HomeMy WebLinkAbout101106931 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: {O110693{
Pin #: 99732
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Proiect Address: 1224 W Cubbon Sta
Assessor's Parcel. 010-272-06 Lot. POR 10
Unrt: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
!nsulation
SFD w/det Garage
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories.
R.3, U
VB
cBc 2019
x-0602320257J
1st FL Area: Patio:
2nd FL Area: T.l Area:
Other Areas: Yards Req'd:
Garage Area: Valuation:
Total:
Owner-Builder form on file.
$7,500.00
Description of Work: Exterior wall insulation throughout property done from inside. New drywall
Planning Conditions:P,crich*:5?
Owner:
Address:
Phone:
r Tenant:
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 #.
A--llrlll-l-L1l r
RrrPt,+ 3 0331?359
Trnnso':t ion Totnl
Hnui Huit;ilopoch
Genernl Plnn Updnte
rll I 1,5lJu?- I16LilJUr.ilJ-
Bu i ld ing
Ll1 1 161ilJ2- il6rllr:r[il:r-
P,Ids Stds Revolvins
u1115ulr2
licrof iltrr & Documer
i1116ttlr2- 17 7 Tlruuu
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES !nsp. Req'd: No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Landscaping lnsp. Req'd: No
Chavez, Dave€e'
Date:
Date:
Date: 06/1 412021
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002 :5t6ot Permit Fee
07776002 57770 Microfilm Records
07776002 s7672 Bldg. Stds. Revolving
07776002 51600 General Plan Update
07775002 57607 lssuance
Fee Total.
Paid to Date:
Balance Due:
$172 64
$4 0s
$1.00
$23 79
$5e 30
$260 78
$0 00
$260.78
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No
Account#Tota!
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days after ifs issua nce,or if the work authorized
on the site by such permit is suspe nded or abandoned for a period of 360 days after
the time the work is commenced.
01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 57770
$23 79
$231 .94
$1 .00
$4.0s
lnspector MID#: 2021-166718
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/S!G.COMMENTS OWNER BUILDER DELCARATION
I hcrcby affirm undcr lrcmlty of pcrjury thol I m cxcmpt liom thc Contractor' Liccnrc ljs for thc folkrwing rea$n (Ss.7031.5
Busincss and Profession Codc): Any Cily or County which rcquircs a Frmit to construcl. allcr. improvc. dcmlish or rcJEir uy
structurc. pdor lo its issuancc, also rcquircs lhc applicanl for such Frmit lo filc a sigred statcmnt thal hc or shc is liccnsed pursuant
ro thc provisions of thc Conlractor's Liccnrcd law (Chaptcr 9. Commcncing wih Scclion ?00O of Division 3 of Ihc Busincss and
Prcfcssions Codc) or that hc or slrc is cxcmpt thcrcfrom ed thc bnsis for Ihc allcgcd excmflion. Any violalion of Setkrn ?03 I.5 by any
rpplicant for a lrcmit subjEts thc applicant to a civil pcnally of nol mrc than five hundrcd dollas (3500).
_1. as owncr of thc propcrty, or nry employecs with wagcs as thcir sole compensation. will do thc work and thc structurc is not
intendcd or oft'crcd for salc (Scrc.7044. Busincss and Profcssions Code: Thc Contractor's License Law does not apply to an owner of
thc propcrty who builds or funprovcs thcrcon. arxl who docs such work himself or herself or through his or hcr own empbyccs.
providcd that such improvcnrcnts arc not intcndcd or offcrcd for salc. lf, however. thc building or improvcnrcnt is rcld within onc ye{r
of comphtion. thc Owner Buildcr will have the burdcn of proving that hc or shc did not build or improvc thc progrcrty for thc purpse of
mh).
_1. as owncr of thc propcrty. am cxclusivcly contracting with liccnscd contractors to construct thc projcct (Scc. 7U4, Ilusincss
and hofcssionCode: TheContractor'sLiccnsc[,awdocsnotapplyloanowncrofpropertywhobuildsorintprovcsthcrcon.
and who contracts for such projects with a Contractrlr(s) liccnscd pursuant to thc Contractor's Liccttsc Law).
_l anr undcr Scction_. B. &lirr this
,()t//v
OgCLnn {rION
I hcrcby affirm undcr pcnalty of pcrjury onc of thc following dcclarations:
_l havc and will maintain a Certificatc of Consent lo Scll-lnsurc for workers' comlrcnsation, as provided for by .Scction 37fi) of the
L-abor Code. for thc grcrfornunce of thc work for which thc Jrcrmit is issucd.
_l have and will maintain workcrs' compcnsalion insurancc. as rcquircd by Scction 3700 of the l.abor Codc. for thc Jrcrformancc of
thc work for which this prmit is issucd. My workcrs' compcnsation insurancc carrier ad plicy numbcr arc:
Policv Numbcr: Exnires:
_l ccrtify that in the pcrfornrancc of thc work lirr which this pcrnrit is issucd. I shall not cnrploy any lrcrson in any rnanncr
so as to bccorrrc subjcct to the workcrs'cornpcnsation laws of California, and agrec that if I should bcconrc subjcct lo thc
workcrs' compcnsation provisions of Scction 37ff) of the l-abor Code. I shall. forthwith comply with thosc provisions.
WARNING: Failure to secure workcrs'compcnsation covcragc is unlawful, and shall subjcct an empkrycr to criminal pcnaltics and
civil fincs to one hundrcd thousand dollars ($100.fim). in addition to lhc of compensation, damages as lhc
.Scction of thc Labor Codc. intcrcst and allorrrcy's t'ccs.
/
t)t,lcl,AltA'l'l()N
I hcreby affirnr undcr penalty of pcrjury that I anr liccnscrl undcr provision of Chaptcr 9 (cornmcncing with Scction 7000) of Dr yision 3
of thc Busincss and Profcssions Codc, and nry liccnsc is in full force and cffcct.
Liccnsc
flolo.
W
I hcrcby affrm undcr Fnalty of Frjury that thcrc is a @nstructk n bnding agercy for lhe pcrformrcc of thc work for which thls prmit is
issucd (Se. 3097. Civ. C.).
lrndcr's Name:
Lcndcr's Acldrcss:
APPLICANT DECLARATION
I hcrcbyaflirmunder pcnalty of perjury onc o[the following dcclarations:
Dcnxrlition Pcrmits-Asbestos Notification Fcdcral Rcgulations (Titlc 40. Part6)
-Rcquired
Lcttcr of Notification
rcrnovalarc nol applicablc to this projcct.
atxrvc inlirrnration is corrcct. I agrcrc to comply with all City and County
of this City and County lo cntcr upon thc
atxlvc mcnlioncd property for inspcction
Applicant or Agent
Pemtilee name
hercby auth<lrizc
Oav,r 6 _/r{-LO?l
Set Backs
Forms/Stee!/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf Ioor/VenVI nsu Iation
Roof Sheathinq
Shear Wall
Framinq
lnsulatio nlEnerqy 7-l L -2t lg,?,rd 9z-
Drywall t -?- ?-r }lri.f, .0u
Ext./lnt. Lath
Brown Coat
[Masonry
Poo! Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif
j<
FINAL l) -, {.1 I Fr{?1)
Certificate of Occupancy
Notes, Remarks, Etc.
Carrier:
Licensc Numbcr: