HomeMy WebLinkAbout10194535 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa-Ana, CASZTOZ Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: {O{94535
Pin #: 78281,/b
Proiect Address: 3901 W Crvstal Ln
-
Assessor's Parcel: 108-722-01 Lot: 1
Unit.Bldg: Address Range:Suite Range:
Zoning: RlBlock: NA Tract: 8924 Historic: No
Building Use:
Job Type.
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Single Family P*elling
Addition
Addn
SFD w/att garage
1sU2nd floor addn
Occupancy.
Constr Type
Code.
Flood Zone'.
# of Stories:
R-3, U
VB
cBc 2016
x-0602320256J
2
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area:
Total:
611
533
Patio: 167
T.l.Area:
Yards Req'd:
Valuation, $t 50,000.00
1144
Ooac ption of work: Add f.mily room & tr2 bathroom on l6t floor, Add New 2nd floor with ('l) ma.tor bedroom, (1) m.Bter bethroom, (2) w.lk-in
clo3et(3). lncludE new167 8f patio covor at rsa. A now skyllghta. Paid GGUSO on rr,0936
Planning Conditions: AII materials to match existing
Owner:
Address:
Phone:
Tenant:
Shane Keheian
3901 W Crystal Lane
Santa Ana, CA 92704
(7141 514-9950
Contractor: Fullfab lnc
Address: 1138 Felicita Lane
Escondido, CA 92029
Phone: (800) 293-5454
State Lic #: 722955
Lic Type: B, C-16, A, C-10, C-51
Bus. Lic #: 347842
Workers' Compensation I nsurance:
Carrier: State Fund
Policy #: 9162919
Expires: 0712012019
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
AQX Engineerlng
Qiang Xiao
1520 Brookhollow, Ms
Santa Ana, CA 92705
(7141 662-0510
5289
David Michael Designs
Andre Tardlf
712 Center Street
Costa Mesa, CA 92627
(s4s) 701-9539
6 t:ilJ r:ru [t
Planning Approval By:Jerry
Plan Checked By
Permit lssued
NPDES lnsp.
PWA Insp. Req'd No Fire lnsp. Req'd
Planning lnsp. Req'd: Yes Police lnsp. Req'd
Landscaping Insp. Req'd: No Flood Zone Cert. Req'd: No
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 180 days afterits issuance,or if the work authorized
on the site by such permitis suspended or abandoned for a period of 180 days after
the time the work is commenced.
Teri
Date. 1011912017 Misc. Receipt:
Date: 0710912018 Misc. ReceiPt:
Date: O7tgll21lg Misc. Receipt:
Subject to Field:
No
No Account#
01 1 16002 51600
01 1 16002 51601
01116002 51612
01 1 16002 57770
08901001 24000
$22fts q&,7b
$1 ,822.14
$6.00
$75.20
$1e s0
Permit Fee
Plan Check Fee
Microfilm Records
SMIP - Category 1
Bldg. Stds. Revolving
General Plan Update
lssuance
Fee Total:
Paid to Date:
Balance Due:
701 86
Tota!
07775002
07776002
07776002
08907007
07776002
07776002
07716002
57607
s3600
57770
24000
57672
57600
s7601
$1 ,767.10
$2,799.74
$7s.20
$19.s0
$6.00
$22.08
$55.04
$4,744.66
$1,854.56
$2,890.10
lnspector MID#: 2017-137777
SITE-WORK DATE ID/SIG.COMMENTS
Set Backs \\
Forms/Steel/Holdowns
Erection Pads lu_,\
UFER Ground /:\\ /n ',/il/
SLAB Floor {\\ ,\,-
S u bf loor/Vent/l n s u I ati o n
Roof Sheathinq \l ,
nShear Wall \.'''l l-ol ziL
Framinq ,/\l- t ' t \t
-\Insulation/Energy I ./
Drywall {*p,i
Ext./lnt. Lath I
Brown Coat
Jt/asonry
Pool Fence
T-Bar
Handicap Req.
Deputv Final Report
Enqineer Final Report
Flood Zone Certif
FINAL zt trtD A7
Certificate of Occupancy
Notes, Remarks, Etc.
I CN Utt
I u Ilv
OWNIIR BUILDER DEI,CARATION
I hercby atljrnr undcr pcnalty of perjury that I atn cxctnpt from lhe Conlraclors' Licensc [-aw for the following I ..s
Busincss snd Profcssion Codc): Any Cily or County which rcquircs a Jrrmit lo conslrucl. allcr, impmvc. dcmlish or rcpair any
structurc. prior to its issuancc. als requires thc applicdnt for such Jrcrmit to l'ilc a signcd slstcmnt thal hc or shc is liccnscd putsuant
to lhe pmvisioos of thc Contructor's Liccnscd [aw (Chaptcr 9. Commncing wilh Scclt)n ?fiD of Division 3 of lhc Busincss and
Prcfcssions Codc) or that he or shc is excmpt thcrcfrom end thc basis for thc ollcScd cxcmption. Any viohtion of Setbn 701 I .5 by any
applicant lbr a lcrmil subjccts lhe applicont to a civil pcnolty of not morc thrn fivc hundrcd dollars (5500).
-l.as
owncrol'thcpro;rcrty.ormyenrployecswithwagcsaslhcirsolcconrpcnsalion.willdothcworkandthcstructutcistxll
intcndcd or oll'crcd ftrr salc (Scc.7044. Busincss and Prot'cssions Ctilc: Thc Contraclor's l-iccnsc l-aw does not apply lo itlt owttcr ol'
thc proprty who huilds or improvcs tlrcrcxrn. and who docs such work himsclf or hcrsclf or lhrough ltis or hcr own clnployccs.
providcd thal such itnprovctrrcnts are not intcndcd or ollbred lirr sale. lf. howcvcr. thc huikling or irnprovcment is sokl within otlc yc:tr
of conplction.llrc Owncr Buildcr will have thc burdcn of proving that trc or shc did rxrt builcl or inrprove the propcrty for lhc purprscof
sah).
-1.
asowncrof thc profrcrty. amexclusivclycontracting u'ith liccnscd contractorslo c()nslruct thc projcct (Scc.7014.llusittess
and ProfcsskrnCodc: 'IhcContractor'sLiccnscLawdocsnotapplyloanowncrofpropcrlywhobuiltlsorintprttvcsthcrcott.
and who contracls ltrr such projccts with a Conlructor(s) liccnscd pursuant to lhc Contractor's Liccnse Law).
-lulncxclrtplundcrSectiott-.B.&P.C.forthisrcastln'Dale: Owner:_
WORKFRS' CONIPENSATION
NECLARATTON
I herchy affirrn undcr pcnalty of prjury onc of thc following declarations:
_l havc arxt will nuintain a Certif-rcate o[Conscnt to.Sclf-lnsure for workcrs'comlrcnsalion. as providcd for byScclion.]7fi) of thc
Labor Codc. for thc Jrcrformancc of thc work for which thc ;rcrnrit is issucd.
_l havc and will ntaintain workers'compensalion insurarrcc. its requircd by.Scction 37(X) of thc Labor Code. f<rr thc pcrlirrnuncc o[
thc work frrr which this pcrmit is issucd. My workcrs' cornpensation insurancc carricr antl Jxrlicy numbcr are:
Policy Numbcr: Expircs:
_l ccrtily that in thc pcrforrnance of thc work lirr which this pcrnrit is issucd. I shall nol crnploy any person in any tniltlncr
so aslohccorncsuhjccttothcworkers'conrpcnsationlawsofCalilbrnia.andagrecthatif lshouldbcconrcsubjccttothc
workers' conrpcnsalion provisions oI Scction 37fi) of thc Latxrr Codc. I shall. forthwith contJrly with thosc provisions.
IVARNING: Failurc lo sccure workers'unlarvf'ul.shall suhi'ct an cntploycr to critniltal pcnaltics antl
civil fincs up lo onc hundred thousand dollars ($irr cosl o[ cornJrcrtsaliott. danuges as provitlc-tl lor lhc
Scction 1076 of thc Lrtnr Code. inlerest
ox", 67 - 3 l- zo IB
I al'lrrln thal I arrr
rurtrl lir ll
Zol
I hcrchy affirnt undcr lrcnalty of perjury
issued (Scc. 3097. Civ. C.).
Lcnder's Narnc:
thcrc il agency tirr lhc pcrlorrnattcc of thc work lbr which this prnrit is
Lendcr's Addrcss:
APPLICANT DECLARATION
I hcreby allinrr under pcnalty of perjury onc of thc following dc.clarations:
Dcmolition Permits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40. Part6)
-Rc<luircd
l-ctter of Notificalion
_l ccrtily that thc l'cclcralregulations rcgartlirrg asbcslos rcrnovalarc rtol a;rylicablc to this projcct.
_l cerlily rcad with all City antl County
ordinanccs and County Itl cnlcr ul)ort thc
abovc
Applicant or
Pernritee nanre
for
t hat
- o,n, o7'3 i'ZO I b
BUILDING. INSPECTOR RECORD
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