HomeMy WebLinkAbout30115173 - PermitD Plumbing Permit #: 30{ {5{73
r 'l CUy of Santa Ana
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20 Civic Center Plaza (M-19), Santa Ana, CA 92702I Permit Counter: (714) 647-5800 lnspection Requests: (7141667-2738 //-,
Project Address: 1802 S Van Ness Ave Suite:
Block: I
Bldg:
Tract: 531
Address Range:
Historic: No
Suite Range:
Zoning: RlAssessor's Parcel: 015-042-20 Lot: 1 5, 16
Owner:
Address:
Lisa Cangiano
1802 S Van Ness Ave
Santa Ana, CA 927072636
(7141 751-6467
Fee Type
Repipe Res
lssuance
Amount
15.00
30.00
Qty
2.00
1.00
Fee
$30.00
$30.00
Phone:
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Building Use:
Type of Work:
Nature of Work:
Single Family Dwelling - D( Constr Type
Miscellaneous Occupancy:
Repipe SFD Code:
VN
R3&Ul
cPc 2001
Notes:
Planning Conditions:
Planning Approval By:Date:
Date:
Date:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Plan Checked By:
Permit lssued By:
Subject to Field:
\(A Hernan dez, Kathy 01128t2004
Building Permit A Fee Total:
Paid to Date:
Balance Due:
$60.00
$0.00
$60.00
This permit shall expire by limitation and become null and void if the work authorized by this permit
is not commenced within 180 days from the date of this permit, or if the work authorized by this
permit is suspended or abandoned at any time after the wo* is commenced for a period of 180 days.
Before such work can be recommenced, a new permit shall be first obtained to do so.
Account #: 01 1-01-5912 lnspector
I
PLU MBI NG.I NSPEGTOR RECORD I t' 1
APPROVALS DATE ID/S!G.COMMENTS Ownfr-Bdlda D*lmtiil
t hmby aIEm uda Fmlty of pdjury thd I m acmpt fm thc Cmtrrcrm' Limsc Law ftr thc following rson (s@.7031.5 BuitrB!
md Profcim Codc): tuy City 6 Cmty which rrquiE . pGrnit to mstuct, dtd, improvc, dmolish or rcpair uy ttrusturc, pri6 to its
isume, also rcquiro thc rpplimt fo ruch pcmit to filc a signcd rlttqnat thr hc s shc is liccnscd pmuut io thc provilim of thc
Cmtnrrtr'! Ururd Ifl (Chrpt6 9, Cmcing rith S6tim ?000 of Dvirim 3 of thc Buin*s dd Ptofasimr Codc) or that hc u
3hc i! aanpt tharfioin md thc bsis fc thc rllcScd qdrptio .Any violtim of Setim 7031.5 by uy applimt fc a pcmit $bjsts thc
lpplist to s civil parrlty of nd m@ rhe fivc hmdrcd tlollm ($500).
_I, r oma of thc popctty, c my mploye with wag6 a dicir slc csrpeasrtion, sill do thc work md thc structw k not intm&d
or oficrcd fa illc ( 56.7044, Buin63 ed Prcfsim Codc: Thc Cobacic'i Lic63c Lsw dc not spply to a om6 of rhc propctty
who buildr c inprovs thacon" md who docr ruch work hinsclf tr hmclf c thrcugh his a ha om mployu, povided tha such
imprcmmt rc not iiladcd d offcrcd ftr sdc. lf, howcv6, thc builditr8 d improvmmt i! sold within onc ycar of complaion, thc
Owna-Builds will havc thc burda of provitrS that hc s lhc trot build o improve for thc putpoc ofsalc).
[], u mr of thc propcrty, m qclwivcly utracting with limccd mtretm to cmrtruct thc prcjcct ( Scc. 7044, Bsiner ed
Prcfcsrim Cods Thc Cmtrelo'! Licffi Law dm not apply to m oma of propcrry who builds c improva thcor , ud who
contracts for such projects with a Contracto(s) licensed pursuant to the License Law.).
\
_l anr exempt under Section for this
Date:
I hereby aftirm underpeflalty of perjury one
_I harc od will mintdn r Cdtifietr of CMt to Sclf-Inlm fff wortd' cmpaBltim, s povidcd fc by Serion 3700 of rhc
L:bor Codc, fqthc p6fme of thc wdl fcwhich drc psmit ir irsucd.
Ihtwmdyillmaintrinwqhm'companruioninrwcc,u r€quircdbySdion3T00ofthcLabqCodc,for0rcpcrfomeofthc
wor* f6 which thir parnit ir ircucd. My wor*m' mpcruatim instme mia md policy nmbq uc:
Policy Number: Expircs:
(This section necd no, br.rnpl"rd if ,he pcrmit is for One hundred dollan {$lO0} or less)
_l certify that in the pcrformuce of the work for
became subject to the workers ' compensation laws
which this is issued, I in any manner so as to
that the workers'
compensation provisio,N of Soction 3700 of the Lsbor Codc, I
WARNING: Failure to secure workers'
fines up to one hun&ed thorsand dollars
compqlsation
($loo,ooo),in
unlawful, and an cmployer to criminal pcnalties and civil
addition to the cost of compc-nsation, damages as provided for the Scction 3076 of
the Labor Code, interest and attorney's fees.
@
I hrcby affim udcr paslty of pcjury thrt t m limrcd udcr Fovirio of Chaptr 9 (mmacing with Scction 7000) of Divisio 3 of
thc Buins ud Prcfsim Codc, ud my limc is in full fG md cfr61.
Liccrue Class: License Numbcr
Date: Contractor:
@
I hacDy rfEm m&rpa.lty of pajuy lhrt thc ir r cquruction lcodi4 garcy fc 0ro pqfmc of thc wdk fq which rhir pcnnir it
isucd (Sc. 3097, Civ. C.).
Lada'rNffi:
Lender's Ad&ess:
APPLICANT'S DECLARATION
Dcmolition Permits-Asbestos Notificuion Federal Regulations (Title 40, Part 6)
_ Rcquired l,ater of Notification
_I certi$ that the federal regulations regarding asbestos removal are not applicable to this project.
_ I certi$ that I have read that the a[ove information is correct. I agrce to comply with all City and County
above mcntioned
Applicant or agert sig.
Pcrminee namc (print):
and hereby authorize reprccntatives of this City County enter upon the
UNDER GROUND
Waste & Vent
Water-Underfloor
Gas-Underfloor
Building Sewer
Area/Storm Drain
I nterceptor/ Cla rifier
TOP OUT
Waste & Vent
Water Piping
Gas Pipeing
Roof Drain
Tub/Shower Test
Rough Water Heater
POOUSPA
P-trap/Drain Line
Main Drain/Pool Piping
Fill Line/Back Flow
Pool Heater/Gas Line
Misc
Gas Service t
Water Service ZIL r)L w tqfr
Lawn Sprinkler L'/ -
Sanitary SewerlCap
Back Flow Device
Rough Plumbing t rsr Bat
Final Gas Test -t-/
Meter Release
FINAL
Notes, Remarks, Etc.
&.
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employ any
become
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