar
Handicap Req
Deoutv Final Report
Enqineer Final Report
Flood Zone Certif
I rl ;1
FINAL n r)\ 1n )hr v6t trrt
Certificate of Occupancv I I
Notes, Remarks, Etc.
Rev. 08-07-2015
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