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HomeMy WebLinkAbout101108016 - PermitProject Address: 1916 S Cypress Ave Assessor's Parcel: 403-163-01 Lot: 7 Unit:Bldg: Address Range:Suite Range: Zoning: R2Block: A Tract: 284 Historic: No City 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 #: 1O11O8O{6 Pin #: 95920 Building Use: Other Occupancy: B 1st FL Area Job Type: Reroof Constr Type: V B 2nd FL Area Nature of Work: Reroof Code: CBC 2019 Other Areas Existing Bldg. & Use: Church Flood Zone: X-0602320276J Garage Area Proposed Use: # of Stories: Totat Description of Work: Reroof w/t.o.-Remove shingles and apply cool roof shingles/sheathing to remain/handout given Patio: T.l.Area: Yards Req'd Valuation: $95,000.00 I0tch+: '5lJjrl ice: (:Planning Conditions: l Owner: Address: Phone: Tenant La Semilla 1916 S Cypress Santa Ana, CA 92707 (7141 957-3131 Contractor: Address: Owner-Builder Phone: State Lic #: Lic Type: Bus. Lic #: Workers' Compensation lnsurance: Carrier: Policy #: Expires: Engineer: Address. Phone: License #: Architect / Desiqner: Address. Phone: License #: 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 Mendoza, Jessica Hernan dez, Kathy Date: 0912112021 Date: Date: 0912112021 Subject to Field: Misc. Receipt: Misc. Receipt: Misc. Receipt: 07776002 07776002 07776002 07776002 07776002 57607 57770 57672 57600 57607 Permit Fee Microfilm Records Bldg. Stds. Revolving General Plan Update lssuance Fee Total Paid to Date: Balance Due: $863 20 $4 05 $2.00 $23.7e $s9.30 $es2.34 $0 00 $952.34 Fire lnsp. Req'd: No Police lnsp. Req'd: No Flood Zone Cert. Req'd. No 01 1 1 6002 51 600 01 1 16002 51601 01 1 16002 51612 01 1 16002 57770 Account#Total Every permitissued shall become invalid unless the work on the site authorized by such permit is commenced within360 days afterits issuance,or if the work authorized on the site by such permit is suspe nded or abandoned for a period of 360 days after the time the work is commenced. lnspector MID#: 2021-168872 $23.79 $e22.50 $2.00 $4 05 BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION I hoc$l afum und6 paalty of psjury that I m qmpt fiom thc Contrs.lon' Licre law for thc followiag rwn (Sc.7031.5 Buins and hofeion Codc): Atry City or County which rcquim a pumit to coEtruct, sltq, isprovq daaolish or npair my struclue, Fior to it3 ismcc, also rcquire thc ryplicet for such pcnrit to filc E signcd statmot thd hc or shc b licasrd plmst to thc prcvisioru of thc Conractor's Limcd law (Ch4tq 9. Commcing with Sction 7000 of Division 3 of the Buine md PrcfeiomCodc)orthathcorshcisq@ptthqc&omedthcbosisforthcallcgcdaoption. AnyviolationofS€rion703l.5byey applicet for a psmit subjets the applic&t to a civil pcnalty of not more thd fivc hundred dollus (S500). _1, s oma of thc Fop6ty, or my mplolc with wag6 a thcir slc @mpsMtioo, will & thc wr* ad tlE srrudrc b mt intqrdod or ofiqed for salc (Sa.7044, BEins ud ProfsioN Codq The Conlmctor's Licffi trw do6 not apply to u oMs of rhcFopqty whohrildsorimprorcttuocsdwhodo6zuchwr*hiwlforhelforthrcughhisorhqommploye, providcd that such improffits rc mt intqrdcd or ofu for slc. lf, trcw, thc hiHhg or inprovmt is sld within onc )qr of compl*bn thc oluao BuikLr wil lurc thc hrd6 of poving tha hc or strc did mt huiH or inprovc thc popaty br thc prpos of sdc). -1. I oMq of thc propqty. m cxcluivcly coilmcling with lic@s.d contrutoB to coctrud tlrc Fojet (Se. 7044. BNinB and Profcsim Codc: Thc Contrctor's Licdsc Law do6 not apply to e own6 of prcpcrty who builds or imprcvG thq@o, md who coolracls for such prcjcts with 8 ConEaclo(s) licascd punuant to thc Confactor's Licre hw). _l am under Section-. B. & P.C. for this rcason. I hereby affrm undcr penalty of pojury one of the following declarations: _l have and will maintain a Certificate of Consext to Self-lnsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the p€rfonnancc of the work for which thc pcnnit is issued. _l have and will maintain workers' compensation insurancc. as required by Section 3700 of the L^abor Code. for thc performancc of the work for rvhich this permit is issued. My workers' compensation insurance carricr and policy number are: { _l certi$ that in the performance of the work for which this permit is issued, I shall not employ any p€rson in any manner so as to bccornc subject to the workers' compensation laws of California, and agrce that if I should become subject to thc workcrs' compensation provisions of Section 3700 of the kbor Code I shall. forthwith comply with those provisions. WARNING: Failure to secure workers' compemation coverage is unlawful, and shall subject an employer to criminal poulties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation, damages as provided for the Section 3076 of the l-abor Code, interest and attorney's fees. DECI,ARATION I hereby affurn under penalty of perjury that I arn licenscd undcr provision of Chapter 9 (cornmencing with Section 7000) of Division 3 of the Business and Professions Code, and rny license is in full force and effect. License Class: License Number: Contrrctor: W I ha$y alhm undo pqdty of psjury rhd thc is a @n$rucliotr lading agmy for thc psforocc of thc wrk for which this pqtnh b isucd (Sc. 3097, Civ. C.). I-cnder's Namc: lender's Addrcss: APPLICANT NECLARATION I h€rcby affirm under penalty of perjury one of the following declarations: Demolition Perrnits-Asbestos Notification Fcderal Regulations (Title 40, Part6) -Required lrtter of Notification -l cdiry that thc fcddal tcgulatioro rcgading ubatos r@oval ac not appliceble to this proj61. _l cdiry that I havc rcad this application and statc thal thc abovc inforrralion is corot. I agre to @mply with 8tl City ed County ordimcG ed Statc lrs rchting to building coDgruclion, ad h@by authorizc rc?rBqrtarivc of this City md Couty to otq upoo thc above mentioned property for irspection Applicant or Agent l'ermitee nRme Dric ltulL{ Set Backs Forms/Stee!/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/Ve nUl n s u Iation I t I Roof Sheathinq 0 \q0\1L vwy I / Shear Wall rl / Framing Insulation/Enerqy Drynrvall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Fina! Report Engineer Final Report Flood Zone Certif t .A e I FINAL l\q\7/\ulr{6 Certificate of Occupancy Notes, Remarks, Etc. 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