HomeMy WebLinkAbout101105980 - PermitProject Address: 322 S Cooper St
Assessor's Parcel: 108431-08 Lot'.27
Unit:Bldg: Address Range:Suite Range.
Zoning: RlBlock: NA Tract: 3775 Historic: No
City 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 #: {O11O598O
Pin #: 43932
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Single Family Dwelling
Reroof
Reroof
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories:
R-3
VB
cBc 2019
A-0602320252J
1st FL Area
2nd FL Area
Other Areas:
Garage Area
Totat
Patio:
T.l.Area.
Yards Req'd
Valuation:$3,113.00
Description of Work: Tear off existing, resheath, and install 1'l squares of comp roofing
Planning Conditions:
Owner:
Address:
Phone:
Tenant
Sang Lam
322 S Cooper st
Santa Ana, CA 92704
Contractor: Jeffrey L Ray
Address: 1447 N El Camino Real
San Clemente, CA 92672
Phone: (949) 498-2274
State Lic #: 567238
Lic Type: B, C-39
Bus. Lic #: 0002825
Workers' Compensation I nsurance:
Carrier: State Comp lns Fund
Policy #: 1903180
Expires: 0710112021
Engineer.
Address.
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd:
Date: Misc. Receipt:
Date: Misc. Receipt:
Date: OZl2St2O21 Misc. Receipt:
Subject to Field:
No
No Account#
07776002
07776002
07776002
07776002
07776002
57607
57770
57672
s7600
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuance
$345.28
$4.05
$1.00
$23.79
$se.30
web_user
No
No
No
No
Fire lnsp. Req'd:
Police lnsp. Req'd
Flood Zone Cert. Req'd: No
Total
N/A - No
N/A - No
N/A - No
Balance
Balance
BalanceEvery permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days afterifs 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.
Inspector MID#: 2021-164536
Fee Total
Paid to Date:
Balance Due:
$433.42
$433 42
$0.00
BU!LDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG COMMENTS OWNERBUILDERDELCARATION \
I hcrcby ailfum undcr lEnalty of lrcrjury that I am crcmpl from thc G)ntrackrn' Lfucnsc Law for tl#luwing riasrn (Scc.7031.5
Busincss arrl Profcssion C<xlc): Any City or County which rcquircs a ;rrmit k) conslruct, allci improvc. dcm(tlish rrr rcpair {ny
slruclurc. pri(rr to its issuancc, alm rcquircs thc applicant for such lEmit to tilc a signcd statcmnl thrt hc or she is liccnsd Pusuant
to tlrc pruvisiotrs of thc Contractor's Liccnsd llw (Chaptcr 9, Commcrcing wilh Sstion 70ffi of Division -l of thc Busircss and
PnrlbssionsColc)(nthatlEorshciscxempllhcrcfromandthchasisfirrthcallcgcdercmption. Anyvi(rlatttnofsetionTofl.5byany
applicant tbr a JErmit subjccts the applicant k, . civil pcnalty of not mtrc than fivc hundred dollus (Ssfi)),
_1. as owncr of tlrc propcrty, or my cmployccs wilh wagcs as thcir solc compcnsalion, will do thc work and thc stru,cturc is not
intcrrrJcd or ol'fcrcd tirr salc (Sc'c.7M4, Busincss and Pnrt'cssions Cmlc: Thc Contractor's Liccnsc [-aw dtrcs not apply to an owner of
thc pnlJrcrty who builds or improvcs thcrcon, and who drrcs such work himsclf rlr hcrself or through his or hcr own cmployccs,
provided that such impnrvcnrcnls arc not intcndcd or ollbrcd lirr salc. It, however, tlrc building or impr)vcnrcnt is sokJ within onc ycar
ol'comphtkrn, thc Owncr Buikicr will have thc burdcn ol'proving that hc or shc did not buihl or improve the pntJrcfly firr thc purJxtsc o[
salc).
_1. asowncrof thc proF-rty, amexclusivclycontracting with liccnsed contraclorstoconstruct thc pnljcct (Scc.7044, Busincss
and holbssion Codc: Thc Contractor's Liccnsc Law docs not apply to an owncr of prolrcrty who builds or improvcs thercon,
and who contracts tbr such projccts with a Contractor(s) liccnscd pursuant to thc Contractor's Liccnsc [aw).
-IamcxcmptundcrScctirln-,B.&P.C.tilrthisreastln.
}VORKERS' CONI I'I,NSATION
DECLARATION
I hcrcby atTirm undcr Fnalty of pcrjury onc of thc lirlkrwing dcclarations:
_l havc arxl will maintain a Ccrtilicatc of Conscnt to Sclt'-lnsurc tbr workcrs' compcnsation, as providcd for by Section 3700 of thc
latxrr CuJc, for thc Jrcrlbrmancc of thc work lilr which the ;rcrmit ls issucd.
_l have and will maintain workcrs' compcnsation insurancc, as requircd by Scction .17fi) of thc Labor CuJc, ftrr thc Srcrtilrmancc of
thc work lilr which this permit is issucrJ. My workers' compcnsation insurance carricr arxl Jxllicy numbcr arc:
Policy Numher: Expircs:
_l ccrtily that in thc pcrlirrmancc ol'the wrlrk tor which this Jrcrmit is issucrl, I shall not empkly any pcrson in any manncr .
so as to bccomc subjcct to thc workcrs' compcnsation laws of Calitbrnia, and agrcc that if I should hccomc subjcct to thc
workcrs' comgrcnsation pr<lvisions ol'Section 37ffi of thc [:hrr Crxlc, I shall, tirrthwith comply with tlxrsc provisions.
WARNING: Failurc to sccurc workcrs'comJrcnsation covcragc is unlawful, and shall subjcct an employcr to crinrinal pcnaltics and
civil lincs up to ()nc huntlrcd thousand dollars ($100,000), in addition to thc cost of comlrcnsalion. damagcs as providcd tbr thc
Scction 3076 of thc Labor Crxle, intcrcst and attorncy's l'ccs.
Date: Applicantl
LICENSED CONTRACTOR
DECLARATION
I hcrcby atlirm undcr pcnalty of pcrjury that I am liccnrcd undcr provision of Chaptcr 9 (commcncing with Scction 7fiX)) of Division 3
of the Busincss and Professions Ctxlc, arxl my licensc is in full forcc uxl effcct.
Liccnse Class: Liccnse Numbcr:
Contractor:
W
I hcrcby allirm undcr JEnalty of Frjury that rh@ is a c$nstruction hnding agcrey for thc lErfomnce of lhc sork lirr which this tsmit is
issucd (Se. 3U)7, Civ. C.).
kntler's Nanrc:
I-cndcr's Address:
APPLTCANT DECLARATION
I lrcrcby allirm undcr Fnalty ot'pcrjury one of thc folkrwing dcclarations:
Dcmolition Pcrmits-Asbestos Notification Fcdcral Rcgulations (Titlc 40, Part6)
_Rcquircd l,cttcr of Notitication
_l ccrtily that the fcdcralrcgulations rcgarding ashcstos removal arc not applicablc to this projcct.
_l ccrtity that I havc rcad rhis .pplicatbn dxl statc that tlrc ah)rc information is corcct. I atre k) $mply with all Cityand County
ordinarecs and Statc hws rchting to huilding construclion, atx.l hcrcbyaullf,rrizc rcFesntntivcs ofthis City and County to cntcr u[x)D thc
atxlvc rentioncd prolrcny for inslrcction puli)scs.
Applicant or Agent Signature:I)ate:
Pcmite mm€ (prinl):
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/Ve nVl ns u latio n /)
Roof Sheathins }..ro Jh ec*qwo,, 16llu c*t* bo+W
Shear Wall I
Framing
lnsu lation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Jt/asonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
lt
FINAL tgl'lgl-A Dk+E7
Certificate of Occupancy
Notes, Remarks, Etc.
Florr
^9,-fi79nl
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