HomeMy WebLinkAbout101108014 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CAS27O2 Building
PermitCounter: (714)647-5800 lnspection Requests: (7141667-2738 lnspector Section. (714)647-5853
Permit #: {O11O8O14
Pin #: {99OO
Proiect Address: 1811 N Greenleaf Sta
Assessor's Parcel: 002-104-26 Lot: POR 1
Unit:Bldg: Address Range:Suite Range:
Zoning: R1Block: B Tract: 256 Historic: No
Building Use: Singte Family Dwelling Occupancy: R-3, U 1st FL Area . Patio:
Job Type: Reroof Constr Type: V B 2nd FL Area T.l.Area:
Natureof work: Reroof code: cBc 2019 otherAreas yards Req,d
Existing Bldg. & Use: SFD w/det garage Flood Zone: x-0602320163J Garage Area Valuation:
Proposed Use: # of Stories: Total
Description of Work: Reroof w/t.o.-Remove and apply comp shingles to sfd and det garage/replace sheathing/handout given/auth on file
Planning Conditions: Material to match roof on addition
$t s,000.00
l,Engineer:
Address:
Phone:
License #
Architect /
Desiqner:
Address:
Phone:
License #
nno ll ir
nerol I
Owner:
Address:
Phone:
Tenant
Janna Middel
1811 N Greenleaf
Santa Ana, CA 92706
(7141 3s6-2734
Contractor:
Address:
Ovrner-Builder
Phone.
State Lic #.
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #.
Expires:
Planning Approval By:
Plan Checked By:
Permrt lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 01116002 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 57770
t
Gomez, Pedro
Hernan dez, Kathy
Date: 0912012021
Date:
Date: 0912112021
Subject to Field:
Mrsc. Receipt:
Misc. Receipt:
Misc Receipt:
07775002
07776002
07776002
0L776002
07776002
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuance
s7607
57770
57672
57600
s7607
$34s.28
$4 05
$1 00
$23.79
$5e 30
b*
No
No
No
No
Account#Tota!
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,s suspended or abandoned for a period of 360 days after
the time the work is commenced
$23.79
$404.s8
$1.00
$4 0s Fee Total
Paid to Date:
Balance Due:
$433 42
$0 00
$433.42
lnspector MID#: 2021-168858
BUILDING. INSPECTOR REGORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DEICARATION
I hqcby aflim und6 p@alty of pcrjury that I m qmp ftom thc Contrrcton' Liccre trw for the follouing rtmn (Sc.7031.5
BEins dd Prcfsion Code): Any City or County which rcquirc a pomit to @nstruct, 6ltq. imprcvg danolish or rtpair my
srucrc Fior to its isuocc. also rcquira thc applicmt for such pcndt to 6lc a signcd $d@6t that hc or slE b licascd pl,l!@t
to the provisiore of tlE Coilrrctor's Licoscd l"aw (Chapt6 9. Comcncing with Sstion 7000 of Division 3 of thc BEins md
hofsior Codc) or thd hc or shc is cxmpt thscfrom ed thc besis for thc allclcd q@ptioa. Any violation of Sdion 7031.5 by any
applicet for 8 psmit subjets thc .pplicant to s civil pcnally of not morc thil fivc hudrcd dollm ($500).
_1. 6 om6 of thc poparn or my mployG whh w8g6 6 thcir $h compcrEdioG will do drc wod( [d tlE srtutw is mt
intqdcd or offqcd for slc (Sr.7044. BBins md Profsioc Codc: Thc Contrac{tr's Licqe kw doB not eply lo m om6 of
thc propqty who tuilds or improvc tlsou and who doc $ch w* hirelf or harlf or tlrough his or ho om mploye,
providcd that such improvqurts m mt htqrdod or olfuod for sh. If, how, tlrc hrilding or impromt is rH whhin onc )@
of cornpl*br\ thc o\mq BuiHr will haw thc hrda of pmviry dld hc or shc dil rct hild or ir4rorc thc popaty for ttrc puposc of
$le).
_1, as owner of the propcrty. am exclusivcly contracting with licersed contractors to construct the projed (Sec. 7044. Brsiness
builds or improves thereon.and Rof€ssion Code: The Contractor's Licensc Law does not apply to an owner
and who contracts for such projccts with a Contracto(s) licosed pursuant to Licensc Law).
_l am under B.&/r ZJ
I hereby affrrm under penalty of perjury one of the following
_l have and will maintain a Cenificate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the
Labor Code, for the performance of the work for which the pennit is issucd.
_l have and will maintain workers' compcrsation insurance. as required by Section 3700 of the Labor Code, for the pcrformance of
the work for which this permit is issuod My workers' compensation insurance carrier and policy numbcr are:
Carrier:
Policy .f
_l certi& that in the pcrformance of the work for which this permit is issued. I shall not employ any pcrson in any manner
so asto becorne subject
workers' compcnsation
WARNING: Failure to
to thc workers'compensation laws of California" and that become subject to the
provisions of Section 3700 of the t-abor Code. I shall.with those provisions.i
seture workers' compcnsation coveragc
thousand dollars ($100,000), in
is unlawful. and an firploy€r to criminal po'ultics and
civil lines up to damages as provided for the
Section [abor intcrcst and attorney's fees.
(
I hereby aflirm under penalty of perjury that I am liccnsod provision of Chapter 9 (commencing with Sccrion 7000) of Division 3
of the Business and Profcssions Codc. and my license is in full forcc and effect.
License Class: License Numbcr:
Dete:
W
I hwby affum unda poalty of pojury thst thrc is a @nstruction hnding ag@cy for the pqfoIrmcc of thc rcrk for uhich this psrnit is
issucd (S*. 3097, Civ. C.).
lrndq's Nmc:
APPLICANT DECL{IL{TION
I hereby aflirm under penalty of perjury one of the following declarations:
Demolition Perrnits-Asbcstos Notification Fedcral Rcgulations (Tille 40, Part6)
-Required
Lrtter of Notification
-l
certi& that thc lbdcral rqgulations regarding asbestos not applicable to this project.
with all City and County
above mentioned propcrty for
, enter upon thc
zoZl\Applicant or
and state that information is correct. I
and
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bfloor/VenUI ns u latio n tt Alt d
Roof Sheathing /?/ild E%ITA,Ka%
Shear Wall 1nflat l-Y[Hrt t116)
Framing
lnsulation/Enerqv
Drlnuall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Fina! Report
Flood Zone Certif
lt l/1 /n
FINAL lolil l9r brfr,*t ,{U
Gertificate of
Notes, Remarks, Etc.
-fl
^^-r-^^a^-.
Lcnder's Address:
Permitee name (print):_
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