HomeMy WebLinkAbout101107904 - PermitCity 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
Project Address: 1215 N Daisy Ave Unit:Bldg: Address Range:
Assessor's Parcel: 405-1 04-02 Lot: 25 Block: NA Tract: 1899 Historic: No
Permit #: {O11O79O4
Pin #: 96964
Suite Range:
Zoning: Rl
.-J
Building Use: Sinolo F.mlly Dwslllng Occupancy: R-3, U 1st FL Area Patio:
Job Type Roroot Conslr Type VB 2nd FL Area T.l.Area:
Natur€ of work Roioof Code cBc 2019 Other Ar€aa yards Reqd
Existing Bldg. & LJse: std w, Flood zonq x{ao232olirlJ cerage Area vatu.uon: lg,ooo.o0
Poposed Use: #ofstories:
Totat
Daacrlptlon of truork Roaoof houaa & attachad gtrago - iamova com, rcplece any damagod aheathlng, ln8trll naw comp ahinglaa. Handout! given.
Planning Conditions:
Owner:
Address:
Phone:
Tenant
Tu Trang Kieu
1215 N Daisy Ave
Santa Ana, CA 92703
(4241 212-9245
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires:
Engineer.
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
pdnte Fee
0rttrrt -
Iv ins
E
m&
E
I 61 2LlLlLt-
Documen t
777r-n1n fi-
Planning Approval By.
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd
Machado, Miriam Date: 09/08/2021
Date:
Date: 0910812021
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002 57607 Permtt Fee
07776002 57770 Microfilm Records
07776002 s7672 Bldg. Stds. Revolving
07776002 57600 General Plan Update
07776002 57507 lssuance
Fee Totat
Paid to Date:
Balance Due:
$345.28
$4.0s
$1 00
$23.7e
$59 30
$433.42
$0.00
$433.42
Amsden, Julie
Landscaping lnsp. Req'd
Every permit issued 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.
lnspector MID#: 2021-168658
No
No
No
No
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No
Account#Total
01 1 16002 51600
01 1 16002 s1601
01 1 16002 51612
01 1 16002 57770
$23.79
$404 s8
$1.00
$4.0s
BUILDING- !NSPECTOR RECORD
SITE.WORK DATE ID/SIG COMMENTS
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bfloor/VenUI ns u lation /+\
Roof Sheathinq /D-11 -Ll Lr) frq)
Shear Wall \rz
Framinq
Insulation/Energy
Drynruall
Ext./lnt. Lath
Brown Coat
[\4asonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report I
Flood Zone Certif
.a),
FINAL D-n-LL wX77/.,
Certificate of Occupancy \-.-
Notes, Remarks, Etc.I
-v dP KI /}ODD
I Dt,|VV /
I hoeby aflirrn undo penahy of pcrjury that I m exqnpt from thc ContrsctoE' Licosc Law for the following rcen (Se.7031.5
Ilusino md Profcion Code): Any City or County which requirs a pomit to coNtruct. alte, improvq dcmolish or repair ay
struc:lwe. prior to its isuilcc. also rcquic lhc applicilt for such pemit to filc a signed slalmot that hc or shc b licscd pmmt
to the prcvEions of the Contretor's Licmrcd taw (Chapt6 9. Commencing with Setion 7000 of Division 3 of the Busins ud
Prefesions Code) or that he or shc is exmpt thftftom od the basis for thc allcged exmption. Any violation of Sstion 7031.5 by any
subjects thc applicant cir,il penalty of not than five hundrcd dollars ($s00).
as with wages as their sole compensation.
and Professions Code: The Contractor's
u'iII do the s'ork and the structure is not
intcnded Liccnse Law does not apply to owner of
the property who builds or irnproves thereon. and who does such work himself or herself or through his or her own employecs,
provided that such improvemcnts are not intended or offered for sale. I[, howet/er. the building or improverncnt is sold within onc year
of conrplaion, the Orvner Builder will have the hrden of proving that he or she did not build or irnprove the prope'ty for the purposc of
sale).
-1.
as owner of the property, arn exclusively contracting with licensed contractors to construct the project (Sec. 7U4, Business
and Profession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon.
and rvho contracts for such projects with a Contractor(s) liccnsed pursuant to the Contractor's License l-aw).
I am exemot under Section
DECLARATION
I hereby affrm under penalty of po'jury one of thc following declarations:
_l have and will maintain a Certificate of Consent to Self-lnsure for workers' cornpensation, as provided for by Section -j700 of the
Labor Code. for the perfonnance of the work for which the permit is issued.
-l
have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code. for the pcrformance of
thc rvork for which this pennit is issued. My workers' compensation insurance carier and policy number are:
cerrifu that in the performance of the work for which this perrnit is issued. I shall not ernploy any person in any manner
if I should becorne subject to thesoas to become subject to the workers'compensation laws of California. and agre'e that
workers' compensation provisions of Section 3700 of the l-abor Code. I shall. forthrvilh comply with thosc provisions.
WARNTNG: Failure to sec'ure n'orkers'compensation coverage
dollars ($100.000). in r
and
civil fines up to one hundred thousand for the
Section 3076 of the interest
I
and attorney's fees.2
DECI.ARATION
I hcrcby affirm undcr penalty of perjury that I arn licensed under provision of Chapter 9 (comrnencing with Section 7000)
of the Business and Professions Code. and rny license is in full force and effect.
License Class: License Nurnber:
Contractor:
W
I hrcby affrm undo penalty of pcrjury that thqe is a construction loding agacy for thc prfomuce of thc work for which this psmit i3
issucd (Ss. 3097, Civ. C.).
lddd's Nmc:
Lender's Addrcss:
APPLICANT DECLA]IATION
I hercb}, amrm under penalty of pcrjury one of the following declarations:
Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6)
_Required Lctt er of Notification
above rnentioned property for inspection
Applicant or Agent
I'ernrilcc nanle
this project.
the
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