HomeMy WebLinkAbout30141597 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Plumbing
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: 3O141597
Pin #: 484T{
Project Address: 2109 N Pacific Ave
Assessor's Parcel: 001 -072-09 Lot: 58
Unit:
Block: NA
Bldg:
Tract 1724
Address Range:
Historic. No
Suite Range:
Zoning: Rl
Owner:
Address:
Jason Labahn
2109 N Pacific
Santa Ana, CA 92706
(7141 206-5345
01 1 16002 51602
01 1 16002 5160C
01 1 16002 51602
01 1 16002 5777C
Fee Type
Sewer Alter/Repair
General Plan Update
lssuance
Microfilm Records
Amount
46.25
22.95
57.20
3.91
Qty
1.00
1.00
1.00
1.00
Fee
$46.25
$22.95
$s7.20
$3.91
Phone:
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Batch+:53133 lI/22/?ltl9 ID: PZuniso
Oaa i ce: CTYH Trnnsf: g I sf 1
Acct*: Ref *: s(tl +11?7
Rcp bi : tr?91 1555 LI /?2/ 2019 1(t: 15 AH
Trqngocb i on Totsl t130.31
.lflson Lnbnhn
Genernl Plnn Updnte Fee
01116002- 5160000fi-
Plumb i ng
r-r1 I 16[102- 516CI?000-
Ilic'rsf iln & DocumentE
01 1 I 6t:r02- 1777ttLrL1U-
Visn
CC+: rrr*r*r*rrr*8653
i22.95
_ t1tts.45
$3,?1
$13[t.31
Auth*: SZZi1ZO
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Single Family Dwelling
Miscellaneous
Sewer Repair
\0[
Hernan dez, Kathy 11t22t2019
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total
Paid to Date.
Balance Due:
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
R.3, U
VB
cPc 2016
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 sife by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
01 1 16002 51600
01 1 16002 s1602
01 1 16002 57770
$22.e5
$1 03 4s
$3 91
$130.31
$0 00
$130.31
lnspector MID#: 201 9-156071
,,
PLUM BING.INSPECTOR RECORD
APPROVALS DATE !D/S!G COMMENTS OWNER BT'ILDER DELCARATION
I lrcrcby afftrm unds pcnslty of Frjury rhar I m excrpt fiom thc CoilrctoD' Liens kw for the following rc8sn (Se.703la
Busincss ard Prcfcssion Codc): Any City or County whkh rcquircs s Imit to snstruct, dte, inprcrc, &mlish or rpair any
structm. pdor to its, ieruancc. dso rcquircs the applicmt for such pcmit to file a signed statcmnt thst lE or rhc k licnsed puunt
lo the prcvisions of thc Confrctor's Liccnsd [:w (Chapttr 9, Comrercing with Sstion 7000 of Division 3 of thc Business rnd
Pmfcssions Codc) or thrt hc q she is cxcmpl thercfrom aod thc b&sis for the rllegcd cxcrl,,thn. Any violstion of Scctbn 703 1.5 by any
spt licant for r pcmit subjixts lhe spplic8nt to 8 civil pcmlty of mt mrc lhsn five hundrcd dollur ($500).
!( ". o**, of thu Fo1rrty, tr my empk les with wrges &s thcir $lc ompcosation. will do tlE wGk ud llE ilnrrw k mt
intendcd r olfercd for sle (Se.7044. Busircss ud Prcfcsions Codc: Thc Contrac{ff's Lkrns hw does not spply lo u owrer of
thc tmtrcny who buildr or itr{mrcs thcmn. ard who des ffh wrk himrelf or hcrslf or lhmugh his or hcr own cmployes.
providcd that such impmrcmnts re rct htqdcd or ofu for sle. lf. howrei the buildinS or impmwmnl is sh within onc ]qr
of @tr{rl:tbn, the Owrer Builder sill haw ilE burdcn of prcving th[t ]E or shc dit mt boild tr itrproE tlE pmFry for thc purpos of
mls).
_1. as owner of the proFrcrty. am exclusively contrBcting with liccnscd conlraclors lo construct thc projcct (Scc. 704/. Business
atd Profcssbn Codc: Thc Contractor's License LBw docs not apply lo an owner of propcrty who builds or improvcs thereon.
and who contracls for such projccts wilh a Contractor(s) licenscd pursuunt to the Contraclor's Licensc l-aw).
-l
artt urrdcr B.P.C. ltrr this
Dale:2 4
I hcrcby alfirrn undcr Jrcnahy of pcrjury onc of thc
l-alxrr Crxlc. Ibr thc pcrfrrrrnancc oI thc work ltrr which lhc pcrrttit is issucd.
-l
have and will maintain workcrs' comlrnsation insurance. as rcquircd by Scc'tion 37fi) of lhc [:bor Codc. for the ;rcrformarrcc of
lhc work for which this pcrmit is issued. My workcrs' compcnsation insurancc carricr and plicy numhr are:
that in lhe pcrfornrance of thc work for which this pcrmit is issucd. I shall not employ any person in any manrrcr
should bccorne subject to lhe rso as lo hccomc subjccl to thc workcrs'comF,cnsation laws of California. and agrce thal if I
workcrs' compcnsation provisions of Section 37fi) of thc l-abor Code. I shall. forthwith comply with those provisions..
WARNING: Failurc to s:ccurc workcrs' conrpcnsation coverage is unlawful. and shall aln arxl
civil lincs up to onc hundrcd lhousand dollars ($1fi).fiX)). in lo lhc cosl of thc
Sccliolr .1076 Codc. inlerest and attrlrncy's
I hcrchy affirm undcr pcnalty of pcrjury that I ant Chaptcr 9 (commcncing with Scction 7m0) of Division 3
ol' thc Busincss and Professions Codc, and nry is in full lirrcc ancl clfccl.
Licensc Class: License Numbcr:
l):rlr ('onlritt'lrlr
W
I hcrcby affrm undcr pcmlty of lErjury thrt thse is s @nstrctbo bnding agercy for the frcrformre of the wrk for which this Imil is
issucd (Se. 3097. Civ. C.).
kndcr's Namc:
[.cndcr's Address:
APPI ICANT NT'CLARATION
I hcreby sffirm under penalty of perjury one of the following declarations:
Demolition Permits-Astrstos Notification Federal Regulations (Title 40. Part6)
-Rcqu
ired [rtter of Notificatbn
-l
ccrtify that lhc fcdcralrcgulations rcgarding asbcstos rcmovalarc not applicable to this proicl.
_l ccrtity that I havc rcad this application and statc that thc atnvc information is concct. I agrcc to comply with all City and County
ordinanccs and State laws rclaling lo
atxlvc mcntioned properly for insJrcction
r\llplicant ()r /\gent
Pernrilee nanre
hercby authorizc representatives of this City and County to enter upon thc
UNDER GROUND
Waste & Vent / /-)).rq /ZC2l 7
Water-Under floor
Gas-Underf loor
Buildinq Sewer
ArealStorm Drain
I nterceptor/ CIarif ier
TOP OUT
Waste & Vent
Water Piping
Gas Piping
Roof Drain
Tub/Shower Test
Rough Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heaterlcas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary SewerlCap
Back Flow Device
Rough Plumbing
Final Gas Test
Meter Release
F!NAL / l "€,1'1 trc%r,I
Notes, Remarks, Etc.
0wner:
Carrier:-
Itt