HomeMy WebLinkAbout101102301 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: {O11O23O{
Pin #: 16088
{1
Proiect Address: 2247 S Rousselle Sta
Assessor's Parcel: 016-101-29 Lot: POR 6
Unit.Bldg: Address Range:Suite Range:
Zoning: RlBlock: J Tract: 668 Historic: No
Building Use: Single Family Dwelling Occupancy: R-3, U 1st FL Area:
Job Type: Demolition & Clear Lot Constr Type: V B 2nd FL Area:
Nature of Work: Demo & clear lot Code: CBC 2016 Other Areas:
Existing Bldg. & Use: Sfd w/att garage Flood Zone: X-O6O2320278J Garage Area:
Proposed Use: # of Stories:
Total:
Description of Work: Demo & clear lot. (1660sf) CITY JOB - FEE EXEMPT, NO BOND PAID, MEMO ON FILE.
Planning Conditions:
Patio:
T.l.Area:
Yards Req'd:
Valuation: $10,000.00
Owner:
Address:
Phone:
Tenant:
City of Santa Ana
20 Civic Center Plaza
Santa Ana, CA 92702
Contractor: lnterior Demolition lnc
Address: 2621 Honolulu Ave
Montrose, CA 91020
Phone: (818) 2494932
State Lic #: 603409
Lic Type: B, ASBS, C-21 , C-12
Bus. Lic #: 337823
Workers' Compensation lnsurance:
Carrier: State Fund
Policy #: 1977624
Expires: 0912712020
Engineer:
Address:
Phone.
License #:
Architect /
Designer:
Address:
Phone:
License #.
Planning Approval By: Graham, Jeffery
Plan Checked By:
Permit lssued By: a) ^Amsden, Julie
NPDES lnsp. neq'O:'' ,K
PWA lnsp. Req'd: ( - No Fire lnsp. Req'd
Date: 1112112019
Date:
Date: 1112112019
Subject to Field:
Misc. Receipt:
Misc. Receipt.
Misc. Receipt:
07776002
07776002
07776002
07775002
07776002
57607
57770
57607
57572
57600
Permit Fee
Microfilm Records
Fee Exempt
Bldg. Stds. Revolving
General Plan Update
Fee Total:
Paid to Date:
Balance Due:
$166.53
$3 e1
$-1 94 39
$1 00
$22 e5
No
Planning Insp. Req'd: No Police lnsp. Req'd: No
Landscaping lnsp. Req'd: No Flood Zone Cert. Req'd: No
Every permitissued shall become invalid unless the workon the site authorized by
such permit is commenced within360 days afterifs issuance,or 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.
Account#Total
N/A - No Balance
N/A - No Balance
N/A - No Balance
$0 00
$0 00
$0.00
lnspector MID#: 2019-156023
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS O\1'N [.R l]t I I l,l)l:lt l)ltl.('A RA'tlON
I hseby allinn unds penalty of pdjury that I m ercmpt from thc Contmclon' Licme law for thc following remn (Sc.70-11.5
Busincs and Prof6sion Codc): Any City or County which rcquira a pcmit to coEiruct. alta. improta danolish or rtpair my.
struclurc. prior to its isswcc, also rcquirs thc eplicet for such pemit to file a signed statmot that hc or dlc is licffed pummt
to the provisions of th€ Contmctor's Liccnsed taw (Chapts 9. Commocing with Sction 700O of Division 3 of the Buin* md
ProfsionsCode)orthatlEorsheiscxmflthccfromudlhcb6sisforthcallegcdexmptioo. AnyviolalionofSationT03l.5byat
applicant for a pcrmit subjcts the applicant to a civil pmlty of not morc thil five hundrel dollffi ($500).
_1. c orvnq of the prcFny. or my employ€ with wag6 a their olc compewtion. will do thcwork md thc stnr1rc is not
intqd€d or offscd for ulc (Sc.7044. Businm ud Prcfxiom Codc: ThG Contractor's Licdsc lrw do6 not apply to an omq of
the prep€rty who buildr or imprcE thq@tr and who do6 such wd< himsclf or hcmlf or thrcugh his or ho own mploym.
providcd that such improvqmts rc rct inodod or ofTqed for slc. lf. horvd6. th€ boiHing or improvorcnt is mld within onc )ar
;fcompletion. the Owno Buildg will havc thc hrd6! ofproving tha hc or dre did rct build or imprcvc thc propqry for tlrc purpos of
elc).
_ I. 6ownd of the propo'ty. an crclusivelycontncting wilh licqBd conlmcloG lo @nslrucl thc projed (36. 7044. BEins
and Profssion Code: The Contractor's Liccmc Law do6 not spply lo m orvne ofproperty who builds or improvs thq@n.
and who contracts for such prcjcls wilh a ContEcto(s) licoscd punmt to lhe Contraclor's Licorc Law).
I am exernpt under Section-. B. & P.C. for this reason.
l)nlr:( )rr ner:
I hereby affrrm under penalty of perjury one of the follorving declarations:
_t have and will maintain a Cerlificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the
Labor Code. for the pei'formance of the work for rvhich the permit is issued.
_ I have and rvill maintain workers' cotnpensation insurance. as required by Section -i700 of the Labor Code, for the performancc of
the work for which this pennit is issued. My workers' compensation insurance calrier and policy number are:
.r*,.,, S{r< \-e t;r,^.-\ r I
Poricy*,,u*, [1-?-? 6?-1 Expires::-@
_l cerrify that in the performance of the work for which this perrnit is issued. I shall not employ any person in any manner
so as to become subject to the n'orkers'compensation laws of California. and agree that if I should become subject to the
n,orkers' compensation provisions of Section -3700 of the Labor Code. I shall. forthrvilh comply rvith thosc provisions.
WARNING: Failure to sccure rvorkcrs' compensation coverag,e is unlarvfrrl. and shall subject an onployer to criminal penalties and
civil fines up to one huntlred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the
Section 3076 of the Labor (lode. interest and attorney's fees.
,,,., t t \z--r \eo nov,inn
DECLARATION
I hereby affrrm under penalty of perjury that t am licensed under provision of Chapter 9 (cornrnencing u'ith Section 7000) of Division 3
of the Business and Professions Code. and my license is in full ftrrce and effect.
Licensc Nurnbcr:o '1 0
CONSTRUCTION LENDING ACENCY
I hacby affirm undo penalty of pqjury thal thqc is a construction lending agmcy for the pofomce of the rvork for which this pflnil ls
issued (Sec. -3097. Civ. C.).
l-ender's Name:
Lender's Address:
APPLICA N'f DE(l LARJI"I'lON
I herebyaffinnunder penalty of perjury one of the follorving declarations:
Derno lit ion Perrnits-Asbestos Notifi cat ion Federal Regulat ions ('l'itle 40, Parr6)
__- Required Letter of Notification
-l
cqtiry that the fedqal rcgulaliom rcgrding rbctos rmoval uc not applicablc to this prcjdt.
I
-hfcgri& rha I hrvc rdd this applic8tion ild state that the abovc itrfomation is cor6t. I agjeto @lnply wilh 8ll City md County
qdinaocB ild Statc taws rchting io building construclioo, ild hqcby authoria rcpr6mtativ6 of this City ud County to olq upon thc
above rnentioned property for inspection purposes.
Allplicurt or Agenl Signattrrc:
t,er,ircerir.re(prirrr): N \ C- L< ff\J \2YZ<.J S
,nre\, V-,\*
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bfloor/Ve nUl n su lati on
Roof Sheathinq
Shear Wa!!
Framing
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputv Final Report
Enqineer Final Report
Flood Zone Certif.
FINAL IZ tq q )ft thz tu+yt
Certificate of Occupancy ,
Notes, Remarks, Etc.
\\l)ale: \ \
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