HomeMy WebLinkAbout101107173 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: 1O1107173
Pin #: 71998
Project Address: 1810 E Albion Ave
Assessor's Parcel: 390-521-1 3 Lot: 13
Unit:Bldg: Address Range:Suite Range:
Zoning: R1
nvtr
Block: NA Tract: 4714 Historic: No
Building Use:
Job Type:
Nature of Work:
Existing Bldg & Use:
Proposed Use:
Single Family Dwelling
Alteration
lnsulation
Sfd w/att garage
Occupancy:
Constr Type:
Code:
Flood Zone'
# of Stories:
R-3, U
VB
cBc 2019
x-06023201 64J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Totat
Patio:
T.l.Area:
Yards Req'd
Valuation: $9,000.00
Description of Work: lnstall 1500sf of R-38 insulation in attic
Planning Conditions:
Owner:
Address:
Phone:
Tenant
Elizabeth Mc Cauley
1810 E ALBION AVE
Santa Ana, CA 927056801
(7141 633-1 384
Contractor: Enery HVAC Services lnc
Address: 181 30 Calvert St
Reseda, CA 91 335
Phone: (818) 300-6519
State Lic #: 1056299
Lic Type: C-36, C-20
Bus Lic #: 373765
Workers' Compensation I nsurance:
Carrier: State Fund
Policy # 9261315-2020
Expires: 0912512021
Engineer:
Address:
Phone:
License #.
Architect /
Desiqner:
Address:
Phone:
License #:
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd. '
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping Insp. Req'd
Amsden, Julie
Date:
Date:
Date: 0710812021
Subject to Field:
Misc Receipt
Misc Receipt
Misc. Receipt
077750 0 2
0777600 2
0777600 2
07L760 0 2
077760 0 2
57607
57770
57672
57600
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
$172 64
$4 05
$1 00
$23 79
$5e 306
No
No
No
Account#TotalFire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01116002 57770
$23 79
$231 94
$1 00
$4 0s
Every permitissued 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
Fee Totat
Paid to Date:
Balance Due:
$260 78
$0 00
$260.78
lnspector MrD# 2021-167329
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hcrcby al-frm undcr pnalty of frcrjury that I am cxcmpt from tlrc Contractors' Liccnsc [:w for the following rcason (Sec.7031.5
Business ard Profcssion Code): Any City or County which rcquires a permit to construct. ahcr, improve, dcmolish or rcpir any
structurc. prior to its issuance. also rcquires the applicant fbr such pcrmit to frle a signcd st&tenrcnt thal hc or shc ls liccnscd pursuant
to thc provisions of the Contractor's Licensed Law (Chaptcr 9, Commencing with Scction 7000 of Division 3 of thc Busincss and
Profcssions Code) or that hc or shc is exempt therefrom and thc basls for thc allcgcd cxemption. Any violation of Scction 7031.5 by any
applicant for a pcrmit subjccts thc applicant to a civil penalty of not morc than five hundrcd dollars ($500;.
-1,
as owncr of thc propcrty. or my employces with wagcs as thcir sole compcnsation. willdo the work and the strrrcturc is rnt
intcndcd or otTcrcd for sale (Scc.7044. Business and Prolbssi<lns Code: The Contraclor's Licensc [:w does not apply to an owncr of
the property who builds or improvcs thcrcon and who docs such work himself or herself or through his or her own employces.
providcd that such improvcnrcnt.s are not intendcd or offcrcd for salc. lf. however, thc building or inprovcnrcnt is sold within one )rcar
of completiott thc Owncr Buiklcr will have the burden of proving that trc or she did not build or improve thc proprty for thc purposc of
sab).
-1,
as owncr of the pmpcrty, am cxclusively contracting with liccnscd contractors to conslruct thc prolct (Sec. 7W, Busircss
and [lofcssion Codc: Thc Contractor's Licensc Law docs not apply lo an owncr of propcrty who builds or improvcs thcrcon.
and who contracts for such pr<ljccts with a Contractor(s) liccnscd pursuant to the Contractor's Licensc [.aw).
_l am exempt undcr Scct B. & P.C. for this reason.
f 1., r...
YQBf,EESIOMS$SAIIAN
DECI.AEAtrON
- I hcrcby affm undcr [rcnalty ofpcrjury ore ofthc following dEluarions:
-l
haw anC will roinlain a Ccnificate of Consnt to Self-lnsw for wrkqs' orpcnsation. ai provided for by Strtion 3700 of thc
Labor Codc, for thc pcrforlrec of the work for which the pcmit is issued.
k'4t n"t"
"na
*itt *intrin workcrs' @mpensation insurarcc, as rcquired by Sstion 3700 of lhc Labor Code, for lhc prfomre of
I
thc work f<rr which this --Xt;rkcrs' cornpcnsation insurance carricr and plicy number are:
c
*rr*, f z6[3/J- Expircs:r,/.r/z t
fty*nify that in the pcrfortrulncc of the work for which rhis pcrmit is issued. I shall not cnrploy any Frerson in any manner
so as to bccomc subjcct lo thc workers' compensation laws of California, and agrce that if I should bcconrc subject to ttrc
workers' compensation provisions of Section 3700 of the latnr Code. I shall, forthwilh comply with those provisions.
WARNING: Failurc to rrccurc workcrs' compcnsation covcragc
civil fincs up to one hundrcd thousand dollars ($100.0ffi). in
ls and shall subjcct an cmployer to crinrinal Jrcnaltics and
o[ conrpcnsation. danragcs as providetl for thc
Codc, intcrest and attorncy's t'ccs.
Applicant:
DECI ^ TIATION
I hercby affirm under pcnalty of pcrjury that I am licenscd undcr provision of Chaptcr 9 (comnrcncing with Section 7000) of Division 3
of the Business and Profcssions Code, and my liccnsc is in full force and effect.
I iccnsc ctorr, C-'ZO
-Liccnsc
o 2?f
Z Contritctrlr:urr/t 4 c\
CONSI?UCTION LEIDING AGENCY
I hcrcby allirm urdcr 1rnally of JErjury that th@ is r constructhn lcnding agcrcy for the 1uforrucc of the work for which this Jrcrmit is
issct (Sc. 3097, Civ. C.).
bndcr's Nam:
l-cndcr's Addrcss:
APPLICANT DECLARATION
I hcrcby allinn undcr pcnalty of pcrjury one of thc following dcclarations:
Dcmolition Permits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40. Part6)
_Required lrtter of Notification
I ccrtifv that lhe
lAcertify that I have
fcdcralrcgulations regarding asbcstos rcnnvalarc not applicablc to this projcct.
rcad this application and state that with all City and County
and County to enter upon thcordinances and Statc Laws rclating to
abovc nrcntioncd propcrty for inspcction
Tpplicant or Agent
\Permitee name At
Z(
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf Ioor/VenVI ns u latio n
Roof Sheathing
Shear Wall
Framing
lnsulation/Enerqv
Drywall
Ext./lnt. Lath
Brown Coat
lt/asonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif .
I I tl ^u s7-
FINAL lll ,l'u Dffwo /
Certificate of Occupancy I
Notes, Remarks, Etc
\
/
\
Rev. 0B-07-201 5
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