HomeMy WebLinkAbout101105430 - PermitCify of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 ' ' Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: {O11O543O
Pin #: 6,4374
Proiect Address: 914 E Clemensen Avea
Assessor's Parcel: 396412-05 Lot: 91
Unit:BIdg: Address Range:Suite Range:
Zoning: RlBlock: NA Tract: 4226 Historic: No
Building Use: Single Family Dwelling Occupancy: R-3, U 1st FL Area:
Job Type: Swimming Pool/Spa Constr Type: V B 2nd FL Area:
Nature of Work: Swimming Pool & Spa Code: CBC 2019 Other Areas:
Existing Bldg. & Use: Sfd Watt garage Flood Zone: X-0602320163J Garage Area:
Proposed Use: # of Stories:
Total:
Description of Work: New inground swimming pool & spa; change gates to open outward. Letter of auth on file.
Planning Conditions:
Patio:
T.l.Area:
Yards Req'd:
Valuation: $+0,000.00
0
Owner:
Address:
Phone:
Tenant:
Juan Madrigal
914 E Clemensen Ave
Santa Ana, CA 92705
(7141 656-8669
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
Pool Engineering lnc
Todd L. Lacher
1201 N Tustin Av
Anaheim, CA 92807
(7141 630-6100
67656
Planning Approval By:
Plan Checked By:
Permit lssued By:
Graham, Jeffery
Lee, Wayne
Amsden, Julie
Date: 1211012020
Date: 1211012020
Date: 1211012020
Subject to Field.
Misc. Receipt:
Misc. Receipt:
Misc. Receipt.
07776002
07776002
07775002
07776002
07776002
07776002
57607
s3600
57770
57672
s760 0
57607
Permit Fee
Plan Check Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
$292.50
$26s.s0
$12 15
$2.00
$23.79
$5e.30
NPDES lnsp.
PWA lnsp. Req'd:No
No Account#Planning lnsp. Req'd:
Landscaping Insp. 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 within360 days afterifs issuance,or if the work authorized
on the site by such permitis suspended or abandoned for a period of 360 days after
the time the work is commenced.
No
No
No
No
Fire lnsp. Req'd:
Police !nsp. Req'd:Total
01 1 16002 51601
01116002 51612
01 1 16002 53600
01 1 16002 57770
$23.79
$351 .80
$2.00
$265.s0
$1 2.1 5
Fee Total:
Paid to Date:
Balance Due:
$655 24
$0.00
$655.24
Inspector MID#: 2020-1 63232
ra
SITE.WORK DATE 'iD/slG.COMMENTS
Set Backs
Forms/Steel/Holdowns /-5'2{lfe,ltfi hd6
Erection Pads
UFER Ground A
SLAB Floor
Su bf Ioor/VenVl nsu Iation
Roof Sheathing
Shear Wall
Framing
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Jt/asonry ilt )
Pool Fence f./?d{a-m rud6
T-Bar
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif.
I I NL --^ r,
FINAL l\lylu s{ililfr,wa \
Certificate of Occupancy I I
Notes, Remarks, Etc
a
I hcrcby aflirm undcr JEnally of pcrjury lhat I m cxcmpt ln)m lhc G)nlraclos' Liccnsc llw l(rr thc folkrwing rca$n (Scc.70-11.5
Busincss anl Prolbssion CGlc): Atry City or County which rcquircs a lrcrmit lo conslrucl. allcr, improvc. dcmolish or rcpair any
structurc, Fior to ils issuancc, also rcquircs thc applicant for such Jrmil m lih a sigrcd statcmnl lhat hc or shc is licrnsd pusuant
lo lhc pft)visions of thc Conlrackrr's Liccnsd kw (Chaptcr 9. Commcncing with Scction 70{X) of Division -J of thc Busincss and
Pn)lbssions Codc) or that hc or shc is cxcmpt thcrcliom and thc hasis lirr thc allcgcd cxemption. Any violation of Scction 701 1.5 by any
lirr a pcrmit subjccts thc applicant to a civil pcnalty of not murc than fivc hundrcd dollars ($.5m).
t
as owncr <lf thc propcrty. or nry cmployccs with wagcs.rs thcir solc compcnsation, will do thc work ard thc structurc is not
intcndcd or oflcred frrr salc (Scc.7(X4, Busincss and Pnlfbssions Crxle: Thc Contractor's Liccnse Law docs not apply to an owncr of
thc pn)pcrty who builds or impnrvcs thcrcon, and who d<rcs such work himself or hersclf or through his or hcr own cmpkryccs,
providcd that such impnlvcrncnts arc mlt intcrxlcd or oll'crcrl tirr sah. It, howcvcr. thc buikling or improvcnrnt is sokJ within onc ycar
ol'comphtkrn, the Owncr Builtlcr will havc tlrc burdcn of prlving that hc or she did not builJ or impnrvc thc pnrpcrry lbr tlrc purJxlsc of
salc).
_1. as ownL'r of thc proF-rty. amcxclusivcly contracting with liccnscd conlract()rs to construct thc pnrjcct (Scc. JOd{, [ttsillsss
anrl ltulbssrln Codc: The Contraclor's l-icense Law docs not apply lo an owncr of proJrcrty who builds or improvcs thcrcon,
and who contracts lirr such pro.iccls with a Contraclor(s) liccnscd pursuant to thc Ct>ntractor's Liccnsc [-aw).
_l amcxcmpt undcr Scction_, B. & P.C. lirr this rcason.
I
DECLARATION
I hcrcby allirm under Jrcnalty ol'Jrcrjury onc of the following dcclarations:
_l havc and will maintain a Ccrlilicatc of Conscnt to Sclt'-lnsurc tor workcrs' compcnsation, as providcd for by Scction -1700 of thc
Lahrr Ctx-le, for thc pcrformancc of thc work fbr which the pcrmit Ls issucd.
-l
have and will maintain workcrs' compcnsation insurancc, as rcquircd by Scction 3700 of thc Labor Codc, titr thc pcrformancc of
thc wrlrk lilr which this pcrmit is issucd. My workcrs' compcnsation insurancc carrier and g>licy numbcr arc:
Numbcr: Expircs:
ccrtily that in the Jrcrlirrrnancc ol'thc wrlrk tilr which this Jrcrnrit is issucd. I shall not cnrpkry any frcrs()n in any manncr
Io hccomc subjcct to lhc workcrs'comJrcnsation laws of Calilirrnia, and agrec that if I should bccomc subjcct to thc
workcrs' comJrcnsati<ln provisions ot'Scction 17ffi of thc [:hlr Gxlc. I shall, tilrthwrth comply with thosc prlvisions.
fVARNtNG: Failurc to sccurc workcrs' compensation covcragc is unlawlirl. and shall suh.jcct an to criminal Jrcnaltics and
r:ivil lincs up lo onc hundrcrl thousand dollars cost of rlamagcs as providcd tor thc
Scctiorr 1076 of thc Lahrr Crilc, intcrcst and
o^rc, 12 '/o' ZO
I hcrchy allirm undcr Jrcnalty ot'prjury that I am licenrcd of Chaptcr 9 (commcncing with Scction 7UX)) of Division -]
ot' thc Busincss and Prol'cssiorts Codc, and my liccnsc is in tirll tirrcc and ctl'cct.
Liccnsc Class: Liccnsc Numbcr:
I)alc:
W
I hcrcby atfum undcr frcnalty of Frjury that thsc is a custruction bnding agency for the Jrcrlbrmncc of thc vork for which this tsmit is
issucd (Ss. J097, Civ. C.).
kn,lcr's Nam:
I-cntlcr's Addrcss:
APPLICANT DECLARATION
I hcrchy allirm untlcr pnalty ol'Jrcrjury onc of thc tirllowing dcclarations:
Dcrrxrlitiorr Permits-Asbcstos Notification Federal Regulations ('l'itlc 40, Part6)
-Rcquircd
lrttcr ol' Notilication
ccrtily that the t'erlcralrcgulalions rcgarding asbcstos rcn'xrvalarc nol applicablc to this projcct.
that I havc rcad this application and statc that thc atxrvc with all City and County
and County to cnter uJxrn lhcand Statc
ahlvc mcntioncd
or /2,
nantc
and
€-hl 41-
.r-(c)
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