HomeMy WebLinkAbout101107773 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
Permit Counter: (714) 647-5800 lnspection Requests'. (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: {O11o^7773
Pin #: 38065
Project Address: 2616 W Knox Ave
Assessor's Parcel: 414-071-07 Lot: 21
Unit:Bldg: Address Range:Suite Range:
Zoning: RlBlock: NA Tract: 8326 Historic: No
Building Use:
Job Type:
Nature of Work:
Existing Bldg & Use:
Proposed Use:
Single Family Dwelling
Reroof
Reroof
Occupancy:
Constr Type:
Code:
Flood Zone.
# of Stories:
R-3
VB
cBc 2019
x-0602320259J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Totat
Patro:
T.l Area.
Yards Req'd
Valuation: $4,207.00
Description of Work: Tear off existing, install 29 squares of comp roofing
Planning Conditions:
Owner:
Address:
Phone:
Tenant
KIM VU
2616 W KNOX AVE
Santa Ana, CA 92704
(7141 661 -0776
Contractor: GPA Construction lnc
Address: 58 Elderwood
Aliso Viejo, CA 92656
Phone: (7141 357 -6241
State Lic #: 1049988
Lic Type: C-39
Bus. Lic #: 378293
Workers' Compensatron lnsurance:
Carrier. State Fund
Policy #: 9244580
Expires: 0210412022
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address.
Phone:
License #:
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd:
Date: Misc. Receipt.
Date: Misc. Receipt.
Date: Ogt2StZO2l Misc. Receipt:
Subject to Field:
No
No Account#
0777600 2
0777600 2
07776002
0 7776002
0 7776002
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuance
5760 7
57770
57672
57600
57607
$345 28
$4 0s
$1 00
$23 7e
$5e 30
web_user
No
No
No
No
Fire Insp. Req'd:
Police lnsp. Req'd:Total
Flood Zone Cert. Req'd: No N/A - No Balance
N/A - No Balance
N/A - No BalanceEvery permitissued shall become invalid unless the work on the site authorized by
such permit is commenced withtn 360 days after rfs lssua nce,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
Fee Total
Paid to Date:
Balance Due:
$433 42
$433 42
$0.00
lnspector MID#: 202'i-168438
,/
BU!LD!NG. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DEI,CARATION
I h6eby affirm unds p€nalty of perjury thd I m qmpt fiom thc Contractos' Licw l:w for thc folb*ing .*n lio.ZOlt.S
Businss ud Profeion Codc): Any City or County which rcquirc a ponit to @nstruct, altq, improvc, dmrolish or rcpeir uy
struciue. prior to its isswcc. also rcquire thc applicet for such pannil to filc a signcd stdmmt that hc or slrc b licmscd plNdt
to the prcvisions of thc Contretor's Licenscd Law (Chaptq 9. Commcncing with Setion 7000 of Division 3 of thc Buincs md
Prcfessions Code) or thal hc or shc is excmpt thGcfrom ed the bssis for the allcgcd exmption. Any violation of Sa-tion 703 1.5 by any
applicantforapcmitsubjetsthc applicanttoacivilpenaltyofnotmorcthufivchundreddollus($500).
-1.
as owner of the property. or my employccs with wages as their sole cornpensation. willdo the work and the structure is not
rntended or offered for sale (Sec.7044, Business and hofessions Code: The Contractor's License Law does not apply to an owner of
thc propctty who builds or improves thereon. and who does such wort hirnself or herself or through his or her own employees.
provided that such improvonents arc not intcndod or offirod for sale. I[, hower/er. the building or imp,rovement is sold within one ]eu
of complaion. the Orvner Builder will have the hrden of proving tlra he or she did not build or impove the propoty for the prx?ose of
sale).
-1.
as owner of the property, am exclusively contracting with licenscd contractors to construcl thc p,roject (Sec. 7044, Business
and hofession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon.
and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License Law).
-l
arn exempt under Section-, B. & P.C. for this reason.
I)nto'0*-or'
WORKERS' COIITPENSA
DECLARATTON
onc of the following declarations:I hereby affrrm under penalty of pojury
-l
have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, €rs provided for by Section 3700 of the
Labor Code. for the performance of the work for which the permit is issued.
_l have and will maintain workers' compensation insurance. as required by Section 3700 of the L,abor Code. for the pcrformancc of
the work for which this permit is issued. My workers' compcnsation insurance carier and policy number are:
Carrier:
Policv Numbcr: Expires:
-l
cediry that in thc perfororc of thc work for which this pqmit is issued. I shall not onploy any pomn in uy mancr
rc a to beomc subjet to the rcrk6'compcEarion law of Califomia, ild !8rc that if I should beome subjet to the
workm' comperution prcvisiou of Sction 3700 of thc labor Code I shall. forthwith comply with thos prcvisiom.
WARNTNC: failuc to sre rcrkm' cotnpqEalion covmgc is unlawful, ad shall subjct m mpb)rcr to qininal poEllics ud
civil fine up to onc hundrcd thousd doll6 ($100.000). in addition to thc cost of compcwtion. dmag6 s providcd for thc
SEtion 3076 of the tibor Code, intsGt od attomcy's fe.
LICENSED CONTRACTOR
DECT,ARATION
I hereby a(Tirm under penalty of petjury that I arn licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code. and my license is in full force and effect.
License Class: License Numbcr:
Contrector:
CONSTRUCTTON LENDING AGENCY
I hwby affirm undq pemlty of pcdury that thae is a comtruction loding agency for the pcfommce of the work for which this pqmil is
issued (Ss. 3097. Civ. C.).
Lender's Narne:
Lender's Ad&css:
APPLICANT DECLARATION
I herdry aflirm under penalty of pojury one of the following declarations:
Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6)
_Required Letter of Notification
-l
cdiry thal thc ftdral rcxulatiom rcgarding rbstos movd uc not applicablc to this projct.
_l cetiry th8t I havc ud this applicarion dd statc that thc abovc informdion is cor€t. I agre to mmply with all City ud County
ordimcG ud Statc ks clatiDg to building consructiorl ed hftby authorizc rcpreatativc of this City ad Couty to ata upon thc
.bovc m@tionod prcpqty for iospcrion purpos.
Appliont or Agsa Slgnrturc: Drlc:_
PemltE trtme (prlnt):
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bfloor/Ve nUl n s u latio n I .A I
Roof Sheathins aftlzt Lurc7 )ffl No€
Shear Wall ,
Framinq
!nsu !ation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Jtlasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
lt 7
FINAL Tntn Lu (91)
Certificate of Occupancy t ,\.7
Notes, Remarks, Etc.
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