HomeMy WebLinkAbout101108015 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Saqta Ana,-CAI27O2 Building
PermitCounter: (714)647-5800 lnspection Requests: (714).667-2738 lnspectorSection: (714)647-5853
Permit #: {O11O8O15
Pin #:,rw
Project Address: 4222 W Flight Ave
Assessor's Parcel: 188-103-19 Lot: 53
Unit:Bldg: Address Range:Suite Range:
Zoning: RlBlock: NA Tract: 3656 Historic: No
Building LJse: Singlo Family Owelllng Occupency: R-3,U lstFLArea Patio:
Job Type R.ilof Constr Type V B 2nd FL Area T.l.Area:
Nature ofwo*: Rsroot code: cBc 2019 otherAreas yards Reqd
Existing Bldg & use: sFD w, att 0.rago Flood zone: x46o2320256J carage Area vatu.fion: ,?,ooo.oo
Proposed Use: # of Slories:
Totet
Ooacrlptlon of Work TrO exilitng rool and ln.tell n.w comp shlngles to SFD with .tt ched g.6ge. R.pl.co sh.athlngrplywood ar neodod. Hand out
glvan Own€r torm on file.
Planning Conditions:
i Engineer.
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
Owner:
Address.
Phone:
Tenant
Dung Tran
4222 W Flight Ave
Santa Ana, CA 92704
(7141 603-5830
Contractor:
Address:
Owner-Builder Botch*:6t-t8t-t3
Lllf ice: (:TYH
A - -L I rHl-l- L 1t r
licr,t+:[t3+13???
lr cr[r sf ; ?
Ftef *,
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires.
lrOnSOtIB I CIn l0f,OI
)urr s l'r'nn
GerreroI Plnn Updcrte
Ltl I 16lJtJ2- 5l6rlurl[ilJ--
liuildins
r-r1 1 I,sr-rr:rf- 516tJ 1r-r[rr.r -
[t]ds Stds Flevolvins
Fee
Planning Approval By:
Plan Checked By:
Permit lssued By.
NPDES lnsp. Req'd. No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Landscaping lnsp. Req'd: No
Martin, Eric
Zuniga, Allissa
Date: 0912112021
Date:
Date: 0912112021
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
0L776002 5760t Permit Fee $34s 28
07776002 57770 Microfilm Records $4.0S
07776002 57672 Bldg: Stds. Revolving ,: $1.00
07776002 57600 General Plan Update $23.79
07776002 57607 lssuance $59.30
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 57770
Account#Total
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within360 days afterifs 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.
$23.79
$404 58
$1.00
$4 05 Fee Totat
Paid to Date.
Balance Due:
$433.42
$0.00
$433.42
lnspector MrD#'. 2021-168896
e
.1
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.CoMMF.NTS -OWNER BUILDER DEITARATION
I hacbry affm unds poalty of pcrjury that I m qempt ftom thc Contre{ots' Liccrc Law for thc following resn (Se.7031.5
Buhes and Profsion Codc): Any City or Coumy which rcquire a pemit to constocl, alta. improvc. danolish or rcpair uy
slrucluc, prior to its ismcq a&o rcquirc thc applic&t for such pcmh to filc 8 signcd stat@t thrt he or shc b licfiscd pwril
to thc prcvisio$ of thc Contrrctor's Licenscd taw (Ctaptq 9. Comscing with Setion 7000 of Division 3 of thc Buitrs ed
Prcfwions Codc) or thst hc or shc is cxmpt thqcfrom ud thc bosis for thc allclcd q@ption. Any violation of Setiotr 703 I .5 by my
applimtforaparnitsubjctsthc applicmtroacivilpcoaltyofnotmorcthmlivchun&eddollm($500).
_[. u omq ofthc prcpcrry. or my cmplo]B with wag6I thcL slc compasalion. wi[ do tlE wrk Ed tlE nrudrc b rct
intqdcd or olFqrd for salc (Se.7044, Bcioe ud Profeiore Codc: Thc Contraclor's Licce llw do6 not spply to e om6 of
thc lropqty who hrilds or imprcs thooq ed who doo swh w]t himsclf or hwlfor thrcugh his or h( om mplolcc,
prcvidcd that such imfovmts rc not intodcd or ofrcrcd 6r sb. I[, how. tlE hrilding or inpromt is mU withh onc ]an
ofconphtbrr the Owns Buildq will havc thc hrdar ofprcving thd hc or shc did oot buiH or improvc thc popqty br thc pupos of
slc).
-1,
I omq of thc propqty, m ocluivcly contraaing with licqEcd contractoG to @nslIud thc projct (Se. 7044, BBin6
ud Profssion Co&: Th€ Contrrctor's Liccnse Law do6 not apply to u ownq of propqty who builds or imprcvd thqon,
md who contracls for such pojcds with a Contnao(s) licoscd pwwt to thc Contrac{or's Lic$e Liw).
-l
am excmpt B. & P.C. for this reason.
I hcreby alfirm under penalty of perjury one of the following declarations:
-l
have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as providd for by Section 3700 of the
I-abor Code for the pcrformancc of the work for which thc po'mit is issued.
_l have and will maintain workers' compensation insurance. as required by Section 3700 of the L^abor Code, for the performance of
thc work for which this permit is issuod My workcrs' compensation insurance carrier and policy number are:
)
Policv Number: Exoires:
-l
certi$ that in rhc pcrformance of the work for which this permit is issued. I shall not employ any person in any manner Iso as to become subject to the workers'compensation laws of California, and agree that if I should become subject to the
worters' compersation provisions of Section 3700 of the Labor Code, I shall, forthwilh comply with those provisions.
WARNTNC: Failure to secure workers' compensation coverage is unlawful. and shall subject an onployer to criminal ponlties and
civil fines up to one hundred thousand dollars ($100,000).to the cost of compensation, damages as provided for the
Scction 3076 of the labor Code. intercst and attorncy's
",r", oq fJl I J,l
DECI.,ARATION
I hereby affrm under penalty of pcrjury that I arn liccnsod under provision of Chapter 9 (commcncing with Section 7000) of Division 3
of the Business and Professions Code, and my liccnse is in full forcc and effect.
Numbcr:
Ilo t o.
CONSTRUCTION LENDING AGENCY
I hcreby affrm under peiralty of pcrjury that there is a construcrion k:nding agency for the pcrformance
issued (Sec. 3097, Civ. C.).
lrnder's Name:
of the work for which this perrnit ls
I-cndcr's Address:
APPI ICANT DECL{IL{TION
I hCIeby afErm under penalty of perjury one of the following declarations:
Demolition Permits-Asbcstos Notification Fcderal Regulations (Tille 40. Part6)
-Required
lrtter of Notification
-l
ccrti& that the fedcral regulations rcgarding asbestos removal arc not applicable to this projcct.\
-l
certi& that I have read this application and state that the above information is correct. I agree to comply with all City and County
ordinances and State Laws relating to construction, and hereby authorize representatives of this City and County to enter upon the
above mcntioned propcrty for
Applicant or Agent
Pernritee name
purposes.
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bfloor/Ve nUl ns u latio n n
Roof Sheathing TLtlu 'JrftoShear Wall tl /V
Framing I
lnsulation/Energy
Drlnrvall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
I l\
F!NAL lalqlu Jtrtrao
Certificate of Occupancy I l I V
Notes, Remarks, Etc.I
Contractor:
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