HomeMy WebLinkAbout101107908 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: {O11O79O8
Pin #: 52O4O
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Project Address: 1905 W Hall Aye
Assessor's Parcel: 412402-36 Lot: 80
Unit Bldg: Address Range:Suite Range:
Zoning. RlBlock: NA Tract: 3679 Historic: No
Building Use: Single Family Dwelling Occupancy: R-3, U 1st FL Area
Job Type: Alteration Constr Type: V B 2nd FL Area
Natureof Work: pooldemo Code: CBC 2019 OtherAreas
Existing Bldg. & Use: Sfd w/att garage Flood Zone: X-0602320259J Garage Area
Proposed Use: # of Stories: Totat
Description of Work: Demolishlinfill swimming pool & remove associated equipment. Handout given.
Planning Conditions:
Patio:
T.l.Area:
Yards Req'd
Valuation: $+,000.00
I Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
Owner:
Address:
Phone:
Tenant
Tuan Anh Nguyen
1905 W Hall Ave
Santa Ana, CA 92704
(909) 217-8287
Contractor: Protech Seal Construction lr
Address: 1932 S Janette Ln
Anaheim, CA 92802
Phone: (7141 293-8093
State Lic #: 1007054
Lic Type: B
Bus. Lic #: 378707
Workers' Compensation lnsurance:
Carrier: Norguard lns Co
Policy #: PRWC202134
Expires: 0112012022
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA Insp. Req'd:
Planning Insp. Req'd:
Machado, Miriam
Amsden, Julie
Date: 09/09/2021
Date:
Date: 09/09/2021
Subject to Field.
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
0 7776002
07776002
07776002
077760 02
07775002
0 7776002
Permit Fee
Plan Check Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuance
57507
5360 0
57770
57672
5 7600
57607
Fee Totat
Paid to Date:
Balance Due:
$172.64
$11967
$4 05
$1.00
$23 79
$se 30
$380.4s
$0.00
$380.45
No
No
No
Fire Insp. Req'd.
Police lnsp. Req'd
No
No Account#Total
Landscaping Insp. Req'd Flood Zone Cert. Req'd. No
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.
01 1 16002 51600
01 1 16002 51601
01116002 51612
01 1 16002 53600
01 1 16002 57770
$23.79
$231 94
$1 .00
$1 19.67
$4.0s
lnspector MID#: 2021-168667
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BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hreby affinn unde pcnalty of pojury thar I m cx€mpt fiom thc Contraclo6' Lic@sc Law for thc following t@n (Sw.7031.5
Businas md Prcfasion Code): Any City or Couty which rcquire a pqmit to @6truct. altc, improvc, dcrnolish or repoir uy'
strucluc, prior to its issuocc, also requirG thc applicer for such pcrrnit to filc a signed ststmmt that hc or shc is lic$ed pmumt
to thc provisioG of thc Contrrctor'E Licosed taw (Chaptq 9, Comcncing with Setion 7000 of Division 3 of the Busine ud
PrcfesionsCode)orthalhcorsheisexmptthsefromedthcbasisforthcallcgcdcxmptiotr. AnyviolationofSdionT03l.5byily
applicant for I pqmit subjets the applicut lo a civil pemlty of not more the fivc hundrcd dollrs ($5@),
_1. as owner of the property. or my employees with wages as their sole compensation. willdo thc work and the structure is not
intcnded or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License law does not apply to an owner of
the property who hrilds or improves thereon, and who does such work himself or herself or through his or her own employees.
provided that such improvements are not intended or offered for sale. I[, howerrer. thc building or improvement is sold within one )ear
of complaion. the Or,vner Builder will have the hrden of proving tha he or she did not build or imp,rove the propoty for the purposc of
sale).
-1.
as owner of the prop€rty, arn exclusively contracling with licensed contraclonr to construct thc project (Sec. 7044, Buiness
and Prcficssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon,
and who contracts for such projccls with a Contracto(s) licersed pursuant to the Contractor's License l-aw).
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am exempt under Section-, B. & P.C. for this reason.
Dnte' O*ner'
WORI(ERS' COMPENSATION
DECLARATION
I hereby affrnn under pcnalty of perjury one of the following declarations:
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havc and will rnaintain a Certificate of Consent to Self-tnsure for workers' compensation, as provided for by Scction 3700 of the
Labor Code. for the perfonnance of the work for which the permit is issued.
1#have and will rnaintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the pcrformance of
work for which this permit is issued. My workers' compensalion insurance carrier and policy numbcr are:
rt/v Cytt *&,)I
Policy L oi__ oe *y
_l certify that rn the performance of the work for which this perrnit is issued, I shall not
so ,rs to becorne subject to the workers'compensation laws of Califomia, and agree that if I
employ any pcrson in any manner
should become subjcct to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with thosc provisions.
WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an onployer to r;riminal pcnalties and
in addition to the cost of compensation. darnages as provided for the
or,", Q-0Q-L)
DECI"ARATTON
I hereby aflinn under penalty of perjury that I am licensed under provision of Chapter 9 (cornmencing with Section 7000) of Division 3
of the Business and Professions Code. and my license is in full force and effect.
License Number:t0o7Os-4
Dil", 0q- Ocl - L\ Contracro, Bffecrr gttU f oruSfzuCr/arJ
CONSTRUCTION LENDING AGENCY
I h@by affm und6 penalty of pcrjury that thqc is a consruction lcnding agocy for thc pqfomucc of thc work for which this p6mil i3
issued (56. 3097. Civ. C.).
lrnder's Narne:
Lender's Address:
APPLICANT DECLARATION
I hercby affinn under pcnalty of pc'rjury one of the following declaratioo*
Dernolition Perrnits-Asbestos Notilication Federal Regulations (Title 40, Part6)
_Required Letter of Notification
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cerri$, that the federal regulations regarding asbestos removal are not applicable to this project.
a(r*ify that I have read this application and state that with all City and County
and County to enter upon theordinances and State Laws relating to
above mentioned property for
Applican( or Agent
Itcrntitcc nlunc
a-z)
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bfloor/VenUI ns u lation
Roof Sheathing
Shear Wall
Framing
Insulation/Enerqy
Drynruall
Ext./lnt. Lath
Brown Coat
Masonrv
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif tl
D*n* P*-,1 / Et / brn-,uh/u Jtilax/I ,\IV
FINAL rclhlh I )4s
Certificate of
Notes, Remarks, Etc.l
Carrier:-
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