HomeMy WebLinkAbout40135738 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA92702
Permit Counter (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Mechanical Permit #: fiiI573I
Pin #: Iigo24,
1^AT:T
Project Address: 1626 W Twelfth St Unit:
Block. NA
Bldg Address Range:
Historic: No
Suite Range:
Zoning: RlAssessor's Parcel:405-1 52-11 Lot: 11 Tract: 1307
Owner:
Address:
Hermila De Lira
1626 W. 12th St.
Santa Ana, CA 92703
(7141543-2188
01 1 16002 51604
01 1 16002 51600
01 1 16002 51604
01 1 16002 57770
Fee Type Amount
Wall Heater/Floor Furnace 70.64
General Plan Update 23.79
lssuance 59.30
Microfilm Records 4.05
Qty
100
1 .00
100
1 .00
Fee
$70.64
$23.79
$59.30
$4.05
Phone:
Tenant Name:
Contractor:
Address:
Specialty AC Heat
4650 Arrow Highway, Suite C6
Montclair, CA 91763
(eoe) e82-7eesPhone:
State Lic #. 784495
Lic TVpe: C-36, C-20
Bus. Lic #: 349795
Workers' Compensation lnsurance:
Carrier: SecuritY National lns Co
Policy #: SWC1307380
Expires: 1012312021
Building Use:
Job Type:
Nature of Work.
Single Family Dwelling
Miscellaneous
Mechanical
Occupancy:
Constr Type:
Code:
R-3
VB
cMc 2019
Notes. Mechanical
Planning Conditions
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field.
Building Permit #:
web-us"'f\,/
Date
Date
Date 07t15t2021
Account#
Misc. Receipt:
Misc. Receipt.
Misc. Receipt:
Total
Every permit issued 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 the srte by such permit is
suspended or abandoned for a period of 360 days after the time the work
is commenced.
N/A - No
N/A - No
Balance
Balance
Fee Total.
Paid to Date:
Balance Due:
$157.78
$157.78
$0.00
lnspector M lD#: 2021-167 460
INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BTIII NFR DFLCARATION
I hereby affinn under penalty of perjury that I am exonpt form the Conffactors' License Law for the following reason (Sec.7031.5 Business
and Profession Code): Any City or County which requires a pcnnit to construct. alter. improve. demolish or repair any structure. prior to its
issuance. also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to thc provisions of the
Conractor's Licensed l.aw (Chapter 9. Commencing with Section 7000 of Division -1 of the Business and Professions Codc) or that he or
sheisexempttherefromandthebasisfortheallegedexemption. AnyviolationofSectionT03l.5byanyapplicantforapennitsubjecsthe
applicant to a civil penalty of not more than five hundred dollars 1$.500).
!o-t. ,t owner of the property. or my employees with wages as their sole compensation, will do the wort and rhe structure is not inrcnded
or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Law docs not apply to an owncr of the propcrty
who builds or improves theteon. and rvho does such work himself or herself or through his or her own cmployees. p,rovidcd that such
improvonents arc not intended or offered for sale. lf. howerrer. the building or improvement is sold within one year of complaion. the
Orvner Builder rvill have the burden of proving that he or she did not build or improve dre property fcr the purposc of sale).
xo-1. at owner of rhe property. am exclusivety contracting with licensed contractors to construct the project (Sec. 7044. Business and
Profession Code: The Contractor's l,icense [-aw does not apply to an owner of property who builds or improves thereon. and
rvho conlracts for such proiects rvith a Contractor(s) licensed pursuant to the Contractor's License Law).
rc-t am exempt under Secrion . B. & P.C. for this reason.
woR.KrRs' CoMPENS {TION nFCl ^ RATION
I hereby alTirm under penalty of perjury one of the following dcclarations:
rc I h.*,. and will maintain a Certificate of Consent to Self-tnsure for workers' compensation. as provided for by Section 3700 of rhe
Labor Code, for the performarce of the work for which the permit is issued.
YE6
-l have and will maintain rvorkers' compensation insurance. as required by Section -1700 of the Labor Code. for the performance of the
work for which this permit is issued. My worters' compensation insurance carrier and policy number are:
. 9ccurlty Natlonal( arTrer:
swc1307380l'olicv Nrrrtther._Expires:
1112312021
NO
_ I certifu that in the performance of the work for rvhich this permit is issued. I shall not employ any percon in any manner so
as to become sub.iect to the workem' compensation laws of California. and agree that if I should become subject to the workcrs'
compensation prrrvisions of Section 3700 of the Labor Code. I shall. forthrvith comply with those provisions..
WARNING: Failure to secure rvorters'compensation coverage is unlawful. and shall subject an onployer to criminal penalties and civil
fines up to one hundred thousand dollars ($100.000), in addition to the cost of compensation, damages as provided for the Section .1076
of the Labor Code, interest and attorney's fees.
I ICTNSTN CONTRAC'I'OR NFCI {RA'TION
I hereby alTirm under penalty of perjury that I am licensed undcr provision of Chapter 9 (cornmencing rvith Section 7000) of Division -3 of
the Business and Professions Code, and my license is in full force and effect.
c2o-c30
l-icense ('lass:78'f495
l,icense Number
(.ONSTRUCTION I TNUNG AGFNCY
I hereby affinn under penalty of perjury' that there is a construction lending agerrcy for the perfonnance of the work for which this Jrermit is
issued (Sec. .1097. Cir,. C.).
[.ender"s Name:
l-ender's Address:
APPr ICANT nFCt ^RrdrtON
I herebv affimr under penalty of per1ury one of the followrng declarations.
l)enrol ttion Penttrts-Asbeslos Notr ticatron Federal Regul atrons (Title 40, Part6 )
p_ Required Letterof Notification
YEs f cerlifo that the federal regulations regarding a-sbestos removal are not applicable to this project.
ttt
t certiS, that I have read this application and state that the atrrve informarion is correct. I agree to comply wirh all City and Cotmty
ordinances and State Laws relating to building construction. and hereby authorizc representatives of this City and County to enter upon the
above mentioned property for inspection purposes.
Reroof
Roof (Diaphragm Sheathing/Frame)
Structural Final
Plumbing
Under Floor I Under Slab
Rough
Shower Pan / Tub Test
Water Service
Sewer / Sewer Cap
Gas Air Pressure Test
Plumbing Final
Electrica!
Service (Meter I Panel)
Grounding / Bonding
Rough
Electrical Final
Mechanica!
Gas Air Pressure Test
Rough
Piping (HW, CW, etc.)
Exhaust Ducts tl
Mechanical Final tbl trlT t7 ts 99
I I
Notes, Remarks, Etc.
a