HomeMy WebLinkAbout101102266 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #: {011o.22fi,6
Pin #: 252oiN
Project Address: 809 S Townsend St
Assessor's Parcel: 109-61 1-22 Lot: 26
Unit:Bldg: Address Range:Suite Range:
Zoning: R3Block: NA Tract: 3391 Historic: No
Building LJse ttulti-F.mily (5 o, more unlts) Occupancy: R-2 lst FL Area: Palio:
Job Type: Rerool Constr Type: V B 2nd FL Area: T.l.Area:
Nature ofwoft: Roof Rep.ir code: cBc 20t6 other Areast yards Reqdl
Existing Bldg. & Use: Apartments Flood Zone: X-0602320257J
prcpoaed use: # of stodes: Gerage Area: valuatlon: ll'000'00
Total:
Daacription ot Work: Ropair laaking rcof at laundry room. Flat roof torch down. Owner-Buildor iorm on fila. Handout given.
Planning Conditions:
Bnbch*:53rJS5 lI/19/?r:r1? ID: HGAF:(:Iri
Olf ice: {:TYH Trnns*', L7 1 af i
{
En€ln6€r R.!t+:t?Sl[[II - l1/19/2t!9 9144 411Own€I: Pund.rl C'Gmtl ConlEclor: Own.r€ulld.r lror,s(ctioo Totfll $,;le.li
Addres.: 18500 .r[nlqu. Cou.t Addreas: Addr$.:
Yllh P.rlq CA !2881 Pundori C'6'rntri
Phon6: Flia) !23-2232 Phone: Phon€:.. 6ene,.ol pton ijpdste t-ee ,t?).rt
Tsn.nt sr.t€ Lb*: uoen.6 r: c1116002_ 5160t1[0t1_
Lic rype: Iclitec{/ Xijijjfii. ,r*r** _. tser]':r'
Bu.. Llc *:
workerscompensarionrn6uranc.: ;::fl: lifirffi: iilii;iH . 11':]tr
Carier: nicrofilr & DoruriEnte i:r.t1Pottcy#: Phone: 01116tfl12- 5777trn8i-erpir"", rb"n* *, uiil.-------_----,.",." ,......r, ,111e.::
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuance
Fire Insp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No
Account#Total
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 lnsp. Req'd: No
Kelaher, Selena
Chavez, Dave
Date: 1111212019
Date:
Date: 111'19/201 9
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
077760 02
0 7776002
07776002
07776002
07776002
57507
57770
57672
57600
57607
Fee Total:
Paid to Date:
Balance Due:
$333 06
$3 91
$1 00
$22 9s
$s7 20
$418.12
$0.00
$41 8.12
Every permitissued shall become invalid unless the work on 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 daysafter
the time the work is commenced.
01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01116002 57770
$22 e5
$3e0 26
$1 .00
$3 e1
lnspector MID#: 2019-155784
I
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hcrchy allirm undcr lrcmlty of pcrjury that I m crcmpl fmm lhc C(rtrlrack)s' I-iccnrc Lrw tor thc lilllowinS rca$tn (Scc.7031.5 -
Busincss arxl Prol'cssion Codc): Any City or C'ounly which rcquirc$ a Jrmit lo c('trslnrcl. allcr. improvc. dcmolish or Tpair ily
struc(urc. lrior lo ils issure, also rcquircs thc applicanl lbr such fEmil kr lilc a sigrcd stalcmnl thal hc or s]rc ir liccnsd pursuanl
t() thc pruvisions of tlE Conlractor's Licensd [lw (Chaptcr 9. Commcncing wlh Setion 7Ux) of Division -1 of thc Busircss and
PrufcsskrnsCodc)orthathcorshciscrcmpllhmliomandthcbasisforlhcallcgcdcxcmplion. AnyviolalionofScction?03l.5byany
applicant lirr a lEmit subjccts the applicatrt k, a civil pcnalty of n(rl morc lhan fivc hundrcd dollils ($50$). 'o,.
YLUI
". u*n", of th" JroJErty. or my employes with wagcs as thcir solc comlrcnsalion, will do Ihc wffk arr.l ltr slrctw is n(rt
intcdq! orotlercdforslc(5(.7044,BusincssmdP(rfcssionsc(xlc:'IhcG)nlracl(tr'sl-iccnscLawdocsnotapplytoanovrcrof
thc JtrolEny wlf,, huilds or ir{a)rcs thc6n. .nd who d(Es such w)rk him$clf or hcrrclf ()r thnrugh hir or hcr own cmploy@s.
provdcd lhst such impRrwnts rc ilrt intcnlql or ollcrca.l ti)r sah. It, h)wcvcr. lhc huilling or imJnrvcmnt is $ll wilhin (tnc ]4d
o[c\)mphthn. the Owrcr Buiucr will harc thc bunlen of pn]ving thd hc or shc dil nil buiLl or imJerw thc ImJEly tirr lhc purFr* of
sab).
_1, as owmr of thc JnrlEny. amcxclusively contracting with liccnscd conlrncloN l(, construct lhc pft)jccl (Ss. 7044, Busincss
arrl hrrlbsshnCode:ThcContretor'sLicenscLawd@snotopplytoanowrcrofprolrcnywhobuildsorimprovcsthcrcon,
and who conlraclslorsuchprojelswilhaContEck)(s)liccnscdpunuanllothcCotrlracktr'sLiccnsckw).
-l
am cxcmpt undcr Setion-, B. &LC. li[this rcas(tn.
,*. . r (-tq-Zo r ,t o*)( 7C (+^+,'-
IYOB4E&LCOIIPINSAIIQN
DECLARATION
I hcrcby alTirm under penalty of pcrjury onc of lhe fbllowinS dcclarations:
khrr"r*f *iff rrinrainaCcrtit-rcatcofConsnttosclf-lnsurclbrworkcrs comlrcnsatiur,as lrcvidcdti)rhySccti(]n.l7u)oflhc
Lalx)r C(xlc, l'or thc lrcrtbrMcc of the wo* for which thc pcmil is issucd.
_l hrvc nnd will maintain workcrs' compcnsalion insuraNc, as rcquircd by Sccli(ln .17fi) of thc Lahor Cqlc, for thc pcrtomEncc of
the work for which this lEmit is issucd. My workcrs' cr)nrpensrti(tn insuraNc caricr afil lxrlicy numhcr uc:
Policy Numhcr: Expircs:
_l ccnify that in thc pcrlilrmancc of thc work for which thi$ pcrmit is issucrl, I shall mrt cmpl(ry any pcrson in any manncr
v) ns h lrccomc suhjel to lhc wo]kqs' compcnsation laws of Calilirnria. and atrcc th{t if I should hcc()me suhF-{t lo llE
wortcrs'er)mpcnsalionprcvisionsofScclionl?00ofthcLahorCulc, lshrll. lbrlhwilhlr)mplywilhtlxrrcprcvisions.
WARNING: Failurc to *curc workers'compcnsation qlvcrugc is unlswlul. and shall suhjccl an cntpkrycr t, crimiul lEnaltics atrd
crvil fincs up to onc hundrcd lhoused dollars (Sl00,Ux)), in addili(il k) lhc cosl ol comlrcnsulion. danugcs as Jtr)vidcd for l],1
-
.1
ol' thc Busincss and Prot'essions Codc, and my liccnsc is in litll tirrcc anrl cl'tcct.
Liccnsc Class: Liccnsc Numhcr:
CONSTRUCTTON LENDING AGENCY
I hcrchy alfum undcr JEnalty of lErjury that thcrc is a constructbn lending agcncy for thc Jrrfirrmrec of the wrrk for which lhis Imit i3
issucrl (Se. .1097, Civ. C.).
lrndcr's Nam:
I-cnrlcr's Atltlrcss:
APPLICANT DECLARATION
I krchy aflinn undcr pcnalty of perjury onc o[ the tirlkrwing dcclaratiruts:
Dcrnolition Pennits-Asbcstos Notit'icalion Fcdcral Rcgulations ('l'itlc 40. Parl6)
,-Rcquircd [-ct tcr of Notilication
_l ccrtily that thc l'cdcral rcgulations rcgarding asbcst()s rcnx)valilrc nol a;rplicahlc to this projcct.
&f,.\n,ly that I havc rcild this application and statc that thc ah)vc inlirrnrtlion is con'ccl. I agrcc lo cotnply
rcprcscnlativcs ()f this City
with all City arrd Courrty
and C()unty to cnlcr upott tltcordinanccs antt Stalc [,aws
abovc nrcntioncd p()pcrty
Applicarrt or Agent
Itcnrrilcc nanrc (nrinl):X- P,""D4ni h A tvTt
I -?-o lq
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/VenVl ns u lation
Roof Sheathinq
Shear Wall
Framing
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
[\Iasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
, ,-1t /
FINAL t 2_/1 '*/ /7 r 'L\TL/oq
Certificate of
Notes, Remarks, Etc
+