HomeMy WebLinkAbout40127825 - Permitl,
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City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Mechanical
Permit Counter: (714) 647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #: 4o^127825
Pin#: ,%?,
Proiect Address: 27 14 W Anahurst PIa
Assessor's Parcel: 408-223-03 Lot: 132
Unit:
Block: NA
Bldg:
Tract: 2260
Address Range:
Historic: No
Suite Range:
Zoning: Rl
State Lic #: 9U720
Lic Type: C-20
Bus. Lic #: 336944
Workers' Compensation lnsurance:Carrier: Mid Century lns Co
Policy #: A0946T48}
Expires: 1012512015
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Maria Colon
2714 W Anahurst
Santa Ana, CA 927044506
(714I- 641-0962
Synergy Mechanical Air Con
9375 Archibald Ave il1403
Rancho Cucamonga, CA 91
(909) 829-5673
Single Family Dwelling
Miscellaneous
Wall Heater
Fee Type Amount
01 1 16002 51604 Wall Heater/Floor Furna 57.80
01 1 16002 51600 General Plan Update 19.46
01 1 16002 51604 lssuance 48.52
Qty
1.00
1.00
1.00
Fee
$s7.80
$19.46
$48.52
\(
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
R.3, U
VB
cMc 2013
12t18t2014
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes: change out
Fee Total:
Paid to Date:
Balance Due:
11$
Hernan dez,Kathy
01 1 16002 51600
01 1 16002 51604
$19.46
$106.32
$125.78
$0.00
$125.78
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 180 days after its
issuance, or if the work authorized on fhe site by such permitis suspended
or abandoned for a period of 180 days after the time the work is
commenced.
ID
rnI F'1
6002-
+u1
lJ6r
Inspector MID#: 2014-1 18354
A
/
APPROVALS DATE ID/SIG.COMMENTS
Appliances
Metal Fire Place
Evap Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-lnsulation
Insulation
Smoke Detectors Installed
Rough Ductwork
Vents
Toilet Room / Clothes Dryer
Residential Range
Other
Hood
Type I Hood
Type II Hood
Grease Duct
Fire Damper
Openings
Installation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rough Mech.
Final Test
Meter Release
FINAL h]r/ LILEn lo-[j2t a) v\Qq(ru 7€12yttT
I hereby affirm under penalty of perjury that I am exempt form the Contractors' License l-aw for the following reason (sec.703l .5 BSin.rt
md Profssion Codc): Any Cily or County which rcquim a pcmir to comtrucl, alts. imprcvc. dcmolish or rcpsir my structuc. prior to its
issuncc. also rcquirc thc rpplicsnt for such pcmit to Iilc a signcd statcmcnt thrt hc or shc is liccrocd pmuut to thc prcvisioG of thc
Conlractor'3 LiccBcd Lsw (Chspts 9, Commcncing *ith S@tion 70OO ofDivbion ! ofrhc Buriner and Profarioro Codc) ol'that hc or
shc is cxcmpt th@from rnd thc b6i! for thc sllcgcd cxcmflion .Any violatiou of Sectioo 7031.5 by my spplic8il for r pcmit subjcct! sE
applicsnt to 8 civil pcmlty of not mrc rhu tivc hundrcd dollm ($500).
_1. r ownr of thc prcpcrty. or my cmployc with wag* r thcir soh comDNtioo, will do thc wott md thc struclre is not inhdcd
or offocd for rlc ( Se.7oil4, Bain63 tnd Profcssions Codc: Thc Contnctor'r Liccrec Lr* do6 not rpply to m oma of thc prcpcny
who builds or imprcvc thc@o. std who d6 s$h wort himclf or hcrclf or thrcugh his or hcr owtr cmploy€, prcvidcd th8t such
imprcvmcnts e rct iilcndcd or off6(t for s!lc. If, how€E thc buildiog or imprcvmcnt is rcld within orc yc of complaio[ thc
olrm-Builda will havc thc bwdcn of prcving thlt hc or shc lot build or imprcvc for thc purpo$ of slc).
_1, I owocr of thc propcrly. m excluivcly cotrtncting with liccBcd contr&toF to oBtruct ttr pIojct ( Sa. 7044. Bwinss md
Prof!$ion Codcr ThG Contrrclor's Liccnsc lrw do6 not spply to m owffi of prcpaty who builds or improvg thc@n . aod who
@nt6ct! fo. such proje$ with a Contncto(3) liccnlcd puBunt to thc Contnclor's LiccN lrw).
_l arn excmpt under Section .8. & P.C. for this reason.
Date: Orvner:
WORKDRS COMPENSATION DECLARA'I'ION
I hcrcby aflirm under pcnalty ofpcrjury one ofth€ following declarations:
I havc and will mainlain a Ccrtificatc ofConscnt to Self-lnsure for workers' conrpcnstion. as provided for by Section 3700 ofthe
trbor (bdc. for lhc perfornraocc oflhc work for which the pcrmit is issucd,
_l havc and will mintain worken' ompcmtion insuranca r required by Sedion 3700 of the Lrbor Code. for thc pcrfornuncc of thc
work for which thfu pcrmit i3 isucd. My workcrs' ompcnstion insuran@ €ricr rnd policy oumbcr rc:
Policy Number: Exphes:
(This section n. 001 or less)
_l certify that
bccame subject
in the performance of the work for which this permit
of California, and
is issued. I shall not in any manner so as to
to the workers' compensstion laws agree that if the workers'
compensation provisions of Section 3700 of the labor Code. I shall.those provisions.
WARNING: Failure to secure workers' compensation is unlawful, and shall subject an employer to criminal penalties and civil
fioa up to orc hundrcd thoMd dolhB ($100.000),in addition to thc cost of compffiaioo. damges r providcd for thc Setion 3076 of
thc lrbor Codc, intcrBt snd rttorrcy's fc.
W
I hcrcby sffim und6 pcmlty ofpajury thrt I m licenrd undr prcvision ofChapta 9 (commcncing with Scction 7000) ofDivision 3 of
thc Buincss and Professio6 Codc, End my liccBc h in full forcc and cfftrt.
License Nurnber za
Date:-/
('ONS'TRI.'C'TION LENDING AGEN('Y
I hcreby aflirm uodcr pcnally ofpcrjury lhal lhere is a construclion lcnding agency for lhc pcrfonnance ofthc work for which lhis pcrnrit is
issucd (Scc..1097. ('iv. ('.).
Lender's Name
Lender's Address:
APPLICANT'S DECLARATION
Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part 6)
_ Required l-ctter of Notification
_l certify that the fcderal regulations regarding asbestos removal are not applicable to this project.
_ I certiff that I have read this application and state the above information is correa. I agree to comply with all City and County
ordinances and State l-arvs relating to and hereby authorize representatives of this City and County to enter upon the
above mentioned property
Applicant or agent
Pennittce narne ( print):
/z- /u^ /
M ECHANICAL.INSPECTOR RECORD
4ol 3666?
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Date :