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' City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana , CA 92702 Plumbing Permit#: 30437467 <br />Permit Counter: (714) 647-5800 Inspection Requests: (714) 667-2738 Inspector Section: (714) 647-5853 Pin#: 78129 <br />Project Address: 121 E Washington Ave <br />Assessor's Parcel: 398-132-06 Lot: POR 10 <br />Owner: <br />Address: <br />Phone: <br />Tenant Name: <br />Contractor: <br />Address: <br />Phone: <br />State Lie#: <br />Lie Type: <br />Bus. Lie#: <br />Rosalva Garcia <br />121 E Washington Ave <br />Santa Ana, CA 927013779 <br />(714) 392-1276 <br />Dr Rosalva Garcia, DDS <br />Sky Blue Construction <br />24000 ALICIA PKWY #17367 <br />Mission Viejo, CA 92691 <br />(949) 422-3419 <br />987832 <br />B <br />350542 <br />Workers' Compensation Insurance: <br />Carrier: BENCHMARK INSURANCE COMPANY <br />Policy #: CST5007918 <br />Expires: 03/16/2017 <br />Building Use: Commercial Occupancy: <br />Job Type: Constr Type: <br />Unit: <br />Block: G <br />B <br />VB <br />Bldg: Address Range: Su ite Range: <br />Tract: GOODWIN ADD Historic: No Zoning: SP3 <br />Fee Type Amount Qty Fee <br />01116002 51602 Water Closet 13.24 3.00 $39.72 <br />01116002 51602 Sink 11.83 3.00 $35.49 <br />01116002 51602 Penalty 226.47 1.00 $226.47 <br />01116002 51600 General Plan Update 20.56 1.00 $20.56 <br />01116002 51602 Issuance 51.26 1.00 $51.26 <br />Ga~ch~:36247 -11/1S/2U16 IO: PLUPEZ5 <br />Of 1 1 ,:,2: Cf YH ·1·,·an ::.=:c: U 4 of ~. <br />Rco ~~~:01663541 -ij 1 j~;;Ji6 11~24 (1l·i <br />lransaction •1·otGi $~,069 aU'.::: <br />Sk s Blue Const ruction <br />{ie111~r-al Plan UPdGtr, /-!::(2 ·,n o .. '.:';.11 <br />01li6002-51600uo u- <br />f'.lu1,ib ins ·iiT52 .. '-/'i <br />ut .i i 6u02-5i.60~~uuu - <br />',_I i,,,,, $2? i:•.·\7 'i:1·:, <br />~~~~***********~31i8 Au th~i0124 1~ <br />Nature of Work: <br />Tenant Improvement <br />Tl/Demo/Restrooms Code: CPC 2013 <br />Notes: Remove illegal demising wall that created Unit B. New <br />partitions to create (2) new accessible restrooms, <br />waiting area, & hallway on 1st Floor. New partitions to <br />create storage, billing, & chart rooms on 2nd Floor. Planning Conditions: <br />Planning Approval By: Date: <br />Plan Checked By: Date: <br />Permit Issued By: Zuniga, Allissa ~ <br />Subject to Field: <br />Date: 11/15/2016 <br />Account# <br />Building Permit#: 10489282 <br />Every permit issued shall become invalid unless the work on the site <br />authorized by such permit is commenced within 180 days after its <br />issuance, or if the work authorized on the site by such permit is suspended <br />or abandoned for a period of180 days after the time the work is <br />commenced. <br />Inspector MID#: 2016-128828 <br />01116002 51600 <br />01116002 51602 <br />Misc. Receipt: <br />Misc. Receipt: <br />Misc. Receipt: <br />Total <br />$20.56 <br />$352.94 <br />Fee Total: <br />Paid to Date: <br />Balance Due: <br />$373.50 <br />$0.00 <br />$373.50