HomeMy WebLinkAbout30139435 - PermitAssesso/sParcel: 109-443-16
l,Jnil:
Block: NA
Address Range:
Historic; No
q
city of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CAg?702 Plumbing
Permit Counter: (714\ 647-5800 lnspection Requestsr (714) 667-2738 lnspector Section: (714) 647-5853
Owner:
Address:
Contractor;
Address:
RAFAEL CHAVEZ
1IO5 S SHELLEY ST
Santa Ana, CA 927043237
Futura Energy lnc
9211 Greenleaf Avenue
Santa Fe Springs, CA 90670
(562) 941-7459
Fee Type Amount
01'116002 51602 Wtr Hlr (Res up to 50 g. 21.42
01116002 5160C General Plan Update 21.25
0'1116002 5'1602 lssuance 52.98
Qty
1.00
1.00
1.00
Fee
$21 .42
$21.25
$s2.98Phone
Tenant Name:
B(tEh+343772 - 5/15/2018
off irel CTYH Trnns+: 26Acct+: Ref+:
Rcpti:02264353 - 5/15/2019
Tnsnsqct ion Totsl
lof
13943i
339 All
.63State Lic #: 945827
Lic Type: C-35, B, C-10, C-20
Bus. Lic #: 351485
Workers' Compensataon lnsurance:
Carrier: Property & Casualty Co of Hartford
Policy #: 76WEGGB7317
Expires: 0712512018
ID: HGAR(:I
30
1
t91
Futurc Energv Inc
Generol Plon lrpdote Fee
0llr61102- 5r6uri00tl-
PIu b ins
uI116002- i1602000-
ICL (:heck $03636
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
Water Heater
Occupancy:
Constr Type:
Code:
R.3, U
VB
cPc 2016
zunisa,arrisN/
Date:
Date:
Date:05t15120't8
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Every permit issued shall become invalid unless the work on the site
authoized by such permit is commenced within 1 80 days aftet its
issuance, ot il lhe worl< authorized on the site by such parmit is suspended
or abandoned fot d pe od of180 days aftet the lime the wo* is
cofifienced.
lnspector MID#: 2018-143359
01 '1 16002 5't600
01 1't 6002 51602
$21 .25
$74.40
Fee Totat
Paid to Date:
Balance Due:
$95.65
$0.00
$9s.65
Permit #: 3O139435
Pin #: 66092
Project Address: 1105 S Shelley St Bldg:
Tract 3353
Suile Range:
Zoning: R1Lot: 40
Phone:
Notes: Change out. Hand out given.
PLUMBING-INSPECTOR RECORD
APPROVALS DATE ID/SIG.OWNEII IIUILDER DELCARATION
I hcrby al6rm u id$ pcmhy or prjxry rhd I ar .rcmfl fon rhe Coorrlcio6 Li.cn* ljw ld rh. rollrwins rcisn ( Scc.r0.l l.5
ausircrs nnd Ptufusrn,n C.dc): Any ciry or Cou ry whi.h ruquirs r ltnnir ro (nriru.r. lllci nnprorc. dcmnhh nr rcnrn rn,
slddur. ri)rk) n\ irsunftc. nl$ rcquncs rk+ rt'rli.,trr for (u.h l*rn h filcr ri8trcd s{cmnt lhalhcor shc is li(.n{J Fr\uanr
ro thc F)!isn,n\ of rlf, G,nt,.roas Li.cn{d llw (Ch4rcr 9. C. !nc..in! wirh Sc.rion 7m(}.r Divhiotr :l ofrhc lrusinc$ rnd
Pdtsrio.s Codc) or Ihd lEorshc hcxcmp[hccrio Mdrhc bish rbr ihc.lL8.n crcmllion AnyriollrionofsccrbnT0:ll5byany
artli.tur nrnpcnnir suhjcct\ rhe {'rlicrnr ro I cilil Itfulry of n.r nuc rhln fivc hr.drcddollrl(S50o)
-!.
as owrcr oa rh. polf,ny, or my chployes oirh w,8.s trs rhcir $lc strlp€nerion. vill do ltE so* dd rlE surEr@ G Fr
iillor&d or orced lor slc (56- 7044. B$im$ lrd Ptofcssions Codc: Thc Cont8dur's Littre Lrw d@r nor loDly to e os( of
rhc pqEny who h(iildr or inp,o@\ oEstr ard qlb dG Mh eort hidrll or lEBlf o, rhreu8t hai or tE. own cnplords,
provid.d rhrl .u.h inpEkmnk m mr i cnd.d o olidrd td $le. lt howM. dE tuiui.e o irlorm h sn wirni, om ,sol@r{,Lt4 tr O{n.. Builrer wiu lbw th trrdcn ofFoving rhd lr or shc dil mt bild or i'r{rcr dE l'DFry fr, ui purlo* of
-1.Iovrcrotth.lrtp.ny.amcr.lusiv.lycont.&'irgwnhleoed.o.a.lo6roconstrudltupmjcd(SN.'7044.Blrirc$rnd hohssim Codc: Th. Conrmlols Lkcnsc kw dcs an amly lo .n oqncr oaprorErry who blilds or impolcs rhclcon.
ond wk) bmEcrr for such l6,xl3 eirh , conracrods) ltcnsd puala 16 rrE comra.ktrt LieM tlw).
I am.xcnrfl nndrr sNtio
D.l.: ____ (rrn.i: _ _ ,woRKF[r coMPFi{:siTiiiN
DECI,AIdIIAN
Ihct byrmrnuoderpcn lryolpcrjuryon..lrhcfolLwingdccldariorsl
Ilrvc.idqillnrinraiinCcnfic,.ofCdNciir,Scliln\urcl,nNorkcrr(nnn(Nr .rslloridcdktrbyS(lionl?lx)olrhc
hlxtr Crxlo. nrrhc p.rtun Jtu.ofrhc sork ror wh'rhrl[ ncnnii n is{rcd
_l hNe and will nrinrain *ortcN compcnsrtion inslBicc. trs rcqlircd by Sdion 1700 olrhc kbo. Codc. a.i the pe.t()@kc of
thc wort for which lhiq pcmil n
+i-I -t -2b-1<
I ccnifyihd in rh. Frrorm(. of fi. wort for whichrhirp.ron is issucd. ! sholl not cnploy any !.son i.onynrnncr
h N lo bccom subr..l ro rhc s*m onwtrstion bws of Colifomig. lnd u8E. rh itI sholld hccdm slbist brhc
wo*c6 sm!.nsalion lmvisionsofScdion 1700 ofth.l,bo Codc,I rhall. fonhenhcddtly wnh rho* tmlni,ni.
lute b sm {ork rc mn{x.qrior rov.nec ir unl,{tu|, ,nd shall subrccl !n cmphrr lo siminal r*iBlti6 a.d
ok huddRd rhuu\xtrd dollm ($l(l. in lddiri.r ro rh. con ofcomF.slion, drmgcs I !rcvidcd for lhc
".,.,
t)--
!.[!]-A]:!-11!lll
o, rl( lln{rc\\ n(ll},na\\ior\Co(|.- rn,lf,y li.cn\c N ir hnlturr. rtr!]_rr.r qfqsL\c- 3v/b -\
c()Ns'rRtjc'mlN I UNDIN(; A(;t'NCY
I hcruhy arftnr ntulcr l)cnrlryolFrju.yrhar rhcrc i\ a.on(n,.rion Lnii.s r!.oc! lnr iLc !.rronDrcc ol rhr \ork rit Nhi.h rhis liflnir i\
is\ucd rsc. 1097. ci( c )
AIILICANLDSCI.AAAION
I lmhyanjnnu Jer pcn0lty orI,-ljury on. oflhc lolh{nr8 dLrl.rarior\:
D.nmlirion PcrmirsAsb.ios Norilicdio. FrdcrrlRcAul io.r ( l irlc 40. Pfi6)
-Rcqutcd
L.trcr oi Noin.ation
-l.tnili
rhrr rhc ndcralr.rtlii,ns rsrdira r\bt{o\ rcnrklrrr ior rtrrli.rhr. k, rh'\ ln,jL{r.
l.difyrhar I Mvc rcod thn aptlk,rion ind nntc rhalhc abrc i.formrion is.orer. l.8N ro conll]ly sith.U Ciry and C.lnry
oniin.nc.s Md Sbrc trws Nhling lo bu horiz.rcI,c*ntalivcsoflhisCilylndColnlyrocnr$ug,n t
!h c Drtrrbncd lI)p.nyi, in
,\pplirnnl or /1Acnl Sigtr$lum L ,"" 6 - 16-'16
UNDER GROUND
Waste & Vent
WaterUnder f loor
Gas-Underfloor
Buildinq Sewer
I nterceptor/ Clarilier
TOP OUT
Waste & Vent
Water Piping
Gas Piping
Tub/Shower Test
Rouoh Water Heater
POOL/SPA
P-trap/Drain Line
l\4ain Drain/Pool Pipinq
Pool Heatericas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary Sewer/Cap
Back Flow Device
Rough Plumbinq
Final Gas Test
Meler Release I \
FINAL stl't llD \Y4-?{+
Notes , Remarks, Etc.
COMMENTS
Area/Storm Drain
Roof Drain
Fill Line/Back Flow
--'-1-
knd.r'( AJdE3t
-
II
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