HomeMy WebLinkAbout101105888 - Permitcity of Santa Ana 20 civic center Plaza (M-19), santa Ana, cA927O2 Building
PermitCounter: (714)647-5800 lnspection Requests.(714)667-2738 lnspectorSection. (714)647-5853
Permit #: {01105888
Pin #: ,OW
Project Address: 1139 W Santa Ana Blvd Bldg: Address Range:
TTact: SHELTON & DEUELS ADD
Unit:
Historic: No
Suite Range:
Zoning: PAssessor's Parcel: 008-084-11 Lot: 11 Block: B
Building Use: Commorcial Occupancy: F-2 1st FL Area Patio:
Job Typq R.ioof Constr Type V B 2nd FL Area T.l.Area:
Nature ot work Reroof code: cBc zll9 olher AreaE yards Req,at
Existing Bldg. & use commedcal Flood zone: x.o802320257J carage Area vatuafion: g25,ooo.oo
Proposed Uae: # of Stories: Total O
Ooacrlptlon of Work R R exlltlng roof wlth now GAP TPO high pefom.nco commorci.l gr.d. rcoflng ayatom to.xiating commorical building. Roplac.
aheathingrplywood a8 noedod, Hand out giverl.
Planning Conditions
Owner.
Address:
Phone:
Tenant
Samir Mughrabi
1139 W Santa Ana Blvd
Santa Ana, CA 927033832
(7141 403-6067
Contractor: Certified Roofing Specialist:
Address: 9281 Larkspur Dr
Westminster, CA 92683
Phone: (7141 668-0757
State Lic #. 956843
Lic Type: C-39
Bus Lic #: 337515
Workers' Compensation I nsurance:
Carrier: State Compensation lnsurance Fut
Policy #: 1949902
Expires. 1210112021
Engineer.
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
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Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd. No
PWA lnsp. Req'd: No
Planning lnsp. Req'd. No
Landscaping lnsp. Req'd: No
Kelaher, Selena /
Zuniga, AllissaV
Date: 0211612021
Date:
Date. 0211612021
Subject to Field.
07776002 57607
07776002 57770
07776002 57672
07776002 57600
07776002 57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssua nce
Misc. Receipt.
Misc. Receipt:
Misc. Receipt:
$345.28
$4.0s
$1 .00
$23.7e
$se 30
Fire !nsp. Req'd:
Police lnsp. Req'd
No
No Account#Total
Flood Zone Cert. Req'd: No
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.
01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 57770
$23.79
$404.58
$1.00
$4.05 Fee Totat
Paid to Date:
Balance Due:
$433 42
$0.00
$433.42
lnspector MrD#'. 2021-164283
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BUILDING. INSPECTOR RECORD
SITE,WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hcrchy anirn undcr Fnalty of lrcrjury that I am cxcmpt from lhc Conlractos' Liccnsc [:w lor lhc tirlkreitrS rca$n (x*.70]1.5
Busincss anl Profcssion C*Ic): Any City or County which rcquircs a Frmit lo construcI. alttr. impr(rvc. demolish or rcJtsir any
struclure, Fi()r lo ils issuancc, also rcquircs thc rpplicaDt for such Fmit k, lilc a signcd strtcmnt that hc or slrc is liccnscd pmuet
to lhc pruvisi(nts of thc Contractor's Liccnrcd trw (Chaptcr 9, Commcruing with Scction 70fi) of Division .l of thc Busincss and
ProlbssionsCode)orthathcorshciscxcmptthcrcfromandthcbasisforthcallcgcdcxcmption. AnyvkrlationofscctionT03l.5byany
applicant ti)r a lrcrnrit subjccts thc applicant to a civil pcnalty of not morc thdn livc hundrcd dolles ($5OO).
_1, as owncr ol'thc propcrty, or my employccs with wagcs as thcir solc comfrcnsation, will do thc work and thc structurc is not
interxJcd oroll'ercd lirr salc (Scc.7044, Busincss and Prof'cssions CuJc: Thc Contractor's Liccnsc [:w dtrcs not apply to an owncr of
the pnlpcay wlxl huikls ()r improvcs thcrcrrn, anl who dtrcs such work himsclf or hcrsclf or through his or hcr own cmpklyccs,
providcd that such improvcrncnts arc not inlcnlcd or otlbrcd fbr sah. It, txlwcvcr, thc buikling or improvcnrcnl is sokl within onc ycar
of complctk)n, thc Owncr Buildcr will havc thc burdcn o[proving that hc rlr shc rlid not buikl or improvc thc pnr;r'rty lirr the purJxrsc of
sale).
_-1, as owncr of thc pro[rcrty, am cxclusivcly contracting with liccnserl contractors to construct the projcct (Sec. 7M4, Busincss
and Pnrli:sskrn Codc: Thc Contractor's Liccnsc Law drrcs not apply to an owncr of proJrcrty who builds or improvcs lhcreon,
and wlxr contracts lilr such projects witlr a Contractor(s) liccnscd pursuant to thc Contractor's Liccnsc Law).
_l am cxcmpt undcr B. & P.C. for this rcason.
f\.rla.
WORKERS' COTIIPENSATION
DECLARATION
I hcrcby aftirm undcr pcnalty of pcrjury onc of thc tirlklwing declarations:
-l
have and will maintain a Ccrtiticatc of Conscrrt to Sclt'-lnsurc tor workcrs' comJrcnsation, as pnlvidcd tbr by Scction 3700 of the
Labor C<xlc, lbr thc pcrlirrmancc of the work ftrr which thc pcrmit is issuctl.
_l have and will maintain workers' comJrcnsation insurarrce, as rcquircd by Scction 37fi) of the Labor Codc. for thc pcrfbrmance of
thc work lbr which this pcrmit is issued. My wrlrkcrs' comlrcnsation insurancc carricr arxl Jxllicy numbcr arc:
canicr: \ 9lq\C Corn em6c.{ic/n aF.r9 FrrnJ
Pohcy - tqaQgoll q tf- t-)-0 1l
_l ccrtily that irr thc Jrcrftlrnrancc of the work tilr which this Jrcrmit is issued, I shall not cmpkry any pcrson in any manncr
so as l() bcconrc suhjcct to thc workcrs' comJrcrrsation laws of Califbrnia, arrd agrcc that if I should bccomc subjcct to lhc
workcrs' compcnsation provisions of Scction .3700 ol'thc Lahlr Codc, I shall, lorthwith comply with thosc pnrvisions.
IVARNING: Failurc to sccurc workcrs' compcnsation coveragc is unlawlul, and shall sub.icct an cmployer to criminal Jrcnaltics and
civil lincs up lo onc hundrcd thousand rkrllars ($lU).m0), in addition to thc cosl ol'compensation, danragcs as providcd fbr thc ,
Section 3076 of thc l-ahrr Ctxlc, intercst and (
I\.-. ^ .2-*l[ -:-l
I hercby atlrrnr unrlcr pcnalty ol'prjury that I am liccnscrl 9 (commcncing with Scctiort 7firu) of Division 3
of thc Busincss artd Prot'cssiotts Corlc, ard my liccnsc is in tull filrcc urd cll'cct.
F
Liccnsc
q
I
W
I hcrcby aflirm undcr pnalty of pcrjury that thcrc is a qrnslructi)n bndfuU a8crey li)r thc Frfomncc of lhc work for which this pcrmit is
issucd (Scc. J(x)7. Civ. C.).
[anlcr's Namc:
[rndcr's Addrcss:
APPLTCANT DECLARATION
I hcreby atlim undcr pcnalty of ;rcrjury onc of thc lirlkrwing declarations:
Derrxrlition Pcrmrts-Asbcstos Notification Fcdcral Rcgulations (Titlc 40, Part6)
_Rcquircd lrttcr of Nrxilication
-l
ccrlily that thc lbdcral rcgulations rcgzutlinS oshcstos .cmval e not applicnhlc kr lhis projcct.
f, Ln, ,nr, I havc rcarl this application ild statc that thc ahrve infirrmatiur is corcct. I agrc to comply wilh all City and County
ordinanccs aDd Stntc Laws rclaling to building construction, atrl hcrcby authorizc rcltrcsntalivcs ofthis City ond County b cnts ulDn lhc
atxrvc mcntionccl pnrJrcrty lirr
Applicant or Agent
Pernritee nanle
o"t.' 2- E -) l
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf !oor/VenUl ns u latio n I
Roof Sheathing -7 Dqct(e;1
Shear Wall t I)
Framing r
Insu lation/Energy vl
Drywall
Ext./lnt. Lath
Brown Coat
[\Iasonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif .
Ir ,
FINAL q t0 A WWT 7
Certificate of Occupancy -l
Notes, Remarks, Etc.
nq-n7 -2n 1 tr
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