HomeMy WebLinkAbout10192957 - Permit (3)City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #:1lJ192957
Pin #: 264fJ1
Proiect Addressi 175 E CiW Place Dr
Assessor's Parcel: 041-212-04 Lot: NA
Unit:Bldg:Address Range: 2761-3001 N
Main/l01-199
Historic: No
Suite Range:
Zoning: SD59Block: NA Tract: NA
Building Use: Commercial Occupancy: N/A 1st FL Area:
Job Type: Signs Constr Type: N/A 2nd FL Area:
Nature of Work: Illuminated Wall Sign Code: CBC 2016 Other Areas:
Existing Bldg. & Use: Commercial Flood Zone: X-0602320163J Garage Area.
Proposed Use: # of Stories:
Total:
Description of Work: lnstall non-illuminated wall sign/"Mile High Company"/bond posted on M-69573
Patio:
T.l.Area:
Yards Req'd:
Valuation: $1,500.00
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lirrl*:Planning Conditions:lrll
Owner:
Address:
Phone:
Tenant: Mile High Wall
Main Street Concourse Llc
555 12th Street #215
Oakland, CA 94607
Contraclor: Caliber Signs & lmaging lnc
Address: 1775'l Skypark East 2F
lrvine, CA 92614
Phone. (949) 748-1070
State Lic #: 972755
Lic Type: C45
Bus. Lic #: 349569
Workers' Compensation I nsurance:
Carrier: Foremost lnsurance Company Gra
Policy #: WC008330021
Expires: 11123120'17
Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
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Itr75 - 1/t8/21)t7 9:26 In Totql $62S.98
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Revolvins
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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:
Kelaher, Selena
Hernandez, Kathy
Hernandez, Kathy
Dale: 0510412017
Dale: 0511112017
Date: 05/18/2017
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:,/l
07776002
07776002
07776002
07776002
07776002
57607
s3600
s7672
57600
s7607
Permit Fee
Plan Check Fee
Bldg. Stds. Revolving
General Plan Update
lssuance
$149.25
$206.91
$1.00
$20.56
$51.26No
No
No
No
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 01116002 s1600
01116002 51601
01116002 51612
01116002 53600
Account#Total
Every permit issued shall become invalid unless fhe 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 rs suspended or abandoned for a period of1 80 days after
the time the work is commenced.
$20.s6
$200.51
$1.00
$206.91 Fee Total:
Paid to Date:
Balance Due:
$428.98
$0.00
$428.98
lnspector MID#: 2017-135965
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BU!LDING- INSPECTOR RECORD
SITE-WORK DATE ID/SIG.COMMENTS OWNER I}UILDER DEL('ARATION
I hreby affirm undo penalty of perjilry that I m exernpt fiom the Conlraclore' License Law for the follow'ing remn (Se.7031-5
Businss and Profssion Code): Any City or ('ounty lvhich requirG a pennit to construct. allq. improve. dmolish or rqrair any
structure. p.ior to its issumce. also requirB the applicant fur such ;rcmit to frle a signed statanml lhal he or she is licmsed pursumt
lo thc provisions ofthe Contractor's Licensed [,a$'(Chapt6 9. Commencing Nith Scction 7000 ofDivision 3 ofthe Busin*s and
ProfessionsCode)orlhathcorsheisexemptthqefromandlhebasisfortheallegedexemplion. AnyviolationofSectionT0-ll.5byany
applicanl for a pennit subjccts the appl icant to a civi I penalty of not more than fi\'e hundred dollars ($500 ).
I. as owner o f the prcfffy. or nry etnployeG $ ith rvage m their sole cornpensat ion. rvill do the \vork md lhc struduc is not
intordcd oroffqedforsle(Sa.7(X4.BusinssandProfesioNCodc:'lheContractor'sl-icenseLawdo$nolapplytoano$f,erof
lhepmftry uhobuildsorimprovslhq@n.mdr\hodossuchuorkhimselforhcrselforthroughhisorhoosnemploles.
pro\idedthatstrch improvonotsilenolintodedoroffscdforsle. lf,horvo'a.lhetilildingorirnprovqntrtis$ldwilhrnonelar
ofcornpletion. lhe Ourer tluildq will have the burclm ofproving that hc or shc did not build or improve the property for the prrpo* of
sle).
_ l. as orvner oflhe properly. iln erclusively contracling with licenscd contracl06 to construcl the project (Ss. 7044. Business
md l'rolBsionCode:'[he(bntraclor'sl-icensel-awdosnolapplyloanolvnerofpropenywhobuildsorirnprovesIhoeon.
and $ho contracls for such prejsls \\'ilh a (-onlracto(s) licensed pursuant to lhe Conlractor's Liccnse la* ).
-l
m exempt under Sslion-. B. & P.C. for this re6on.
Drte: 0nner:
wotrKl.rra'( oNrPt'tNs,r r r(ii\
t)lt('l,',\trA iloN
ol thc Ii)ll(l\\ iilg (lcchr nl i(,nsI hereby aflirm unde poalty ofpoiury one
I have ild will mainlain a Cflificate ofConsent to Self-lnsure for workqs comptrsation. d frovided for by Scction 3700 ofthe
Labor Code, for lhe pcfonnuce of the work for rvhich the pmtit is issued.
[./_l have and rvill mainlain works' compensation insurance. 6 reqtrired by S(tion -]700 of the l-abor Code. for the pafomance of
the work for which this pernit is isued. My worktrs compssation imurmce canio md policy numbo ae:
,*,* h { ,1.4o *r S, 6tl * i'v G
Pori.yN,.bo, l, "rc oo8<3ooz ? E,pi,",,t1tl
_l ccrlify that in lhe psformance of lhe work for which this pomil is issued. I shall not snploy any poson in any rnanno
so m to become subjet to the workq's' compensation laws o I Californin. md agrft lhal i f I should bccome subject to lhe
\vorkm' compenstion provisions ofSetion 1700 oflhe t.abor Codc. I shall. fonhNilh comply sith thos provisions-
WARNINC: l-ailure to sure workss' compensalion is and shall subjct an mployr poaltiur and
civil fines up lo one hundred thousand dollils ($lO0.il00).
Selion .1076 of thc tnh)r (bde. trtsGl md attomey s fc6.
lo lhc cosl ol provided for the
o^r",5,i7'11
DECI,iRATION
I hreby affinn under poalty of perjury that I m licmsed undo pro! ision ofr (cornmflcing \r'ith Setion 7000) of Di!ision l
of the Ilusiness and Profcssioro Code. md my licose is in full forcc md effecl.
Licensc Class:
Drte:S
CONSTRUCTION LFNDING AGENCY
I hffiby amm undq p€nahy of perjury that th6e is a conslruclion loding agmcy for thc gnfomsce of thc lvork for N'hich lhis FEmit b
issued (Se. 3097, Civ. C.).
[f,nder's Nme:
Lfids's Addr6s:
APPLICANT DECLARAI'ION
I hodry atfm under poalty of perjury one ofthe follot'ing dclarations:
Demolition Pennits-Asbestos Nolification Fed{al ReEulatfuns ('l illc 40. Part6}
Required t-ellq oI Notificalion
I ccrtif,v lhat lhe ledcral regulatioils asbeslos removal are nd applicable lo this prejccl
I cdify thd I have read Ihis ()n lhal rhc I aSre to comply wilh all City and ('ounty
ordinanccs and Slate l,aws rcl0ling lo oflhis Cily and ('ounly to enls'ufx)n lhe
above nlenlioned property for
Applicrill or Agcnt Signattrre:
Pemite name (print):
and
in[onnalion
_*,., {. /8. I 7
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bfloor/VenUl nsu lation
Roof Sheathinq
Shear Wall
Framinq
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
lt/asonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
FINAL 1 -L- t7 J /c5-*w)
Certificate of Occupancy
Notes, Remarks, Etc.