HomeMy WebLinkAbout30118170 - Permitai Citf of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738
Plumbing Permit #: 30{,1 817O
lnspector's Section: (714) 647-5853 A"
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Project Address: 1937 W Meadowbrook Dr
Assessor's Parcel . 140-061-75 Lot: 145
Suite:
Block: NA
Bldg:
Tract: 1631 1
Address Range:
Historic: No
Suite Range:
Zoning: SD4
Owner:
Address:
Phone:
Paul & Lina Cheng
1937 W Meadowbrook
Santa Ana, CA 92704
(7141 317-5462
Fee Type Amount
Sink 8.15
Garbage Disp 8.1 5
Each Add'l Sewer Conn 8.15
Extend Gas Line 23.50
Lawn Spkr 10.25
lssuance 32.50
Fee Total:
Paid to Date:
Balance Due:
Qty
1.00
1.00
1.00
1.00
1.00
1.00
Fee
$8.1 5
$8.1 5
$8.1 5
$23.50
$10.25
$32.50
$e0.70
$0.00
$90.70
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
C i ts of $onto Ana
PD : g/512tJ05I0 :00LHE00 LoC : CTYH - 0113CUST: IHV:301 1S170
00S5 0003 110003131 8/5/2005 3:29Pll
THA}.ISACTIOH TOTAL: I27L.79Building t9l1'7[t
Notes: Extend gas line for new bbq.
Building Use:
Type of Work:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By
Single Family Dwelling - D( Occupancy:
Miscellaneous Constr Type:
New Fixtures Code:
Teri
Date:
Date:
Date:
R3/U1
VN
cPc 2001
08tost2005
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Building Permit #:
This permit shall expirc by limitation and become null and void if the wo* authorized by this pemit
is not commenced within 180 days from the date of this permit, or if the wo* authoized by this
permit is suspended or abandoned at any time afterthe wo* is commenced for a period of 180 days.
Before such worl< can be tecommenced, a new permit shall be firct obtained fo do so.
Account #: 01 1-01-5912 Inspector
' (fdmffi
Permit lssued By:
Subject to Field:-
PLUMBI NG.INSPEGTOR RECORD -t
^APPROVALS DATE ID/SIG COMMENTS
UNDER GROUND
Waste & Vent z d
Water-Underfloor
Gas-Underfloor
Buildi Sewer
ArealStorm Drain
!Clarifier
TOP OUT
Waste & Vent
Water
Gas Pi
Roof Drain
Tub/Shower Test
Water Heater
POOUSPA
n Line
Main Drain/Pool Pipi
Fill Line/Back Flow
Pool Heater/Gas Line
Misc
Gas Service
Water Service
Lawn nkler
Sa Sewe
Back Flow Device
Plumbin
Final Gas Test
Meter Release
FINAL
Notes, Remarks, Etc.
applicUion and statc
to and hereby
Declaration
I hocby affim uder paulty of pcrjury tha I m amp fm thc Cotretm' Limlc hv fc thc following mm (s.7031.5 Duitrs
ud Profcsim Codc): Any City tr Conty which rcquiro a pomit ro m3truc! rtt6, improvq doolish c rcpair my s6uchlrc, pritr to iEisrwe, also rtquiro thc applimt fq srch pcmit !o lilc 8 siSncd stamat ther hc o ihc is limscd pmuur o thc prcvisimi of rhc
Cmtretor's Ljfficd L8w (Chaptlr 9, Comcncing with Scrim 7000 of Division 3 of thc Buin6r od prcf*ioro Codc) u that hc or
ihc i8 cmPt thrcfrom md thc bsis fc$c allcgcd aarptim .Any violation of Scctim ?03t.5 by uy applimt fc apcrnit subjcrs rhc
applimt to a civil poalty of noa mffi rhm firc hu&cd <follu (S5OO).
It 6 oma of thc prcpcily, q my mployH with wagc u thcir solc mpcnsarim, witl do thc wst ud Oc sluctrc is mr intcn&d
or offqcd fc $lc ( Sa.7(N4, Buins ud Profqiou Codc: Thc Cont&ts't Licoc Law dq not apply to s omq of rhc prcpcrty
.who builds or imForo thm, ad who ds ruch wor* himclf or h6clf s thrcugh his c hcr om cmployccs, Fovidcd thar such
imPrcvmmls ec not inhdcd tr off@d fil salc. tf, how*cr, thc building or impovmcnt is sold withia'oi y; of cmplaion, 1rc
Omq-Builda will havc thc bur&n ofprcving rhat hc c shc nor build or improvc for thc purpocc ofsalc).
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s our of thc Propqrty, m cxcluivcly onfrcting with licmred mrrcon to cotrstucr rhc prcjcr ( Sa. 70/14, Buincsi edPrcfqim Codc: Thc Cmtracld's Liffi Irw dG oot apply !o & omcr of prcpaty who buitas u iriprovc ucm , urd wtro
conts&E ftr such prcjcts with a Conractry(s) limcd puumt !o thc Conrreior'E Liw Lsw.).
_l arn excmpt under Section
Date:
I hereby aftirm undcr pcnalry ofperjury onc ofthe
-I
hrrc ud will mintain r Catificrrc of Cmat to Sclf-Imw fq wckcn' compasrtim, as proddcd fc by Setifl 37oO of thc
Labor Codc, fq thc psfme of thc wqt ftrwhid &c p€dnit i! isucd.
-I hre ud will mintain wqtm' onpers*io irmcq a ,cquircd by Sctim 37oo of thc Labor Co&, for thc Dcrf96e of 111cwct fc which thir pcmit ir isucd My watcn' cmporddl iDme uia ud policy nmba m:
Policy
(This section need not be complaed if the pcrnrit is for One hundred dollan ($loo1 or less)
_I certify that in the pcrformancc of the work for
bccame subjcct t(, thc workcrs ' compcnsation laws
which this is issucd, I shall not cmploy any in any manner so as to
of should bccome to the workerr'
compensation provisions of Scction 3700 Labor
WARIING: Failure to securg workers' cor4pensation
fincs up to one hundred thousand dollars ($(OO,o0Oy,in
the Labor Code, intcrcst and anorney's fccs.
is unlawful, and shall subjcct an
addition to the cost of compansuion, damages as providcd for the Scction 3076 of
Ihmbyafiimunda-,.,o,*i**",ffingin8withscctid7ooo)ofDivisim3of
thc Buins ud Prcfxim Codc, md my limc is in full fmc md cflct.
Datc: Contractor:
I hcty afEm u&r pqdty of p6jury thd *me of rhc wat fqwhich rhir psmit iri$ud (Scc. 3097, Civ. C.).
Lender's Name:
Lendcr's Addrcss:
Demolition Psrmits-Asbestos Noti fi cation Federal
_ Required Lener of Notification
APPLICATYT'S DECLARATION
Reguluions (Title 40, Part 6)
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certify that the fedod reguluions regarding asbcstos rqrnoval are not applicable to this project.
that is correct. I agree to comply with all City and County
above
of this City and County to entcr upon the
Applicant or
Permittee name
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