HomeMy WebLinkAbout40111158 - Permit{
.City of Santa Ana
20 Civic Center Plaza (M-19), Santa Ana, CA 92702
Mechanical Permit #:40111158
Permit Counter: (714) 647-5800 lnspection Requests: (714\ 667-2738 /L
Project Address: 1802 S Van Ness Ave
Assessor's Parcel: 015-042-20 Lot: 1 5, 16
Suite:
Block: I
BIdg:
Tract: 531
Address Range:
Historic: No
Suite Range:
Zoning: R1
Owner:
Address:
Phone:
Lisa Cangiano
1802 S Van Ness Ave
Santa Ana, CA 927072636
(7141 751-6467
Fee Type
Wall Heater
Gas Piping lncidental
lssuance
Amount
22.00
15.00
30.00
Qty
1.00
1.00
1.00
Fee
$22.00
$15.00
$30.00
$67.00
$0.00
$67.00
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:
Plannlng Gonditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit
Single Family Dwelling - D( Constr Type:
Miscellaneous Occupancy:
Walt Heater Code:
VN
R3&U1
cMc 2001
0
Date:
Date:
Date:0112812004
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Notes:
Fee Total:
Paid to Date:
Balance Due:
Hernan dez, Kathy
il
This permit shall expire by limitation and become null and void if the work authoized 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 work is commenced for a period of 180 days.
Before such work can be recommenced, a new permit shall be first obtained fo do so.
Account #: 01 1-01-5915 lnspector
,
MECHANICAL.I NSPECTOR RECORD
t
APPROVALS DATE ID/SIG.COMMENTS Ownar-Buildtr Dcclmtion
t hscby aflim undcr Fnslty of pcrjuy ihat I m crmp fm thc Conretffi' L|€NG Law fc thc iollowing mo (rc.7031 .5 Builrc
ild Prcfgsim Codc): Any City a County which rcquire r pcmit to @ffitruct, alta, improvc. dcmlirh c Epsir sy structurq Fitr to ia
issuacc, also rcquiG thc applimt ftr such p.mit to filc s sigtrcd st.tcrmt th.t hc s shc is licascd puswt to thc povisiou of thc
Cmtretor's Limscd Law (Chrptcr 9, Commencing with Serim 7000 of Divirio 3 of thc Buins ud Prcfcim Codc) c thu hc or
shc is cxcmpt thftfm ed thc bais fff thc rllcged cxcmption .Any violrtim of S*tion 7031.5 by sy appliot f6 s F fliit subj@o Oc
applicmt !o a civil pcnslty ofnot morc the fivc hundrcd dollm (3500).
_1, o owna of thc popcrty, or my cmploycB with wag6 I thcir solc mpcnsatim, will do lhc wqk ud thc structuc is not int6&d
or offcrcd fq salc ( Scc.7044, Bsin6 ud Prcfsions Codc: Thc Conretq's Licqsc Lrv dc not .pply lo a wtrq of thc prcpcny
who builds or improvc th6m, ild who dG such wqk hiroclf or h6.lf r 6rough his c hc own mployc, Fovidcd thlr such
improvcmoB uc not intcndcd or offqcd for salc. lf. howcvcr. thc building u imprcvmcnt is sold within onc ys of @mplction, thc
Owncr-Builds will havc the burdar of proving that hc or she not build or improvc for thc purpcc ofsalc).
_1. as owner of thc property. am exclusively contracting with liccnscd contractonr to construct the projcct ( Sec. 7044, Business and
Profession Codc: The Contractor's License Law does not apply to an o\pncr of propcrty who buil& or improves thereon . and who
contracts for such projcc6 with a Contractor(s) licensed puruant to thc Contractor's License ky )'
_l am exempt under Section for
Date' Ownsr:
I hercby affirm under pcnalty of perjury one
_l havc ud will mintaia a Ccnificatc of Conscnt to SclfJnsurc for wortm' compcm8tion, u povidcd fo by Scction 3700 of thc
Labq Codc, for thc pcrfmc of thc wtrk ftr which thc pqmit is isucd.
_l havc ud will mintaio wcko' mpafatim imwe, a Equirrd by Scction 370O of thc Labc Codc, ftr thc p6fm* of th.
work for which this pqmir ir isucd. My wtrkm' cmpansatiil in3uocc tria ud policy numbcr re:
Policy Numbcc Expircs:(Thissectionn atc.s)-
_l certify that in thc pcrformance of the work for which this pcrmit
became subject to thc workers'compcnsation laws of California, and
is issued, I shall not in any manner so as to
the workcrs'that if I
compcnsation provisions of Scction 3700 of the Labor
Date:
WARNING: Failurc to securc workerc' compcnsation
fines up to one hundred thousand dollan ($100,000),in
the Labor Code, intcrcst and attorney's fecs.
coveraSc is unlawful, and an employer to criminal pcnaltics and civil
addition to the cost of compcnsation, damagcs as providcd for the Section 3076 of
LICENSEI' CONTRACTORS DECLARATION
I hscby affim und6 psfldty of pajury thst I m liccnscd uda povie io of Chrpr 9 (ommocing with Setio 700O) of Diyirion 3 of
thc Buinu ud Prcfsiom Codc, ud my limrc is in full fwc md cfrct
Liccnse Clacc'License Number
Datc: Cmtracttr:
CONSTRUCTION LENDTNG AGENCY
I hmby rlfim undcr padty of pdury rhst thc ir r mstructim lmding rgmcy fc thc p6fm8e of thc wdt fq which thir Fmit ir
i$scd (Se. 3(D7, Civ. C.).
Lender's Name:
Lender's Address:
APPLICAIIT'S DECLARATION
Demolition Permis-Asbcstos Notification Federal Rcgulations (Titlc 40, Parr 6)
_ Required Lener of Notification
-l
certify that the federal regulations regarding asbcstos rcmoval are not applicable to this project.
all City and County
County to enter upon the
Applicant or agart
Permittce nane (print):
and state with
Appliances
Metal Fire Place
Evap Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-!nsulation
lnsulation
Smoke Detectors lnstalled
Rough Ductwork
Vents
Toilet Room / Clothes Dryer
Residential Range
Other
Hood
Type I Hood
Type ll Hood
Grease Duct
Fire Damper
Openings
lnstallation
F.D. Drop Test
Above Hard Lid
Above T-Bar
I I
Rough Mech iltol d9 r A)?2r
Final Test I Y-Z
Meter Release
FINAL
a
t
\
/2
bccome
srrSject
abovc mentioned property
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