HomeMy WebLinkAbout40135656 - PermitProject Address: 622 W Juniper Ave
Assessor's Parcel: 410-171-14 Lot: 59
Unit:
Block: NA
Bldg:
Tract 6703
Address Range:
Historic: No
Suite Range.
Zoning. R1
Cify of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Mechanical
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #:40{35656
Pin #: 75288
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone.
Kalli & Nicholas Langsdorf
622 W Juniper Avenue
Santa Ana, CA 92707
(7141 34s-1 478
Nexgen Air Conditioning an,
700 N Valley Street, Suite K
Anaheim, CA 92801
(657) 208-1e87
01 1 16002 51604
01 1 16002 51604
01 1 16002 51604
01 1 16002 5160C
01 1 16002 51604
01 1 16002 5777C
Fee Type
Heat Pump
Air Handling
Add'l Vent Sys
General Plan Update
lssuance
Microfilm Records
Amount
97.17
47.95
46.99
23.79
59.30
4.05
Qty
1 .00
3.00
1 .00
100
1 .00
1 .00
Fee
$e7.1 7
$143.85
$46.ee
$23.7s
$se.30
$4.05
t23 .'79
t4 - t-t5
i317 . ;J I
t566 .69
Botch*159377 - 6/I6/2$2L I0: omoroleslS
Office: CTYH Tronsi: 4 2 of 2Accti: Ref * : {01 35656
Rcpt*:0332rr 66b 6i I6/2it2I 8:43 AH
Tronsact ion Iotgl t566.69
Hexsen Arr Conditionins snd He
State Lic #: 101 1173
Lic Type: C-20
Bus. Lic #: 353953
Workers' Compensation I nsurance:Carrier: Old Republic Gen lns
Policy #: Al CWA001 1S02
Expires: 03/01 12022
General F'lon Updote Fee
Ul I 16(102- Sl6tttttt0tt-
ll icrof i lm & Docurents
trl I 16002- 3777tr8[t(t-
llechsn i cs I
0l I 16[102- 516040[r[r-
ICL Checlr 114556?Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Single Family Dwelling
Alteration
Heat Pump
Jacinto, Heidi
Notes:
Fee Total
Paid to Date:
Balance Due:
06/1 6t2021
06/1 6t2021
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Verduzco,Viofet\$
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
R-3, U
VB
cMC 2019
Every permitissued 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 site by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
lnspector MID#: 2021-166811
01116002 51600
01 1 16002 51604
01 1 16002 s7770
$23.79
$347.31
$4.0s
$375.1 s
$0.00
$375.15
M ECHANICAL.I NSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hmby affm undc pmslty of pojury that I m qmp from thc Contractors' Licfls Lew for thc following r@r (Se.703lJ
Bwincs and Profeion Codc): Atry City or County which rcquirc a pamit to sEtrud, alts. improvc danolish or rtpair my
stsuctuc Fior to its isuace, also rcquirc thc applicet for such psmit to filc a sigtrGd darcmt thd hc or slE b licos€d BEUat
to thc provisios of thc Contractor's Liccnrcd Law (Chapt6 9, Commcing with Sctioo 7000 of Division 3 of thc Buiae ud
Prcfeioro Co&) or that hc or shc b qmpt thscfrom sd thc b8is for thc allegcd cxmption. Any violation of Sdbtr 7031.5 by aoy
applicmt for a pcmit subjcts thc applicut to a civil pmlty of not morc the fivc hundrcd dollm ($500).
-1,
isi owner of the property. or my employee with wages as their sole compensation. will do the work and the structure is not
intended or off€red for sale (Sec.7044. Business and Profcssioru Code: The Contractor's License Law does not ryply to an owner of
the property who builds or improvcs thcreon, and who does such wort himself or herself or through his or her own employees,
provided that such improvcnrents are not intcndod orofu for sale. If, howwer. th€ buiHirry or improvcment is sold within one )ear
of complaion, the Orvncr Build€r will have thc hrdcn of proving thd hc or she did not hrild or inprove the property for the purposeof
sale).
-1,
as owner of the property. am exclusively contracting with licensed contraclors to construct the project (Sec. 7044. Brsiness
ard Professbn Code: The Contractor's License Law does not apply to an owner of propcrty who builds or improves thereon.
and who contracts for such projects with a Contraclor(s) liccnsed pursuant to the Contractor's Liccnse l.aw).
-l
am exempt under Section-, B. & P.C. for this reason.
Owner:
WORKERS' COMPENSATIM
DECLARATION
I hreby affm undo pcmlty of pcjury one of thc following dclratiom:
_l havc Ed will maint8in a Cstificatc of Comt to SclfJmurc for rcrkds composation, c providcd for by S6tion 3700 of thc
labor Codq for thc pGfomcc of thc wo* for which thc psmit b issucd,
,llflmuc ma *itt maintain wor*cru' com[mation iruuarcc. 6 requircd by Setion 3700 of thc lrbor code. for thc pofomcc of
Ihc worl for wNch this pcmit is issuod. My works!' comFrution irewcc mis ad policy numbcr uc:
a (e
Policy
_l certi& that in the performance of the work for which this permit is issued, I shall not anploy any person in any manner
so as to become subject to the workers'compensation laws of California. and agree that if I should become subject to the
worters' compensation provisions of Section 3700 of the l-abor Code, I shall. forthwith comply with thosc provisions..
WARNTNG: Failure to secure workers' compansation coveragc is unlawful, and shall subject an crnployer to criminal penahics and
civil fines up to one hundred thousand dollars ($100,000). in addition to the cost of compensation, damages as provided for the
Section l-abor ''r"*and attorney's {L(
I ICENST'N CON'IRACTOR
DECI ARATION
I hereby aflirm under penalty of perjury that I arn licensed under provision of Chapter 9 (commencing rvith Section 7000) of Division 3
of thc Business and Professions Code, and my liccnse is in full force and cffect.
License Numbcr:
W
I hcby alfm unda Fnlty of pqjury thd th@ is s constructbn koding agmcy for thc pqfomcc of thc work for which this Fnit b
Civ. C.).
Lender's Address:
APP! ICAN'I' DECI ARATION
I herdry affrnn under penalty of perjury one of the following declarations:
Demolition Permits-Asbcstos Notifrcation Fedcral Regulations (Title 40. Parr6)
-Required
Letter of Notification
.
-l
catiry tbd thc fcdoal rcgulatioc rcgodiag Eb6tos @oval rc trot applic8ble to this prcjcl.
Mdi$ ttu llwcsd thb applicstion ed statc thd thc abovc informariotr is cotrcl. I agrE to comply with all City ed Couty
'ordioins ud Stuc hw rclding to builditrg cordructioo, md h6rby uthorirc rc?rMtdiE of this City ud Couty to 6ta upon thc
above mentioned property for
Applicant or Agent
I
Permitee niune
a
*,,S/t6l)l,
Appliances
Metal Fire Place
Evaporative Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-lnsulation
lnsulation
Smoke Detectors lnstalled
Rough Ductwork
Vents
Toilet Room / Clothes Drver
Residentia! Range
Other
Hood
Type I Hood
Type ll Hood
Grease Duct
Fire Damper
Openings
Installation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rough Mech.
Final Test
Meter Release l- ,/l-. \raJ ?)
FINAL \H\ l/> l0 l yWv o7
Notes, Remarks, Etc.\
Date:.
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