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Home My WebLink About30143681 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Plumbing Permit Counter: (714\ 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853 Permit #: 3O14368{ Pin #: 60{58 Proiect Address: 2223 S Park Dr- -a- Assessor's Parcel: 015-202-06 Lot: 5 Unit: Block: NA Bldg: Tract 1192 Address Range: Historic: No Suite Range: Zoning: Rl Owner: Address: Noe M Gonzalez 2223 Park Dr. Santa Ana, CA 92707 (7141 662-7262 01 1 16002 51602 01 1 16002 5160C 01 1 16002 s1602 01 1 16002 5777C Fee Type Amount Wtr Htr (Res up to 50 gi 23.97 General Plan Update 23.79 lssuance 59.30 Microfilm Records 4.05 Qty 100 100 1 .00 1.00 Fee $23.97 $23.79 $5e 30 $4.05 Phone: Tenant Name: Contractor: Address: Specialty AC Heat 4650 Arrow Highway, Suite t Montclair, CA 91763 (sos) s82-7essPhone: State Lic #: 78U95 Lic Type: C-36, C-20 Bus. Lic #: 349795 Workers' Compensation lnsurance.Carrier: Security National lns Co Policy #: SWCl307380 Expires: 1012312021 Building Use: Job Type: Nature of Work: Single Family Dwelling Miscellaneous Plumbing Occupancy: Constr Type: Code: R-3 VB cPc 2019 Notes: Plumbing Planning Conditions: Planning Approval By: Plan Checked By: Permit lssued By: Subject to Field: Building Permit #: web_user Date: Date: Date:09t2712021 Account# Misc. Receipt: Misc. Receipt: Misc. Receipt: Total Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 360 days after its issuance, or if the work authorized on the sife by such permitis suspended or abandoned for a period of 360 days after the time the work is commenced. N/A - No Balance N/A - No Balance Fee Total Paid to Date. Balance Due: $1 1 1.1 $111.1 $0.00 lnspector MrD#'. 2021-169044 PLUMBING-INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS OWNER BUTLDER DELCARATION I hcrcby aflirm undcr penalty of pcrjury that I am cxcmpt frcm the ConlrrctoE' Liensc kw for thc following rcaon (Scc.7031.5 Busincss and Profcssion Codc): Any City or County whhh rcquircs r lErmil to construct. altcr, imprcvc. dcmlish or rcpair uy strucfirc. Fior to ils issuancc. elso rcquircs thc tpplicant for such lrcrmit to filc a signcd ststcmnl thrt hc or shc is licensd pursrnt ro rhc Fovisions of thc Contractor's Liccn$d tlw (Chaptcr 9, Comrcing vith Setion 7000 of Division 3 of thc Busircss and PmfcssionsCodc)orthathcorshciscxcmpllhscfrcmaixlthcbasisforthcallcgcdcxctr{,tion. AnyviolstionofsctitnT03l,5byany applicanl for a lrcrmiI subjcts the applicsnt to a civil pcnally ofnol mrc thil five hundrcd dollars ($50O). -1. as owncr of thc prclrcrty, or my cmplo)rcs with wagcs as thcir slc comlEnsalion, will do tlrc work and thc stnrc1rc is ret inrcndc{ or offcrcd for slc (SN,7(X4. Busincss and Prcfcssions Codc: The Contnctor's Liccn* [:w docs not apply to il osrer of thc pmlEny wlx, builds or impmrcs lhcmn, ard wlb dms rch mrt himsclf o. hcrclf or lhmugh his or hcr own cmployccs. pmvidcd that such imprcrcmnts rc rct inlended or offcrcd for slc. lf, lDscrci the buiHing or itr{rrcwmnl is sld wilhin onc }eu of @rphtion. thc Owncr Buildcr will h8w thc bordcn of Fovirg that hc or shc did mt buiH or imgmrc 0rc lmpcty for thc purtDs of slc). _1. as owncr of thc Jrcpcrty. am cxclusivcly cotrtrscting with liccnrcd conlnclos to construct thc projEt (Ss. 7(X4, Busirc$ and ProfcssionCodc:TheContractor'sLiccnrcLawdocsmtapplytoanownerofprolrcnywhobuildsorimprcvesthercon, and who qrntrcts for such pmjccts with a Conlmcto(s) liccnrcd pursumt to the Contraclor's Liccns [5u), -l sm cxempt undcr Sction-. B. & P.C. for lhis rcaen. l)atc: WoRKFRS' COMPEI{S ^ flON DECI ARATION I hereby affirrnundcr penaltyof grerjuryonc of the following dc.clarations: _I have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the Labor Codc, for thc performance of the work for which the permit is issucd. -l havc and will maintain workers' compâ‚¬nsation insurarrce, as rcquircd by Section 3700 of the l-abor Codc, for the performance of the work for which this permit is issr.red. My workers' compensalion insurance carrier ard plicy numhr are: Policy Numbcr: Expircs: _l certify that in the pcrformancc of thc work for which this pcrmit is issucd. I shall not cmploy any pcrson in any manncr so as to becornc subict to thc workers' compensalion laws of California, and agrce that if I should become subpct to thc workcrs' compcnsation provisions of Scction 3700 of the l-abor Codc. I shall. forthwith comply with those provisions.. WARNING: Failurc to sccurc workers' compensation covcragc is unlawful. and shall subjcct an employcr to criminal pcnaltics and civil fincs up to one hundred thousand dollars ($100,000), in addition to thc cost of compcnsation, damagcs ss providcd for thc Scction 3076 of thc Labor Codc, intcrcst and attorncy's fccs. flo la. LICENSED CONTITACTOR NECLARATION I hcrcby alfirm urrdcr pcnalty of pc{ury that I am liccnscd undcr provision of Chaptcr 9 (cornnrcncing with Scction 7000) of Division 3 of thc Busincss and Profcssions Codc, and my liccnsc is in full forcc und cffcct. Licensc Date: W I hcrcby aflrm undcr lEnaky of Frjury that thcrc is a @nstructk n lcnding lgcrcy for thc Jrcrfomrcc of thc work for which this pcmit is issued (Se. 3097. Civ. C.). lrndcr's Nsmc: lrndcr's Addrcss: APPT ICANT DECLARATION I hcrcby allirnr undcr pnalty of pcrjury onc of thc l'olkrwing dcclarations: Dcnrolition Pcrmits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40. Parl6) -Rcquircd [*ttcr of Notification -l ccrrify that thc fcdcral rcgulations rcgarding ashcslos rcmval rc not applicsblc to this pmjst, _l ccrtify that I have rcad this applicalion ard statc thst rhc abovc informtion is const. I agre lo @mply with rll Cityand County ordinanccs .nd Sltrtc kws rclatirg to building construclion. ud hcrcby suthorirc rcprcscntativcs ofthis City anrl County to cnlcr uJDn lhc obovc mntioncd prepcny for insFction purlDss. Applicant or Agent Permitee namc l nrirrl )' Date: UNDER GROUND Waste & Vent Water-Under floor Gas-Underf loor Buildinq Sewer ArealStorm Drain I nterceptor/ Clarif ier TOP OUT Waste & Vent Water Pipinq Gas Piping Roof Drain Tub/Shower Test Rouqh Water Heater POOL/SPA P-trap/Drain Line ltlain Drain/Pool Pipinq Fill Line/Back Flow Pool Heat erlcas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary Sewerlcap Back FIow Device Rough Plumbing Final Gas Test Meter Release I tl -72 F!NAL t|fi3/2t t@m v-w Notes, Remarks, Etc. Owner:_ _License Number: Contractor: