HomeMy WebLinkAbout30141532 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Plumbing
Permit Counter: (714) 647-5800 lnspection Requests: (7141667-2738 lnspector Section: (714) 647-5853
Permit #: 3O141532
Pin #: E2t.3-l
Project Address: 210 E Occidental St
Assessor's Parcel: 403-187-03 Lot: 3
Unit:
Block: NA
Bldg:
Tract: 252
Address Range:
Historic: No
Suite Range:
Zoning: Rl
Owner.
Address:
Phone
Tenant Name:
Contractor:
Address:
Phone
Veronica Serafin
210 E Occidental St
Santa Ana, CA 92707
(7141 697-8368
Rescue Rooter
740 N Hariton St
Orange, CA 92868
(7141 771-7481
01 1 16002 51602
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
Fee Type
Sewer Alter/Repair
General Plan Update
lssuance
Microfilm Records
Botch+:52990 F ll/12/21-tl9 ID: ELIZABETH0ffire: CTYH Trnns*: 21 I of IAccti: Ref*: 301 41532
Rcpti:tr2s(r59tr8 LI/12/2919 2:58 PlI
Tronsoct i on Totol t130.31
ReEcue Rclot er
Amount
46.25
22.95
57.20
3.91
Qty
1.00
1.00
1.00
1.00
Fee
$46.25
$22.95
$57.20
$3.e1
*?2. ?5
$3,?1
$1r-r3,45
t
State Lic #: 765155
Lic Type: C-36, A, C42
Bus. Lic #: 319175
Workers' Compensation lnsurance:Carrier. Liberty lns Corp
, Policy #: WA763D508631019
Expires: 10/01 12020
Gerrernl PInn Updote Fee
0t I 16t102- F I 6tttlt-1t-ttt-
I,l icrof i In & Documents
tt I I 1 60t12 - ?-,777 tttl[tt] -
P /(. FI u;rtt i ns
Ltl I l6r:trt2- 536rJ21t00-
I (:L (:h ecll B I t-t I tt 12599
Notes: Cleanout and re-drain bathroom.
Fee Total:
Paid to Date:
Balance Due:
s 13(
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/Redrain
Zuniga,
Occupancy:
Constr Type
Code:
Date:
Date:
Date:
R-3, U
VB
cPc 2016
11t12t2019
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt.
Total
Every permitissued 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 permit is suspe nded
or abandoned for a period of 360 days after the time the work is
commenced.
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
$22.es
$103.45
$3.e1
$130.31
$0.00
$130.31
lnspector MID#: 201 9-155794
PLUM BING-INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER EUILI'ER DELCARATION
I hcrcby smrm under pemlty of pcrjury lhat I m crsmpi from the Conlrelm' Licens l.lw for lhe following msn (54.7031.5
Business rnd Pmfession Code): Any City or County which rcquircs I Fmill to sNtruct. rlt6. imprcre. demlish or repair any
structure. prhr to its issuance. also requires the spplicsnt for such Jrrmit Io filc a signed slalemnt thst hc or shc is licnsd ptrunl
to thc pmvisionr of tlrc Conlmctor's Liccn$d kw (Chqrter 9. Comncing wilh S$tion 7(m of Division 3 of lhc Busiress md
Prcfessions Codc) or lhst he or sh€ is crempt tffim and thc besis for thc rlhg€d excmptk o, Any violstion of S€rirn 7031.5 by rny
applicant for ! ,rcmit subjsts thc spplicsnt to 8 civil lEmlty of ml mrc lhsn five hundrcd dollus ($5fi)).
_l.as ou'ncrol'lhcpropcny.orrtrycml)loyccswithrvagcststhcirsolccornl)cnsiltion.s'illdollrcu'orkilndthcslnr-lurcisnot
intcntlcd ()r ()flcrc(l frlr salc (.Scc.7(114. l]usincss and Prolbssions Cloclc: 'l'hc Cortlractor's Liccnsc l.itrv <locs not itpply lo itn owncr of
thcpropcrly u'hohuildsorinU)rovcsthcrcon.andwhorl<rcssuchwrlrkhirnsclforhcrsclforthrouglthisorltcrowttctnployccs.
of'corrplcliotr.llrc Ou'ncr Buildcr u'ill havc thc burdcn ol'pror,ing lhat hc or shc clitl rxrt build or irrtJrrovc lhc propcrly for lhc purprsco[
srlc).
_1. as owncr of thc proprty. am cxclusively contracting u'ith licensed cclntractors to construct lhc pmjcct (Sec. 7W. Business
and Pnotbssion Codc: The Contraclor's License Law docs not apply lo an owner of proSrcrty who builds or improvcs thereon.
and who conlracls for such projccls with a Contractor(s) licensed pursusnl lo the Contractor's Liccnse Law).
-IantcxcmplundcrSection-.B'&P.C.forthisrcason'Owner:___
WORKF'ITS' COM PENSATION
DECLAR.ATION
I hereby uffirm under pcnalty of pcrjury one of thc following dcclarations:
-l
have arxt will maintain a Certificatc of Consent to Sclf-lnsurc for workcrs' compcnsation. as providcd for by Scction 3700 of the
latror Codc. for the Jrcrfonnance of thc work for which thc grrmit is issued.
-l
havc and u,ill mainlain .3700 of the Labor Code. for the pcrformance of
thc rvork lhis and Jxrlicy rturnbcr ire:
Policy ?63 6 /O-/-ZQ
_l ccrtify that in the yrcrforrnancc of thc work for which lhis;rcrmit is issued. I shall not employ any person in any manncr
so as to become subjcct to the workers' compensation laws of California. and agree that if I should bccomc subject to the
workers' compcnsation provisions of Seclion 3700 of the Labor Code. I shall. l'orlhwilh comply with thosc provisions..
)
lVARNIN(]: I;ailurc l() sccurc \t,orkcrs'is unlawt'ul. and shall subjcct an cmploycr to criminal ,Lnahies and
addition lo thc cost of comlrcnsation. damages as providcd for thccivil fincs up to onc hundred thousand
Scction -1076 of thc l.irtnr Codc. intcrcst and
/-
I hcreby affirnr undcr Jrcnalty o[ prjury that I arn liccnscd Chaplcr 9 (comrrrcncing with Scction 7U)()) of Division 3
of thc Business and Profcssions Code. and my licensc is in full force and cffe'ct.
)
Numher:
q6S) sfLicense
Dale:(/-fr.-t9
CONSITITJCTION LENITNG AGENCI
I ltrcby alftrm urdcr Fnslry of pedury thst therc is s ansttrtbo lerding rgcmy for the perfomre of lhc mrk for whhh this pcrmil h
issucd (Ss. 3097. Civ. C.).
l-cndcr's Nantc:
lrndcr's Addrcss:
APPLICANT DECLARA'I'ION
I trcrehy allrrnr undcr pnalty of pcrjury onc of thc follos'ing dcclarations:
Dclrrolit iorr Pcnnits-Asbcstos Not illcal ion Fcdcral Rcgulat ions (Titlc 40. Part6 l
_Rc<lu irctl l-ct lcr of Notillcal iort
_l certify lhal thc fcdcral rcgulations regarding asbcslos rcnnvalare nol applicablc to this proict.
-l
certify thal I havc rcad this with all City and County
and County to cnter upon the
abovc rrrcntioncd propcrty tbr
Applicanl or Agent
(^)Pernritee n0nre 4
orrr. I )-)2'17
UNDER GROUND
Waste & Vent lt I t1 ltl DAmai Lkl'f - Aur*l Cce*tmrl {
Water-Under floor ur
Gas-Underf !oor
Building Sewer
ArealStorm Drain
! nterceptor/ Clarifier
TOP OUT
Waste & Vent
Water Piping
Gas Pipinq
Roof Drain
Tub/Shower Test
Rouqh Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary Sewer/Cap
Back Flow Device
Rough Plumbing
Final Gas Test
Meter Release I
FINAL lt nlPt maoe LfrIOI
Notes, Remarks, Etc.I f'
[hea,^
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