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HomeMy WebLinkAbout30143459 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Plumbing Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853 Permit #: 30{43459 Pin #: 2EG,47 ['^Project Address: 1002 E Buffalo Ave Assessor's Parcel: 003-21 2-16 Lot: 56 Unit: Block: NA Bldg: Tract: 1529 Address Range: Historic: No Suite Range: Zoning: Rl Owner. Address: Elio Osorio 1OO2 E BUFFALO AVE Santa Ana, CA 927063042 (7141 667-6101 01 1 16002 51602 01 1 16002 51600 01 1 16002 51602 01 1 16002 57770 Fee Type Sewer Alter/Repair General Plan Update lssuance Microfilm Records Amount 47.95 23.79 59.30 4.05 Qty 1 .00 100 1.00 1.00 Fee $47.95 $23.79 $se 30 $4 05 Phone: Tenant Name: Contractor: Address: Owner-Builder Phone State Lic #: Lic Type: Bus. Lic #: Workers' Compensation lnsurance: Carrier: Policy #: Expires: 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 Miscellaneous Sewer Repair Chavez, Dave<2{''08/1 9t2021 Account# Misc. Receipt: Misc. Receipt: Misc. Receipt: Total Occupancy: Constr Type: Code: Date: Date: Date: R-3, U VB cPc 2019 Notes. Sewer repair. Owner-authorization on file. Fee Total: Paid to Date: Balance Due: 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 fhe sife 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 $107.25 $4 05 $13s.09 $0.00 $135.09 lnspector MID#: 2021-1 68293 PLUMBING.! NSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DEI,CARATION I hftby aftm und6 poalty of pqjury thst I m qcmpt from thc Contrrcloc' Licw Law for thc following Iwn (Sc.7031.5 Buinas and Prcft*sion Codc): Any City or Courty which rcquiro a pannit to corutrucl, alts. improvc. &tmlish or rcpah uy strucle prior to ils ilsumce" d$ rcquiB thc eplimt for such Fnrit to filc s signcd statml thd hc or $c is licoEcd pmuant to thc provisioru of thc Contrscttr's Licmscd taw (Chaptq 9. Commacing with Sction 7000 of Division 3 of thc Busine ud PrcfeionrCodc)orthsthcorsh€isqmptthrcfromddthcbaisforthcallqgcdamption. AnyviolationofsetbtrT03l.5byay spplicmtforsp6mitsubj€tsthc applicuttoacivilpcrultyofnotmorctfunfivchundrcddollm($500). _1. as owner of the propcrty. or my cmplolccs with wages as their sole compcnsation. will do the wort and thc structure is not intcndod or off€red for sale (Sec.7044, Business and Professions Code: The Contractor's Liccnse l-aw does not apply to an owner of the property who tuilds or improves tlreron" and who does zuch wort himself or hersclf or through his or her own cmployees. provided that such impovcnrents arc not intendcd orofferod for sale. If. however. ttrc tuilding or improvemcnt is sold wilhin one ),!ar of compktion the Orvner Build€r will have the hrrdcn of proving thd he or she did not build or inrprove the p,roperty for the purposc of sale). _1. 8s owner of the propcrty, am exclusively contracting with licenscd contractors to construcl thc project (Sec. 7044. Business ard Pnoftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improve thereon, and who conmds for such projects with a Contracto(s) licanscd punuant to the Contractor's Licensc law). _l am under B. & W. for this r@son. l/-7.r-, I nta-o,nn..lD(. of the following'declarations :I hereby affrrm under penalty of perjury one _l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as providcd for by Section -3700 of thc Labor Codc. for the performance of the rvork for which the permit is issucd. _l have and will maintain workers' compensation insurance. as required by Section 3700 of the labor Code. for the perfrrrmance of the work for which this permit is issued My workers' compensation insurance carrier and policy number arc: Policy _l ccrtify that in the performance of the work for which this permit is issued. I shall not cmploy any person in any manncr so as to become subject to the workers' compcnsation laws of California, and agree 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.. WARNING: Failure to secure workers' compemation coverage is unlawful. and shall subject an onployer to oiminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the fecs. t I hereby affirm under pcnalty of perjury that I am licensod of Chapto 9 (commcncing with Scrtion 7000) of Diuision 3 of the Business and Professions Code. and my liccnsc is in full force and effect. Licensc Class: License Number: W I hmby affm uda pqulty of pcrjury thd th@ is r coDstruclion loding agacy for thc pqfomcc of thc wrk for which thb pqmit b issucd (Sc. 3@7, Civ. C.). Lender's Name: Lender's Ad&ess: APPLICANT DECLAfuITION I herdry affrnn under penalty of perjury one of thc follorving declarations: Dernolition Permits-Asbestos Notification Federal Regulations (Title 40. Pafl6) -Required Letter o f Notification _l certi$ that the federal regulations regarding asbestos rernoval are not applicable to this project. with all City and County and County to enter upon the Applicrnt or Agent , Pernritee nnnre b 4^ UNDER GROUND Waste & Vent Water-Under floor Gas-Underfloor ,I ,1 Building Sewer f175['?,1 Dfr-W1 wtst- *o bitto\- c'lu Area/Storm Drain I I nterceptor/ Clarifier TOP OUT Waste & Vent Water Piping Gas Pipinq Roof Drain Tub/Shower Test Rough Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Pipinq Fill Line/Back Flow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary Sewerlcap Back Flow Device Rough Plumbing Final Gas Test Meter Release I I ,4 \. 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