HomeMy WebLinkAbout30141722 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Plumbing
Permit Counter: (714) 647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #1 30141722
Pin #: 64763
Proiect Address: 1242 W Pine Sta
Assessor's Parcel: 777-777-77 Lot:
Unit:
Block: NA
Bldg:
Tract: 1363
Address Range:
Historic: No
Suite Range:
Zoning: Rl
Owner:
Address:
Phone
Life Cycle Management, LLC
25 Brookline
Aliso Viejo, CA 92656
(e49) 412-821s
01 1 1 6002
01 1 1 6002
01 1 1 6002
01 1 16002
01 1 16002
01 1 1 6002
01 1 1 6002
01116002
01 1 1 6002
01 1 16002
01116002
51 602
s1 602
51 602
51 602
51 602
51 602
51 602
51 602
51 600
51 602
57770
Fee Type Amount
Water Closet 14.78
Shower/Bathtub 23.12
Sink 13.20
Clothes Washer 14.52
New Sewer (First 100') 67.1 3
Gas System 1-4 46.25
Tankless Water Heater 68.14
Hose Bibb 16.08
General Plan Update 22.9s
lssuance 57.20
Microfilm Records 3.91
Qty
4.00
4.00
5.00
1 .00
1 .00
1 .00
100
200
100
100
100
Fee
$s9.1 2
$e2.48
$66.00
$14.52
$67.1 3
$46.25
$68.1 4
$32.1 6
$22.e5
$57.20
$3.91
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation Insurance.
Carrier:
Policy #:
Expires:
Building Use:
Job Type:
Nature of Work:
Single Family Dwelling
New
New SFD
Occupancy:
Constr Type
Code:
Date:
Date:
Date:
R-3, U
VB
cPc 2016
Notes: Plumbing for construction of a new two-story SFD
w/att ADU (ADU on separate,permit) and attached 2-car
Garage.
i.ir.Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By: Chavez, Dave
Subject to Field:
Buirdins Permit #: 1 01 1 0 261 5
04t09t2020
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 sife by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
01 1 16002 s1600
01 1 16002 51602
01 1 16002 s7770
'$22.95
$503.00
$3.91
Fee Total:
Paid to Date:
Balance Due:
$529.86
$0.00
$529.86
lnspector MID#: 2019-156629 \
PLUMBING-INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS 0WNER BUII,DER DEI,CARATION
I hcrchy ullirrn undcr pcnalry of pcrjury rhar I am cxctrrpl fft)m lhc Grilrack)rs' [-i<rnse hw lirr thc followirrg E*", tSi,rX tt-s
Bu\iIcss and Prolcssion Codc): Any City ol (lrunty shich rcquires a ;rrmil lo onstruct. ilher, imptorc. dcmlish or rcFEir any
structurc. Prior lo ils issuancc. llso rcquircs lhc npplicant for such [Ennil lo l'ilc a si8ncd slatclrcnl lhiil hc or shc is liccnsed pursrunl
b thc prolisions of tlrc Contrilckrr's Liccnscd law (Chnptcr 9. ConrrEncin8 with Sstion 7Ux) of Diviskrn J of thc Busircss and
Pmfcssions Codc) or lhat hc or shc is cxcmpt thcrcfrom rnd thc hd$is lilr lhe trllcgcd crcmplion. Any viohti{)n ofSsttrn 7031.5 by any
applicsnl lbr a pcnnil suhjsl$ lhc ilpplicanl h a civil pcnahy (,f not n{)rc thrn fivc hund.cd dollilrs ($5(x)).
_1.ts owncrofthcpmFrcny.orDycnrpkryeswilhwagcsrthcirvrlcconrpcnsalion.willdothcworkudlhcslnrlurcisnot
inlcn<lcxl oroffcrcdforslc(SN.?044.BusincssandProfcssiorsCfrlc:'lhcC{nlmclor'sLiccnshwd(tcsnolapplyloanownctof
thcpn)[Eny whohuildsorirll,rowslhcG)n.aildwhodessuchso*hitrr\clforhcrsclforlhroughhisorhcrowncmployccs.
f()vklcd that such improrcnEnts arc not irilcillcd or olIcrcd for salc. lf. hrwcvcr. thc huilding or impmtcrrcnl ir skl wilhir onc )car
ol cotrDldion. thc Owncr Buiklcr will halr lhc hurdcn ofproving thilt hc or shc dil ml huikl or in{rrolc lhc pmlrrly for lhc purtns of
slcl.
_1. as owner of the proFrerty. am cxclusively contracting with licenscd conlractors lo construct the pmjc.ct (Sec. 7W. Business
and Profession Code: Thc Contractor's Licensc Law does not apply lo an owner of property who huilds or improves thereon.
and who contracts for such proFcts with a Contracto(s) licenscd pursuant to the Contractor's License [aw).
-latltcxc!llptundcrScclion-.B.&P.C.ltlrlhisrcastrn.
I )ulr: ( )rr ltt'r:
WORKERS' COMPFNSATION
DF'CLARATION
I hcrcby affirnr undcr Fnalty of Jrcrjury onc of lhc frrllowing dcclarations:
_l huve and will maintain a Certificatc of Conscnt to Sclf-lnsurc for u'orkcrs' conrFrcnsation. as pflrvidcd for by Scction -37fi) of the
l:txrr Codc. for thc lrcrformancc of thc work for which thc lrcrrnit is issucd.
_lhavcandwill maintainworkcrs'conrpensationinsurancc.as rcquircdbyScction3T00ofthcLaborClodc.forthelrcrformanceof
thc work frlr which this pcrnrit is issucd. My workcrs' conrpcnsation insurance carricr and policy nunlbcr &re:
Policy Nurnbcr: Expircs:
-l
ccrtify that in thc prfornrancc of thc work for which this pcrrnit is issucd. I shall not cmploy any 1rcrson in any manner
so ns to heconrc suhjcct to the workcrs' conrJrcnsation laws of Califrrrnia. ancl agrcc lhal if I should bcconr subjcct lo thc
workcrs' comJrcnsation provisions of .Scction 37U) of thc l-.atnr Codc. I shall. forthwith cornply with ttxrs'e provisions..
WARNING: Failure to secure workcrs' comyrcnsation covcragc is unlawful. and shall subject an cmploycr lo criminal penalties and
civil fines up to one hundred thousand dollars ($100.00t1). in addition lo the cost of compensation. damagcs as providcd for thc
Scclion 3076 of the Latnr Codc. intercst and Bttorncy's fees.
l):rlt': ,\;rplic:rrrl:
LICENSED C()N'I'RAC'TOR .
DECLARA'I'ION
I hcrchy alfirm undcr Jrcnalty of pcrjury that I anr lic',cnscd undcr prrvision of Chaptcr 9 (comrncncing u'ith Scclkrn 7fin) of Division .3
of thc Busincss and Profcssions Clodc. arxl nry liccnsc is in full forcc antl cfl'cct.
Licensc Class: Liccnsc Numbcr:
I)nte:
W
I hercby sffrm undcr pemlty of lErjury thsl ttm is I @ritruction hndirS sgercy for thc pcrfomre of thc wk fot vhich this Fmit is
isswd (SE. 3097, Civ. C.).
Lcnder's Namc:
knder's Addrcss:
APPLICANT DECI ARATION
I hcrchy allinn urrtlcr pcnalty of pcrjury onc of thc ltlllowing dcclarltions:
I)crrxrlitiotr Pcrnrits-Asbcstos Notiflicalion l:cclcral Rcgulations ('titlc 40. l'lrt6)
-Rcquircd
Lctter of Nolificaliorr
|
-l
certify thst the fedcml ESuhlio!! rguding asbeslos rcmEl re ml rpplbsbh ro this pmirr.
I|
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cmify that I havc Erd thk spplhrtion otd ststc rhat rhc sborc infomtion ir cqrEt. I sgE ao otrply wilh lll City and Couoty '
I ordimrcs sid Ststc LrB EhrlrB to buiHing sntrwliotr rod hcEby autlDrize EprcstsiiG of ahis Cily lrd Crunty lo nl6 upon 0r
I sborc rcntbrcd popcny for impcctbn purposs.
Apgrlicnnl or Agcnl Signalure:J.-
I
Permitee nnnre (print):__ _
UNDER GHOUND
Waste & Vent
Water-Under floor
Gas-Underf loor
Buildinq Sewer
ArealStorm Drain
I nterceptor/ Clarif ier
TOP OUT
Waste & Vent
Water Pipinq
Gas Piping
Roof Drain
Tub/Shower Test
Rouoh Water Heater
POOL/SPA
P-trap/Drain Line
l\Iain Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heaterlcas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary SewerlC.ap
Back Flow Device
Rough Plumbing
Final Gas Test
Meter Release
FINAL
Notes, Remarks, Etc.
,,
APPROVALS DATE ID/SIG.
Under floor
Drain
GUNDER
Waste
CIarif ier
TOP OUT
W &
Drain
Tub/Shower T est
ater
POOUSPA
ItIain
Flow
Pool
Miscella neous
Gas
Water
Flow
Final
Meter _t/!r
FINAL
Etc.
PLUMBIN G-INSP ECTOR RECORD
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