HomeMy WebLinkAbout40133681 - Permit (2)Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Project Address: 2229 1/2 W La Verne Ave unit:
Assessor's Parcel: 109-121-15 Lot: 15 Block: NA
Bldg:
Tract: 1346
Address Range:
Historic: No
Suite Range:
Zoning: Rl
,
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Mechanical Permit #i 4lc{336E{
Pin #: 54062
Owner:
Address:
Phone.
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires.
DAVID & ANGELICA MEDRANO
2229 W LA VERNE AVE
Santa Ana, CA 927043509
(7141 501 -726e
01 1 16002 51604
01 1 16002 51604
01 1 16002 51604
01 1 16002 51604
01 1 16002 51600
01 1 16002 51604
Fee Type Amount
Wall Heater/Floor Furna 65.57
Bathroom Fan 30.52
Laundry Fan Envir. Air 34.84
Gas Piping Incidenta! 22.38
General Plan Update 22.08
lssuance 55.04
Qty
1.00
1.00
1.00
1.00
1.00
100
Fee
$6s.s7
$30.52
$34.84
$22.38
$22 08
$s5 04
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llarha+l i aa Iaat-Ltataaa t b$-
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tl i r-atrJu
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t
Building Use:- Job Type:
Nature of Work:
Accessory Dwelling Unit-C Occupancy:
Conversion Constr Type
ADU Code:
Date:
Date:
Date:
R-3, U
VB
cMc 2016
Notes: converf.ffidfiEhEd-#i466$1r(gu (4s?iif.l[,i'tii\ t:' : "
bedrooffi, 1 bathrooffi, kitchen, living room & laundry
and storage area (160sf). Auth on file.
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Buildins Permit #: 1 01 988 34
Every permitissued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
issuance, or if the work authorized on the sife by such permit is suspended
or abandoned for a period of 360 days after the time the work is
commenced.
lnspector MID#: 201 8-1481 30
Chavez , Daveo
rrl t 06125t2019
Account#
Misc. Receipt.
Misc. Receipt:
Misc. Receipt.
Total
01 1 16002 51600
01 1 16002 51604
$22 08
$208.3s
Fee Total:
Paid to Date.
Balance Due:
$230.43
$0 00
$230.43
-M ECHANICAL.I NSPECTOR RECORD a
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILI'ER I'ELCARATION
I hqchy allirm unda pcuhy of pcrjury thrr I m qmpt from thc Coflr8ctoc' Lic* Law for thc following ron (Ss-7031.5
Buines and Prcfssion Codc): Ary City or County which rcquiro a pcrnit to coutruct, altq, imprcvc. danrolbh or npah oy
structuc. Fior to its isumca also rcquirc thc applicet for such pcnrit to filc a signcd stdmdt thrt hc or shc i liccnscd purgrilt
to thc provisioG of thc Contractor's Liccnscd txw (Chipt6 9, Comcncing with S*tion 7000 of Division 3 of the Busin* md
Prcfeions Codc) or that hc or she is cxmpt thacfrom fid thc bdh hr thc ,llegcd cxmption. Any violation of Sction 7031.! by my
applicmtforapcrmit3ubjeBth€ applicilttoacivilpcmltyofnotmorcthmfivchundrcddollus($500).
W.* omo of thc prcpcny. or my mplole wirh wag6 a thrt $le ompcrtsdion. will do thc wor* &d tha $nrtE b mt- intordcd oroffrcdforsalc(Sc.T(X4,BuiromdProfcsiouCodeThcCootmtor'sLicreLawdo6noteflytomowof
the prcpqty who hril& or inpros thsoG dd who do6 sch rc* himsclf or hmlf or thrcugh his or hr ow mployc.
providcd that such imFovqrcots e rct inladcd or oftrcd for $lc. lf, how. thc huiHilrg or impromt is sld within onc )ar
of compldiotr. the Omq Buik r wil havc lhc burdo of proviru thd hc or shc did rct build or improE thc propcty fur thc Frpos of
slc).
--1.
as owner of the property. am exclusively contracting with licensed contrac{os to construct the project (Sec. 70t14. Btsiness
and hofession Code: The Contractor's License Law does not apply lo an owner of properfy who builds or improve thcreon.
and who contracts for such projects with a Contracto(s) licensed puniuant to the Contractor's License [arv).
-l
am exempt under
orrc, J 6- 2-* O
DECLARATION
I hereby' alTirm under penalty of po'jury one of the follorving declarations:
-l
have and rvill nraintain a Cerrificate of Consent to Self-lnsure for \\'orkers' compensation. as provided for by Section -1700 of the
I-abor Code. for the perfonnance of the work for rvhich the pennit ls issued.
--l have and will maintain \r'orkers'cornpensation insurance. as required by Section.1700 of the l-ahor Code. for the perlormance of
the u'ork for rvhich this pennit is issued. My s'orkers' cornpensation insurance carrier and policy number are:
Policy l:r1lit t's
Wcertify that in the performance of the work for which this permit is issued. I shall not emptoy any person in any manner
so as to becorne subject to the workers' compensation laws of California. and agree that if I should become subject to the
workcrs' compensation provisions of Section 3700 of the Labor Code. I shall. forthrvilh comply with those provisions..
WARNING: Failure to secure workers' compersation coverage is unlarvful. and shall subject an €mployer to criminal penahies and
civil fines up to one hundred thousand dollars ($100.000). in addition to of damages as providd for the
Section 3076 of the Labor Code. interest and attorney's fees.
or*, 6- 25- /?I
LICENSED CONTRACTOR
DECI"ARATION
I hoeby aflirm under peoaltyof perjury tha I am licensed under povision of Chapter 9 (commancing with Soction 7000) of r)ivision 3
of the Business and Professions Code, and my liccnsc is in full force rrd effect.
l.iccttse ('lass: I .iccrrst' Ntrrrrhcr :
l)irlt'
CONSTRUC ION LENDING AGENCY
I heeby affifln undo Srnahy of pajury that th6e is a mnshrclion lqding agmcy for the pcrfonnmce of thc Nork for $hich this pmit is
issued (56. -!097. Civ. C.).
l,cnder's Namc:
Lender's Address:
AfII.ICANLDECI.AEAIION
I hwby aflim unde paalty of perjury onc of thc following dcluations:
Demolitiotr Pmils-Asb6tG Notification Fc{aal Rcgulations (Titlc 40. Pan6)
-Rcquircd
Lctts of Notification
-l
cqtify that thc lidcal rcgulatiom rcgarding ubetos rmoval ue not applicablc to this prcjccr.
fiLlJ catifytfatl havc rad thb application od state that the above infonmtion is cortrt. I .8rc to comply with all City and County
ordinancq and Statc lrrc rclating to building con$ruction, ud hmby authorizc reprMtativc of this Cityud Countylo at6 uportlE
above mentioned property for inspection
Applicant or Agent
Pennitee narne
*n", t (- 2-\- - /7
Appliances
Metal Fire Place
Evaporative Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-lnsulation
lnsulation
Smoke Detectors lnstalled
Rough Ductwork Mrrs? / ral
Vents
Toilet Room / Clothes Dryer a la,ft-e 16? ,oz
Residential Range
Other
Hood
Type I Hood
Type !l Hood
Grease Duct
Fire Damper
Openings
lnstallation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rough Mech.
Final Test
Meter Release lt
FINAL vl*lra i u,c"-u+e;@h/
Notes, Remarks, Etc.(ur \--,2
B. & P.C. for rhileason. />e
WORKERS' CONI PENSATION
()n lrer:
8lz, lr q
-+