HomeMy WebLinkAbout30143667 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Plumbing
Permit Counter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714\647-5853
Permit #: 3O143667
Pin #: 90985
Project Address: 1137 S Shelton St
Assessor's Parcel 013-061-12 Lot: 63
Unit:
Block: NA
Bldg:
Tract: 557
Address Range:
Historic: No
Suite Range:
Zoning: Rl
a
Owner:
Address:
Phone:
Tenant Name:
Contractor.
Address:
Phone
ROBERT & LAURA MONZON
1137 S SHELTON ST
Santa Ana, CA 927071028
(7141 319-6934
Happy Cowboy Plumbing
495 Richey St, #204
Corona, CA 92879
(626) 7s5-1s40
01 1 16002 51602
01 1 16002 51602
01 1 16002 5160C
01 1 16002 51602
01 1 16002 5777C
Fee Type Amount
Gas Line repair/replace 4l .gs
Water Service (Each 10 4T .gs
General Plan Update Z3.Tg
lssuance 59.30
Microfilm Records 4.05
Qty
1.00
1.00
1.00
1.00
1.00
Fee
$47.9s
$47.9s
$23.79
$59.30
$4.0s
State Lic #: 1078645
Lic Type: C-36
Bus. Lic #: 378938
Workers' Compensation lnsurance:Carrier: State Comp lns
Policy #: 9304065
Expires: 08l,2U2022
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By: (
Subject to Field: \
Building Permit #:
Single Family Dwelling
Alteration
Gas piping repair
Occupancy:
Constr Type:
Code:
Date:
Date.
Date:
R-3, U
VB
cPc 2019 Notes:Gas piping repair & water service replacement
1Amr 09t21t2021
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
sden, Julie
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.
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
$23.79
$1s5.20
$4.05
Fee Total
Paid to Date:
Balance Due:
$183.04
$0.00
$183.04
for"pg (:owt
lnspector MID#: 2021-1 68909
/
PLUM BING.INSPECTOR RECORD
APPROVALS DATE ID/SIG COMMENTS
UNDER GROUND
Waste & Vent
Water- U nderTldor GPop NO't "7-z'.) -zl l?L' (A
Gas-UnderfhrUr Crz*1rrrD 4 7-Z?- Lr Ro(rr)
Buildinq Sewer \.-
ArealStorm Drain
I nterceptor/ Clarif ier
TOP OUT
Waste & Vent
Water Pipinq
Gas Piping
Roof Drain ,/
Tub/Shower Test \
Rough Water Heater \
\
POOL/SPA /
P-trap/Drain Line
l\Iain Drain/Pool Pioino
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary Sewer/Cap
Back Flow Device
Rouqh Plumbinq ,l .4.
Final Gas Test 1l*lu fZts 69
Meter Release tl
FINAL Y*lzv fu)@:)
Notes, Remarks, Etc.
\
OWNER BUILDER DELCARATION
I hcrcby affirm undcr Jrcnally of lErjury lhat I am excmpl ftom thc ContractoN' Liccns liw for lhc following rca$n (Ss.70-11.5
Busincss und Prolbssion Codc): Any City or County which rcquircs n JrcrmiI to onstruct. altct hnpovc. dcnrelish or rcpir any
$truclurc. prior to its issuance. also requircs thc applicant for such Jrcrmit to lilc a signcd stalcmnt that hc or shc is liccnscd pu$uanl
Io thc provisions of tlrc Contractq's Liccnscd kw (ChapIcr 9. Comrrcrcing with Sslion 70OO of Division 3 of Ihc Busiress and
PmfcssionsCodc)orthathcorshciscxcmptthcrcfromandlhcbosisforthcullcgcdcxcmption. AnyviolalionofsdbnTO3l.5byany
applicanl for a pcrmit subjels thc applicant to I civil pcnahy of nol mrc lhil fivc hundrcd dollus ($500).
-1.
es owncr of Ihc popcdy. or my cmplo)ms with wages {s thcir slc @mpcnsation, will do the wort and thc slrwlrc is mt
intctrdcd or oflbrcd for slc (Se.7Ol4, Busincss and hofcssions Codc: Thc Crnlractor's Liccns ljw d@s not trpply to an owncr of
IhcpD[rcrty whohuiHsorimprcrerthcmn.udwhodessuchmrkhimsclforhcrslforlhrcughhisorhcrowncmployccs.
providcd thrt such imprcwmnts rc mt htcndd or oflercd for sh. lf, horcw. lhc building or impmvcmnl is $ld wilhin oilc )ts .
ofcorplcthn. thc Owncr BuiLdcr will harc thc burdcn ofprcving that hc or slrc dii mt build or impmvc 0rc pmFrly for thc purfns of
sle).
-1.
as owncr of thc pmfErty. am cxclusivcly contracting with liccnsd conr&lon b conslruct thc projct (56. 7(X4, Busircss
and ftafcssion Codc: The Contrrclor's Liccnsc Law docs not apply lo an owncr of prctEny who builds o. impmws thcrcon,
and who conlructs for such prcjccts with a Contmcto(s) licensd pursuant lo lhc Contrrclor's Liccns [aw).
-lamcxcmplundcrscclion-.B,&P.c'forlhisrcasn.
floIr.'
EOEtrEINTOMPIN&IIION
DECIdMIIQN
I hcrcby affirnr undcr pcnulty of psjury orc of thc following dcchations:
b&u" und *ill minlain tr Ccnificorc of Conrcnt ro Sclf-lnsurc for workcrs'orrrrcnsation, as prcvidcd for by Section -1?00 of thc
-,a/hbor Codc, for thc lrcrformrcc of thc work for which thc fsmit is issucd.
)L4.n*c and by Scction 3700 of the l-abor Code, for the perfonnarcc of
thc work for plicy numbcr are:G.rnilo
t
\ ,nu.y Z
)t1, ccrtify that in rhe pcrformance of thc work for which this pcrmit is issued. I shall not cmptoy any pcrson in any manncr
so as lo become subjcct to the workers'compensation laws of California, and agree that if I should becomc subict to the
workcrs' compcnsation provisions of Section 3700 of the L:bor Code. I shall, forthwith comply with thosc provisions..
WARNING: Failurc lo sccurc workers'compcnsation covcragc is unlawful, and shall subjcct an employcr to criminal pcnaltics and
civil fincs up lo onc hundrcd thousand dollars ($l00.UlO). in addition to thc cost of compcnsation. damages as providcd for thc
os
I hereby affrm undcr penalty of pcrjury that I am liccnsed undcr (commcncing with Section 7000) of Division 3
of thc Busincss and Profcssions Codc. and my liccnse is in full forcc and effecl.
Nurnbcr:
<)qg
W
I hcrcby affirm undcr Fnahy of perjury lhat thcrc is a construction bnding agcncy for thc [ErfoMcc of the work for whhh lhis pcmit is
issucd (Scc. 3097, Civ. C.).
lrndcr's Namc:
[-cnder's Address:
APPLICANT DFCLARATION
I tnrcby allirm undcr pcnalty of prjury onc o[ thc following dcclarations:
Denrolition Pcrmils-Asbestos Notification Fcdcral Rcgulations (Titlc 40. Parl6)
_Rctluircd lrttcr of Notilication
-l
certi& that the federal regulations regardrng asbestos rcrnoval are not applicabh to this pmject.
>81*ify that I havc read this applitxtion and state that thc above information is correct. I agree to comply with alt Cityand County
ordinanccs arrd Statc [.aws relating to building collstruction. and thc
abovc mcnlioncd propcrty for
(/Applicant or Agent
, Permitee name
rcprcscntativcs of this City and lo cnlcr
and BCI2 qlt
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