HomeMy WebLinkAbout101102153 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA92702 Building
Permit Counter: (714) 647-5800 lnspection Requests. (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 1O11021 53
Pin #: 28ut_t
Project Address: 3014 S Rita Way
Assessor's Parcel: 412-013-10 Lot. 2
Unit:Bldg: Address Range:Suite Range:
Zoning: RlBlock: NA Tract 6036 Historic: No
Building Use: Single Family Dwelling Occupancy: R-3, U 1st FL Area
Job Type: Reroof Constr Type. V B 2nd FL Area
Nature of work: Reroof code: cBc 2016 other Areas
Existing Bldg. & Use: SFD w/att garage Flood Zone: X-0602320259J
Garage Area:
Proposed Use: # of Stories:
Total
Description of Work: Reroof-apply comp shingles over (1) layer of (e) comp/handout given/auth on file
Patio:
T.l.Area:
Yards Req'd
Valuation:$t t,000.00
Plannlng Condition.:
Fngineer: ,: ,,
Ot/vner: Lynn Vercle Contractor: Ca$edy Roofing,lnc
Phone: lti4l7s4-7277 Phone: (s62) 9aa-5E17 Pione: (.!!rode tioli rn3, lnr
Tsnant slate Lic # 53i906 License r:
Licrypq c-3e Archirecr / Iillfiliirl,li.lj,rfllil,: ",Bus. Licf 34aam
workerr compensarion rnsurance: ffi'::'J' li'iilloiii ,,n,,r,Cafiiol: Redwood Flro rnd Caaualty ijldlr l,t,dr ii{:vlrlv:tjlr
Policy *: cAwc030la9 Phone: Ci i l,{r:r',? ril/,tir:lrilri
Erpires: o1fr1lm2o License#: rri:r'i'lil6 [ iJ''Li'ni'''
60A2 ,sL60L Permit Fee $333 0G
Address: 3014 S Rita Way
Santa Ana, CA 927046735
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd:
Address: 13021 Lakeland Rd
Santa Fe Springs, CA 90670
Address:
Total
0777
0777
0777
0777
0777
Rcpt,+:02802tt23 ll/6/2Lrl9 3:/r[r F'r
Tronsoct i on Totol t?1ll ,'] lt
6002 57770 Microfilm Records
6002 s7672 Bldg. Stds. Revolving
6002 57600 General Plan Update
5002 57607 lssuancew
Gomez, Pedro
Hernan dez, Kathy
Date: 1110G12019
Date:
Date: 1110612019
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Fee Total
Paid to Date:
Balance Due:
$3.e1
$1.00
$22.9s
$57.20
$418 12
$0 00
$41 8.12
No
No
No
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No
Account#
Every permitissued shall become invalid unless the workon the site authorized by
such permit is commenced within 360 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.
01 1 16002 51600
01 1 16002 51601
01116002 51612
01 1 16002 57770
$22 9s
$3e0 26
$1.00
$3 91
lnspector MID#'. 2019-155686
BUILDING. INSPECTOR RECORD
S!TE.WORK DATE ID/SIG.COMMENTS OWNER BUII.DER DELCARATION
I hseby amrm undq penalty of pcrjury thst I fln crqnpt from the ContractoB' Licw law for the following rcen (56.7031.5
Busines md Profsion Code): Any City or County rvhich requirs a pomil to construcl. altq. imprcvq dmolish or rcpair a'ry
structuc. pdor to its isuancc. also requirG thc applicant for such pcmit to filc a signcd statmqt that he or shc is licdEcd pu6uu,
to the provisions of the Contractor's Liccnscd lrs (Chapls 9. Commcncing with S(tion 7000 of Division 3 of lhc Busins ild
Prcf6siomCodc)orthathcorshcis€xemptthqcfromudthcb6sisforthcallcgedcxmption. AnyviolationofsdionT03l.5byany
applicant for a pamit subj*ts the applicant to a civil pmalty of not morc thil five hundrcd dollrs ($500).
-_ l. as owner of the propefly. or my employees with rvages as their sole compensation. will do the work and the struclure is not
intended or offered for sale (Sec.7M4. Business and Professions Code: The Contraclor's [.icense Law does not apply to an owner of
the properly who hrilds or improves theron. and who does such wort himself or herself or through his or her orvn employees.
provided that such inrprovonents ile not intcnded or ofF€red for sale. Il. horve'/er. the btrilding or itnprovement is sold rvithin one ycu
of complaion. the Orvner tsuilder will have the burden of proving that he or she did not build or irnprove the propory for the purpos€ of
sale).
__1. as o\r'ner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7M4. Business
and I'rofession Code: The Contractor's License Larv does not apply to an owner of property w'ho builds or improves thereon.
and rvho contracts for such projects rvith a Contracto(s) licensed pursuant to the Contraclor's License Larv).
-l
arn exempt under Section---, B. & P.C. for this reason.
I)ate:Orr':ter:
WORK IiRS' COI\I PENSA'I'ION
DECLARATION
I hereby aflirnr under penalty of perjury one of lhe follorving declarations:
_l have and will rnaintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the
Labor Code. for the performance of the work for rvhich the perrnit is issued.
_l have and rvill maintain rvorkers' compensation insurance. as required by Section 3700 of the Labor Code. for the pcrfonnance of
the work for which this permit is issued. My workers' compensation insurance carrier and policy number
,*rr"r, kJ "*c,,J H-{,. < d C a5' t.r.l(V
are:
policyNurnuer CAU. CCi.3C, i Y ? Expircs:LO
__ I cerrify that in the perforrnance of the work for rvhich this permit is issued. I shall not ernploy any person in any manner .a
so as to become subject
rvorkers' compensat ion
to the rvork€f,s' compensation larvs of California. and agree that if I should becorne subject to the
provisions of Section -1700 of the Labor Code. I shall. forrhrvith comply provisions.
WARNING: Failure to secure rvorkers' compensation coverage is unlas,ful. and shall subject to crinrinal pnaltics and
civil fines up to one hundred thousand dollars ($100.000). in addition to cost of damages as provided for the
Section -1076 Latxlr Code. interest and attorney's fees.
/r q v-
I hereby affirrn under penalty of perjury that I arn licensecl under provision of Chapto'9 (comntencing rvith Section 7000) of Division -3
of the Business and Professions Code. and nry license is in full force and effect.
License ct "", C'- 3 1 Nurnber:
o,t", /r /(. // f
I hrcby affirrn undu penalty of perjury that thqe is a comtruc{ion lending agmcy for the Ju'fonnmcc of the work for rvhich this pqmit b
issued (Sec. 3097. Civ. C.).
Lender's Narrre:
I-enclcr's Adclress:
APPLICANT DECLARATION
I hereb,y affrnn under penalty of perjury one of the follorving declarations:
Dernolition Permits-Asbestos Notification Federal Regulations (f itle 40. Parr6)
-Required
Letter of Notification
_l certify that the federal regulations regarding asbcstos rernoval are not applicable to this project.
_ -- l cerrify that I have reacl this application and statc that thc alxtve is con'cct. I agrcrc to comply rvith all City ancl ('ounty
ordinances and State Larvs relaling to building attrl represefltatives of this City and Countyld/enter upon the
/q
above tnentioned propet'ty for inspection
Applicnnl or rtgcnl (-L--\
Permitee neme QAnO: FFrZ-A t *t e k4 u-F Z
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bfloor/Ve nUI nsu latio n ,
Roof Sheathing il-?s ///fu.t ,ry
Shear Wall /
Framing
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
FINAL /l-?C.- I 9 E*t/ot
Certificate of Occupancy
Notes, Remarks, Etc.
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