HomeMy WebLinkAbout101108271 - PermitProject Address: 825 S Cypress Ave
Assessor's Parcel: 01 1-052-03 Lot. POR 8
Unit: A Bldg: Address Range:
TTact: PART OF MCFADDEI$WILBlock: NA Historic: No
Suite Range:
Zoning: R2
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #: {01108271
Pin #: 28792
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Duplex
Alteration
Window C/O
Duplex
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories:
R-3
VB
cBc 2019
x-0602320276J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Totat
Patio.
T.l.Area:
Yards Req'd
Valuation: $S,000.00
Description of Work: Legalize window change out.
Planning Conditions:
Owner:
Address:
Phone:
Tenant
KEVIN KIEU
13762 BELLE RIVE
Santa Ana, CA 927052836
(7141 878-0812
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 #:
f'flIl5Ctt
t4
oLtLf .c
:h ec |l
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
Machado, Miriam
Verduzco
Date: 1011312021
Date:
Date: 1011312021
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07176002
07776002
07776002
077760 02
07776002
57607
57770
s7672
57600
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
Fee Total
Paid to Date.
Balance Due:
$172.64
$4.0s
$1 00
$23.79
$5e 30
$260.78
$0 00
$260.78
No
No
No
No
Fire Insp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd. No
Account#Total
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within360 days afterits 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.
lnspector MID#: 2021-169431
01 1 16002 51600
01 1 16002 51601
01116002 51612
01 1 16002 57770
$23.79
$231 .94
$1 00
$4.05
llt, /
vi"r$
BUILDING. INSPECTOR RECORD
SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DETCARATION
I h6ety aftm undq pcoalty of pqjury that t m cx€mpt from thc ContrmtoE Licffi Lsw for thc followiag t@n (Se.703t.5
Bwins and Prcfcssion Codc): Any Ciry or County which rcquirG 8 psmit to @narud, alta, improvq dmolish or Epqir uy
structrc, pior to its iswcc. also rcquim thc applicut for such pcmit lo filc a sign€d statmot rhd hc or shc is licascd pwant
to thc provisioN of thc Cont@tor's Licmscd taw (Chaptq 9. Commcing with Setion 7000 of Division 3 of thc Buim ed
PrcfmionsCodc)orthatlEorshcisqmptth@ftommdthebasisfor$ealtcgcdumption. AnyviolationofStrtionT03l.5by|ny
applicutforapamitsubjetsthc applimttoacivilpqultyofnotmorcthafivchun&cddollus($500).
_1. I om6 of thc praperty. or my mployc with wagc r thcir elc compcnsation, wil do tlrc wqk ard thc {nrtrc b mt
intqdcd or offcrcd for sale (Sc.7044, Buins ild ProfesioB Codc: Thc Contraclm's Licw law do6 not eply to u omq of
rhc Fopqty who tuil& or impros th@n. ad who dc uch wrt hirelf or hcrclf or thrcugh his or ho om mploye.
providcd that such improwt3 rc rct htqd.d or offqcd for slc. lf, hows. the huiklitrg or impromt is sld wthin onc )qr
of compbtbn thc Owna Builds will havc the hrrkr of prcvhg that he or $€ did not build or imForc thc propsty for thc prrpoF of
sh).
-1.
I om6 of the propqty, m qcluivcly cortractitrg with licms€d contmcloE to @nstmcl tlE projel (Se. 7044. B6ins
ard Proftssim Co&: Thc Contretor's LiccN Law do6 not apply to a own6 of propcrty who builds or imprcv6 lhs@n,
md who @ntacls for such prcjd-ts with a Contrac,to(s) lic€nscd puB@t to thc Contractor's Licce kw).
_l am exempt B.&reason.\
I hereby affrrm under penalty of perjury one of the following
_l havc and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as providd for by Scction 3700 of thc
labor Codc, for thc performance of the work for which thc pcrrnit is issued.
_l have and will maintain workers' compensation insurance. as rcquired by Section 3700 of the Labor Code. for the performancc of
the work for which this pcrmit is issucd My workers' compensation insurancc carrier and policy numbr are:
Policv Number: Exoires:
_l certi& that in the performance of the work for which this permit is issued, I shall not employ any person in any manner
so as to becomc subject to the workers' compcnsation laws of California, and agrec that if I should bccome subject to the
work6s' compcnsation provisions of Section 3700 of the Labor Codc, I shall, forthwith comply with those provisions.
WARNING: Failure to secure workef,s' compersation coverage is unlawful. and shall subject an onployer to criminal poaltics and
civil fines up to one hundred thousand dollars ($100,000), in to the cost of damages as providd for the
Section Code, interest and attorney's fees.
DECI.ARATION
I hereby aflirm under pcnalty of perjury that I am liccnsed under provision of Chaptcr 9 (commetrcing with Scction 7000) of Division 3
of the Business and Professions Code, and my license is in full force and effect.
License Class: Licerse Number:
W
I hcby affm udo pqdty of pqjury that thqe is a onstoc{bn landing agocy for thc pqforocc of thc work for which this pqmit b
hsucd (Se. 3097, Civ. C.).
Lcnder's Name:
Lendcr's Address:
APPLICANT DECLARATION
I h€reby afnrm undcr penalty of perjury one of the following dcclarations:
Demolition Permits-Asbestos Notification Fcderal Regulations (Title 40, Parr6)
-
Required Lrttcr o f Notification
_l certi& that thc fedcral regulations regarding asbcstos removal are not applicable to this projcd.
_l cerri0 that I have read this application information is correct. I agrec to comply with all City and County
ordinances and State Laws relating to
above mextioned property for
Applicant or Agent
I'ermitee nnnle
state that thc
representatives of this City and County to enter upon the
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bfloor/Ve nUl nsu Iatio n
Roof Sheathinq
Shear Wall
Framinq
lnsulation/Energy
Drvwall
Ext./lnt. Lath
Brown Coat
ltllasonry
Poo! Fence
T-Bar
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
1 rd 2/
FINAL a \lil
'{,
PVryt I
Certificate of Occu pancy \\V
Notes, Remarks, Etc.
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