HomeMy WebLinkAbout101105551 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
Permit Counter: (714) 647-5800 lnspection Requests. (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: {01105551
Pin #: 54584
Zrv
Proiect Address: 2239 W Fifth St-a
Assessor's Parcel: 007-313-15 Lot: POR 39
Unit:Bldg Address Range: 2223-2239
Historic: No
Suite Range.
Zoning. C2Block: NA Tract: 1341
Building Use: [ulti+.mily (5 or mor. unlta) Occupancy: A3, B 'lst FL Area Patio:
Job Type llilcellaneou. Constr Type V B, SPK 2nd FL Area T.l.Area:
Nature of work OT lnspoction Code: cBc 2019 OherAreas yads Reqd
Existing Bidg. & use: Ap.itnent Bullding Flood zone: x-0602320257J carage Area vatuation: So,ol
Proposed Use: # of Slories: Total O
O.lcription ot Work OT lnsFrsction for Decembor 2&30th ,ok per Jo.e Desoto (,( hr3 ..ch d.y), O.n y Nguyon 7l4457{l75 will b. th. in.poctor
Contact: Stov. 62682GE773
Pl.nnlng Condltlona:
Owner.
Address:
Phone:
Tenant
VIRGINIA NICHOLAS
2239 W Fifth St
Santa Ana, CA 92703
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires:
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
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
Zuniga,Allissa
Date:
Date:
Date: 1212312020
Subject to Field:
Misc. Receipt:
Misc. Receipt.
Misc. Receipt:
Flood Zone Cert. Req'd: No 01 1 16002 51601 $ 2,071 .6g
07776002 57770 Microfilm Records
07776002 57607 O/T lnspection
07776002 s7672 Bldg. Stds. Revolving
07776002 57600 General Plan Update
Fee Total
Paid to Date:
Balance Due:
$0 00
$2,071 .68
$0 00
$0 00
Fire lnsp. Req'd:
Police lnsp. Req'd Account#
No
No Total
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 rs suspended or abandoned for a period of 360 days after
the time the work is commenced.
$2,071 .69
$0 00
$2,071 .69
Inspector MID#'. 2019-149427
BU!LDING. INSPECTOR RECORD
SITE.WORK DATE IDiSIG.COMMENTS OWNER BUILDER DELCARATION
I hcrchy afiirm undcr lEnalty of lE]jury lhal I am cxcmpt liom lhc Contr.clos' Liccns kw lirr lhc lbllowing rcayrn (Sqi70.ll.s .
Busincss afil Protbssion CuJc): Any City or Counly which rcquircs a JErmil kr drnslrucl. allcr. impruvc, rlcmolish rir rcpair any
slructurc. pri)r to its issuancc, also rcquires thc applicant li)r such [Emit k tilc a signcd slatcmnl that hc or drc i{ liccnsd pursudnt
b thc lmvisi()ns of thc Contrackx's Liccnscd hw (Chaptcr 9. Qommncing wilh Sation 7(xx) of Division -] of lhc Busincss and
ProlbssionsCodc)orlhathcorshciscrcmltthcrcfromandthchrsisforthcallcgcdcxcmption. AnyviolationofSetionT0.!l.5byany
applicaut for a pcrmit subjels thc applicant to a civil pcnally of not morc lhan fivc hundrcd dollus ($5Ur).
_1. as owner of lhc pro;,crty. or my employces with wagcs as thcir sole compcnsation, will do lhc work and thc structurc is nol
intcrrdcd orofl'crcd lirr salc (Sc--.7044, Business and Prof'cssions CrxJc: The Contraclor's Liccnsc Law docs not apply to an owncr ol'
thc pfi)pcrty who builds or improvcs thcrcrrn. and who drrcs such work himsclf or hcrsclf or lhnrugh his or hcr own cmpkryces,
providcd that such imprcvcrncnls arc not intcndcd or otlcrcd lirr salc. It, howcvcr, thc buihling ()r impK)vcnrcnt is solJ within onc ycar
ol'comphtion, tr*h Owncr Buiklcr will havc thc burtlcn ol'proving that hc or shc did not buikl or improvc thc propcrty for thc purprsc of
sah). r
_1, as owner of the profrcrty, am cxclusivcly contracting with liccnscd contractors lo conslruct thc pnlject (Sec. 7M4, Busilrcss
and ftotbsskrn Cor.lc: Thc Contractor's Liccnsc Law docs not apply to an owncr of proJrcrty who builds or improves lhcrcon,
and who contracts lor such projccts with a Contractor(s) liccnscd pursuant to thc Contractrlr's Liccnsc Law).
-IamcxcmptundcrScction-.B'&P.C.forthisrcason.Dale: Owner:
1VORKERS' CON I PENSATION
DT:CI-ARATION
I hcrcby atTirm undcr Jrcnalty ol'Jrcrjury onc of thc ttrlkrwing dcclarations:
_l havc urd will mainlain a Ccrtil'icatc of Conscnt to Sclt-lnsurc tilr wrlrkcrs' comJrcnsati()n, as pnrvidctl tirr by Scction .1700 of thc
Latxlr Ctxlc, lbr thc pcrlirrmancc of thc work tbr which thc Jrcrmit is issucd.
_l havc anti will nraintain wrlrkcrs' compcnsation insurancc, as rcquircd by Scction .17([ ol'thc l-abor Cotlc, lbr thc Jrcrlilrmartcc ol'
thc work lilr which this pcrnrit is issucrl. My workcrs' cotlrpcnsation insurancc camicr and Jxrlicy numhcr arc:
Policy Number: Expircs:
_l ccrtity that in thc Jrcrkrrmancc of thc work lilr which this Jrcrmit is issued, I shall not cmpkry any pcrson in any manncr
so as lo bccomc subjcct t<l thc workers' comlrcnsation laws of Calilirrnia, and agrcc that if I should bccomc subjcct to the
workcrs' comJrcnsation provisions of Scction 3700 of thc [-atxlr Crxlc, I shall, tbrthwith comply with thosc provisions.
WARNING: Failure to sccurc workcrs' comJrcnsation c()vcragc is unlawful, and shall subjcct an cmployer to criminal pcnaltics and
civil lincs up to onc hundrcd thousand dollars ($l00,Un), in addition to thc cost ol'comJrcnsation, damagcs as providcd ftrr thc
Scctiorr 3076 of thc Latxrr Crilc, intercst and attorncy's l'ccs.
Il.rt^.
LICENSED CONTRACTOR
DECLARATTON
I herchy atlirm undc-r Jrcnalty of pcrlury that I am liccnrcd under provision of Chaptcr 9 (cornrncncing with Scctkln 7firu) of Division J
o[ lhc Busincss anrl Pnllbssions Code, arxl my liccnsc is in full lorcc arxl cfl'cct.
Liccnsc Class: Liccnsc Nunrbcr:
W
I hcrcby aflirm undcr Jrculty of Jrcrjury that thqc i\ a clrnstructi()n lcndiog agcrey for the Frlirmucc of lhc work for whtrh this Imit is
issucd (Sec. 3097. Civ. C.).
kndcr's Namc:
I.crtdc'r's Atldrcss:
APPLTCANT DECLARATION
I lrcrcby atlirm undcr Jrcnalty ot'Jrcrjury onc of thc lirlklwing declarations:
ficmolitron Pcrmits-Asbcstos Notit'ication Federal Rcgulations (Titlc 40, Part6)
Rcuuircrl lrttcr ol' NotilicalrrnIt
_l ccrtity that thc l'cdcnrl rcgulations rcgarding asbcstos rcntovalarc n()t applicablc to this pnrpct.
_l ccrtify that I havc rcad this application and state with all City and County
and County t0 enter uJxrn thcordinanccs and Statc [-aws rclaling to building
abovc mcntioncd pnlpcrty lirr
Applicant or Agent
I)t nrrilce nanle
lhc
)Z
Set Backs
Fo rrn s/Stee l/H o ldown s
Erection Pads
UFER Ground
SLAB Floor
S u bf loor/VenVl ns u Iation
Roof Sheathinq
Shear Wall
Framing
Insu Iation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
[/asonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
,a
FINAL 1o- 11 ."1 *fiLl Ul
Certificate of Occupancy \-/
Notes, Remarks, Etc. .I
3 -a \,a.\
Flrrrr n9.-n7 -2n 1 6
Clarricr:
Contractor:
is