HomeMy WebLinkAbout101102205 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 1O11O22O5
Pin #: 6.272i\_l
Project Address: 806 S Shawnee Dr
Assessor's Parcel: 109-753-24 Lot: 101
Unit:Bldg: Address Range:Suite Range:
Zoning: R1Block: NA Tract: 4025 Historic: No
Building Use:
Job Type.
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Single Family Dwelling
Reroof
Reroof
SFD w/att garage
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories:
R.3, U
VB
cBc 2016
x-0602320256J
1st FL Area
2nd FL Area
Other Areas:
Garage Area
Totat
Patio:
T.l.Area:
Yards Req'd
Valuation:$9,600.00
q,
Description of Work: Reroof dt.o.-Remove and apply comp shingles/replace sheathing as req'd/handout given,
Planning Conditions:Lt2gLrS
Owner:
Address:
Phone.
Tenant
Lloyd Boucher
806 S Shawnee
Santa Ana, CA 92704
(7141 928-5109
Contractor: Orange County Roofing
Address: 425 Eighteenth Street
Huntington Beach, CA 9264
Phone: (949) 548-0680
State Lic #: 784622
Lic Type: C-39
Bus. Lic #: 313211
Workers' Compensation lnsurance:
Carrier: State Compensation lnsurance Fur
Policy #: 9074951
Expires'. 1010512020
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner.
Address:
Phone:
License #:
{:ourrts Hsc,f ing
t F lan Updnte Fee6erl
r_r1 1
Bui
Lt1 I
Bld
Ltl 1
t [t[t[t
6rrrt?- 516
d ins
6tr'12- 516
e
I
I
1
r Stds Revolv i ns
t 6tllt?- 51 612lJLl'J-
'olilm.\ Docu,rten
Planning Approval By.
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'{:
Landscaping Insp. Req'd
Graham, Jeffery
\{$ Hernan dez
No
No
No
Date: 1111212019
Date:
Date: 1111212019
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002
07776002
07776002
07776002
07776002
57607
57770
57672
57600
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
$333 06
$3.e1
$1.00
$22.95
$s7.20
Kathy
Fire lnsp. Req'd: No
Police lnsp. Req'd. No
Flood Zone Cert. Req'd: No
Account#Total
Every permit issued shall become invalid unless the work on the site authorized by
such permit is commenced within360 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.e5
$390.26
$1 00
$3.91 Fee Total
Paid to Date.
Balance Due:
$41 8.12
$0 00
$41 8.12
lnspector MID#: 2019-155772
1 16LtLr2- 177 TlJLtlJIJ-(:hec[ r-r[r2478
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION
I heeby aflirm undr pcralty of perjury thd I m crmpt fiom thc (bntnclo6' Licemc Larv for the following rffin (Se.70-l1.5
Busin6s and Profesion Code): Any City or County which requirc a pernit to construct. ahc. improve. denolish or rcpair uy
structue. prior to its isuucc. also requirs the applicut for such pemit to filc a signcd statmot lhat he or shc b lic$cd prcuarl
to the Eovisions of thc Contractor's Licenscd Law (Chapts 9. Commencing with Setion 7000 of Division 3 of thc Busintss md
Professiotrs Code) or that hc or shc is cxcmpt thcefrom ild thc b6is for thc alleged exonption. Any violation ofsction 70-3 I .5 by an)
applicantforapernitsubjEtsthe applicottoacivilpcnaltyofnotmorcth.nfivehundrcddollus($500).
--1. as owner of the propcrty. or rny ernployees with rvages as their sole compensation. rvilldo the rvork and the struclure is not
intended or offered for sale (Sec.7M4. Business and hofessions Code: l-he Contractor's l.icense Larv does not apply to an ou'ner of
the properry rvho builds or improves thereon. and rvho does such rvort hinrself or herself or through his or her own employees.
provided that suclr improvanents are not intended or offered for sale. lf. horvever. the building or improvement is sold within one year
of complaion. the Or*ner Builder rvill have the burden of proving that he or she did not build or improve the propoty for the purpos€ of
sale).
-1.
as owner of the propefly. am exclusively contracting rvith licensed contractors to corr.struct the projecl (Sec. 7044. Business
and Profission Code: The Contractor's License Lau' does nol apply to an owner of property u'ho builds or improves thereon.
and rvho contracts for such projects with a Contractor(s) licensed pursuant to the Contractor's License l.aw).
-l
arn exempt under Scction-
Dele:
-. B. & P.C. for this reason.
()rr rtcr:
\\'()RK Errs' ('()Nr PENjSA'r roN
l)ll('l,Att^'t'toN
foIlou ing tlcclaratiotts:I hereby alTirm under penalty of po'jury one of the
--_l have and rvill maintain a Certil'icate of Consent to Self-lnsure for workers' conlpensation. as provided for by Section -1700 of the
Labor Code. for the po'fonnance of the rvork for rvhich the pcrrnit is issued.
_ I havc and
the u'ork ftrr
rvill rnaintain rvorkcrs'3700 of the l-abor Code. for the perfomrance of
and policy number are: sl
('an'icr:
=
- fo -r+oLo
t.\Drres:Policv Number:o s-
a'
__ I cenify that in the performance of the work for s'hich this permit is issued. I shall not employ any person in any manner
so as to bc-come subje<t to the workers' cornpensation law's of Califonria. and agrc.e that if I should bccome subject to the
provisions of Section .1700 of the Latxrr Code. I shall. forthrvith cornply rvith those prcr,isions.rvorkers' cornpcnsation
WARNING: [;ailure to secure rvorkers' cornpensation coverage is unlau'ful. and shall an anployer to criminal penalties and
civil fines up to one hundred thousand dollars ($100.000). in addition cost of dalnages as provided for the
Section .3076 of the Lakrr interest and attorncy's,\L'
I hereby alhrm under penalty of pcrjury that I arn license<l 9 with Settion 7000) of Division .3
of the Business and Prolcssions ('ode, and my license is in full force and efl""Lt.
l-icense.-,rr* C3CT
u,,u,--t l:tl'llI-
(z
I hereby affirm under Srenalty of pojury that there a construclion lending agency for the perfonrrance of the work for u'hich this perrnit is
issued (Sec. 3097. Civ. C.).
l.ender's Narne:
Lender's Address:
APPLICANT DECLARA'I'ION
I h€reby aflinn under penalty of perjury one of the follorving declarations:
Demolition Perrnits-Asbestos Notification Federal Regulations ('title 40. Parr6)
-Required
Letter of Notification
__l cc'r1ify that the federalregulations regarding asbcstos rernoval are not applicable to this prnject.
I colify that I have reacl this application and w'ith all City and ('ounty
ordinanccs and State Larvs relating to building and Counly to enter upon the
above mentioned property for inspection
r)are: ( /L,t7Applicant rlr Agent Signnture:_
I'el'rnitcc !riunc (llrint):
atnve
I
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bfloor/Ve nul n s u latio n ,
Roof Sheathing tl trltq )r4/&- fr
Shear Wall ll -;-
Framing
lnsu Iation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
Ir .l
FINAL tr lrfr1lr fvryr
Certificate of Occupancy vt t
Notes, Remarks, Etc.
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