HomeMy WebLinkAbout40134144 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Mechanical
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #:40134144
Pin #:
Project Address: 351 3 S Towner St
Assessor's Parcel: 410-202-19 Lot: 11
Unit:
Block: NA
Bldg:
Tract: 7000
Address Range:
Historic: No
Suite Range:
Zoning: Rl
Owner:
Address:
Leslie Anuu
3513 S Towner St
Santa Ana, CA 927073865
(949) 315-3640
01 1 16002 51604
01 1 16002 5160C
01 1 16002 51604
01 1 16002 5777C
Fee Type
Furnace
General Plan Update
I ssuance
Microfilm Records
Amount
68.1 6
22.95
57.20
3.91
Qty
1.00
1 .00
1.00
1.00
Fee
$68.1 6
$22.95
$57.20
$3.91
Phone
Tenant Name:
Contractor:
Address.
Builder Services Group dba
475 Rivera St #D
Riverside, CA 92501
(386) 304-2222Phone
State Lic #: 1034361
Lic Type: B, C-61 , C-2, C-20, C-33
Bus. Lic #: 368185
Workers' Compensation I nsurance:Carrier: Ace American lnsurance Company
Policy #: WLRC50799475
Expires: 06130/2020
Building Use:
Job Type:
Nature of Work:
Single Family Dwelling
Miscellaneous
FAU
Occupancy:
Constr Type:
Code:
R-3, U
VB
cMc 2016 Notes:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Hernan dez, Kathy
Date:
Date:
Date.11t07t2019
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 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 51604
01 1 16002 57770
$22.95
$125.36
$3.e1
Fee Total
Paid to Date:
Balance Due:
$1s2.22
$0.00
$152 .22
lnspector MID#: 201 9-155728
\
M ECHANICAL-INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDF,R DELCARATION
I hercby afftrm undcr pcnalty of lErjury that I m excmpt ftom the Crnlrrcton' Lie[s llw for the following rc8sn (Se.7031.5
Business and Prcfession Codc): Any City or County which rcquires a pcrmit lo onstrucl. 8lls. itr{,row, dcmlish or rcpair any
struct[c, prior to its issuece. also rcquires the applicant for such pemit lo lilc 8 signcd ststemnt lhat he or shc is lienwd pursant
to thc prcvisions of the Contrctor's Licnsd trw (Chsplcr 9, Comrcing with Scclion 7000 of Division 3 of thc Business 8nd
Ppfc$ionsCodc)orlhatheorshcisexcmpttlrefromsrdthebasfuforthcalhgcdcremption. Anyviol8tionofS6lboT03l.5bysny
applicant for a pcmit subjcrts lhc spplicsnt to a civil pemlty of rct mrc than livc hundrcd dollus ($50o).
_1. as owncr of thc property. or my employees with wages as their solc comlrcnsation. will do the work attd the structure is not
intcndcd or offered for salc (Sec.7044. Business and hofessions Code: The Contractor's License law docs not apply lo an owncr of
lhc property who huild.s or improvcs thcrcon. and who docs such work himself or herself or through his or hcr own cmployccs.
providcd that such improvenrcnts arc not inlended or offered for salc. If. hcrwever. ttrc btrilding or inqrroverEnt is sold within onc )tar
of complctkrn, thc Owner Builder will havc thc burdcn of proving that hc or shc did not build or inprove the property for thc purynseof
sale).
_1. as owncr ol'thc propcrty. arn cxclusively contracting with liccnscd conlraclors lo construct lhc projccl (Sec. 7(A4. Busittcss
antl PnlfcssionC<ldc: ThcContractor'sl.iccnscLawclocsnotapplytolnowncrof'propcrtywhohuildsorintprovcslhcrcott.
and who conlracls lbr such pnrjccls wilh a Contractor(s) licenscd pursuattl lo lhc Contraclor's Liccttsc Law).
-IatttcxcltlpluttderScction-.I}.&P'C.tilrthisrcustllt.
l\^a^,
}VORK[' RS' CONT PENSA'I'ION
DECI ARATION
I hcreby alTirnr undcr pcnalty of pcrjury onc of the following dcclarations:
I have and will maintain a Certificate of Consent to Self-lnsure for workcrs' compcnsation. a.s provided for by Section 37fi) of thc
l.abor Codc, for the performancc of thc work for which the pcrmit is issucd.
-l
havc and will maintain workcrs' compcnsation insurance. as rcquircd by Section 3700 of thc l.abor Code. for thc performance of
the work for which this pcrmit is issucd. My workers' comlrcnsation insurance carricr and policy nunrbcr arc:
Policy Number: Expircs:
-l
certify thal in the pcrformance of the work for which this pcrmit is issued. I shall not employ any pcrson in any manncr
so as to becomc subject to the workers' compcnsation laws of California. and agrcc that if I should bccome subject to thc
workers' compcnsation provisions of Scction 3700 of thc Latnr Code, I shall. forthwith comply with those provisions..
WARNING: Failurc to sc"curc workcrs' compensation covcrage is unlawful. and shall subject an employer to criminal pcnalties and
civil lines up to onc hundrcd thousand dollars (S100.m0). in addition lo thc cost of compensation. damages as provided for the
Sc.ction 3076 of thc [:bor Code, inlerest and attonry's fccs.
LICENSED CONTRACTOR
DECI.^A.RATION
I hercby affirm under penalty of pcrjury that I am licenscd under provision of Chapter 9 (comrnencing with Scction 70m) of Division 3
of the Busirrcss and Professions Code. and my licensc is in full forcc ard effcct.
License Class: License Number:
I)ate:
W
I hcrcby allirm undcr pnalty of Frjury thot therc is a conslructk n hnding rgcrcy for thc pcrforrorcc of thc work for which lhis lEmil is
issued (Scc. 3097. Civ. C.).
kndcr's Nrnrc:
[-endcr's Addrcss:
A PPI ICAT{T DECLA ILITTON
I hcreby aflurnunder penalty of perjury orrc of the following declarations:
Demolition Pcrmits-Asbestos Notification Federal Regulations (Title 40. Part6)
-Required
lrtter of Notification
-l
ccrrify thlr the fcderal rcgulstions Egrding abesloi rcmval re rct applicablc lo lhis prcixl.
-l
csrify thst I harc rc8d rhis rpplicstion 8nd ststc thql thc .bow infomtbn is cqrcl. I agrc to mmply with all City 8d County
otdimres 8nd Ststc L8ws rchting to buiHing @n$ilclio[ ard hercby aulhoria rcpresntrrircs of thi! City md County to cnts qEn the
abovc mcntioned propcrty for inspcction pur[xlscs.
Applicant or Agcnt Signutur"' t D"t",
Pcnnitcc nanrc (nrint):
Appliances
Metal Fire Place
Evaporative Cooler
Furnace
Compressor
[tIisc. Equipment
Duct Work
Pre-lnsulation
lnsulation
Smoke Detectors lnstalled
Rough Ductwork
Vents
Toilet Room I Clothes Dryer
Residential Ranqe
Other
Hood
Type I Hood
Type II Hood
Grease Duct
Fire Damper
Openings
lnstallation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rouqh Mech.
Final Test
Meter Release I ^l
FINAL tZtl2)l)t\ nr t4rffi
Notgs, Remarks, Etc
t ?/, 17,0 N0 ftntf t,V€TL D\rnc L +fT
I u
Owner:_
Carrier:
Date:_Applicant: +
ContractorK