HomeMy WebLinkAbout30243166 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Plumbing
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (7141647-5853
Permit #:30.243{66
Pin #: 5{ 446
/L^,rProiect Address: 1520 S Van Ness Avea
Assessor's Parcel: 013-1 92-19 Lot: 1 8, 19
Unit:
Block: F
Bldg:
Tract: 531
Address Range:
Historic. No
Suite Range:
Zoning: Rl
Owner:
Address:
Phone:
Millenial lnvestments, LLC
P.O. Box 17914
Long Beach, CA 90807
(562) 253-2415
Fee Type
01 1 16002 51602 Chg Owner/Contr
01 1 16002 51600 General Plan Update
01 1 16002 57770 Microfilm Records
Amount
71 .22
23.79
4.05
Qty
1.00
0.00
1.00
Fee
$71 22
$0 00
$4.05
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires:
(dL {t'?-l
l0., Lt '10-'LL0
Building Use:
Job Type.
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Single Family Dwelling OccuPancy:
Alteration Constr Type:
"**cHG IN OWNER"*"N/V 3116code:
Date:
Date:
Date:
R-3, U
VB
cPc 2019
Chavez, Dave
Subject to Field:
Buirdins Permit #: 102106712
Y
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.
05/1 9t2021
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total:
Paid to Date:
Balance Due:
01 1 1 6002 51 602
01 1 16002 57770
$71.22
$4.05
Remove unpermitted, attached room additions at rear
of house & at rear of garage, remove unpermitted,
attached patio cover at rear of house, remove laundry
connections inside garage. Legalize windows
changed out.
$75.27
$0.00
$75.27
lnspector MID#: 2021-1 64688
PLUMBI NG.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEITARATION
I hmby affm unda poahy of pa;jury that I m qmpt tom thc Corilnc{oB' Licce lrw for thc fonowiog tE$t(Se.7031.5
Buincs and Prof6ion Codc): Any City or County which rcquirc a pcmit to coniruct. alt6. iEprovc. dorclirh or npeir my
struourc.priortoits isumc,alsorcquircthrqplimtforsuchpamhtofilcasignodstdmtthatrorrbcbtc&sodpuiuul
to thc provisioE of thG Cootsscttr's Licmsod kw (Cfupt6 9. Commiog with Setioo 700O of Division 3 of thc BuitB ell
Profsioro Co&) or thst hc or shc b qmpt thqcfiom md thc basis for thc dlcgcd qmption. Any violation of Sctbn 7031.5 by my
applicmt for a pcnnit subjets thc applicet to 6 civil pcnalty of mt morc the tiv€ hudttd dollm (5500).
Dldl, * o*o of thc Fopqty, or my mplo)6 with wagB s thcir mlc ompenstion, will do thc wut and 0E suudrc b rct
inrdrdcd or ofrcred for elc (Sc.7M4, Buins ud hof*ioro Codq Thc Conlrsclor'r Lic@c kw do6 rot rpply to il om6 of
thcplopqty whobuildsorimFovctluon ardwhodsswhwr*hirelforhmlforthrcughhisorhaoMcmploycB.
prcvidcd that such imgovqEfs e mt htqdcd or olfqcd fur sb. If, lDwrE, thc hilding or imFowt is $ld within onc ]@r
of ompkiion, thc Om6 Buikk will luw [rc hldar of pmvirg ttra hc c shc dil mt hiH or improw thc prcpaty for thc purpo* of
slc).
-1.
u omq of thc Fopcty, m ecluivcly contracting with licascd cotrtratoE lo cooltruct thc poixt (Se. 7044, &Eins
ad hoftsir Cods Thc Comraaor's Licosc Law do6 lot spply to 6 omq of propqly who buil& or imprcv6 thso!.
ud who @ofets for such projcls with a Coilnc{o(s) licosod puEmt to thc Couttrlor's Lic@ Lrw).
-l
am under P.C. for this reason.
CE
I hcreby affrrm under penalty of pojury onc of the following
_l have and will maintain a Certificatc of Conscnt to SelGlnsure for workers' comp€nsation, as provided for by Section 3700 of the
I-abor Code, for the pcrfonnance of the work for which the pcrmit is issued.
_l have and will maintain workers' compcnsation insurance. as required by Section 3700 of the tabor Code, for the pcrformance of
the work for which this pcrmit is issuod My workers' compensdion insurance carricr and policy numh are:
Policv Number: Exoires:
Dft.*iff that in the performance of the work for which this permit is issucd, I shall not employ any pcrson in any manner
so as to become subject to the workcrs' comperuution laws of California, and agrec that if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with thosc provisions..
WARNINC: Failure to secure workers' compensation coverage is unlawful. and shall subject an ernployer to criminal pcnalties and
civil fines up to onc hundred thousand dollars ($100,000). in addition to thc cost of compensation. damages as provided for the
Section 3076 of the labor Code. interest and attorncy's fees.
I hereby affrm under pcnalty of perjury that I am licensed Chapto 9 (commencing with Scction 7000) of Division 3
of the Business and Professions Code, and my license is in full force and effect.
License Class: License Number:
W
I h@by arfim ud6 pcnahy of pcjury tha th@ is I @rdruclbtr lcoding agocy for thc pafomcc of thc mlt 6r which thi! Fmit ii
issucd (Sc. 3097. Civ. C.).
Lender's Name:
l.codcr's Ad&css:
APPLICANT DECLARATION
I hercby aflinn under penalty of pcrjury one of the following declarations:
Dernolition Perrnits-Asbestos Notification Federal Regulations (Title 40, Part6)
-Rcquired
Letter of Notification
-I
cqtiry that thc fcdGal rcguhtioB rcgadhg ab6tG mval ac trot applicablG to this projcl.
ll(t ccti& thar I luvc rqd this application ed stat€ rhd thc abovc itrfotrnstion is corct. I 8g16 to @mply with rll City ed Couty
ordlmca ud Statc L:w rclding to building coir*ructiolt Ed hqrby 8uthorizc rcpEatativc of thir Cily ud Courty to 6t6 lpotr tlE
above mentioned property for
Applicrnt or Agent
I'ernritee ntrme
.}6 lr[
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underfloor
Building Sewer
Area/Storm Drain
I nterceptor/ Cla rifier
TOP OUT
Waste & Vent
Water Pipinq
Gas Piping
Roof Drain
Tub/Shower Test
Rough Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Piping
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary Sewer/Cap
Back FIow Device
Rouqh Plumbinq
Final Gas Test
Meter Release lf ,l /t
F!NAL k \r,q xt EM#,IS Y
Notes, Remarks, Etc.I
-+
Carrier:
o.,., r 5[t(\211t
Contractor: