HomeMy WebLinkAbout10184508 - Permit (2)City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: {O{84508
Pin #: 3O8K\
Proiect Address: 1038 E Fourth St
Assessor's Parcel: 398461-19 Lot: NA
Unit Bldg: Address Range:Suite Range:
Zoning: M2Block: NA Tract: NA Historic: No
Building Use:
Job Type.
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
!ndustrial
Miscellaneous
Storage Racks
!ndustrial building
Occupancy:
Constr Type
Code:
Flood Zone:
# of Stories:
B, S-1
IIIB, SPK
cBc 2013
x-0602320276J
1
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area
Total:
Patio:
T.l.Area:
Yards Req'd:
Valuation: $5,400.00
0
Description of Work: lnstallation of 20' ft. high storage racks.
Planning Conditions:
Owner:
Address:
Phone:
Tenant:
SPEC Formliners, lnc
1038 E Fourth Street
Santa Ana, CA 92701
(714) 429-9500
SPEC Formliners, lnc
Contractor: UNITEDINSTALLATIONSET
Address: 3224Yorba Linda Blvd., Uni
Fullerton, CA 92831
Phone: (714) 305-3736
State Lic #: 933862
Lic Type: C-61, O-24
Bus. Lic #: 338217
Workers' Compensation lnsurance:
Carrier: Scottsdale lnsurance Co.
Policy #: WC8999923
Expires: 0410112016
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
Seizmic Material Handling Eng
Sal E Fateen
161 Atlantic Avenue
Pomona, CA 91768
(s09) 85s-098s
25969
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd: No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Landscaping lnsp. Req'd: No
Orozco, lvan
Heidari, Fred
Zuniga, Allissa
Date: 03/19/2015
Date: 06/18/2015
Date:06/18/2015
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
65304
Total
07776002 57607 Permit Fee
07776002 s3600 Plan Check Fee
07776002 s7672 Bldg. Stds. Revolving
07776002 57500 General Plan Update
Fee Total:
Paid to Date:
Balance Due:
$423.78
$391.66
$1.00
$19.46
Fire lnsp. Req'd:
Police lnsp. Req'd:
Flood Zone Cert. Req'd: No
Every permit issued shall become invalid unless the work on fhe site authorized by
such permit is commenced within 180 days after its issuance,or if the work authorized
on the site by such permit is suspended o r abandoned for a period of 1 80 days after
the time the work is commenced.
Yes
No Account#
01 1 16002 51600
01116002 51601
01116002 51612
01 1 16002 53600
$19.46
$423.78
$1.00
$195.83 $835.90
$195.83
$640.07
lnspector MID#: 2015-120442
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS Owner-Builder Dccltu6rion
IherebyaffrrnrunderpenaltyofperjurythatIamexemptformtheConlractors LicenseLawforthefollowingreason(sec703L5Busincss
.nd Profcssion Codc): Any ('ily or Counl), which requires a perrnil lo conslrucl. aher. improve, dcmolish or rclair any slruclure. prior ro its
issuance,alsorequircthcapplicantforsuchpcrmiltofileasigncdslalcmenl thf,theorsheislicenscd pursuantlotheprovisionsofthc
Contraclor's Licensed Law (Chapler I, Conlnrencing wilh Seclion 7000 of Division I of the Business ind Profo.ons Code) or lhat he or
shc is cxcmpl thdefrom and lhe basis for the allcged cxemplion .Any violation ofSection 70-1L5 by any applicant f&l a pennit subjects rhe
applicanl 1o a civil pcnalty ofnol rnorc lhan llve hundred dollam ($500).
l. as owner oIlhc properly. or my employces with wages as lheir solc cornpensation. will do the work snd the structure is nol inlended
or offered for sale ( Sec 7044. Busrness and Professlons Code The ContrBctor's l-icense Law does nol applv to an owner oflhe propeny
who builds or irnproves lhercon. and who docs such work himsclfor herselfor through his or her owf, employees. provided lhat such
intprovcmenls are nol inl.nded or offercd for salc. If. howe!cr. thc building or irnprovemenl is sold wilhin one ycar ofconlplction. lhe
()wner-Builder rvill have lhc burdcn of proving lhat he or she nol build or improve l(]r the purposc ofsale)-
-. l. as owner oflhc property. am cxclusively contracting with licensed contractors k) construct thc prdecl ( Sec. 7044. Business and
I'rcfessi()n Code The Contractor's [-icense hw does not apply to an owner of propeny who builds or inrproves lhereon . and who
contrlcts for such p.o.lds with a Contr.clor(s) licenscd pursuanl to the Conlrador's Licensc [rw.)
_l am cxcmpt undcr Sslion _.8. & P.C. for this rccon.
Datc: Owns:
WORKf, RS COMPf, NSATION I'ECLARATION
I herehy aflirn under penalty ofpcrjury one oflhe following declaratioils:
I have and will maintain a Cenilicatc ofConsent lo Self-lnsure for workers' compensatron, as provided for by Secrion 37oo ofthe
lrbor (bde. for lhc pcrforrnancc oflhc work for which thc pennit is issued.
I have and wrll marnlain workers @mpenslion insurance. as required
work for whrch thrs permI rs rssued My workers conrpensalron rnsurancc
canier S",{-tfDot\4,21^rs
by Section 1700 ofthe labor Code, for the perforroncc ofthc
canicr and policy numbr arc:,,_L41 ._
rori.yH,,u",,[dl?lrtf - /t( - -Expircs:(This scction nced not be c6rnplcled iflhe pcrrnit is fiir One hundred dollars {$100} or lcss)
I ceni[y lhnt in thc performancc oflhe work for rvhich lhis is I shall not any person in any rnanner so as to
to lhe workers' compenstron laws ofca rfl subject to the workers
conrpensalion
trare, .h
provisions of Sectionlrlr[1700 oflhc l-ahor ('odc. I provisions..
wARNINC ,railure to secure workers compensalion coverage rs unlawful. and shall sub_lect an employer to cdminal pensllies and civil
fines up to onc hundred thousand dollars ($100.000).in addilion to lhe cost ofcompensalion. darnaScs &s providcd for lhe Scclion .1076 of
the Labor Code. rnler6t and allorney's fees
LICENSED CONTRACTORS DECLARATION
I hereby amnn under penalty of pcrjury that I am licensed under provision of ('h6pter 9 (cornrnencing with Section 7000) of I)ivision -3 of
lhe Business and Profcssions Codc. and my license is in full force and effect-
Licensc Class:
l)^tc: _.__-_
ourllrq [,icense I w*( onlraclorl
CONSTRT'CTION LENDING AGENCY
I hcrcby aflirm undcr pcnally ofpcrjury that thcrc is a coNtruction lending agcncy for thc pcrfomance ofthe work for which this permit is
issucd (Ss. 3097. Civ. C.).
Lender's Name
l.cnder's Addrcss:
APPLICAN'I"S DECLARA"TION
Demolition Permits-AstEslos Notification Federal Resulations ('l itle 40. Pan 6)
_ Required t-eller of Notification
I cenify thal the federal regulalions regardinU asbestos reilroval are nol applicablc to this project.
I ceniry that I have rcad lhis ion and slatc thal lhe ahove information is conect. I agree lo comply wilh all Cily and County
ordinances and State [nws authorizc represenl8livcs of this
G-o.r.,
sbove ,nentioned property for
Applicant or agcnt sig.:
Pcmitlr namc (prinl):
Io conslruction.u,id:
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subfloor/VenUlnsul
Roof Sheathing
Shear Wall
Framing
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
,fl
FINAL ld/nz/E -lM/r ,)
Certificate of Occupancy '/<w
Notes, Remarks, Etc