HomeMy WebLinkAbout101102140 - PermitI
a City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2718 lnspectorSection: (714)647-5853
Permit #: {O11O214O
Pin #: 6271{
Project Address: 2122 'l /2 S Shelton Q!
Assessor's Parcel: 015-204-06 Lot: 68
Unit:Bldg: Address Range:Suite Range:
Zonrng: R1Block. NA Tract: 1192 Historic: No
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Accessory Dwelling Unit-Detachec Occupancy:
New Constr TyPe.
ADU Code:
SFD w/det Garage Flood Zone'.
2nd Dwelling Unit # of Stories:
R-3
VB
cBc 2016
x-0602320257J
1
1st FL Area
Znd FL Area
Other Areas.
Garage Area:
Totat
Patio:
T.l.Area:
Yards Req'd
Valuation:$0.01
0
a
De.crlptlon of Wo.k Ch.nge to contractor-Roplaces BP *{0199547ffe.! pd on t01995,17
Convort detstch.d ga60o to an ADU with (1) b.droom, (l) b.throom, kitchen, dlnlng room, llvlng room, atack.bl. vr.ah.t dryer, E
.ttach6d oo.ch (3tll. SAUSD #3929.
Planning Condltlons:All mabrfala to inatdh.xitting.
Address:2122lr2ssheltonst Address: 20201 shonn.n w.y 1206 Addr€ss: 4949 complor or', unlt A
sant An., cA t27O?3'134 winnetd.. cA 91305 srn Dlegd, CAoAz}
Phon6: F14) 87E{46E Phone: (818} 85s4e23 Phone: g!9)-11-rer8
Ten.nt Stale Lic #: 1014721 License #: C6,61 3
Lic Type: B Architect / Drs.m Xo!?a pitfrlne g D.qtgn
Bus. Lic*: 373691 Dssiqner: Lettct. Portbc.rrlro
Wofters Compensation lnsuranca Addressi 5096 Tolowi AyanueCarier: St te Fund Riverride, CA 92509
Polictx: 922328/0 Phone: 17L1721-3{12
Exparesr 112a2o19 Licena€ #:
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
Hernan dez, Kathy
Date:
Date:
Date: 11119/2019
Subject to Field:
Misc. Receipt:
Misc. Receipt.
Misc. Receipt:
07775002 57607 Change Owner/Contr
07776002 57770 Microfilm Records
07775002 57672 Bldg. Stds. Revolving
07776002 57600 General Plan Update
Fee Totat
Paid to Date:
Balance Due:
$68 70
$0.00
$0.00
$0.00
Fire lnsp. Req'd.
Police lnsp. Req'd:
Flood Zone Cert. Req'd. No 01 1 16002 51601
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within360 days afterits issuance,sr if the work authorized
on the site by such permitis suspended or abandoned for a period of 360 days after
the time the work is commenced.
No
No Account#Tota!
$68 70
$0 00
$s4.70
lnspector MID#: 201 9-149607
$68.70
r,
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG COMMENTS oWNEREUILDERDELCARATION J -
I hcrcby all-rm unrtcr lrcnalty of pcrjury that I m cxcmpt lrum thc Contractos' Liccnrc tjw tor thc lolkrwinl rc.srai (Scc.70ll.5 r
Busincss arxl Prcfcssion Codc): Atry City or County which rcquircs a lrmil kt conslruct. allcr. impnrvc. dcmolish lrr rcpdr uy .'
slructure, prior to its issuancc, also rcquircs thc applicant for such [Ermit kr filc a siSncd statcrcnl that hc or slE i! liccnsd puFuant
to thc provisions of the A)nkactor's Lkuse,l tlw (Chaprcr 9, Commcreing wilh Selion 7U)0 of Division .J of thc Business md
PrufcssionsCode)orthathcorshciscxcmptthcrctrumandthchasislirrthcallcgcdcxcmption. AnyviolalionofscctbnT03l.5byany
apl,licant for a fEmit subjecls lhe applicant k, a civil pcn.lty of not nx)rc than fivc hundrcd doUus ($5U))
_1, 6 owncr of the prolrcrty, or my cmpbyes with wagcs as thcir vrlc comlrcnsation, willdo thc wort and lhc stmlE h not
intcfilot oroflbrcd for sle (Se.?(X4, Busincss and Proltssions Gxle: 'fhc Conlrretor's Liccns llw d(Es not aPply lo an owncr of
thc poJErty who builds or inprurcs thcmn, dil wk) des such w)rk himsclf or hcr*lf or thruugh his or hcr ovn cmpktyccs,
provi.lcd that such imporcmots N mt intcnlcl or ollbBl lbr sab, If, tDwcwi lhc huilling or imlrcwmnt is sokl within orc )td
of compbtio[ the Osncr Builter will havc rhc buden of proving that hc or shc rlid m huiLl or ir{x)vc thc pmtEly for thc PUrJns of
slc).
_1, asowncrof the pmlErty, mcxclusively conlracling with liccn*d cotrlractr6 k) construcl lhc pn)jcct (Se. 7(X4, Busincss
arxl l,iufqsbnCodciThcContractor'sLiccnscLawdocsnolapplytoanovncrofpruFrtywhohuildsolimprovcsthcrcon.
and who @nlncls lbr such Jmjets wilh a ContBclo(s) liccnscd pursuanl b lhc Conlracbr's l-iccns kw).
-l
m excmpt undcr Setion-, B. & P.C. lbr this rcason.
,,f&,
}VORKERS' I:ON I PENSATION
I)ECLARATION
alfirm undcr pcnalty of pcrjury onc of thc lirlkrwing declarations:
_l havc arxt will maintain a Certilicatc of Conscnt to Sclt'-lnsurc ft)r workers' compcnsation. as p()vidcd tirr by Scction -1700 of the
I-:bor CcxJc, for the Jrerf<rrmancc of the work litr which the Jrcrmit Ls issucrl.
_lhavcanrJwillmaintainworkcrs'compensationinsurancc,as rcquircdbyScctionlT00oflhc[-aborCodc,forthcperftrrmancetlf
thc work firr which issucd.workers'insurancc calricr and Jxllicy number arc:
)
Policy
_l ccrtili that in the pcrlbrmance of the work tirr which this Jrcrmit is issucd. I shall not cmpk)y any lrcrson in any maltncr
so as to bcconrc subjcct to thc workers'compcnsation laws of Calitirrnia, and agrcc that if I should hccomc suhjcct to thc
workers' compcnsation provisions o[ Scction J7fi) of thc Latxrr Crxlc. I shatl, tilrthwirh comply with ltxlsc pntvisirlns. !
WARNING: Failure to rccurc workers' compensation covcragc is unlawful. and shall suhjccl an cmploycr to criminal Jrcnaltics and
civil lines up to one hunrlrcd thousand rlollars (Sl00.Um), in adrJition lo thc cosl o[ comJrcnsation, danutgcs as providcd ttlr thc
Scction the CtxJc, intercst and altorncy's t'ces.
I hcrcby atlrm under pcnalty of prjury that I am liccnscrl undcr pnrvision 9 (commcncing with Scctkrn 7firu) of f)ivision 3
of thc Business and Prot'essions Codc, and nry license is in t'ull lilrce and cttcct.
b /rLiccnsc
CONSTRUC-TION LENDING AGENCY
I herchy affum undcr Fnaltyof Jrcrjury that thrc is a qrnstruction hnditrg {gcncy tbr lhc lfftbrmancc of thc work for which this lrcmit is
issucd (Se. 1097, Civ. C.).
Lcndcr's Name:
[rnder's Addrcss:
APPLICANT DECLARATTON
I lrcrcby altirm undcr pcnalty of prjury onc tlf thc lblbwing dcclarations:
Demolition Pcrmits-Ashcstos Notification Fcdcral Rcgulations (Titlc 40, Parl6)
-Rcquircd
lrtter of Notilicatitln
_l ccAily that the f'edcral rcgulations rcgarding ashcslos rcrnovalare nol applicahlc to this pnljcct.
-l
ccrtily that I have rcad this application and slate lhal thc ahtvc
rlrdfuranccs and Statc Laws relating to building conslntctitltl,
ahmvc mentioned propcrty for inspcction purposes.
Applicant or Agent
Penttitee nante
i(
inlilnttittiott
Set Backs
Forms/Steel/Holdowns l(DM'O6L
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/VenUl n su latio n
Roof Sheathinq
Shear Wall tl L1 tat >*11{kt,*',ft
Framinq t(tt rrn bAA4 n-7
lnsu lation/Energy It rt DAnnr -il.W
Drywall- A ,-I A l'i q D*Dnaz etr
nt.t2 'l>*mel frffi ttA
/t 'tq'i*n
[\Iasonrv I f eu2+1rr- -
Poo! Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif .
FINAL Dk+wn 7
Certificate of Occupancy T IT
Notes, Bemarks, Etc.
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