HomeMy WebLinkAbout101106983 - Permit (2)!.'i
city of santa Ana 20 civic center Plaza (M-19), santa Ana, cA 92702 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714\ 667-2738 lnspector Section: (714) 647-5853
Permit #: {O11O69E3
Pin #: 96,fc72
Project Address: 1224 W Gubbon St
Assessor's Parcel: 010-272-06 Lot: POR 10
Unit:Bldg:
Tract: NININGER
Address Range:Suite Range:
Zoning: RlBlock. NA Historic: No
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Single Family Dwelling
Miscellaneous
Window Change out
SFD w/det Garage
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories:
R-3, U
VB
cBc 2019
x-0602320257J
1st FL Area:
2nd FL Area.
Other Areas:
Garage Area:
Total:
Patio:
T.l.Area:
Yards Req'd:
Valuation: $4,000.00
Description of Work: Window change out. '10 windows. Owner-Builder form on file.
0
Owner:
Address.
Phone:
Tenant:
Conditions:
Naui Huitzilopochtli
1224 W CUBBON ST
Santa Ana, CA 927034924
(7141 248-3821
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 #:
rEB €['
i111,5
lu i liiit t tA
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES Insp. Req'd: No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Landscaping lnsp. Req'd. No
Chavez, Dave ,at?'
Date: 06/1712021
Date:
Date. 06/1712021
Subject to Field:
Orozco, lvan Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002
07776002
07775002
07776002
07776002
57607
57770
57672
57600
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuance
$172 64
$4.0s
$1.00
$23 7e
$se 30
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 57770
Account#Total
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days afterifs issua nce,or if the work authorized
on the site by such permitis suspended or abandoned for a period of 360 daysafter
the time the work is commenced.
$23.7e
$231 .94
$1.00
$4.0s Fee Total:
Paid to Date:
Balance Due:
$260.78
$0.00
$260.78
lnspector MID#: 2021-166836
BUTLDTNc: rNgPEcroR REcoRD
SITE-WORK DATE ID/SIG.COMMENTS OWNER BUTLDER DELCARATION
I hcrcby aflirnt undcr pcnalty of pcrjury that I am cxcmpt frcm thc Contrsctors' Liccnsc hu for thc following rcasn (Scc.7031.5
Busincss arxl Profcssion Codc): Any City or County which rcquires a Frmit k) construct. altcr, improvc. dcrclish or rcpair my
slruclurc. prior to ils issumc, alm rcquircs thc applhstrl for such [Ermil to filc n signcd statcrrcnl thnt he or $c is liccn$d pursuant
to lhc pmvisions of thc Controctor's Liccnrcd law (Chrytcr 9, Commcncing with Scc]ion 7000 of Division 3 of thc Business and
P(r'cssions Codc) or that hc or shc is cxcmpt thcrcfrom and thc basis for thc alhgcd excmption. Any violation ofScction 7031.5 by any
r
applicant for a pcrmit subjccts the applicsnt to a civil pcnalty of lot morc than fivc hundrcd dollars ($500).
-1.
as owncr of thc propcrty, or my ernployccs with wagcs as thcir solc compcnsation. willdo thc work and thc stnrcturc Ls not
intcndcd or otlcred for salc (Scc.7M4, Busincss and hofcssions Code: Thc Contractor's License Law does not apply to an owncr of
thc propcrty who builds or improvcs thcreon, and who docs such work hinrsclf or hcrsclf or through his or hcr own employces.
provided that such improvcmcnts are not intcndcd or offcrcd for salc. lf. howcvcr. thc building or improvcnrcnt is sold within onc ycar
of cornplction. thc Owncr Buildcr will havc thc burdcn of proving that he or she did not build or irnprovc thc propcrty for thc purynsc of
salc).
?
;
-1.
as owner of the propcrty, am cxclusivcly contracting with liccnscd contractors to construct thc projcct (Sec. 7U4, Busincss
and Profbsskrn Codc: Thc Contractor's Liccnsc Law docs not apply lo an owncr ol'propcrty who builds or inrprovcs thcrcon.
and who contracts for such projccts with a Contractor(s) licenscd pursuant to thc Conlractor's Licensc Law).
_l amcxcmpt undcr Scction_, B. & P.C. for
DFCLARATION
I hcrcby alTirrrr undcr pcnalty of pcrjury one of the tbllowing dcclarations:
-l
have and will rnaintain a Ccrtificatc of Consent to Sclf-lnsurc lbr workcrs'compcnsation. as providcd for byScction 3700 of thc
Latxrr Codc. ltrr thc pcrforrnancc of thc work flor which thc pcrmit is issucd.
-l
havc and will nraintain workcrs' cornpensation insurancc, as rcquircd by Scction 3700 of thc l.abor Codc, for the pcrforrrunce of
thc work for which this prmit is issucd. My workcrs' compcnsation insurancc carricr and plicy numbcr arc:
Policv Numbcr: Exoires:
-l
ccrtify that in thc pcrtbrnuncc of thc work for which this pcrrnit is issucd, I shall not enrploy any pcrson in any nunncr
so as to bccomc subjcct to thc workcrs' comJrcnsation laws of California. and agrcc that if I should bccornc suhjcct to thc
workers' compensation provisions of Section 3700 of thc Labor Codc, I shall. forthwith cornply with thosc provisi<lns.
WARNING: Failurc to sccurc workers'contpcnsalion coverage is unlawful. and shall subjcct an cmployer to criminal and
civil fincs up to onc hundred thousand dollars ($100.000),
Scction 3076 of thc Latxrr CcxJc. intcrcst and attorncy's lbes.
in addition to lhc cost of cornpcnsation. danugcs us thc
L
I)I.]C'I,AIL\'I'ION
I hcrcby alllrrn undcr pcnalty of prjury that I arn liccnsed undcr provisiorr of Chaptcr 9 (comnrcncing with Scction 7000) of Division 3
of thc Busincss and Profbssions Codc, and my liccnse is in lull forcc and cf lbct.
License Class: Licensc Number:
W
I hcrcby aftirm undcr Fnalty of Frjury thst therc Ls { @nstruction lcnding agcncy for thc pcrfomrcc of Ihc work for which this Ismit ir
issucd (S&. 3097, Civ. C,).
hndcr's Nam:
Lrndcr's Address:
APPLICANT DECLARATION
I hcrcby affinn undcr penalty of perjury onc of thc following dcclarations:
Dcrnolition Pcrmits-Asbcstos Notification Fedcral Rcgulations (Title 40, Part6)
-Rcqu
ired lrttcr of Notification
with all City and County
abovc nrcntionctl propcrty lbr
Applicant or Agrnl
l)ernritee nanre
and County to cntcr ugnn the
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/VenVl nsu lation
Roof Sheathinq
Shear Wall
Framinq '?-lt-?t Ydt' cllL
lnsu lation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
[t/asonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif.
FINAL O--lt-l 4t td j'l
Certificate of Occupancy
Notes Remarks , Etc.
-P
a
Date: Contractor:
ccrtity that thc fcdcralrcgulations rcgarding asbcstos rcrrrovalare not applicahlc to this projcct.
ccrtity that I havc rcad this application and statc lhat
and State Laws rclating to building
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