HomeMy WebLinkAbout101108224 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Proiect Address: 2038 W Tenth Sta Unit:Bldg: Address Range:
Assessor's Parcel:004-184-1 5 Lot 17 Block: NA Tract: 3030 Historic: No
Permit #: 1O1108224
Pin #: 75440
Suite Range:
Zoning: R1
Building Use:
Job Type
Nature of Work:
Existing Bldg & Use
Proposed Use:
Single Family Dwelling
Reroof
Reroof
Sfd w/att garage
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories:
R-3, U
VB
cBc 2019
x-0602320144J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Totat
Doscriptlon of Woak: Reroof house & attachad ga.aga - romova comp, leplace any damagsd sheathlng, lnstall comp shlgnels to match exlsting.
Handouta givsn. (Contractor atatea patio covsr haa been rcmoved)
Planning Conditions:
Patio:
T.l.Area:
Yards Req'd
Valuation:$7,800.00
Owner:
Address:
Phone:
Tenant
Martha I Tovar
2038 W 10th St
Santa Ana, CA 927031917
(7141 499-2559
Contractor: American Supreme Roofing
Address: 501 S King St
Santa Ana, CA 92704
Phone: (949) 877 -9074
State Lic #: 1059373
Lic Type: C-39
Bus. Lic #: 374990
Workers' Compensation I nsurance:
Carrier: State Compensation lnsurance Fur
Policy #: 9262616
Expires'. 1011712021
Engineer.
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #.
Planning Approval By:Guevara, Jerry
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd.
Planning !nsp. Req'd
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No
Date: 1011112021
Date:
Date 1011112021
Subject to Field:
Mrsc. Receipt:
Misc. Receipt:
Misc Receipt:
07776002
07776002
07776002
0 7776002
07776002
57607
57770
57672
s7600
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuance
$345 28
$4 05
$1 00
$23 79
$59 30
Amsden, Julie
Landscaping lnsp. Req'd:
Every permitissued 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 permit is suspe nded or abandoned for a period of 360 days after
the time the work is commenced.
No
No
No
No
Account#Total
01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 57770
$23 79
$404 58
$1.00
$4.0s Fee Total
Paid to Date:
Balance Due:
$433 42
$0 00
$433.42
lnspector MID#: 2021-169356
a
BUILD!NG. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hreby affm undo pcnalty of pcrjury that I ar cxcmpt ftom lhc Contracto6' Lic€e kw for thc following reen (54.7031.5
Busincs od Prof6sion Codc): Any City or County which rcquire a pannit to @Ntruct, alts, imprcvq donolifh or rcpair uy
structuc, prior to its issumcc, slso requirB thc applicmt for such pcmit to lile I signcd stal@mt that hc or shc b liccnscd p$uilt
to thc prcvisiorc of thc Contrctor's Licoscd kw (Chapts 9, Commcncing with S(tion 7000 of Division 3 of the Buinc ud
Prcfsions Codc) or that hc or shc is qcmpt thqefrom ild thc bssis for thc allcgcd cxmption. Any violation of S6lion 7031.5 by ey
applicut for a pqrnit subjcts thc applicut to a civil pcmlty of not morc thu fivc hundrcd dollm ($500). r
_1, c owns ofthe prcpcny, or my cmployG with wag6 6 thcir $lc compecation. will do thc rcrt ed thc stndrc b not
intqrdcd or offsed for sl€ (Se.7044, Bwins ud Profsioro Codq The Contractor's LiceN Law do6 not apply to s ownq of
thc prcpsry who builds or impovG th@n. ed who do6 such wrt hirnsclf or hcelf or through his or ho om mploye,
providq! that such improvmts rc not intqrded oroffclcd for elc. If, howq, thc builditrg or improwrcnt is rcH within onc )m s
of comphion, the O*Tq Buikb will havc thc hdgl of Foviig thal hc or drc dil rct build or improve thc prcpqty for thc ptrpos of
ele).
_1, as owner of the propeny, am exclusively contracting with liccnsed contractors to construct the project (Scc. 7M4, Business
and hofcssion Code: The Contractor's License Law does not apply to an owner of propcrty who builds or improves thereon.
and who contracts for such projects with a Contractor(s) licensed pursuant to the Contractor's License Law).
-l
arn exempt under Section-. B. & P.C. for this reason.
Owner:Date:
I WORKETIS' COM PENSATION
DECLARATION
I hereby affrrm under penalty of perjury one of the following declarations:
_l have and will maintain a Certificate of Conscnt to Self-lnsure for workers' compensation. as provided for by Section 3700 of the
for the pei'fonnance of the work for which the pennit is issued.Labor Code, t
k#;x will maintain workers' compensation insurance. as by Section 3700 of the Labor Code, for the performance of
and policy number are:is issued. My workers'
lbtT:L(
_l ccrlify that in the perfonnance of the work for which this pennit is issued, I shall not employ any person in any manner
so ils to becorne subject to the workers' compensation laws of California. and agree that if I should beconte subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall. forthwith cornply with thosc provisions.
WARNING: Failure to secure workers' cornpensation coverage is unlawful, and shall subject an anployer to criminal penalties and
civil fincs up to one hundred thousand dollars ($100.000), in addition to the cost of compensation. darnages as providcd for the
Section 3076 of the labor Code. interest and attorney's fees.
ell 4l
I hereby affirm under pcnalty of perjury that I am licensed under 9 (commencing with Section 7000) of Division 3
of thc Business and Profcssions Code. and my license is in full force and effect.
)/o<g 7iNurnbcr:
.2
I hwby affm mda pcnalty of pcrjury that the is a corgruction lcnding agmcy for thc pofomcc of thc rcrk 6r which this pqmh b
isucd (Sc. 3097, Civ. C.).
[:nds's Nme:
Lendcr's Address:
APPLICANT DECLARATION
I hocby affinn under penalty of perjury one of the following declarations:
Dernolition Permits-Asbestos Notilication Fedcral Regulations (Title 40. Part6)
-Rcquirod
Later of Notilication
- I ccrtifiv that the
,&"k,nu,"
federal regulations regarding asbestos removalare not applicable to this project.
reatl this with all City and County
and County to enter upon the
abovc mentioned properry for
or Agent
state above inflonnation
,,r", lO -l-? I
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bfloo r/Ve nUI n s u Iatio n n
Roof Sheathing i0-{Lf 4('L<:'.2 ,T7
Shear Wall
Framing
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat /
Masonry 4
Pool Fence \
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
n
FINAL l0-lt,'Zl 'Ll) n )
Certificate of Occupancy \.7
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