HomeMy WebLinkAbout10193047 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #: {O{93047
Pin #: 7o,57o^
il..,
Proiect Address: 502 S Forest Avea
Assessor's Parcel. 010-053-20 Lot: 6
Unit:Bldg: Address Range:Suite Range:
Zoning: R1Block: NA Tract: 2140 Historic: No
Building Use: Single Family Dwelling
Job Type: Patio Gover
Nature of Work: Patio cover
Existing Bldg. & Use: Sfd w/att garage
Proposed Use:
Description of Work: New attached patio cover
Planning Conditions:
Occupancy.
Constr Type.
Code:
Flood Zone.
# of Stories:
R.3, U
VB
cBc 2016
x-0602320257J
1
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area:
Total:
Patio: 495
T.l.Area:
Yards Req'd:
Valuation: $9,652.00
6/TS/2TJL7 ID: HGAR(: IA
0
t:
Owner:
Address:
Phone.
Tenant:
Rosalba Cruz Tellez
5O2 S. Forest Ave.
Santa Ana, CA 927034408
(7141 759-7865
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 #.
Acct * :
Rcpt*:t-ti.?i
Trqnsoct i o
Rosnibii i'r
l l,
Lr11i6
BIdsulii6
r'/{. P,
Ref *: llJ1?3t-i
6,t L3/2ltI7 4t28 ::
$435 .4i
rr Ljp d nt e Fee
16r-rt-tt-u.lt-r -
EVUIU i ns
ii:34 . + I
5361-rttt-l0r_r
Planning Approval By:
Plan Checked By:
Permit lssued By:
Kelaher, Selena
Hernan dez, Kathy
Amsden, Julie
Date: 06/1 212017
Date: 06/1 212017
Date: 06/1 312017
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002 si500
08907007 24000
07776002 57572
07776002 57600
07776002 57607
Plan Check Fee
SMIP - Category 1
Bldg. Stds. Revolving
General Plan Update
lssuance
$178 .20
$1 .25
$1 00
$20 56
$s1 26
$435.42
$0.00
$435.42
NPDES lnsp. Req'd:
PWA lnsp. Req'd:Fire lnsp. Req'd: No
Police lnsp. Req'd: No Account#Planning lnsp. Req'd:
Landscaping lnsp. Req'd:Flood Zone Cert. Req'd: No 01 1 16002 51600
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 180 days afterifs issuance,or if the work authorized
on the site by such permitis suspended or abandoned for a period of 180 days after
the time the work is commenced.
No
No
No
No
Total
01 1 16002 51601
01 1 16002 51612
01 1 16002 53600
08901001 24000
$20.56
$234.41
$1.00
$1 78 20
$1.25
Fee Total:
Paid to Date.
Balance Due:
lnspector MID#: 2017-1 36 146
!'
07776a92 5760t Permit Fee
BUILD!NG. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMEI.I+S OWNER BUILDER DELC'ARATION
I hrcby affm undq poalty of pojury that I m cxmpt from thc ContractoE' Licw Larv for thc following ltNn (Sc.70-!1.5 '
Busines ud Profesion Code): Any City or County which requiro a pomit to onstruct, ahc. imprcvc. danolish or rcpair uy
structe prior to its issumce. also rcquiB thc +plicmt for such pcmit to filc a signcd statmmt tha hc or shc ilticoscd pummt '
to thc provisioE of thc Contractor's Licascd llw (Chsptq 9. Commcncing u'ith Sation 7000 of Division 3 ofthc Busincs and '
Ppfsiom Codc) or that hc or shc is crmpt thcctom ild thc basis for thc allcgcd cxmption. Any violation of Scrion 7031.5 b! uy ,
applicantforspcrmitsubjCtsthc applicanttoacivilpcnaltyofnotmorcthiltivchundrcddollus($500).,lLr L-1. r omo of thc propcrty. or my cmploye with wagc r thcir rclc compcmation. will do tlrc mrt md thc stnrc1rc is not
intqdcd or olfacd for slc (Sc.7044. B6ins 6d Profsiom Codq Thc Cortraclor's Licw taw doe not apply to il ownc of
thc properry who buil& or irnprovc ths@tr md N,ho do6 sh w* himsclf or hcclf or thrcugh his or hr om anploye.
providcd that such impro@ts rc rct irtqdGd or offqrd for sl.. I[ hos'a6. thc building or impromt b mH rvhhin onc ]an
ofcompktion. thc 0*16 Buildc will harc thc hrda ofproviry thd hc or shc did mt tuild or inprorc tic propsiy fur the pupos of
slc).
_1. u oms of thc prcpsty. m cxclusively contracting wilh licmed contracloE to @nstrucl thc projccl (SG. 7044. Bsins
ard Profsbn Codc: Thc Coilraclor's Licmsc Law do6 not apply to m oM6 of propsty who builds or imprcv6 th6on.
and who contmcts for such projcts with a ContBcto(s) licds€d pucusrt to thc Contractor's Licw tarv).
I am exemot under Section B.P.C. for this reason.
Iuat"'U.,l-l C"zLlL
I hereby affirm under penalty of perjury one of the follor.r'ing
___l have and will maintain a Ccrlificate of Consent to Self-lnsure for workers' compensation. as provided for by Section -i700 of the
I-abor Code. for the pcformance of the work for which the perrnit is issued.
-l have and will maintain workers' compersation insurance. as requird by Section -1700 of the Labor Code. for the performance of
thc work for which this permit is issued. My workers' compensation insurance carrier and policy numkr are:
Policy E - ^iroo
.
fut catity **.in thc psfomncc of rhc work for which thb pcrmit is isucd. I shall not mploy any p6$n in any munc
s I to bcomc aubjet to thc wotkm' compctrsation laws of Califomia. ild agrc that if I should beotn. subjst to thc
wortm'compqmtionprcvisioroofSelion3T00oflhckborCodelshsll.forthwithcomplywiththorprcvisioro.
WARNING: Failurc to sue wrkm'compcmtion ovmgc is unlawful. ud shall subjat e mplo)€r to uimiml pcnahies md
civil fine up to one hundrcd thouud dollm ($100.000). in addition to thc cosl of compeetion. damage s providcd for thc
Sction 3076 of thc Labor Codq inlo6t ed dtonry's fc.
Z
I hereby affrrm under penalty of perjury that I am licenscd 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code, and my liccnse is in full fiorce and effect.
License Class: License Numbcr:
CONSTRUCTION LENDTNG AGENCY
I hrcby affrm undo p€nahy of pqjury that th@ is a @mtruction lading agocy for thc pqfomece of thc mrk for which thb pqmh is
isucd (Se. 3097. Civ. C.).
[rnd6's Nme:
-
lrndcr's Ad&ess:
APPLICANT DECLARATION
I herdry affinn undcr penalty of perjury one of the following declarations:
Demolition Permits-Asbestos Notification Federal Regulations (Titlc 40. Part6)
_Required Later of Notification
-l
certi& that the federal regulations regarding asbcstos removal arc not applicable to this projecrt.
Ecerti$/ that I have read this application and state thar the above information is corrert. I agree to comply
ordinances and State l:ws relating to building construction. and hereby authorize representatives of this City
above mentioned propeny for inspection purposes.
with all City and County
and County to enler upon the
frpri.rnt or Agent
(Permitee name
?-o L Lo a
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground \
SLAB Floor
S u bfloor/Ve nUI ns u latio n
Roof Sheathing
Shear Wall -)-
Framing / b 12-zl ,&42 u
Insulation/Energy \
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report \
Flood Zone Certif
FINAL l,D-ZZ-q fLc'S/I./S/Zi_S, V/!
Certificate of Occu pancy
Notes, Remarks, Etc
\
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