HomeMy WebLinkAbout101102858 - Permit';t
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 N Buitdins Permit #: {O1102858
Pin #: 66317PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Proiect Address: 2105 N Pacific Avea
Assessor's Parcel: 001 -072-10 Lot 57
Unit:Bldg: Address Range:Suite Range:
Zoning: R1Block: NA Tract. 1724 Historic: No
Building Use:
Job Type:
Nature of Work:
Existing Bldg & Use:
Proposed Use:
Single Family Dwelling
Alteration
lnt. Bathroom
SFD w/att garage
R-3
VB
cBc 2019
x-0602320144J
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area:
Total:
Patio:
T.l.Area:
Yards Req'd:
Valuation: $4,000.00
Occupancy:
Constr Type
Code:
Flood Zone'.
# of Stories:
Description of Work: Legalize interior bathroom. Owner-Builder form on fite.
Planning Conditions:
Owner: Hang Nguyen
Address: 7301 Mirage Dr
Garden Grove, CA 92840
(7141 414-75s7
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 #:
Phone:L-lenant:t H L Home
Hung Le
11071 Dune St
Norwalk, CA 90650
(562) 412-1818
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:
Pezeshkpour, Ali
Ahangian, Kathy
Chavez, Dave nt b
Date: 0111512020
Date: 0212412020
Date: 0212612020
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
No
No
No
No
74027
Total
07776002
07776002
077750 0 2
08907007
0 777600 2
0 77750 0 2
0 7776002
s7607
53600
57770
24000
57672
5760 0
57607
Permit Fee
Plan Check Fee
Microfilm Records
SMIP - Category 1
Bldg. Stds. Revolving
General Plan Update
I ssua nce
$1 66 53
$230 87
$3 91
$0 52
$1 00
$22 9s
$57 20
Fire lnsp. Req'd:
Police lnsp. Req'd
Flood Zone Cert. Req'd: No
No
No Account#
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 daysafter
the time the work is commenced
01 1 16002 51600
01 1 16002 51601
01116002 51612
01 1 16002 57770
08901001 24000
$22 95
$223.73
$1 00
$3.e1
$0.52
Fee Total:
Paid to Date:
Balance Due:
$482 98
$230 87
$2s2.11
lnspector MID#: 2020-157 127
a
SITE.WORK DATE ID/SIG.COMMENTS OWNIiR BU I I,DIiR DICI,CA RATION
I hcreby affirm under penalty of perjury that I am exempt from the Contractos' Licensc [:w for the following reason (Scc.7031.5
Busincss and Profcssion Code): Any City or County which requires a pcrmit to conslruct, aher. irnprove, demolish or rcpair any
structure. prior to its issuance. also rcquires the applicant tbr such permit to file a signed staternent that lre or she is licensed pursuant
to lhe pnrvi.sions of thc Contractor's l.icensed t:w (Chaptcr 9. Commencing with Section 70fi) ol'Division 3 ot'the Busines:a:!
Prot'essions Code) or that he or she is exempt therefrom and the basis tbr the alleged cxemption. Any violation of Section 7031 .5 by any
applicant for a permit subjects thc applicant to a civil penalty of not rnore than live hundred dollars ($5m1.
D& "* owncr of the propcrty, or rny ernptoyees with wages as their sole compcnsation, willdo the work and the stnrcrure is rnt
interxlcd or ofTered for salc (Sec.7(Xn, Business and Professions Cotle: The Contractor's Licensc l-aw docs not apply to an owner of
the property who builds or improves thereou and wtrl does such work hirnself or herself or through his or her own employees,
provided that such improvernnts are not intended or olfered lor salc. Il, howevc'r, the building or improvenrcnt is sold wilhin one year
of completion, thc Owncr Builder will have the burden of proving that he or she tlid not build or improve thc property for tlre purposc of
sale).
_1. as owner of thc property, am exclusively contracting with licensed conlraclors to conslruct the pnrject (Sec. 7044, Business
arrd PnllbssirxrCode: TheContractor'sLicerrseLawdoesnotopplytoanownerofpropertywhobuildsorimprovesthereon.
and who conlracts for such pro.iccts with a Contractor(s) licen.scd Contractor's Licensc taw).
_l anr exempt B.&P
ooL Z6
I hcreby aflirm under penalty of perjury one of the tbllowing declarations:
_I have and will nraintain a Certilicatc of Consent to Selt'-lnsure for workers' comper$ation, as pnrvided for by Section 3700 of the
Lahor Codc. for the Jrcrformance of thc work for which thc permit is lssued.
_l have and will maintain workers' conlpersation insurance, as required hy Section 3700 of the Labor Code, fbr lhe pcrfornurnce of
thc work filr which this pcrmit is issuc'd. My workcrs' compcnsation insurancc carricr arxl Jrolicy numbcr are:
Policy Number: Expircs:
{ t ccrrlty that in thc prlbrmance of tlrc work for which this prmit is issucd, I shall not cmploy any pcrson in any manner
(o iTtn bcconre subjcct to the workers' comlrcnsation laws of Califonria. and agrcc that if I should beconrc subject to thc
workers' .urnp"nruiion provisions of Section 3700 of the Labor Cotle, I shall, forthwith conrply with ttrosc provisions.
WARNING: Failurc to sccure workcrs'compensation coverdgc is unlawful. and shall subjcct an employer to criminal pcnaltics and
civil fines up to one hundred thousand dollars (Sl(X).(XX)). in lo the of damage.s as providc{for the
ISection 3076 of the [:tnr Code, inlerest and attorrrcy's fees.
,r^r".' 0z I zoIznuo
I hcreby allirrn undcr grcnalty of pcrjury that I am liccnsed undcr Chapter 9 (cornrncncing with Section 7ffn) of Dirision 3
of the Business and Protbssions Codc, and my liccnsc is in full lirrcc aml clfcct.
Licensc Class: Liccnsc Numbcr:
l)ate:
CONSTRI.'CTION I,I.]NDI NG AGT.]NCY
I hereby allrrnr under penalty of per.iury that there is a constructirxr lenrling agency for the performarn-:e of the work tirr which this pernrit Ls
issued (Sec. 3097. Civ. C.).
[-cnder's Namc:
l-endcr's Address:
APPLICANT DECLARATION
I trreby affrnr under pcnalty of pcrjury one of the following doclarations:
Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6)
_Required [-etter of Notification
_[ certify that the federal regulations regarding asbestos removal are not applicable to this project.
dd."niry that I have rcatl this apptication arxl state the above informalion is correcl. I agree to comply with all City and County
ordinances arrd State Laws relating to building autlxrrize rcpresenlativcs of thi.s City and County to enter uF)n the
atxrvc mcntioncd prof&.^rty frlr inspcction
Applicant or Agcnt
Permitee nanle
o,,,, Oz [z 6 f zo zu,
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bf loor/Ve nUI nsu latio n
Roof Sheathino
Shear Wall
Framing
Insulation/Eneroy
Drywall
Ext./lnt. Lath
Brown Coat
Nlasonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
t/It /4,
FINAL 5//0/iry/v iln?/w,1 /ffi/
Certificate of Occupancv I I
Notes, Remarks, Etc.
\
s
BUILDING. INSPECTOR RECORD
Rev. 0B-07-2015
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