HomeMy WebLinkAbout30141591 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Plumbing
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 3014159{
Pin #: 3o{tfl
Project Address: 2247 S Rousselle St
Assessor's Parcel: 016-101-29 Lot. POR 6
Unit:
Block: J
Bldg:
Tract: 668
Address Range:
Historic. No
Suite Range:
Zoning: Rl
Owner:
Address:
Phone
Tenant Name:
Contractor:
Address:
Phone:
City of Santa Ana
20 Civic Center Plaza
Santa Ana, CA 92702
lnterior Demolition lnc
2621 Honolulu Ave
Montrose, CA 91020
(818) 2494s32
01 1 16002 s1602
01 1 16002 51602
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
Fee Type
Cap Sewer
Fee Exempt
General Plan Update
I ssuance
Microfilm Records
Amount
103.84
-187.90
22.95
57.20
3.91
Qty
1.00
1 .00
1.00
1.00
1.00
Fee
$103.84
$-187.90
$22.95
$s7.20
$3.e1
State Lic #: 603409
Lic Type: B, ASBS, C-21 , C-12
Bus. Lic #: 337823
Workers' Compensation I nsurance:Carrier: State Fund
Policy #: 19TT624
Expires: 0912712020
Building Use:
Job Type:
Nature of Work:
Single Family Dwelling
Demolition & Clear Lot
Cap sewer
Julie
1102301
Occupancy:
Constr Type:
Code:
Date:
Date.
Date:
R-3, U
VB
cPc 2016 Notes. Cap sewer. CITY JOB - FEE EXEMPT, NO BOND PAID,
MEMO ON FILE.
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Every permit issued 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 fhe site by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
11121t2019
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
N/A - No
N/A - No
Balance
Balance
Fee Total:
Paid to Date:
Balance Due:
$0.00
$0.00
$0.00
lnspector MID#: 2019-156023
PLUM BING.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hcrcby afftrm undcr pcnolty of pcrjury thal I m exempl fn m Ihc Contmclo$' Liense kw for the following rc&sn (Sbc.70-11.5
Business and Profcsskrn Codc): Any City or Counly which rcquircs s Jf,rmit to onstruct. 8lts. imprcve, demlish or Epeir 8ny
structurc. Irior to ils issuuncc. rlso rcquircs lhc o0plicant for such Frmit to fih a signed slstemnt thst hc or slrc k licenred pmusnt
to the Eovisions of thc Contructor's Licensd [{w (Chaptcr 9. Commncing wilh Sction 7fi)0 of Division 3 of the Busircss and
PmfcssionsCodc)orthathcorsheiscremptthmfromandthcblsisforthealhgcdcremption. AnyviolationofsetbnT03l.5bysny
applicanlforapcrmilsubjclsthc opplicanttoscivilpcnallyofnotmrcthanfivehundreddollus($500).
-1.
as owner of thc propcrty. or my cmployces with wagcs as thcir snlc compensation. willdo lhc work and the structurc ls not
interrded or offcrcd for sale (Scc.7044. Busincss and hofcssions Code: The Contractor's License hw does not apply to an owner of
thc propcrty wtxr builds or inqrroves thereon. and who dcrcs such wo* hinrself or hcrsclf or through his or her own employees.
provided that such impnovenrcnts arc rtot intendcd or offered for sale. lf. howevcr. thc building or inqrmvennnt is sold within one )rar
of comphtion. thc Owncr Builder will have the burdcn of pmving that hc or she dkl ncrt build or improve the property for the purpse of
salc).
-1.
as owner of the propcrty, am exclusively controcting with licensed contractors to construct the pojc.ct (Scrc. 7W, Busfuress
attd Prcfessirn Code: The Conlractor's License [.aw does not apply to an owner of property who builds or improves thereon.
and who contracls for such proicts with a Contracto(s) lhensed pursuant to the Contractor's Licensc law).
-l
amexempl under Section-. B. & P.C. for this reason.
l)tlt, ( )rr ltt.r
WORKFRS' COMPF'NS {TION
DF'CL^ RATION
I hcrcby affirm undcr grcnalty of pcrjury one of the following declarations:
-l
have and will maintain a Certificate of Consent to Self-lnsurc for workers' compcnsation. as provided for by Section 3700 of the
l-abor Codc. for the performance of thc work for which thc permit is issued.
-l
havc and will maintain workcrs' c<lnrlrcnsation insurance, as requircd hy.Section
which this permit is issucd. My workcrs' comlrcnsation insurance carrier
3700 of thc l-abor Codc. for the pcrformance of
and policy number are:work frrr
(n"ri.r 1 q lys\r^,I
-l
ccrtify that in lhc prforrnarcc of thc work for which this perrnit is issued. I shall not cmploy any Frcrson in any manner
so as to bcconrc subjcct to the workcrs' compcnsalion laws of California. and agrcc that if I should bccome subjcct to the
workers' compcnsation pmvisions of .Scction 37fi) of thc [atxrr Codc. I shall. forthwith comply with thosc provisions..
WARNING: Failurc to secure workers' comJrcnsalion covcragrc is unlawlul. and shall suhjccl an employer to criminal grcnaltics and
civil fincs up to onc hundrcd thousand dollars ($1m.000). in addition to thc cost of compcnsation. damages as provided for the
Sccliort 3076 ol'lhc Code. intercst and attorncy's
\
I,ICENST.:D CON'I'RA C'I'OR
DUCI {RA'I'ION
of thc Ilusirtcss atttl ['rofcssions (irrlc. and rtry liccrrsc is irr firll lirrcc urrtlcllcct.
Ntttttl-o*r:6c>jYb1\
('ontraclrlr:
W
I hcrcby aflirm undcr Fnollyof Frjury thal lhcrc is u constructinn lcnding agency for thc Isfonmncc of thc work for which this ]Emil is
issucd (Scc. 3097. Civ. C.).
kndcr'* Numc:
Lcrtdcr's Address:
AELIqANI.DECI.ASADON
I My oftmundcr lrcnrlty of perjury onc of lhe following dslarations:
Demlilion Permits-Ashcsros Nolification Rdcrol Regulations (Tillc 40, Part6)
-Rcquircd
[xtlcr of lhifi calion
-l
ccrtify thut lhc fcdcral rcgulations rcgarding asbcstos rcmval arc not applicahlc to this prcjcrt.
1\ mify ttl I hsvc rcad lhis applicrlion and ststc thrt thc stnvc informtion is corrcd. I agrc to smply with all Cityand County
o.dinaEcs und Stalc kws rchting to building conslruclion. and hcrcby authoria rctrcrcntatives ofthis City ard Countyto ent6 uJrn thc
above mcnlioncd propcrty for inspclion
/$pti"rnt or Agent
\ermitee
name c-
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underf loor
Building Sewer
ArealStorm Drain
I nterceptor/ CIarif ier
TOP OUT
Waste & Vent
Water Pipinq
Gas Piping
Roof Drain
Tub/Shower Test
Rough Water Heater
POOL/SPA \
P-trap lDrain Line
Main Drain/Pool Pipinq
Fil! Line/Back Flow
Pool Heaterlcas Line
Miscellaneous t
Gas Service
Water Service
Lawn Sprinkler I
Sanitary SewerlCao lz Ir tt )ftntrt v+ry
Back FIow Device
Rough Plumbins
Fina! Gas Test
Meter Release t,^A
FINAL a I P*\n71 -L_k5:)
Notes, Remarks , Etc fl
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Applicanl:
crass: G-t-\*.wl):rtt:
L)ale:
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