HomeMy WebLinkAbout40134792 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Mechanical
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #= 40134792
Pin #: 96594
Proiect Address: 1242 W Pine St-a-
Unit:
Block: NA
Bldg:
Tract 1363
Address Range:
Historic: No
Suite Range: 1242 & 1242 112/
zonins: Rl 4{xAssessor's Parcel: 777-777-77 Lot:
Owner:
Address:
Life Cycle Management
25 Brookline
Aliso Viejo, CA 92656
(7141 3e3-8001
01 1 16002 51604
01 1 16002 5160C
01 1 16002 51604
01 1 16002 5777C
Fee Type Amount
Furnace/Comp Combo 136.71
General Plan Update 23.79
lssuance 59.30
Microfilm Records 4.05
Qty
1.00
1 .00
1.00
1 .00
Fee
$136.71
$23.79
$s9.30
$4.05
Phone:
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires:
t29 l?tt?lr
'nnE* I 5
Ref*
Building Use:
Job Type:
Nature of Work:
Single Family Dwelling
Miscellaneous
FAU
Occupancy:
Constr Type:
Code:
R.3, U
VB
cMc 2019
',
Notes: auth on file
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
[Ah",nandez,Kathy
Date:
Date:
Date:07t29t2020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Buirdins Permit #: 1 0110261 5
Every permit issued 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.
01 1 16002 51600
01 1 16002 51604
01116002 57770
$23.79
$196.01
$4.0s
Fee Total
Paid to Date:
Balance Due:
$223.85
$0.00
$223.85
lnspector rvlD#' 2020-1 59056
M ECHANICAL-INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS
Appliances
Nletal Fire Place
Evaporative Cooler
Furnace
Compressor
[Vlisc. Equipment
Duct Work
Pre- lnsulation
lnsulation
Smoke Detectors lnstalled
Rouqh Ductwork
Vents
Toilet Room I Clothes Dryer
Residential Ranqe
Other
Hood
Type I Hood
Type ll Hood
Grease Duct
Fire Damper
Openings
Installation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rouqh Mech.
Final Test
Meter Release tl .rl*
FINAL tbl t ho a\\k(b
Notes, Remarks, Etc.-
and hcrcby
I hcrcby aflirm under lrcnalty of lErjury thot I m exempt fDm thc Contracton' Liccns Lsw for the followirg rcssn (Scc.7031.5
Business and Prcfcssion Code): Any City or County which rcquircs r [rcmit to construct, 8ltq. imprcvc. dcmlish or rcJuir rny
struclurc. Fbr Io ils issumc. rle requircs lhc Epplicanl for such pemil lo file 8 sigrcd ststcmnt thsl he or slE ir liensd pur$sfl
1o thc prcvisions of the Contmctor's Liccnsd kw (Chaptcr 9. Comrcrcing with S6lbn 7(m of Division 3 of thc Busincss md
PrrfessionsCode)orthatheorsheiscxemptlhcrcfrcmsndtheb8sisforthcsllcgcdexcmption. AnyviolationofsstbnT03l.5bysny
applicanr for a pcmit subjsts the applicsnt to 8 civil pculty of mt mrc than five hundrcd dollrs ($5fi)).
-1.
as owner of the property, or my employees with wagcs as thcir solc compensalion. will do thc work and the stnrture is not
intcnded or offered for sale (Sc.c.7044. Busincss and Profcssions Codc: Thc Contrnctor's Licensc Law does not apply to an owner of
the property who builds or improves thereon. and who docs such work himsclf or hcrself or through his or her own employecs.
provided that such improvenrcnls are not intended oroffcred for sale. If. however. the buiHing or improvenrcnt is sold within onc )€ar
of comphtion, the Owner BuiHcr will have the burden of proving ttrat he or she did rnt huild or inprove the propcrty for the purynse of
sah).
-1.and l
as owncr of the property. arn exclusivcly contracting with licenscd conlractors lo construct thc pr<rject (Scc. 7044. Business
antl
_l
Profcssion Codc: Thc Contractor's Liccnsc Law docs not apply to an owner of
who contracls for such projects with a Contracto(s) liccnsed pursuant to the
property who builds or improves thercon.
Contractor's License taw).
ll this
I hcrcby atTirrn uncler pcnalty of pcrjury orrc of thc following
-l
have and will maintain a Ccrtifrcatc of Consent to Self-lnsure for workcrs' compcnsation, as pmvided for by Section 37fi) of the
labor Code. for the perforrnarrce of thc work for which thc permit ls issued.
_l have and will maintain workcrs'compcnsation insurancc. as rcquircd byScction 3700of thc LahorCode. forthc performanccof
thc work for which this Jrcrnrit is issued. My workers' cornJrcnsation insurance carrier and plicy numtrer arc:
Policy
-l
certify that in thc performancc of the work for which this pcrmit is issucd. I shall not employ any person in any rumncr
so as to bccome subject to thc workers' comyrcnsation laws of California. and agrcc that if I should becomc subject to thc
workcrs' compensation provisions of Scclion 3700 of thc Labor Codc. I shall. forthwith comply with those provisions..
WARNING: Failure to sccurc workers'comJrcnsation coverage is unlawful. and shall subject an grcnalties and
civil fincs up ttl onc thousand dollars ($100.(XX)). in addition lo thc of providcd for thc
Scction 3076 of thc Codc.li:e s.
I hercby alfirnr under penalty o[ perjury that I anr liccnscd 9 (commcncing with Section 7000) of Division 3
of thc Business and Professions Code. and my liccnsc is in full forcc and effc.ct.
Licensc Class: Licensc Number:
Date:_ Contractor:
C(INSTRUC IION LUNDIN(: A(;f,NCY
I hcrehy affirnl undcr JEnrlly of pcrjury lhal lhcrc is a ()nslructhn hnding ugcocy for thc lErfonuncc ofthc work lo] which this lErnlit is
issucd (SG. .1097. Civ. C.).
Lrndcr's Namc:
Lcndcr's Addrcss:
APPLICANT DECLARATION
I hcreby affrm undcr penalty of perjury one of the following dcclarations:
Demolition Permits-Asbcstos Notification Federal Rcgulations (Tillc 40. Part6)
-Required
lrtter of Notification
-l
certify thut the fedcralregulations rcgarding asbcstos applicahlc to this projccl.
_l ccrtify that I have read this application and state is corrcct. I agree to all Cily and
ordinanccs and State [-aws rclating to thc
atxrvc mentioncd property for
0Applicant or Agcnt
l)crnrilcc nanrc (prinl
reprcscntalivcs of this and lo enlcr
l)ate:
Carricr:-
Exnircs:
€
Dele: +---(--
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