HomeMy WebLinkAbout30143687 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Plumbing
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: 3O143687
Pin #: 53982
/*/-Proiect Address: 5506 W Lehnhardt Avea
Assessor's Parcel: 108-59141 Lot: 8
Unit:
Block: NA
Bldg:
Tract: 4560
Address Range:
Historic: No
Suite Range:
Zoning: Rl
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
Marilyn Elwood
5506 W Lehnhardt
Santa Ana, CA 927041824
(s62) 2304163
King Neptune Pools
1409 Riviera Drive
Santa Ana, CA 92706
17141 200-811s
01 1 16002 51602
01 1 16002 51602
01 1 16002 5160C
01 1 16002 51602
01 1 16002 5777C
Fee Type
Cap Fixtures
Cap Gas Outlet
General Plan Update
lssuance
Microfilm Records
Amount
7.48
9.'.12
23.79
59.30
4.05
Qty
1 .00
1.00
100
1 .00
100
Fee
$7 48
$9 12
$23 79
$s9.30
$4 05
State Lic #: 1010744_
Lic Type: C-53
Bus. Lic #: 363008
Workers' Compensation lnsurance:Carrier: Gompwest lnsurance Co
Policy #: WCVS504964
Expires: 0312412022
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Single Family Dwelling
Miscellaneous
Demo Swimming Pool
Occupancy:
Constr Type:
Code:
Date.
Date:
Date:
N/A
N/A
cPc 2019 Notes: Demo swimming pool and back fill/handout given
{N..erna ndez, Kathy 09t28t2021
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Every permit issued 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 the slte by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
$23.79
$7s e0
$4 0s
Fee Total
Paid to Date:
Balance Due:
$103.74
$0.00
$103.74
lnspector MID#: 2021-168977
PLUMBING-INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER BUTLDEN DELCARATION
I hercby afftrm undcr lxnalty of Frjury th.i I m crcmpl ftom thc ConretoN' Liens bw for thc following rcen (Se.7031.5
BNincss atd Profcssion Code): Any City or County which rcquircs r pmit to mnstruct, rlter, imprcve, dc?mfish or rcpair rny
structrc. prkr to its issume, rlso rcquircs the applicet for such pcrmit to file a signed slrtemnt thst hc or shc is liccnsed pusmt
to thc provisions of thc Contractor'i Liccnsd llw (Chsplcr 9, Comrcing wilh Sction 7000 of Division 3 of thc Bushc$ rnd
Ppfcssions Codc) or that hc or shc ii crcmpl thsrcfrom snd lhc basis for thc allcged eremption. Any violation of S6{ion 703 1.5 by any
applicant for a pcmit subj@ls thc applic8nt to I civil pcBlly of rct mrc lho five hundrc{ dollus ($5fi)).
_1. as owncr of the propcrty. or my cmployces with wagcs as their solc compcnsation. will do thc work and the stnrturc is not
intendcd or offered for sale (Sec.7044. Busincss and Professions Code: Thc Contractor's Liccnsc l-aw does nol apply to an owner of
thc propcrty who builds or improves thereort and who docs such work himsclf or herself or thmugh his or her own employees,
provided thal such improvenrcnts sre not intcndcd or offcred for salc. If. howcrrcr. the building or inpnovenrnt is sold within one )aar
of conqrletion, thc Owner Buildcr will harrc thc burdcn of proving thal hc or shc did not build or inqnove the profterty for the purynsc of
sah).
-1.
as owner of thc property, am exclusively contracting with licensed contractors to construct thc project (Sec. 7W, Business
and hrofessbn Code: Thc Contractor's Liccnse Law does not apply to &n owner of proprty who builds or improves thereon.
and who contracts for such prof'cts with a Contracto(s) licenscd pursuant lo the Contractor's License taw).
-l
amexempl under B. & P.C. for this rcason.
I):rlt'. ( )u lrer.
WORKI. RS' COM PF'NSA TION
DE'CLARATION
I hcrcby affirm under penalty of pcrjury one of thc following declarations:
-l
have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 37fi) of the
Labor Code. for thc grcrformance of the work for which the prmit is issucd.
have and will rnaintain workcrs'tnsurance, as by Scction 3700 of thc labor Code, for thc performancc of
carrier ud plicy number are:ts
Policy 3-
_l ccrtify lhat in thc grcrformancc of thc work for which this permit is issucd. I shall not cmploy any pcrson in any manner
so as to becomc subjcct to thc workers' compensation laws of California, and agrec that if I should bc"conrc subict to thc
workcrs' compensation provisions of Section 3700 of the l-abor Code, I shall. forthwith comply with those provisions..
WARNING: Failurc to sccure workcrs' compcnsation covcragc is unlawful. and shall subjcct an ernployer to criminal pcnaltics and
civil fines up to one hundrcd thousand dollars ($100.000). in addition lo thc cost of comFrcnsation, damagcs as providcd for the
Scction '4":'*t6':y and attorncy's
Ct
I hcrcby affirnr undcr penalty of perjury that I am licensed under provision of Chapter 9 (commcncing with Section 7000) of Division 3
of thc Business and Professions Code, and my licensc is in full force ard effect.
C6eLiccnse
Date:-28- 2l
W
I hcrcby affEm urdcr pcmlty of perjury lh8t thcE is r @nstruction lcnding agcmy for rhe pqf()mre of ihc wqk for whhh this pcmit b
issued (Ss. 3(x)7, Civ. C.).
[,cndcr's Nanrc:
I-cnder's Addrcss:
API'I ICANI' DECLARATION
I hcreby affrm undcr pcnalty of pcrjury one of the following declarations:
Demolition Pcrmits-Ashstos Notification Federal Rcgulations (Title 40, Part6)
-Required
lrtter of Notification
rcmoval are not applicable to this projc.ct.
lhe above with all City and County
and County to enter upon thc
abovc mcntioned propcrty for
Applicant or Agent
and
*r".8'76-2l
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underf Ioor
Building Sewer
ArealStorm Drain
I nterceptor/ Clarif ier
TOP OUT
Waste & Vent
Water Piping
Gas Pipinq
Roof Drain
Tub/Shower Test
Rough Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heaterlcas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitarv Sewer/Cap
Back FIow Device
Rouqh Plumbinq
Final Gas Test
Meter Release
FINAL nldu N/,r(fi,n
Remarks Etc.
-License Number: - ?
X.MAContraclor:
Permitee name (print):_
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