HomeMy WebLinkAbout30443697 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Plumbing
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit#:3044.3697
Pin #: 545 11h;
Proiect Address: 1316 W Civic Center Dra
Assessor's Parcel: 405-074-15 Lot: 28, POR 27
Unit:
Block: NA
Bldg:
Tract 662
Address Range:
Historic: No
Suite Range:
Zoning: P
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
John Fox
1316 W Civic Center Dr
Santa Ana, CA 92703
(714I- e81-0664
California Rooter & Plumbin
1905 E Deere Ave
Santa Ana, CA 92705
(94e) 222-2202
01 1 16002 51602
01 1 16002 51602
01 1 16002 51602
01 1 16002 5160C
01 1 16002 51602
01 1 16002 5777C
Fee Type Amount
Wtr Htr (Comm up to 50 23.97
lnvestigation 104.26
Penalty 261.96
General Plan Update 23.19
lssuance 59.30
Microfilm Records 4.05
Qty
1.00
1.00
1.00
1.00
1.00
1.00
Fee
$23.97
$104.26
$261 .96
$23.79
$59.30
$4.05
Phone:
State Lic #: 703820
Lic Type: C-36
Bus. Lic #: 338141
Workers' Compensation lnsurance:Carrier: Oak River Insurance Company
Policy #: CAWC 245233
Expires: 0113012022
Building Use:
Job Type:
Nature of Work
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Multi-Family (5 or more uni Occupancy:
Miscellaneous Constr Type:
Water Heater Code:
Machado, Miriam
R-1
VB
cPc 2019 Notes: Water heater change out within laundry room facility
Zuniga,Allissa
09t29t2021
09t2912021
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Date:
Date:
Date:
Every permitissued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
issuance, or if the work authorized on fhe sife by such permit rs suspended
or abandoned for a period of 360 days afterthe time the work is
commenced.
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
$23.7e
$449 49
$4 0s
Fee Total
Paid to Date:
Balance Due:
$477.33
$0.00
$477.33
lnspector MID#: 2021-1 69 142
PLUM BING.INSPECTOR RECORD
APPROVALS DATE !D/SIG.COMMENTS OWNEN BULDER DELCARATION
I hcrcby allirm under pcnsty of perjury that I m cxctrlpt from thc Contruios' Licenw law for thc folbwing rcasn (Sc.7031.5
Busincss and Prcfcssion Codc): Any City or County which rcq[ires r lrmir to constrel, alter, improw, demli:h or rcpoir my
Etructurc, prior to its issure, olso rcquires thc applicsnt for such permit to file a sigred staterent that he or slrc is liccnsd pmumt
to thc provisions of the Contractor's Licenscd llw (Chapter 9, Clmmncing wi]h SEtion 7000 of Division 3 of the Business and
Pmfessbns Codc) or that he or shc is crempt thcrcftom ard thc bsis for thc allegcd cxcmprion. Any violation of Scclion 7031.5 by any
applicant for a pcmit subjsts rhe appliont to a civil pcnslty of mt mrc than five hurdtcd dollus ($5m).
-1.
as owncr of thc property. or my cmployees with wages as their solc compcnsation, will do thc work and the stnrturc is not
intendcd or offcrcd for sale (Scc.7044, Busincss and hofcssions Codc: Thc Contractor's License Law docs not apply to an owncr of
thc proSrcrty who builds or improvcs thcrcon, and who docs such work himself or hcrself or through his or her own employecs,
providcd thal such improvenrnls are not interded or offcrod for sale. lf, howcver. thc building or inqrmvcrrcnt is sold within onc )car
of conqllction. thc Owncr Buildcr will have thc burdcn of proving that hc or she did not build or in{rrorre thc property for thc purpose of
salc).
-1.
as owncr of thc propcrty, anr cxclusivcly contracting with liccnscd conlractors lo construct thc projccl (Scc. 7W, Busincss
and Profession Codc: The Contractor's Liccnse Law docs not apply to an owncr of propcrty who builds or irnprovcs thcrcon,
and who contracls for such projccts with a Contractor(s) liccnscd pursuant to thc Contraclor's Liccrtsc l^rw).
-IamexemptundcrSection-.B.&P.C.forthisrcason.I)ate:
WoRKF'RS, COMPFNSATTON
DECLARATION
I hereby affirm undcr pcnalty of pcrjury one of the following dcclarations:
-[
have ard will maintain a Certifrcatc of Conscnt to Sclf-lnsure for workers' compcnsation. as provided for by Section 3700 of ttrc
I-abor Codc, for thc pcrformarrce of the work for whhh the permit is issued.
-l
havc and will maintain workcrs' compensation insurance, as rcquircd by Scction 3700 of thc labor Code. for thc pcrformance of
the work for which this permit is issucd. My workers' compensation insurancc carrier and policy numbcr are:
Policy */-- 3 A -Zz
-l
ccrtify that in thc Srcrformancc of the work for which this permit is issued, I shall not employ any person in any manncr
so as to becomc subjcct to thc workcrs'compensalion laws of California, and agrcc that if I should becomc subject to thc
workcrs' compcnsation provisions of Section 3700 of the labor Code. I shall, lbrthwith comply with thosc provisions..
WARNING: Failure to sercurc workcrs'compcnsation covcragc is and shall subject an cmployer to criminal Jrcnaltics and
compensation. damages Bs providcd for thecivil fines up to onc hundrcd thousand dollarc ($1fi).000). in the cost of
Scction 3076 of thc [:bor Codc, intcrcst and attorney's?7h
I hercby affirrn undcr Jrcnalty of pcrjury thal I am liccnscd provision of Chaplcr 9 (comnrncing with Sc.ction 7000) of Division 3
of the Business and Professions Code. und my liccnsc is in full forcc and cff6t.
1 3b 7o3*Liccnsc
Date:
Nurnber:
t
W
I hercby sfIrm urdtr penrlty of Frjury that tlse is s onslrErbn lading 88cmy for thc pcrforc of dE mrl for which this pqmit is
issued (Scc. 3097, Civ. C.).
l.endcr's Name:
knder's Address:
APPLICANT DECLARATION
I hcrcby af irnr undcr pcnalty of pcrjury onc of the tbllowing dcclarations:
Demolition Pcrrnits-Asbcstos Notitlcation Fcdcral Rcgulations (Titlc 40. Part6)
_Rcquircd lrttcr of Notilication
-
-l
ccrtify that thc federal rcgulations rcgarding &sbcstos rcmoval are not applicable to this projcrt.1
with all City and County
and County lo cnler upon thc
_l certify that I havc read this application and
ordinances and Statc Laws relating to
abovc mentioncd proJrcrty for
Applicanl or Agenl
Pernritee name I
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underf loor
Buildinq Sewer
ArealStorm Drain
I nterceptor/ Clarifier
TOP OUT
Waste & Vent
Water Piping
Gas Pipinq
Roof Drain
Tub/Shower Test
Rouqh Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Pipins
Fill Line/Back FIow
Pool Heaterlcas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary SewerlCao
Back FIow Device
Rouqh Plumbinq
Final Gas Test
Meter Release ^--\
FINAL 16-79-Ll g-o(m I
Notes, Remarks, Etc.
Owner:
O^rr&O ,
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