HomeMy WebLinkAbout40136012 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CAS27O2 Mechanical
Permit Counter: (714) 647-5800 lnspection Requests: (714') 667-2738 lnspector Section: (714) 647-5853
Permit #: 4o^{36012
Pin #: 33952
/*vProject Address: 1611 S Van Ness Avea
Assessor's Parcel: 013-193-10 Lot. 38, 39
Unit:
Block: E
Bldg:
Tract 531
Address Range:
Historic: No
Suite Range:
Zoning: Rl
Owner:
Address:
Phone:
Carlos Marquez
161 1 S Van Ness Ave
Santa Ana, CA 92707
(eos) 251-8704
01 1 16002 51604
01 1 16002 51604
01 1 16002 51604
01 1 16002 5160C
01 1 16002 51604
01 1 16002 5777C
Fee Type
Heat Pump
Air Handling
Bathroom Fan
General Plan Update
lssuance
Microfilm Records
Amount
97.17
47.95
32.88
23.79
59.30
4.05
Qty
300
3.00
2.00
100
1.00
1.00
Fee
$291 .51
$143.85
$65.76
$23.79
$59.30
$4.05
Tenant Name:
Contractor.
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #.
Workers' Compensation ! nsurance:
Carrier:
Policy #:
Expires:
Bstch* i
lf f r ce:A--tlr
'lLLLz
r
icpti: [t
Tr0nsor
Building Use:
Job Type:
Nature of Work:
Single Family Dwelling
Alteration
Mini-splits/Bathroom fans
Occupancy:
Constr Type:
Code:
R-3, U
VB
cMc 2019
(:*: *t****r
Planning Conditions:
Plannrng Approval By: Machado, Miriam
Plan Checked
Permit lssued
Date:
Date:
Date.
09t08t2021
09/08/2021
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes: (3) mini-splits & (2) bathroom fans
Fee Total
Paid to Date:
Balance Due:
Amsden, Julie
Subject to Field:
Building Permrt #:
Every permitissued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
rssuance, 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 51604
01 1 16002 57770
$23.7e
$s60.42
$4 05
$s88.26
$0.00
$588.26
lnspector MID#: 2021-167434
,
M ECHANICAL.I NSPECTOR RECORD
APPROVALS DATE !D/SIG COMMENTS OWNER BUILIIER DET,CARATION
I hcby affm unda p68lty of pqjury that I m qmpt ftom thc Conh&{oB' Liccre L.w for the following l@n (Se.7031.5
Buincs and Profsion Codc): Any City or County which rcquis a psrnit to construct. altE, improvc. danolish or rpair ay
structuq prior to iti issureq also rcquic the eplicmt for srch pamit to 6lc a signcd ststarot thd h! or slE b licaEcd puEusf
to rhc prcvisioB of thc Contretor's Licoscd L:w (Chspt6 9, Comocing wirh S€liotr 7000 of Divisiotr 3 of thc Buin* ed
Profsiom Codc) or that hc or slrc is qcmpt thqctom ud thc basis for thc slcgcd qmplion. Any violation of Setion 7031.5 by ey
q)plicmt for a p6mit subjcts thc applicant to 8 civil pcmlty ofnot morc thm llc hundrcd dollaB ($500).c^
-1,
I omc of thc popaty, u my mplole with wag6 I thcir sl€ @mpcnsaion vill do thc wo* ad thc *ruqw k mt
intadcd oroffrodforslc(Sc.T044.BuinemdProftsiomCodc:ThcContractor'sLirctrudo6mtqplytooomcof
thc prcpqty who tuil& or imprc€ thoue ad who do6 wch wrt hiruclf or hmlf or thrcugh his or lE om @phyc.
providod ahat such imprcwmts rc rct imodod or olftrod for sh. If, how, thc hrilding or imFovqut b sld within orc )a
of onplrbo thc Ovm6 Builda will haE thc hrda of poving tha h or shc dll mt tuild or inForc 0E FoFty fur thc Frpo* of
eh).
-L
a oma of thc popcry, m cxclwivcly cortrethg whh lic€Bcd cotrtractoF to onstrucl thc projcr (Sc. 7il4, Bsine
and Eoftsir Codc: Thc Contmtor's Licffi lrw do6 not apply to m omq of propaly who buil& or imprcvB th66D,
md who @ntrrcts for such FljEl! with a Cootraclo(s) lic@scd pswt to thc Contrrcror's LicGre t w),
I am exemot under B.&
?I )
I hereby affrm under penalty of pojury one of the following
-l
have and will maintain a Ccrtificatc of Consent to Self-lnsure for workers' comperuation, as provided for by Section 3700 of the
Labor Code, for thc perfonnancc of the work for which the pennit is issued.
_l have and will maintain workers' comperuiation insurance. as required by Section 3700 of the Labor Code, for the pcrformance of
the work for which this permit is issued. My workers' compensation insurance carrier and policy number are:
a^*i*.
Policv
c t4',
Numbcr: Expires:
--l certifo that in the performance of the work for which this permit is issued, I shall not employ any person in any manner
so asto
workers'
become subject
compensstion
to thc worters'compensation laws of California, and agree that if I should become subject to the
provisions of Section 3700 of thc l-abor Code, I shall. forthwith comply with thosc provisions..
WARNING: Failurc to secure workers' compensation covcrage
civil fines up to one hundred thousand dollars ($100,000), in
ls and
thc
3076 interest and fees.
(
LICENSED CONTRACTOR
DECI-,ARATION
I hereby affirm undcr penalty of pojury that I arn licensed under provision of Chapto 9 (commencing with Section 7000) of Division 3
of thc Business and Professions Code. and rny license is in full force and effect.
License Number:
f^-r-^nra-.
W
I hrcby aflirm undo pcnatty of pqjury that th6e is a snstructiotr l€nding ag@cy for thc pcfomce of thc wort for which this psmit b
issued (Se. 3097, Civ. C.).
Lnds's Ndnc:
Lender's Ad&ess:
A.'LICANT DECLA TTon
I herdryaffirm under poalty of perjury one of the following declarations:
Demolition Permits-Asbcstos Notification Federal Regulations (Title 40. Part6)
-Required
lrtter of Notification
_l certi& that the federal regulations regarding asbtos removal iue not applicable to this projd.
information is correcl. I agree to comply with all City and County
authorize reprcsentatives of this City and County to enter upon the
above mentioned property for
Applicant or Agcnt
Permitec narnc f\
state
Vfttv{tA
Appliances
Metal Fire Place
Evaporative Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-lnsulation
lnsulation
Smoke Detectors Installed
Rouqh Ductwork
Vents
Toilet Room / Clothes Dryer
Residential Range
Other
Hood
Type I Hood
Type ll Hood
Grease Duct
Fire Damper
Openinqs
lnstallation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rough Mech.
Final Test
Meter Release A,\ .t - 0t
FINAL \ U\trSV'A btt4ry/Yl
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