HomeMy WebLinkAbout101107829 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: 1O1107829
Pin #: 5630{
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Proiect Address: 2017 N Williams St-a- -Unit:Bldg: Address Range:Suite Range:
Zoning: RlAssessor's Parce!: 396-1 05-21 Lot: 33 Block: NA Tract: 6501 Historic: No
Building Use: Single F.mily DwellinO Occupancy: R3, U 1st FL Area Patio:
Job Type Roioof Constr Type V B 2nd FL Area T. l.Area:
Nature ot work Reroof code: cBc mlg oher Arees yards Req.d
Existing Bldg. & use: sfd wr.tt g.r.ge Flood zone: x.o8o23zrl6d
carage Area vetu.tion: tt4,25o.ooProposed Usei # of Stories:
Tolal
Deacrlptlon ot Work Rerco, houra & atlachad ga.age - rcmovs comp, rsplacs any damagod shsathlng, lnBtrll naw comp ahlngla!. Handouts givon.
Planning Conditions:
Owner:
Address:
Phone:
Tenant
Deb Thompson
2017 N Williams St
Santa Ana, CA 927057842
(7141 6584443
Contractor: William J Burken
Address: 12975 Avenida Empresa
Riverside, CA 92503
Phone: (7141 931-8618
State Lic #: 574763
Lic Type: C-39
Bus. Lic #: 370158
Workers' Compensation I nsurance.
Carrier: State Fund
Policy #: 1860441
Expires'. 1210112021
Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
Planning Approval By.Jacinto, Heidi
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA Insp. Req'd:
Planning lnsp. Req'd
Landscaping lnsp. Req'd:
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days after ifs issua nce,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#: 2021-168532
Julie
Date: 08/31 12021
Date.
Date: 08/31 12021
Subject to Field:
Misc. Receipt.
Misc. Receipt:
Misc. Receipt:
07776002
07776002
07776002
077760 02
07776002
57607
s7770
57672
s7600
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuance
$345.28
$4.05
$1 00
$23.7e
$5e 30
Fire !nsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No
Account#TotalNo
No 01 1 16002 51600
01 1 16002 51601
01 1 16002 s1612
01 1 16002 57770
$23 79
$404.58
$1.00
$4.05 Fee Totat
Paid to Date:
Balance Due:
$433.42
$0 00
$433.42
BU!LDING- INSPECTOR RECORD
SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION
I hacby affrm unde penalty of perjury thar I m cxcmpt fiom thc Contracton' Licw Law for thc following rwn (Se.7031.5 -
Buinss od hofesion Codc): Any City or County which rcquirc a pornit to @Etruc{, alto, improvc, dmolish or rcpair my.
structuc. prior to its isumce. also rcqut6 thc applicet for such pennit to lilc a signcd statm@t that h€ or srtc b lic@scd ptMt.
to thc provisioN of thc Contrrctor's Licmscd taw (Chapto 9, Comcncing with Setion 7000 of Division 3 of the Busines ud
Prcfsiom Codc) or that hc or she is exmpt thaefrom ad thc b6sis for thc allcgcd cxmgion. Any violation of Sction 7031.5 b) oy
applicmtforapmitsubjwtsthc applicmttoacivilpcmltyofnotmorcthilfivehundrcddollus($500). t'
--1. as owner of the propcrty. or my employe€s with wages as their sole compcnsation. willdo the work and the stnrcture is not
intcndod or offerd for sale (Sec.7044. Business and hofessions Code: The Contractor's License Law does not apply to an owner of
the property who builds or improves theron. and who does such work himself or hcrself or lhrough his or her own employees,
provided that such improvanents arc not intended or off€red for sale. l[, howerrer, the building or improvement is sold within one ]rar
of completion. the Orvner Builder will have the hrden of proving thd he or she did not build or improve the property for the purpose of
sale).
_1, as owner of the property, arn exclusively contracting with licerued contractors to construct thc project (Sec. 7U4, Business
and Professbn Code: The Contractor's Liccnse Law does not apply to an ownef, of property who builds or improves thereon.
and who contracts for such projects with a Contraclor(s) licersed pursuant to the Contraclor's Liccnse l-aw).
-l
am exempt under Section-. B. & P.C. for this reason.
h.r, a.ffi
I hercby affirm unde penalty of po'jury one of thc following delratioN:
/
-l
have and will maintah a Certifrcstc of CoMt to Sclf-lmurc for workc' comFnsation, r providld for by Sction 3700 of thc
L0bor Codc for thc psfommcc of the wrt for which thc pmit is isued.
%"" "na
*itt r"inr"in *o.t *' .o.p"Eation imumcq I rcquircd by sstion 3?00 of thc Lrbor codc, for th€ pcfoImcc of
-rhc
work for which this pqmit is ised. My worko' ompasaion irourmic cmiq ard policy oumba rc:
uno
12-l-z/
__l cari$ that in the perforrnance of the work for which this perrnit is issued, I shall not employ any person in any manner
so ils to become subject to the workers'compensation laws of California. and agree that if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code. I shall. forthwith comply with those provisions.
WARNING: Failure to secure workers' compensation coverage is unlawful, 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. damages as provided for the
Section 3076 of the Labor Code, interest and attorney's fees.Ar^&8,-3i - zi
I hereby affrrn under pcnalty of perjury that I am licensod 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code. and my license is in full force and effect.
Nurnber:7L/7b 3
,'i/,en
W
I hercby affm und6 penalty of pcrjury that thqe is a corotruaion lcnding agacy for thc pqfomucc of thc work for which this pqmit b
issucd (Sc. 3097, Civ. C.).
Lender's Name:
l-ender's Ad&css:
APPLICANT DECLARATION
I hoeby affrrn under penalty of perjury one of the following dcclarations:
Dernolition Permits-Asbestos Notification Federal Regulations (Titlc 40. Part6)
-Required
Letter of Notification
_l certi& that thc federal regulations regarding asbestos removalare not applicable to this project.
W*ifu that I have read this application and statc that the above infonnation is correct. I agrec to comply
ordinances and State Laws relating to building construction. and hereby authorize representatives of this City
with all City and County
and County to €nter upon the
above mentiond property for inspection
Applicnnt or Agent
I Permitee name
I
oarc, 8-31'21
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bfloor/VenUl n su latio n ,l ,-._
Roof Sheathing q li lt,\J '37
)
Shear Wall \rr7
Framing
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence ,/
T-Bar \
Handicap Req.
Deputv Final Report
Enqineer Final Report
Flood Zone Certif.
/l .--
FINAL L ,LJ iail
Certificate of Occupancy ' I
Notes, Remarks, Etc.
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