HomeMy WebLinkAbout30143354 - 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
Plumbing Permit #: Iot4IS54
Pin #:6r163
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Project Address: 1626 W Twelfth St Unit:
Block: NA
Bldg:
Tract: 1307
Address Range:
Historic: No
Suite Range:
Zoning: RlAssessor's Parcel:405-1 52-11 Lot: 11
Owner:
Address:
Hermila De Lira
1626 W. 12th St.
Santa Ana, CA 92703
(7141543-2188
01 1 16002 51602
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
Fee Type
Wtr Htr (Res up to 50 gal)
General Plan Update
lssuance
Microfilm Records
Amount
23.97
23.79
59.30
405
Qt)'
1 .00
100
1 .00
1 .00
Fee
$23.97
$23.79
$59.30
$4.05
Phone:
Tenant Name:
Contractor:
Address:
Specialty AC Heat
4650 Arrow Highway, Suite C6
Montclair, CA 91763
(909) e82-79eePhone:
e
I
State Lic #. 784495
Lic Tvpe. C-36, C-20
Bus. Lic #: 349795
Workers' Compensation lnsurance:
Canier: Security National lns Co
Policy #: SWC1307380
Expires: 1012312021
Building Use:
Job Type:
Nature of Work.
Single Family Dwelling
Miscellaneous
Plumbing
Occupancy.
Constr Type:
Code:
R-3
VB
cPc 2019 Notes: Plumbing
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By.
Subject to Field:
Building Permit #:
web_user
Date:
Date.
Date:07 t15t2021
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Account#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 fhe srte by such permit is
suspended or abandoned for a period of 360 days afterthe time the work
is commenced.
N/A - No
N/A. No
Balance
Balance
Fee Tota!:
Paid to Date:
Balance Due:
$1 1111
$11111
$0.00
Inspector MID#: 2021-167461
SITE-WORK DATE !D/SIG.COMMENTS O\TNER BU ILDER DT LCARATION
I hereby affirm under penalty of perjury that I am exempt form the Contractors' License Law for the following re:son (Sec.70.1L5 Business
and Profession Code): Any City or County which requires a permit to construct. alter. improve. demolish or repair any structure, prior to its
issuance. also requires the applicant for such permit to file a signed staterncnt that he or she is licensed pursuant to the provisions of the
Contractor's Licensed Law (Chapter 9. Commencing with Section 7000 of Division -i of the Business and Professions Code) or that he or
she is exempt therefrcrm and the basis for the alleged exemption Any violation of Section 7031.5 by any applicant for a pcrmit subjects the
applicant to a civil pcnalty of not more than live hundred dollars ($-s00).
Nl l. "r owner of the prope'rty. or my employees r.r'ith wages as their sole comgrcnsation. rvill do the wort and the structure is not intended
or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License [:w does not apply to an owner of the propcrty
who builds or improves thercrrn, and who does strch work hirnself or herself or through his or her own cmployees. provided that such
improvanents are not intended or offered for sale. lf, howo.er. the building or impnovement is sold within one year of complaion. the
Owner Builder will have the burden of proving that he or she did not build or improve the properil for thc purpc€ of sale).
!! l. a. owner of the property. am exclusively contracting with licensed contmctors to construct the project (Sec. ?044. Business and
Itofession Code: The Contractor's License Larv does not apply to an owner of property rvho builds or improves thereon. and
who contracts for such prcjects with a Contracto(s) licensed pursuant to the Contractor's License Law).
[o I .r, exempt under Section B. & P.C. for this reason.
WORKFRS' COI}I PF'NSATION DT'CI A,RATION
I hereby affirnr under penalty of periury one of the following declarations:
!o-t f,ru. and rvitt maintain a Certificate of Consent to Self-lnsure for workers' compensarion. as provided for by Section 3700 of the
Labor Code. for the performance of the work for which the permit is issued.
YES
_ I have and will maintain workers' compensation insurance. as required by Section .17fi) of the Labor Code. for the performance of the
work for which this permit is issued. My workers' compensation insurance carrier and policy number are:
. Sccurtty ilrtlonal( arner:
1112312021
Policy Number:
NO
Expires:
_ _l certilr'that in the performance of the rvork for which this permit is issued. I shall not employ any person in any manner so
as to become subiect to the rvorkers' compensation laws of California. and agree that if I should become subject to the workers'
cornpensation provisions of Section .1700 of the Labor Code. I shall. forthwilh comply with those provisions..
WARNING: Failure to secure workers'compensation coverage is unlarvful. and shall subject an employer to criminal penalties and civil
fines up to one hundred thousand dollars ($100,000). in addition to the cost of compensation. darnages as provided for the Section 3076
of the l-abor Code. interest and attomey's fees.
LI('F'NSTD CONTRA('TOR t}FCI ^ RATION
I hereby affinn under Srcnalty of grr.iury that I arn licensed under provision of Chapter 9 (commencing with Section 7000) of Division J of
the Business and Professions ('ode. and my license is in full force and effect.
c2(}C30
[.icense ('lass:7E4495
License Number
C()NSTRI.ICTION I T'NNIN(; AGFNCY
I hereby afTirm under penalty of per.jury that there is a constnrction lending agency for the performance of the rvork for which this permit is
issued (Sec. .1097. Civ. C.).
l-ender's Name:
Lender's Address:
APPI ICANT NFCI {R,ATION
I heretry affimr under penalty of per1ury one of the followrng declarations:
Denrolrtion Pernrits-Asbestos Notification Federal Regulatrons (Trtle 40. Part6)
p_ Required Letterof Notification
vel I catify that the federal regulations regarding asbestos removal are not applicable to this project.
1t-t , certiS, that I have read this application and state that the above information is correcl. t agree to comply with all City and County
ordinances and State Laws relating to building construction. and hereby authorize representatives of this City and County to enter upon the
above menlioned property for inspection purposes.
Reroof
Roof (Diaphragm Sheathing/Frame)
Structural Final
PIum bing
Under Floor I Under Slab
Rough
Shower Pan / Tub Test
Water Service
Sewer / Sewer Cap
Gas Air Pressure Test -^
Plumbing Final /b-/>zl Lqryq )
Electrical \-/
Service (Meter I Panel)
Grounding / Bonding
Rough
Electrical Final
Mechanical
Gas Air Pressure Test
Rough
Piping (HW, CW, etc.)
Exhaust Ducts
Mechanical Final
Notes, Remarks, Etc.
INSPECTOR RECORD
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