HomeMy WebLinkAbout101101605 - PermitCity 9f 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 #: {O11O{605
Pin #: eae(l
Proiect Address: 3626 S Van Ness Ave- -a-
Assessor's Parcel: 410-141-31 Lot: 30
Unit:Bldg: Address Range:Suite Range:
Zoning: RlBlock: NA Tract. 6745 Historic: No
Building Use:
Job Type:
Nature of Work:
Existing Bldg & Use:
Proposed Use:
Single Family Dwelling
Alteration
Foundation
R-3
VB
cBc 2016
x-0602320278J
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area:
Total:
Patio:
T.l.Area:
Yards Req'd:
Valuation: $15,000.00
Occupancy:
Constr Type
Code:
Flood Zone'.
# of Stories:
Description of Work: Voluntary foundation repair
Planning Conditions:
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Owner:
Address:
Phone:
Tenant:
Elouise G Augustus
3626 S. Van Ness Ave
Santa Ana, CA 92707
(714I- 975-6456
Contractor: lsland Consultants, lnc.
Address: P.O. Box 1921
Carlsbad, CA 92018
Phone: (760) 889-8150
State Lic #. 970526
Lic Type: C-61
Bus. Lic #: 373934
Workers' Compensation lnsurance:
Carrier: State Compensation lnsurance Fut
Policy #: 9088991
Expires: 0211212020
Engineer:
Address.
Phone:
Lrcense #:
Architect /
Designer:
Address:
Phone:
License #:
Helfrich Associates
Steven C Helfrich
30640 Kristin Court
Redlands, CA 92373
(eoe) 38e-7326
040046
Helfrich
Steven C
30640
Redla
(909) 389.7326
lotol
.rltnnter
? 0LtLt-
r_rtr0u -
1rr?9
Planning Approval By:
Plan Checked By:
Permit lssued By.
NPDES lnsp. Req'd: No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Landscaping Insp. Req'd. No
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 01 1 16002 51600
01 116002 51601
01 1 16002 51612
08901001 24000
Graham, Jeffery
So, Anson
Chavez, Dave
Date: 0912612019
Date. 1111312019
Date: 1111312019
Subject to Field:
Misc Receipt:
Misc. Receipt:
Misc. Receipt:
0 7776002
07776002
08907007
07776002
07776002
07775002
Permit Fee
Plan Check Fee
SMIP - Category 1
Bldg. Stds. Revolving
General Plan Update
lssuance
;Q,
73535
Total
57507
53600
24000
57672
57600
57607
$166.s3
$230 87
$1.e5
$1 00
$22 es
$s7.20
Account#
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days afterits issua nce,or if the work authorized
on the site by such permitis suspended or abandoned for a period of 360 daysafter
the time the work is commenced.
$22 95
$223.73
$1 00
$1 e5 Fee Total:
Paid to Date:
Balance Due:
$480 50
$230 87
$249.63
lnspector MtD#'.201 9-154680
.dt (
BU!LDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION
I hseby amrm undq pmalty of psjury that I m exempt from thc ConlmctoE' l,icffi llw for thc following tten (54.7031.5
Businos and Profesion Codc): Any City or County which requirc a pcmit to conslruct, alto. improvq demolish or repair my
structue, prior to its issuucc, also require the applicilt for such pcnnit to file I signql statmot that hc or she is licosed purcuut
to the provisiom of the Contractor's Liceroql krv (Chapts I, Commencing lvith Setion 7000 of Division 3 of thc Businas md
Prcf6sionsCode)orthatheorshciscxemptthqcfromildlhcb6sisforthcallegcdermption. AnyviolalionofSccrionT03l.5byany
applicant for a pmit subjcts the applicilt to a civil pmlty of not morc tha five hundred dollus ($500).
__1. as owner of the propeny. or my etnployees with wages as their sole compensation. rvilldo the work and the structure is ntlt
intended or offered for sale (Sec.7044. Business and ttofessions Code: 'l'he Contractor's License [,arv does not apply to an orvner of
the propoly s,ho builds or improves theron. and rvho does such wort hinlself or herself or through his or her orvn employees.
provided that such irnprovoncnts are not intended or off€f,ed ftrr sale. lf. horvever. the building or funprovemc'nl is sold within one year
of cornplaion. the (hvner Builder rvill have the burden of proving that he or she did not build or impnove the propoty for the purposc of
sale).
_1. as owner of the propefly. am exclusively contracting rvith licensed contractors to conslruct the project (Sec. 7044. Rusiness
and Ftobsion Code: The Contractor's License [,arv does not apply lo an owner of property who builds or improv€s thereon.
and rvho contracts for such projects rvith a Contracto(s) licensed pursuant to the Contractor's License [aw).
-l
anr excmpt under Sc.ction-- B. & P.('. for this reason.
l)nte: 0n ner:
\\,0 RKF,ITS' ('0N I PI|NS;\TIO N
DI,l('1,,\lt^'l'loN
I heretrv afilrrn urrder pcrraltv oIpcrjurl,onc oIthc follorvinu dccl:rrations:
__l have rrd will mintain 8 Ccnificate of Conmt to Selflnsurc for rvorkm' compmsation, r providcd for by SEtion -1700 of the
l-abor Code for thc pqfomucc of lhe wort for which the permil b issued.
,A hayc m<! will maintain u,orkm' conrperuation imumnce. 6 requircd by Sation 3700 of the Labor Codc. for the pcrfonnecc of
'fhc uork for which this pemit is issucd. My workm' compersalion iroumcc cuicr od policy numbq rc:
cuis:t@,^.,;":;;:@_?/___ _ __ .'xpire: *zllu<l-
_l cqtily that in thc pqformancc of the work for which this Fsmit is issued. I shall not crnploy any [Emn in ily mflns
so as to becomc subject to the \t'ork€rs' compensation la\\'s of Calil'ornia. and agree lhat il'l should bec'ome suhject to the
\r,orket's' cornpcnsation provisions of Section .1700 of the l.atnr (irde. I fortlnvith glunply u'ith thosc provisions.
and shall subiect an crnplo)'er to criminal pcrralties andWARNIN(i: Failurc to secrrc \\'orkers' conll)ensation coveragc is ful.
cir,il fincs up to one hundred lhousand dollars ($100.000).
Section .i076 of the Labor Code. intcrest and attorney's fee{i.
cost o[iorr, tlarrragcs as pt'ovirlcrl ftrr thc
,^r"r- /40/?
I hereb-v alfirrrr under penalty of periury that I anr liccnserJ of Chapto'9 (corntttencing rvith Scction 7000) ol'l)ivision 3
of the llusincss and Professions ('ode, and rny liccnsc is in full lirrce ard eflect.
/
r-icense ct^"r, ' blOA-?70__License a
r)arc: ' 2/la /t q ('onlraclor:
I hereby affrm under penalty of perjury that there is a constnrction
issued (Scc. 3097. Civ. C.).
l,ender's Name:
agency for the perfonnance of the u'ork for nhich this p,ermit ls
l.endcr's Adtt'ess:
-
A PPLICAN'I' DEC I,ARA'I'ION
I haeby affirm under penalty of perjury one of the follorving declarations:
Dernolition Perrnits-Asbestos Notilication Federal Regulations (Tille 40. Pan6)
-Required
l,etter of Notification
__l certify'that the federal rcgulations rcgar<ling astrc'stos rernoval arc not applicablc to lhis project
the ahrve inf<rnnation is corrcct. I agree to cornply w'ith all City and County
and hcrctry authorize rept'escntalives of this City and County to enter up)n the
\pplicnrrt or,\gcnt Signature: *
I l'errnitec name (print):*
- r)nre: . U/23/2
Set Backs
Forms/Steel/Holdowns Lq Dkff)a .En
Erection Pads ,I
UFER Ground
SLAB Floor
S u bfloor/VenUl n su latio n
Roof Sheathinq
Shear Wall
Framing
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
JVlasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Fina! Report
Flood Zone Certif
I
FINAL il 2<fi I)k{v),tu^VKe/
Certificate of Occupancy ,I lr
Notes, Remarks, Etc,\
nlz?llq- vqn<kot>I L
I I I
-+I have reaclthis application
arrtl State [.aw's rclating to building
rncntionctl prope(y lor inspcction
l,l
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