HomeMy WebLinkAbout30122877 - PermitCity of Sqnta Ana
,Permit Counter: (714) 647-5800
20 Civic Center Plaza (M-1 9), Santa Ana, CA 92702 Plumbing Permit #: 30122877
Project Address: 2004 N Ross St
Assessor's Parcel: 002-103-05 Lot: 8
I nspection Requests : (7 1 4) 667 -2738 f nspector's Section: (714) 647-5853
Suite Range:
Zoning: Rl
Unit:
Block: NA
Bldg:
Tract: 788
Address Range:
Historic: No
Owner:
Address:
RUBENR&BEATRICERAYA
2004 N Ross St
Santa Ana, CA 927062506
(7141 550-0584
Fee Type Amount
Water Closet B.7SBathtub 8]sShower B.7SSink 8.75
Sewer Alter/Repair 17.50
Extend Gas Line ZS.ls
Tankfess Water Heater ZS.T5lssuance 35.50
Notes:Flurrrb ins
Cherk
Fee Total:
Paid to Date:
Balance Due:
Bstchl!4{05 - fil/Oll0g I0: E06ARqffice! CTYH Trnns*i Zll 1 of sAcct*: nef+: S0l ZZS,Rcpt*:00218341 - llll1ggg {:51 pn
Tronsoct ion Totol ft;5S3.+a
RUBEHR&BEATRICERAYA
Qty
1.00
1.00
1.00
2.00
1.00
1.00
1.00
1.00
Fee
$8.75
$8.75
$8.75
$17.50
$17.50
$25.75
$25.75
$35.50
$148.25
$0.00
$148.25
Phone:
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires:
Building Use: Single Family Dwelling
Job Type: Addition
Nature of Work: Addition
Verduzco, Vior"il{
L
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
R-3
V-N
cEc 2004
I rt7
t l4g .25
S1r535.46
Planning Conditions: No Field Changes Without Planning Approval.
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
01107 t2008
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Building Permit
This permit shall expire by limitation and become null and void if the wo* authoized by this permit
is not commenced within 180 days from the date of this permit, or if the wotu authoized by this
permit is suspended or abandoned at any time after the wofu is commenced for a period of 180 days.
Before such work can be recommenced, a new permit shall be first obtained fo do so.
Account #: 01 1-01-5912 lnspector MID#: 2003-51695
PLUM BING-INSPECTOR RECORD
APPROVALS DATE ID/SIG COMMENTS Om6-Build6 Debntion o
I hscby rfrum unds pcBhy of pcrjury thlt I m ffipt fom thc Contrrtton' Lkxre lrw for t\e following mtr (G7031.5 Buio6t
md Profarioo Codc): Any City or County which rcquirc r pamit to osuuct, rlts, improvc' dcmolirh or rcprir uy rtructuc Fior o itl
irsuncg rlso rcquirs thc applimt for ruch ptrmit to filc r signcd mtcmtr thrt hc or 3tE i! li@md puruUt to thc pmvisiou of rhc
Conrraor's Limed hw (Chapta 9, Conmcrcing with Scaioa 7000 of Divirion 3 of thc Buin6r Id ProfdbE Codc) or thrt hr or
she ir rempt thacfrom ard the buil for thc rllcgcd acmptbn .Any vioLtiotr of S€tion 7031.5 by [y spplimt for r Fmit subj*r thc
rppliont to r civil pcmlty of mt mrc ttcn fivc hundrcd rl,olhn (t500).
_I, u ow of thc propcrty, or my cmployc with mgc u thcir :olc ompcmtio4 will do thc mrt rnd ths ltructuc is mt iiladcd
or offacd for slc ( 36.70114, Buiu! ud Profesioro Codq Thc Contrrcior'! Limc hw du mt rpply to m ow of thc prcpaqr
who buil& or improB tlrcr@q rnd who do6 ruch mrk hiroclf or h€rclf or tluough hi! or hs ow mploys, prcvidcd dut such
improwmcnr rc not intcndcd or otrscd for nlc. If, howcu, thc building or improwmcnt ir rcld within orc yw of omplaio4 the
Ow-Builds will luve thc bu&n of proving thrt hc or rhc mt build or improw for thc purpolc of slc).
y6o* A*prop<ty, rm aclusivcly @ntnding with li€Ecd ontnctotr to ost uc th€ p(ojdt ( Sa 7044, Buins ud
Prcfqion Codc: Thc Contn tor'3 Liccre hw d6 nor rpply to u ow of propaty who buildt or improE th66n , rnd who
oilncls for such prcjcts with r Contnclo(s) licocd purrunt io thc ContEator'! Licce hw.).
_I am exempt under Section_o
I hereby affrm under penalty of pcrjury one
_I hrvc ud will mintlh r Cqtifietc of CoE6t !o Sclf-Iruurc for mrkf,' omFmtioq u providcd for by Scction 3700 of thc
bbor Codq for thc pqfomm of thc mrk for which thc psmit ir issucd
_I hrvo rnd will roint in workq!' ompcurtion iruunncg u rcquircd by Serion 3700 of th. hbor Codg for thc pdforrme of thc
mrl for which thir pmit ir isud. My mrkm' ompcnretion iilrme fficr rnd policy Nmb6 uc:
Policy Number: Expircs:
(This section need * 00) or less)
Vrdrrrthat in the pcrformance of the work for which this pcrmit
bocame rubjoct to the workem ' compcnsation laws of Californtq and
is issued, I shall not employ any in any manner so as to
to the workers'
compensation provisions of Scdion 3700 of thc Labor Code I L
WARNING: Failure to secure workers' compcrurEtion
fines up to one hundred thousand dollars ($100,000),in r
the Labor Code, interest and attorney's fees.
cover&ge is and shall subject !o criminal penalties and civil
addition to the cost of compensatior\ damages as provided for the Section 3076 of
LICENSED CONTRACTORS DECLARATION
I hcrcby affirm unds pmhy of pqjury thrt I rm lieN€d adcr provision of Chrpts 9 (omcncing with Scrion 7000) of Division 3 of
thc Buircs and Profcssioro Codc, ud my liccrc ir in full fore ud cfrct.
Liere Cbs:_ Liensc Numba _
Drtc: Contnctor:
W
I hccby rfiirm unda pcnhy of pdjury thst thsc i! r @Btruc'tion hoding agcmy for thc pqfomne of thc mrt for which this pamit is
is$cd (Se. 3097, Civ. C.).
kndq's Namc:
Lender's Address:
APPLICANT'S DECLARATION
Demolition Permits-Asbestos Notification Federal Rcgulations (Title 40, Part 6)
_ Required Later of Notification
I sji& tht fte ftdol rcgulatiou rcgudirg ubctor rmnl rc mt rpplioblc to Od! projcct
U(* *rrUnred thir epptietionrnddrtcthrttlErbow hfomriotr is 6rc(L IrSrcto6mply withrll Cityud Couty
ordinances and State [aws relating to of this City and County to entcr upon the
above mentioned property for
Applicant or agent
Permittee name (print):)<
A
UNDER GROUND I
Waste & Vent z/zb ruvD
Water-Underfloor (rl /
Gas-Underfloor
Building Sewer
Area/Storm Drain
I nterceptor/ C la rifier
TOP OUT
Waste & Vent
Water Piping
Gas Pipeing
Roof Drain //I
Tub/Shower Test 7M/0fi .ffilll)
Rough Water Heater l'\r/
POOUSPA
P-trap/Drain Line
Main Drain/Pool Piping
Fill Line/Back Flow
Pool Heaterlcas Line
Misc
Gas Service
Water Service
Lawn Sprinkler
Sanitary SewerlCap
Back FIow Device
Rough Plumbing
Final Gas Test
Meter Release
o f n /^f/,/^-.* rA
FINAL 7/7 / d(Ul%ttr,b{f// g)
Notes, Remarks, Etc.
J
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