HomeMy WebLinkAbout101105899 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: C14)647-5853
Permit #: {01105899
Pin #: 71701frr
Project Address: 1119 W Fifth St
Assessor's Parcel: 008-083-15 Lot: POR 4, POR 5 Block: NA
BIdg: Address Range:
Tract: MCFADDEN & WTLSON ADD Historic: No
Unit:Suite Range:
Zoning: Rl
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use.
Proposed Use:
Single Family Dwelling
Solar
Solar
SFD w/ garage
R-3, U
VB
cBc 2019
x-0602320257J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Total
Patio:
T.l.Area:
Yards Req'd
Valuation: $10,000.00
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories:
0
Description of Work lnstall new roof mounted solar PV system. Per PV checklist.
Planning Conditions:
t
Owner:
Address:
Phone:
Tenant
Maria Rivas
1119 W sTH ST
Santa Ana, CA 927033801
(7141 953-9357
Contractor: Clean Energy Solutions
Address: 417 W. Allen Ave. Suite 105
San Dimas, CA 91773
Phone: (800) 994-1 134
State Lic #: 998787
Lic Type: B, C-10
Bus. Lic #: 349544
Workers' Compensation ! nsurance.
Carrier. State Fund
Policy #: 9292161
Expires: 0210612022
Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
yoursolarplans.com
Phong Truong
3000 E Birch St #2O1
Brea, CA 92821
(844) 783-s483
c70784
qr
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
Fire lnsp. Req'd. No
Police lnsp. Req'd: No
Zuniga,Allissa
Date:
Date:
Date: 0T130l,2021
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002 57607 Permit Fee
07776002 57770 Microfilm Records
01776002 s7672 BIdg. Stds. Revolving
07776002 s7500 General Plan Update
Fee Totat
Paid to Date:
Balance Due:
Account#Total
Flood Zone Cert. Req'd: No 01 1 16002 51601
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 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.
01 1 16002 51612
01 1 16002 57770
$450.00
$1 .00
$56.70
$507.70
$0.00
$507.70
Inspector MID#: 2021-16431 1
$450.00
$s6 70
$1.00
$0.00
BUILDING. INSPECTOR RECORD
tD/:itG.SITE.WORK DATE COMMENTS OWNER BUILDER DELCARATION
I hcrcby aflirrn undcr pemlty of Frjury that I m cxcmpt fmm thc Contracton' Liccns Law for thc following rcNn (Sec.7031.5
Busincss aml Prcfcssion Codc): Any City or County which rcquircs o lrcmit to onstruct. alts. improve, dcmlish or rcpair any
structurc. prior to its issurncc, also rcquircs thc applicant for such lrcmit to filc a sigrcd stalemnt lhsl hc or slE is liccnrcd pur$ant
to thc prcvisions of lhe Contrctor'$ Licen$d llw (Chaptcr 9, Commcrcilg with Scction 7000 of Division 3 of thc Busircss 8nd
Prcfcssions Codc) or that hc or she is cxcmpt ihcrcfrom and the basis for thc allcgcd cxcmption. Any violstion of SEtlln 703 1.5 by {ny
applicant for a penrril subjcls thc applicant lo a civil pcnalty of not morc than fivc hundrcd dollars ($500).
-1.
as owncr of thc propcrty. or my cmployccs with wages as thcir liole comlrcnsation. will do thc work and thc structurc is not
intcndcd or othrcd lor sale (Scc.7044. Busincss and Profcssions Codc: The Contractor's Licensc Law docs not apply to arr owncr of
thc pnrpcrly who builds or improvcs thcrcon. and who dcrcs such work hirnsclf or hcrsclf or through his or hcr own cmployecs.
provided lhat such improvcnrcnts arc not inlcndcd or olTcrcd tbr sah. lf. howcvcr, ttrc building or irnprovcrrnnt is sold within one )rcar
of conrplction, thc Owncr Buildcr will have thc burden of proving that hc or shc did not build or improve thc pncpcrry for thc purglsc of
salc).
-1.
as owncr of thc propcrty, am exclusivcly contracting with licenscd contraclors to construct thc projcct (Sec. 704/. Business
and I'rofesskrn Codc: The Contractor's Liccnse Law docs not apply lo an owncr of proJrcrty who builds or improvcs thcrcon.
and who contracts for such proicts with a Contractor(s) liccnsed pursuant to thc Contractor's Liccnsc [aw).
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amexcmpt undcr Section_. B. & P.C. lbr this reason.
Date:JIwnnr.
}VORKEILS' C()NI I'TNSAl'ION
DECLARATI(TN
I hcrcby aflirnr undcr pcnalty of Srcrjury onc of lhe f<rllowing dcclarations:
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huvc and will rnaintain a Ccrtiflcatc of Consent to Sclf-lnsurc for workers'compcnsalion. as providcd for byScction 37fi) of the
latxrr Codc. for the pcrfbrnuncc of thc work for which thc pcrnrit is issucd.
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havc and will ntaintain workers' compcnsation insurancc. as rcquircd by Scction 37fi) of thc Labor Codc. lbr thc pcrformancc of
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ccrtify that in thc pcrforrrurnce of thc work for which this Jrcrmit is issucd. I shall not cmploy any Frcrson in any manncr
so aslo bccomc subjcct to thc workcrs'compcnsation lawsof California, and agrcc that if I should bcconrc subjcct tothe
workcrs' conrpensation provisions of Section 3700 of thc Latnr Code. I shall, forthwith cornply with thosc provisions.
WARNING: Failurc lo sccure workcrs' compensation covcragc is unlawful. and shall subjcct an ernploycr to criminal pcnaltics and
civil fines up to onc hundrcd thousand dollars ($100,000), in addition to thc cost of compcnsation. damagcs as providcd for the
Scction 3076 of the Labor Codc, intcrcst and attorncy's fees.
Dnre:7ho /lt k'
-/- t
I hcrcbyalllrrnundcr penaltyof pcrjury that I anr liccnscd undcr provision of Chuptcr 9 (commcncing with Scction 7000) of Division 3
of thc Business and Profcssions Codc. arxl my licensc is in full tbrcc and cft'e,ct.
L-(o b7Liccrtsc
I hcrcby affum undcr lrcnalty of perjury that thse is a snstructbn hnding agcrcy for thc prfomncc of thc work for whi,i this pcrmil is
issucd (Ss. 3097, Civ. C.).
kndcr's Namc:
Lcndcr's Addrcss:
APPI ICANT DECLARATION
I hcrcby affinn under pcnalty of pcrjury one of thc following dcclarations:
Denxrlition Pcrmits-Asbcstos Notificalion Fcdcral Rcgulations (Title 40, Part6)
-Requircd
[-et tcr of Notitication
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ccrtily that thc l'cderrl rcgulatiorts rcgarcling asbcstos rcrnovalarc not applicablc to this projcct.
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ccrtify lhat I havc rcad this application and statc that thc ahrvc intbrmalion is conect. I agrcc lo comply
representatives of this City
\ rroro.
with all City and County
and County to cntcr upon thcorclirranccs and State krws rclating to
abovc nrcntioncd propcrty for
/zrApplicant or
Pennitce nanre
construction, and hcreby authorizc
7/to
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/Ve nt/l ns u I atio n
Roof Sheathinq
Shear Wall
Framinq
lnsulatio nlEnerqy
Drywall
Ext./lnt. Lath
Brown Coat
Jtlasonrv
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
I /
FINAL */n/2,Jrr$%
Certificate of Occupancv I I
Notes, Remarks, Etc.
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