HomeMy WebLinkAbout101106635 - Permitt
I City 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
Permit #: {01106635
Pin #: {5566
Ar
Project Address: 626 N Shelton St
Assessor's Parcel: 405-082-09 Lot: 5
Unit Bldg: Address Range: 626-628
Tract: J. W. BIRT'S SUB Historic: No
Suite Range:
Zoning: R1Block: NA
Building Use:
Job Type:
Nature of Work:
Existing Bldg & Use:
Proposed Use:
Duplex
Miscellaneous
Windows
Duplex
Occupancy.
Constr Type:
Code:
Flood Zone.
# of Stories.
R-3
VB
cBc 2019
x-0602320144J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Totat
Patio.
T.l.Area:
Yards Req'd
Valuation:$6,000.00
0
Description of Work (12) window change outs like for like. Auth on file.
Plan Conditions:
I Owner:
Address:
Payam Jahangiri
125 W Main St
Tustin, CA 92780
(7141 7s44111
Contractor:
Address:
Owner-Builder
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
, Phone.
Tenant
Phone:
State Lic #.
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #.
Expires:
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
Fire lnsp. Req'd:
Police lnsp. Req'd
No
No Account#
Pezeshkpour,
Zuniga, Allissa
Date: O5IOT 12021
Date.
Date. 05/1 012021
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002
07776002
07776002
07776002
07776002
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuanceV
57607
57770
s7672
57600
57607
$172 64
$4.05
$1.00
$23 7e
$59.30
Total
Flood Zone Cert. Req'd: No
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 days after
the time the work is commenced.
01 1 16002 51600
01 1 16002 s1601
01116002 51612
01 1 16002 57770
$23.79
$231 .94
$1 00
$4.0s Fee Totat
Paid to Date.
Balance Due:
$260 78
$0 00
$260.78
Inspector MID#: 2021-165998
rl1
BUILDING. INSPECTOR RECORD
SITE-WORK DATE ID/SIG.GOMMENTS OWNER BUILDER DDLCARATION
I hqcb affim undo pmalty of pojury thst I m cr@pt ftom the Contracton' Licffi L{w for thc following twn (Se.7031.5'
Bsin6s ud Profsion Code): Any City or County which requirc a pcrnit to construcl. alle. improvq donolish or rtpair my
structue. pflor to ils issuucq also rcquirs thc applicmt for such pcrmil lo filc a signcd statmot thal he or shc b licsEcd pmuilt
to th. prcvisioB of the Contractor's Liccnscd taw (Chapto 9, Comcncing with Setion 7000 of Division 3 of thc Buine ad
PrcfesionsCode)orthathcorsheisqemflthftfromedtheb6isfortheallescdexmFion. AnyviolationofSEtionT03l.5bymy
applicdtforapcnnitsubjetsthc applicottoacivilp€nahyofnotmorcthufivchundrcddollm($500).
-1.
as o\\,ner of the proprerty, or my employccs with wages as their sole compensation. willdo the work and the structtue is not
intended or oflered for sale (Sec.70a4. Business and Professions Code: The Contractor's License Law does not apply to an owner of
the property rvho builds or improves thereon. and who does such work himself or hcrself or through his or her own employees.
providd that such improvanents are not intended or offered for sale. I[, howwer, the building or improvemert is sold within one y€ar
of cornpletion. the Owner Builder will have the burden of proving that he or she did not build or improve the property for the purposeof
sale).
-1.
as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7U4, Business
and Profession Code: The Contractor's License Law does not apply to an owner of property who builds or improvcs thereon,
and who contracts for such proJects rvith a Contractor(s) licensed pursuant to the Contractor's License taw).
--l
arn exempt under B. & P.C.
Oate, r.5 - | C -?-O ?, I 6 Cr{nv!
l) I,.(' 1.,\ ll,\'l' l( )N
I hereby affirm under penalty of pojury one of the following declarations:
-l
have and will rnaintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of thc
Labor Code. for the perfonnance of the work for which the perrnit is issued.
-l
have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code, for the performancc of
the work for which this permit is issued. My workers' compcnsation insurance carrier and policy number are:
Policy Number: Expires:,
-l
certify that in the performance of the work for which this perrnit is issued, I shall not ernploy any person in any manner
so as to become subject to the workers' compensation laws of California and agree that if I should become subjc.ct to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall. forthwith cornply with those provisions.
WARNTNG: Failure to sccure workers' compensation coverage is unlawful. and shall subject an onployer to criminal p'.nlties and
civil firnes up to one hundred thousand dollars in addition the cost damages as provided for thc
Scction 3076 of the Labor Code. interest and fees.
-ltr'Lg>l ttL>(WW
I hercby affirm under penalty of perjury that I under provision of Chapter 9 (comrnencing with Section 7000) of Division 3
of the Business and Professions Code. and my licensc is in full force and effect.
License
hoto.f'nnlronlnr.
W
I hmby affim unda pcnalty of pqjury that thft is a cotrsructioD loding agacy for thc pcfommcc of thc worl for which this pqrnil is
issucd (56. 3097, Civ. C.).
lfids'sNme:
Lender's Addless:
APPLICANT DECLARATION
I hereby aflirm under penalty of perjury one of the following declarations:
Demolition Perrnits-Asbestos Notification Federal Regulations (Title 40. Parr6)
-Required
Letter of Notification
t-l cenify that the federalregulations regarding asbcstos removalare nol applicable to this project.
_l certi& that I have read this application and state that the is correcl. I agrc to comply with all City and County
ordinances and Statc Laws relating to building representatives of this City and County to erter upon the
above mentioned property for
Applicant or Agent
Perntitec niltne
6rf 0 16 -14
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bfloor/VenUl nsu Iation
Roof Sheathing
Shear Wall
Framing
lnsulation/Energy
Drtnruall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
I I n
FINAL e \aIA pftry-5 7
Certificate of Occupancy I I
Notes, Remarks, Etc.
Carrier:
License Number:
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.,
,
7