HomeMy WebLinkAbout101104253 - PermitBUILDING PERMITCity of Santa Ana PROJECT
ADDRESS:414 N EIPTRTNI, CT
SUITE #.SUITE
RANGE:JOBTYPE: MUI,TT /RR
6t 1-663 *ADDRESS
RANGE;PAR REROOF
NATURE
OF WORK:
LEGAL
OESCRIPTION: Lot 1 Bl@k NA 1 O-UNIT CONDO/RESIDENT
NO. OF EXISTING
BUILOINGS & USE:
rr'ct 10g61 VN
TYPE OF
CONSTRUCTION:R-1OCCUPANCY
GROUP:
I hcrcby atfirm undcr p.nalty ot pcriury that I am cxcmpt from th6 @ntractoE
lic.n$Jaw tor thc follming rcasn:
(*atontOa4A, l, as ilner ol thc propcrty, or my.mploycos with mgcs as
thcir elr @mp€ngtion, will do thc rcrk, and tho structurc is not intcndod or
with
o.,"'? -j-9}
S*tion
ii-mscd
70448, l, as mer of
contracloE to construct
offucd for slc.
405-081-23ASSESSOR'S
PARCEL #:0
TENANT IMPROVEMENT
ANO / OR REMODEL AREA:
FL@OZoNE: X-0
owNER: sHADow wooD H.o.A.0
NEW / AOOL,
1st FLR. SO. FT 0
NEW / ADDL,
OTHER SQ, FT.:
0NEW / ADOL.
GARAGE SO, FT611 N BRISTOL ST/OFFICEADORESS:0NEW / ADOL.
2nd FLR. SO. FT
c-5 /sP-t /lZONING VALUATION 2958.00SANTA ANA, CA 92703
PHoNE: f14/542-3525 APPROVAL BY:
PLANNING KH DATE]07 /09/97
CONTRACTOR:BLDG. SAFETY
PLAN CHECK BY:DATE;
KH YJhPERMIT
ISSUED BY,DATE: 07 / Og / 97ADDRESS:
NII/PROVEMENTS
REOUIRED NLANOSCAPING
REOUIREO
PHONE
* .)wNFp *
STATE
LICENSE #:TYPE:
SANTA ANA
BUSINESS LICENSE #:
I hcreby affim undcr pcnalty of p6qlury onc ot thr lollwing Delarations:
I haw and will maintain a Cerlificate Of Consant to Self-lnsurc lor Workes'
e-omp.nsation, as prryided for by Scclion 37OO of the Labor Code, tor thc
pat omancc of thr rcrk for which this Pcrmit is issued.
_l harc and will mainlain Workc6' Componstion lnsurancG, as required by
S€ction 3700 ot the Labor Code, lor the pertormancc of thc rcrk for which this
p€rmit is issucd. My Workers' Compensation lnsurance carier and policy number
P^li." N,,-h..'
(thitection nred not bc completed if thc permit is lor Onr hundred dollaE {$10O}or,l6ss).c
that in the performance ol the rcrk to. which this permit is issued, I
any peEon in any manner $ as to become sub.i{t to the WorkeB'
WARNING: Failure to secure Workers' Compenstion cryerage is unlawful, and
shall subject an employer to criminal penalties and civil fines up to onc hundred
thousand dollaE ($100,000), in addition to the cost of compsnsation, damages as
prryided tor in Srction 3706 ol the Labor Codo, interest. and attorne)/s fces.
are
prryisions
torthwith those
of Calirornia,agree that rf I
Section 3700 1
subject to the
Code, I shall
ENGINEERYARCHITECT:
ADORESS:
PHONEI
I hcrcby affirm undcr penatty o, p€rjury that I am lic.n*d undcr pryisions of
Chapter 9 (commcncing with Section 7000) of Division 3 of thc Business and
Plolcssions Codc, and my liccnse is in tull lorcc and 6ffect.
Licanu Class:_ Liccnsc
Oats: Cohtractor:LICENSE #:
PARTIAL REROOF WB.U.R. AND APPLY NFLAT AREA ONLY
HANDOUT GIVENNO TAG
PRE-INSPECTION10114252
JOB DESCRIPTION:
PAID ON
o
B
-REMOVEU. R. TO
City of Santa Ana
Building Safety Div. M-19
P.O. Box 1988
Santa Ana, Ca.92701
206 W. 4th. Street
2nd Floor
(714) 647-s800
/r
EW
AMOUNT75.0020.000. 000.000. 000. 000.000.000.00
FEE75.0020.000.000. 000.000.000.000.00
0 .0095.000. 0095.00
FEES:
a TY
1
1
PERMIT FEE
ISSUANCE
FEE TOTALPAID TO DATE
BALANCE DUE
I hucby affirm under p.nalty of periury that there is a construction lending agoncy
tor thc p.rformancc ol thc rcrk for which this pcrmil is issuGd Scc. 3097, Civ. C.)
O.molition Parmits.Asbcstos Notitication Fedsral Ragulations OitlG 40, Part 6)
_Rcqurrcd Lcttcr o, Notifietron.
thc tcdaral ragulations rcgarding asbastos rcmml ar€ not
projcct.
@rcct. I with allto
\
ol this City
Durffies -.+orlinspcction
_lpcnity that
appli6abtc to ttris
/ tccrttyrnat
\r!
I hevc rGad this
and County ordinanccs and Stalc laE
and County io
relating to
Pcrmittcc namc (print):
Applicant or agcnt sig.
OWNERAULDER DECT-ARATION
WORKERS COMPENSATION DECI.ARATION
LICENSED CONTRACTORS OECLARATION
CONSTRUCTION LENDING AGENCY
APPLICANT'S DECLARATION
Mailing Addrcss Puhlic Counter
This permil shall expire by limilalion and become null and void if the work aulhorized
by thjs pemil is nol commenced within 180 days from lhe date of this permit, or if lhe
work aulhorized by lhis permit is suspended or abandoned for 180 dairs, al any time
afrer work was commenced, ln such case a nernr permil shall lirst be oblained 6efore
such work can be recommenced.
PERMITNO. rolr+253
Account No.011-01-5911 - Pemit Validation Cs-6o5
/A9/97 3:31P1't - mbfltbroac0rEJn
AL
f rr,.o,"oo, L
" Lr/
s>
Address UniUSuite
BUILDING ..- INSPECTION RECORD
Site Work Remarks Date Signature t.D
Setbacks
Forms/Steel /Holdowns
UFER Ground
Slab Floor
Steel
Pool Fence
Masonry
Building Remarks Date Signature t.D.
Under Pinninq (floor ioist)
Foundation Ventilation A
Roof Sheath
lnsulalion / Enerqy
7->s41 4a
Dry Wall
Erterior Lath
Brown Coat
T-Bar
Handicap Requirements
FRAMING
FINAL only)
FINAL (Tenant lmorovement)
Io./(7/7k1 ./d;u,,.*39Notes, Remarks, etc.:
- ^ . q-l .ara
^ra<r Rseix.OWNERAUILDER DECLARATION
I hereby affirm under ponalty of per,ury thal I am exempl from the Contractors' License Law for lhe follouring reason
(Sec. 7031.5 Business and Professions Code): Any Cily or County which requires a p€rmil lo conslrucl, aJler,
improve, demolish, or repair any struclur€, prior lo its issuance, also requires the applicanl for such permit lo lile a
signed stalomenl that he or she is licensed pursuanl lo lh6 provisions of lhe Contraclors' License Law (Chapter 9,
commencing wilh Section 7000 of Division 3 of lhe Business and Profersions Code) or that he or she is exempt
therefrom and lhe basis for the alleged exemplion. Any violation of Sec.tion 7031.5 by any applicant for a permil
subjects the applicant lo a civil ponany of nol more lhan live hundred dollars (i500).
_1, as owner of the property, or my employees wilh wages as lheir sole compensalion, will do lhe urork, and the
slruclure is not inlsndod or ofierod for sale (Sec. 7(X4, Business and Professions Code: The Conlraclors' Licenso
Law does nol apply to an or mer of lh€ prop€rty who builds or improves thereon, and who does such v\rork himseJf or
herself or through his or her orvn employeer, provided thal such improvemonls ere nol intendod or ofiered for sale. lf
horuever, the building or improvemenl is sold within one year of complelion, tho Or,vner-Builder will have the burden
of proving lhal he or she did not build or improve for lhe purpose of sale).
_1, as o$,ner of th€ property, am exclusively conlracling with liconsod contrac,lors to conslruc-l lhe projecl (Sec.
7(X4, Business and Professions Codo: The Conlractors' Licon6e Law doos not apply lo an o$,ner of property who
builds or improves lhereon, and who conlracts for such p.oiec'ts with a Conlraclo(s) liccneed pursuant lo the
Conlractors' Licente Law.).
_l am oxompl undor
Dale:_ Orvner:
B. E P.C. for this reason.
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