HomeMy WebLinkAbout30141723 - PermitProiect Address: 1242 1l2W Pine St-a
Assessor's Parcel: 777 -777 -77 Lot:
Unit:
Block: NA
Bldg:
Tract: 1363
Address Range:
Historic. No
Suite Range:
Zoning: Rl
"fr^
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Plumbing
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Perrit #:"3o'l4172g
Pin #: 31 2EO
Owner:
Address:
Phone
Life Cycle Management
25 Brookline
Aliso Viejo, CA 92656
(e4e) 412-821e
01 1 1 6002
01 1 1 6002
01 1 1 6002
01 1 1 6002
01 1 1 6002
01 1 1 6002
01 1 1 6002
01 1 1 6002
01 1 1 6002
51 602
51 602
51 602
51 602
51 602
s1 602
51 600
51 602
57770
Fee Type Amount
Water Closet 14.78
Shower/Bathtub 23.12
Sink 13.20
Cfothes Washer 14.52
Gas System 1-4 46.25
Tankless Water Heater 68.14
General Plan Update 22.95
lssuance 57.20
Microfilm Records 3.91
Qty
100
1.00
2.00
2.00
1 .00
1.00
1.00
1.00
1.00
Fee
$14.78
$23.12
$26.40
$29.04
$46.25
$68.1 4
$22.e5
$57.20
$3.91
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
tsuilding Use:
Job Type:
Nature of Work:
Planning Conditions:
Single Family Dwelling OccuPancy:
New Constr Type:
New 2nd story attached ADLCode:
Date:
Date:
Date:
R-3, U
VB
cPc 2016
Planning Approval By:
Plan Checked By:
Permit lssued By: Chavez, Dave
Subject to Field:
Buirdins Permit #: 1 01 1 0 261 6
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 site by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
lnspector MID#: 2019-156679
04t0912020
Account#
Misc. Receipt:
Misc. Receipt.
Misc. Receipt:
Total
Notes:
Fee Total:
Paid to Date:
Balance Due:
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
$22.95
$264.93
$3.e1
Plumbing for a new second-story ADU attached to new
SFD (on separate permit).
$291 .79
$0.00
$291 .79
a
PLUMBING-INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER ETM.DER DELCARATION
I hercby affrm undcr ]rcnally of pcrjury thst I m cxcmpt ftom the Crntrscton' Lkc[s hu for the following rcsrcn (Sec.7031.5
Busincss rnd Pmfessirn Code): Any City or County whbh requircr s pemit to @nstruct. rlt6. itrprcE,cdcmlish'or rtpair any
strucluB ]rhr lo its issumc. alrc rcquiEs the applbut for such Jrmit to filc s rigrcd slalcrcnl thrl hc or drc k liccnsd pumsd
to thc prcvisk ns of thc Conlrrctor's Liccnred [rw (Chapter 9. Collmrcing with Setion 7000 of Divbion 3 of thc Busiress and
PrcfcssionsCodc)orthstlrcorsheiscxcmpttlHefromaidthebosisforthcrllcgcdexemption, AryviolstionofsetbnT03l.5bysny
applicant for 8 Fmit subjrrts the applicsnt to r civil pcn.lty of nol mrc thm fivc hundrcd dollEs (S50O).
_l.as orvncrol'thcprol)crly.ortnycnrployccswithw:rgcsaslhcirsolcconrpcnsalion.rvillrkrttrcworkarxlthcstruclltrcisnot
inlcrulctl or oll'crctl lirr salc (Scc.7044. Ilusincss arrtl Prol'cssions ('odc: 'l'hc Cirrrlrilclor's Liccnsc l-aw docs not apply lo att owncr ol'
thcpnrJrcrty whobuildsorirrrJrrorcsllrcrcrxr.andwh()rkrcssuchurrrkhirnsell'orhcrsclforlhroughhisorhcrownemployccs.
provitlcd thal such irnprrvcrtrnls arc rxrl iltlcndcd or olll'rcd ltrr salc. lf. hos'cvcr. tlrc huikling rlr irrrprrlvcntnl is sold u'ithin onc ]'c:.rr
ot'corrphtirur. lhc Owncr lluildcr will havc thc burdcn ol'proving lhal hc or shc rlirl not huikl or irrprovc lhc pnrpcrty ttrr tlr'purposcol'
salc).
-1.
aso\r'ncrol'lhc propcrty. arncxclusivclycontractirrg with liccnscd conlrilcl()rslo conslruct lhc projccl (Scc. 7014. Ilusirtcss
artrl Pnrll'ssirrt(bdc: f'hcColrlraclor'sl.iccnscLarvdocsrrotapplyl()ilno$'ncrol'prolrcrtys'hobuiltlsorintprovcslhcrcon.
artrl who contracls lbr such projccls with a Contraclor(s) liccnscd ;lursuartl to lhc C'ontraclor's Liccttsc [.aw;.
_l arn cxcrnpl undcr .Scction_. Il. & I'.('. lirr lhis rcasorr.
l )lle ( )u rtt.r.
WORKERS' COMPENSATION
NECLARATION
I hcrcby alTirm under pcnalty of perjury onc of thc following declarutions:
-l
havcantl will maintainaCcrtificutco[ConscnttoSclf-lrrsurclirrworkcrs'corrrpcnsalion.ils providcdforbyScctionSTfi)ofthc
Llbor Codc. lirrlhc pcrforrrurncc of thc work for which thc pcrnril is issucd.
_l have and will nrainlairr rvorkers'corrrf^-nsalion insurancc. ils rcquired hy Scclion -37(D of lhc l;rbor Codc. for llrc pcrlormancc ol'
thc work tor which this pcrrnit is issucd. lVly w<lrkcrs' conrpcnsation insurancc carricr and grlicy nunrhcr arc:
Policv Numbcr: Exoires:
_l certify lhat in thc pcrfornunce of the work for which this pcrmit is issued. I shall not crnploy any pcrson in any manncr
so as lo heconrc subjcct to thc workers' compcnsation laws of California. and agrcc lhat if I should becornc subject to thc
workcrs' compcnsation prnvisions of Seclion 37fi) of thc labor Codc. I shall. forthwith comply with thosc provisions..
WARNING: Failure to sccure workers' comlrcnsation coversgc is unlawful. and shall subject an employer to criminal pensltics and
civil fincs up to one hundred thousand dollars ($100.0001. in addition to the cost of com[rcnsation. darnages as providcd for the
Scction 3076 of thc l-abor Code, intercst and attorncy's fccs.
l):rlc: A;lplicunl:
LICENSED CON'IRAC'I'(IR
DFCLARA'TION
I hcrcby atllrrn undcr pcnalty of pcrjury lhal I am liccnsr'cl under provisiort of Chuplcr 9 (cornnrcrtcing witlr Scction
ol' thc Busirrcss and Prol'cssions Codc. and nry liccrrsc is in lirll ftrrcc and cftl'cl.
D
I
7m0) of Division 3
License Class: Liccnse Number:
('oltl rirclor.
W
I hcrcby aIfirm under pnslty of perjury thal thm is r constructk n hnding agency for the [Efomnce of thc work for which lhis Imit is
issued (56. 3097, Civ. C.).
Lendcr's Nanrc:
l-crttlcr's Adrlrcss:
APPLICAN'I DECLARATION
I trrcby alTirrn under pcnalty of pcrjury onc of lhe following dcclarations:
Dcrnolit ion Pcrnrils-Asbcslos Notillcat ion Fcdcral Rcgulations (l'it lc 40. Part6)
-Rcquired
[-cttcr o[' Noliticalion
-l
cenify thsl Ihe fcdcnlrcgulations rcgording rsbcstos rcflrval trrc not applhshlc to this projel.
-l
enify lhal I havc rcad thir application ald state that thc abovc informtion is corcl. I aere to omply with all City and County
ordinsres dd Stste tjws rclating to buiHirrg conslruclk n. &d hcrcby sulhorirc rcpresilativcs of lhis Cily rnd Counly lo cnts utnn thc
abovc rentiorcd pmpcrty for irslrcrtion purFn$s.
Appllml or ASenl Slgnolurc: Drle:-
Permllee name (print):
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underf Ioor
Buildinq Sewer
ArealStorm Drain
! nterceptor/ Clarif ier
TOP OUT
Waste & Vent
Water Pipinq
Gas Pipinq
Roof Drain
Tub/Shower Test
Rough Water Heater
I
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heater/Gas Line
I
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary Sewerl}ap
Back Flow Device
Rough Plumbing
Final Gas Test
Meter Release
FINAL
Notes, Remarks, Etc.
I
!
a
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ELECTRIC AL-INSPECTOR RECORD
DATE ID/SIG.COMMENTSSite-Work
round
th
Fountains
/Low
Fire Alarm /
Cable
Buildi
Under I Flaor
I I
Air
&
-Bar
Meter
Etc.
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