HomeMy WebLinkAbout20158097 - Permit (2)Proiect Address: 117 W Fourth St
Assessor's Parcel: 398-258-03 Lot: POR 2, POR 3
unit: 300
Block: 14
Bldg: Address Range:
Tract: TOWN OF SANTA Atlistoric: Yes
Suite Range:
Zoning: SD84
frh Ciff of Santa Ana 20 civic center Plaza (M-19), santa Ana, cA s2702 Electripal
@ Permitcounter: (714)o4T-sroo lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853 S
Permit #: 2O{58O97
Pin #: 30662
Owner:
Address
Phone:
Tenant Name:
Contractor:
Address:
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Fainbarg V
129 W Wilson St #100
Costa Mesa, CA 92627
19491722-7400
Specialty Coffee Assoc of America
Owner-Builder
01 1 16002 51603
01 1 16002 51603
01 1 16002 51600
01 1 16002 51603
Fee Type
Light Fixtures
Min Fee Adj
General Plan Update
lssuance
Amount
0.95
32.03
't9.93
49.68
Qty
36.00
1.00
1.00
1.00
Fee
$34.20
$32.03
$19.93
$49.68
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #;
,1rt ,"rn"ndez, Kathy 10t07t2015
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes: auth on file
Fee Total:
Paid to Date:
Balance Due:
Commercial
Alteration
TI
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
B
ilrB
cEc 2013
01116002 51600
01 1 16002 51603
$19.93
$1 15.91
$135.84
$0.00
$135.84
Every permit issued shall become invalid unless fhe work on the site
authorized by such permit is commenced wtthin 180 days after its
issuance, or if the work authorized on the site by such permit is suspended
or abandoned for a period of 180 days after the time the work is
commenced.
lnspector MID#: 2015-124335
t
ELECTR!CAL.INSPECTOR RECORD
APPROVALS DATE rD/stG COMMENTS Owner-Builder Dcclararion
IherehyafTirnrunderpenaltyofperiurythalI6mexempllorn]lheContractors LicenseLawforthefollowingreason(sec7o.lL5llusincss
and Profession Code): Any City or County which rcquircs a permit to constnrct. allcr. irnprove. dcrnolish or repair any slructure, pr;rr lo ils
issuance. also requires lhc applicant f<rr such permit to filc a signed slalcmcnl lhst hc or she is licenscd puGuant lo thc provisions o.flhc
Contractor's Licensed l,aw (( hapter 9. Conrnrencing wrth Seclion 7000 of Divasion I of the Business and Professions Code) or that he or
shc is excmpt lhcreFom and lhe basis for lhc allegcd cxemption .Any violation ofScclion 70-11.5 by any applicant for a pcmit subjcds thc
rpplicanl lo d cilil 0enalty ofnot more than five hundred dollam ($500).
l. as os'ner oflhe proped!. or nry ernployces wilh wages as lheir sole compcns6lion. will do lhe work hnd the s!ucture is not inlended
orofferedlorsale(Sec7044.BusinessandProfessionsCode'lheConlrachr'sLicenseLawdoesnolapplytoanownerofthepropeny
rvho builds or improvcs lhereon. {nd who does such wo* himselfor herselfor through his or her own ernployecs. provided that such
irnprovemenls are nol inlended ot oflercd for sale. If. howevcr. the building or irnprovcmcnt is sold within one year ofcomplction. the
Owner-Builder will have lhe burdcn ofproving lhat he or she not build or irnprove for thc pIrpose ofsale).
I. as owner oflhe property. arn crclusively contractin8 with liccnscd contraclors to construct lhc projecl ( Sec. 7044. Busin6s and
Profession Codc: The Conlraclor's l-icense law doc not apply to an owner of properly who builds or inrproves thereon , and who
conkacls for such projects wilh a Contraclo(s) licensed pursuant lo ( ontractor's l.icense l.aw )
I irn c\c,Int qnder Sc.tion
,r^r, !?ftf .8,&P
;*-P<
C lhis renson.
I hcrchy alljrm undcr penally ofperjlry onc ofthe follow
__l havc and will rnaintain a Ccdific&tc ofConscnt lo Sclf-lnsure for workers'conrpensation, as provided for hy Section lToo oflhe
tnbor Codc. for thc pcrfomance olthc work for which lhc pcrmil is issucd.
_l have and will maintain workers' compen$lion insurrnce, as required by Seclion 3700 oflhe kbor Code. for the performance oflhc
work for which lhis pcrrnil is issued My workers compenstion insumnce arrier ond policy nunrber are'
Canier:
Policy Nunrber:_ Expircs: _.__-_
(l'his seclion n.ed not be complcted if rf," p*ir is fr fXc fr,rn*.anolt-m l$ tOOl or lcss)
_l ccnity lhal in the pcrfomancc of the work for rvhich this pcrmit is issued. I shall nol cmploy any pcreon io any manncr so as lo
*:*::'::::-=iK#r#*l, l, l.l. ) .,
fines up lo onc hundrcd lhousand dolla6 ($100,000).in sddition to thc cosl ofcompcnsation. damagcs as providcd for lhc Scctioo 30?6 of
lhc tibor Codc. inlsest ind atloroey's fe
LICENSED CONTRAC'TORS DECLARATION
I hereby amnt under penally of perjury lhat I am licensed under provision of ('hapt.r 9 (commencing with Sectfun 7000) of l)ivision 3 of
the tlusiness and Profcssions Code. and my license is in full force and effccl.
[-iccnse Class:
Date:
License Nurnber
Conlraclor:
(ONSTRT)CTION LENDING ACENCY
I hcreby affirm und{ pcnalty of pcrjury that lhere is I conslruclion lending rgcncy for the perfomancc of thc work for which this permit is
issucd (Sec. 3097. Civ. ('.).
Lender's Nanre
[-ender's Address
APPLICANT'S DECLARATION
Demolition Pcnnils-Asbcstos Notil'ication Fcderal ReSulalions ( l itle 40. Pan 6)
Requircd l-etler of Notifi cation
I ccrtify that the fcdcral regulations rcgardinS asbcslos removal arc not 6pplicablc to lhis project.
I ccrtify thal I havc read this application and statc lhal thc abovc infomation is corcc't. I agrcc lo
ordinances and Slalc taws relatingfp building comtruction. and hercby 6uthorizc rcprGcnlativcs oft
ahovc mcnrioncd properry for[KfI purpos6
Applicent or trgenl sig , , _& __ Dale:
permifleenamc(prinr,,
-
-t S*B{,Oac{
-
I cornply silh all ('ity and County
this City and ('ounty to enler upon lhc
q t,
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Building
Under Slab / Floor
Bonding / Grounding / UFER
Transformers
Torquing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rough)
Ceilings (Hard & Soffit Rough
Ceilings (T-Bar Rough)
Meter Release
Rough
Service Meter nr/I /
FINAL "//1 /tQ a
Notes, Remarks, Etc.-?-*)