HomeMy WebLinkAbout10191609 - 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{9{6O9
Pin #: 4{8OO
Proiect Address: 1100 W Warner Avea
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Lot: NA
Unit:Bldg: Address Range:Suite Range:
Zoning C2Block: NA Tract: NA Historic. No
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Other
Signs
Monument Sign
vacant
Occupancy:
Constr Type:
Code:
Flood Zone:
# of Stories.
N/A
N/A
cBc 2013
x-0602320259J
0
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area:
Total:
Patio:
T.l.Area:
Yards Req'd:
Valuation: $5,000.00
Description of Work: Relocate monument sign, "SCPA South Coast Post Acute". Bond posted on M-70232. Alth on file,
Planning Conditions:
Engineer: SullawayEngi neering
Owner:
Address:
Phone:
Tenant:
Orange County Convalescent Hos; Contractor
1030 W Warner Ave Address:
Santa Ana, CA 927073'|.47
(714)546-64s0
South Coast Post Acute
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
PO Box 28789
San Diego, CA 92198
(858) 312-5150
48588
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd:
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 53600
08901001 24000
Pezeshkpour, Ali
Ahangian, Kathy
Zuniga, Allissa
Dale: 1110212017
Date:06/19/2017
Dale: 1'|.10212017
Subject to Field:
Misc. Receipt
Misc. Receipt
Misc. Receipt
07776002
07776002
08907007
07776002
07776002
07776002
Permit Fee
Plan Check Fee
SMIP - Category 2
Bldg. Stds. Revolving
General Plan Update
lssuance
57607
53600
24000
57672
57600
57607
$154.26
$213.86
$1.40
$1.00
$21.25
$52.98
No
No
No
No
Account#Total
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 the site by such permit ts suspended or abandoned for a period of1 80 days after
the time the work is commenced.
$21.25
$207.24
$1.00
$213.86
$1.40
Fee Total:
Paid to Date:
Balance Due:
$444.75
$0.00
$444.7s
lnspector MID#: 2016-133462
Assessor's Parcel: 410.431-05
r-. H
BUILDING. INSPECTOR RECORD
S!TE.WORK DATE ID/SIG.COMMENTS OWNTJR BUII,DER DEL(.ARATION
I heretry affrm unde poalty of perjury that I an erempt from lhe Conlraclos Licnsc Law for the follorving reurn (Se.70i 1.5
Businss and Profasion Code): Any Ciry or Counly rvhich requira a;nrnit to conslruct. alt6. improve. dmolish or rcpair any
I
slructure. Frior lo ils isudce. also requirB lhe applicanl f<rr such pennit lo file a signed statement lhat he or she is licosed luGuant I
to lhe provisions of the ('onlraclor's Licensed Law (Chapt6 9. Commencing with Section 7000 of Division 3 of the Brrsincss and .-
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Profesions Code) or that he or she is exempl lhtrefiom and the b6is for the alleged eronption. Any violation ofSaion 703 I 5 hy an1
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applicantforapennitsubjslsthe applicaf,lloacivilpcnallyofnotmorethanfivehundrcddollars($500). I
I. as orvncr oflhe Jroperty, or my employG rvith wags o their ole compomtion. u.ill do the work md the structltrc is not
intoded or offqcd for sle (Se.7044. Busins and hofessions Code: 'fhe Contractor's Licflse Law docs nol apply to an o\!ner of
theproperly rvhotuildsorimprovoth6@n.mdwhodo6suchrvorkhimselforhoselforthroughhisorhaownemployec.
providcd lhat such improvqnmts tre not intmded orolTsel for ele. l( howsq. the boilding or impormot is mld s'ilhin onc yw
ofcomplaion. the Ou,ns Buildq will have the burdo ofproving thd he or she did nol build or improle the prcp€ty for the purlFse of
ule).
I. as ower ofthe properly. an erclusively contracting rvith licmsed contractore lo construcl the projd (S(. 7O14. Bwins
and Prcfasion Code: l-he Contractor's l"iccnse Law do6 not apply to il o\\'ns ofpropcny who builds or irnproves lhoeon.
and Nho conlracls for such proiets u'ith licensed lo the Cont'.ck)r's l-icmse Lalv).
I an exempt undtr Setion . l].P,C
r)r,e. lt-L-t|
I hcreby affirrn under penalty ofpojury one oflhe follorving
I have ild will nrainlain a Cfiificale ofconsol to Sclf-lnsure for workes cornpeisalion, o provided for by Section 1700 ofthe
kbor Code. for lhe psfomancc of lhe rvork for which the pmnit is issued.
- I have and rvill maintain workm' compeNalion insurance. as required by Sslion 3700 oflhe Labor Code. for the psfonnance of
the work for which this pmnit is issued. My rvorkos' comgrnsation insurdce cffiier md policy numbo ue:
Policy Numba:Expires:
_l cenily that in lhe pofirnrance ofthe rvork for which this permit is issued. I shall not onploy any pemon in any nranner
sr aslobcornesubjectlotheworkqs'compensationlawsofcalifomia.andagrcthatiflshouldbccornesubjcttothe
rvorkos'cornpensationprovisiomofSelionlT00oftheLaborCode.lshall.fonhrvithcomply*'ithlhosprovisions.
WARNING: Failurc lo sure s'orkfis'composalion is unlal'lirl. and shall subjcct an onpkrvcr lo oilnirral poallis and
civil fines up to one hun&ed lhousnd dollars ir d(ldil lhe comPensation.as provided for the
Section 1076 ofthe l-abor Code. inttrst dd allomey
I hereby a{Iifln undo pmahy of pojury that I am licosed undr
of the Busines and Profesions Codc. ad my licmse is in full
Sation 7000) of Dit.ision l
Liceroe Class:-[,icense Number:
I)itlc:Contrac(or:_
CONS'TRUCTION LENDINC AGENCY
I hoeby affitm under penalty ofperjury that th6e is a construclion lending agmcy for the psfonnance ofthc work for rvhich this permit is
issued (S(. 3097. Civ. C.).
Lendo's Name:
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t,ods s Addr6s:
APPLICANT DECLARATION
I hqd:) aflim unds poalty ofprjury one ofthe following declarationsl
Demolition Psmits-Asbestos Nolification Federal Regulations (Title 40. Par16)
Required t-etl6 of Notificalion
_ I cfiify thal lhe ,aleral regulatiore regading mhstos rmoval ue nol applicable to this preject.
I cdii, lhal I have read this applicalion ed statc that the atp|e infonnation is corecl. I agre to comply
: reprMtaliv6 of this Cily\_
lvith all City and Counly
md Counly lo enle upon Iheordinancs and Stalc Laws
above mmtioned propeny for
Aplrlicailt or Agenl
)I'ernrite neme (prin():
lo and horize
D^1" l12-/7
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bfloor/VenVl nsulation
Roof Sheathinq
Shear Wall
Framinq
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
FINAL ?-tB-re JJ.Jo*rTr\
Certificate of Occupancy
Notes, Remarks, Etc
('an'icr:
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