HomeMy WebLinkAbout102106943 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
PermitCounter. (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #:1O2{06943
Pin #: 95174
UnitProiect Address: 2007 W Dahl Lna
Assessor's Parcel:109454-21 Lot: 69 Block: NA Tract. 3356
BIdg: Address Range:Suite Range:
Zoning: RlHistoric: No
Building User Single F.mily Dwelling Occupancy: R-3, U lst FL Area Patio: 507
Job Type Patio Covor Const Type V B 2nd FL Area T.l.Area:
Natureofwork NrV - Petio Cov.rrwindowr Code: CBC 2013 OtherAreas yards Reqd
Existing Bldg. & User Std wlatt garage Flood Zone: X..0602320257J
proposed use: * of stories: Ga-ge Area vtlu'tlon: ll0'000 00
Total
O.rctiption ol Work L€g.liz. p.tlo cov.r and chango out of (7) wlndow! .nd (l).liding 91..3 door, roplece tile in(2) 3howe]3,rep.ir dem.go coiling as
req'd, .lmova unpormiltad arc end rcpairwell
Planning Condltlona:
?Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
Owner:
Address:
Phone:
Tenant
Christine Mai Nguyen
2OO7 W Dahl Lane
Santa Ana, CA 92704
(7141 467-8243
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
t
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Fire lnsp. Req'd.
Police lnsp. Req'd:
No
No Account#
Orozco, lvan
Ahangian, Kathy
Hernan dez, Kathy
Date: 06/1 412021
Date: 06/1 412021
Date: 06/1 612021
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07775002
0 77760 0 2
07776002
077760 0 2
077750 0 2
08907007
077760 02
077760 0 2
077760 0 2
Permit Fee
Plan Check Fee
Microfilm Records
lnvestigation
Penalty
SMIP - Category 1
Bldg. Stds. Revolving
General Plan Update
I ssuance
$568.36
$21 8.01
$8 10
$ 1 04.26
$261 .96
$1 .30
$1 00
$23 7e
$5e.30
$1,246.08
$0 00
$1,246.09
Total
s7607
s3600
57770
57607
57607
24000
57672
57600
57607
f,t vt
No
Landscaping lnsp. Req'd: No Flood Zone Cert. Req'd: No
Every permit issued 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.
01 1 16002 51600
01 1 16002 51601
01116002 51612
01 1 16002 s3600
01 1 16002 57770
08901001 24000
$23 79
$993.88
$1 00
$2t8 01
$8.1 0
$1 .30
Fee Totat
Paid to Date:
Balance Due:
lnspector MID#'. 2021-166752
BUILDING- INSPECTOR RECORD
SITE-WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION
I hcrcby affirm undcr pcmhy of Frjury that I m cxcmpt frcm thc Contractos' Liccns law for thc following rcasn (Scc.703l.S
Busincss and Prcfcssion Codc): Any City or County which rcquircs a ;rcmit to construct. altcr. improve. demlish or rcpair any
structurc. Jrior Io its issuancc. also rcquircs the applicant for such prmir to filc a signed statcmnl that hc or shc is liensd pursu.nt
to thc pmvisions of the Contractor's Liccnred kw (Chaptcr 9. Commercing with S$tion 7fiD of Division 3 of thc Business and
PrcfcssionsCodc)orthathcorshciscxcmptthcrcfromondthcbasisforthcallcgedcxemption, AnyviolationofSetionT03l.5byony
applicant for a Jrrmit subjccts thc opplicant to a civil pcnalty of not mrc than fivc hundred dollus ($500),
_1. as owncr of thc propcrty, or my ctnployces with wagcs as thcir solc conlpensation. will do thc work and thc structurc is not
intcndcd or ofl'crcd tbr salc (Scr.7044. Busincss and hofessions Codc: Thc Contractor's l-icensc [^aw does not apply lo an owncr of
thc propcrty who builds or itnprcvcs thcrcon, and who dcrcs such work hinrsclf or hcrsclf or lhrough his or her own enlployccs.
providcd that such improvcnrcnts arc not intcndcd or oft'crcd for salc. lf. however. thc building or improvcnrcnt is sold wilhin onc ycar
of conphtion. ttrc Owncr Builder will have thc burdcn of proving that hc or she did not build or irnprovc thc property for thc puryn$ of
sillc).
_1. as owncr of thc propcrty, atn cxclusivcly contracting with liccnscd contractors to construcl thc projccl (Sec. 7M4, Busincss
ard Prolbssion Codc: Thc Contruclor's Liccnsc Law docs not apply lo an owncr of propcrty whcl builds or improvcs thcrcon,
atrd who contracls for such projccts with a Contractor(s) liccnscd pursuant lo the Contractor's Liccnsc [aw).
-l
um cxcrnpt undcr Scction-. B. & P.C.this rcason.
Date:__b'lb'Ll
I hcrcby alllrrn undcr pcnalty of pcrjury one of thc following dcclaralklns:
_l havc and will lnaintain a Ccrtificatc of Conscnt to Sclf-lnsurc tbr workcrs'contpcnsation. as providcd for bySection 3700 of thc
l,irtxrr Codc, for thc perfornrancc of thc work for which thc pcrmit is issucd.
_l havc and will maintain workcrs'compcnsation insurancc. as requircd bySection3T00of thc LaborCodc. forlhcpcrfornurnccof
thc work for which this grcrmit is issucd. My workcrs' cornpensation insurance carrier and gllicy number are:
Policy Evnirn..
_l ccrtify that in thc performancc of thc work tbr which this pcrrrrit is issued, I shall not cmploy any pcrson in any manncr
so as to bccome subjcct to thc workcrs' cornpcnsation laws of California. and agrce that if I should hcconrc subject to the
workers' compcnsation provisions of Scction 3700 of thc l-^atnr Code. I shall. forthwith comply with those provisions.
WARNING: Failurc to sccurc workcrs' compcnsation covcragc is unlawful. and shall subjcct an employer to criminal pcnaltics and
civil fincs up to one hundrcd thousand dollars ($100,000), in addition to lhc cost of conqrcnsation. damagcs as providcd for the
Scclion 3076 of thc [:bor Codc. intcrcst and attorney's fccs.
--
DECI ARATION
I hcrcby at'llrrn undcr penalty of pcrjury lhal I am liccnscd undcr provisiott of 9 (conrmcncing with Scction 7m0) ol'Division 3
of thc Busincss and Profcssions Code. and my liccnse is in full force and cffcct.
Liccnse Class: License Numbcr:
I )utr::Contractor:_
CONS'I'RI.IC'I'I0N I,I.]N I)IN( ; A(; IiNCY
I lrcrcby aflirm udcr Fnalty of Frjury that thcrc is a construction lcnding agency for lhc lrcrtbrmncc of thc work for which l,iit lrcrmil is
issucd (Scc. 3097. Civ. C.).
Lcudcr's Naurc:
[rndcr's Addrcss:.a
3
APPLICANT DFCI ARATION
I hcrcby affinn undcr pcnalty of pcrjury onc of thc following dcclarations:
Dcrnolition Pcrmits-Asbestos Notiticalion Fcdcral Regulations (Titlc 40. Part6)
-Rcquircd
lrttcr of Notification
_l ccrtify that the fcdcral regulations rcgarding asbcslos rcmoval iuc not applicable to this projcct.
_l ccrtily that I have rcad this application and state that thc akrvc inforrnation is corrcct. I agrcr to cornply
ordinanccs and Statc [:ws rclating to building construction. and hcrcby authorizc rcprcsentatives of this City
I
abovc nrcntioncd property for
with all City and County
and County to cnter uJxln thc
e-l$ -ilApplicant or Agenl
Ifcrnrilce nnnrc
Set Backs
Forms/Steel/Holdowns !x7 at DnatdFr Per\ro W\rY(
Erection Pads
UFER Ground
SLAB Floor
Su bf Ioor/Ve nVl nsu I ati o n t
Roof Sheathinq I )Ll lrt
Shear Wall I ,/
Framinq r
17 I tV ,lLt l>{4w I
lnsulatio nlEnerqy -,
Drvwall
Ext./lnt. Lath
Brown Coat
I\/asonrv
Poo! Fence
T-Bar
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
tl D-
FINAL /17 ?(utw 5v/
Certificate of Occupancy
Noteg, Rpmarks, Etc.I
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