HomeMy WebLinkAbout101100877 - Permit (2)City of Santa Ana 20 Civrc Center Plaza (M-19), Santa Ana, CA g2io2 Building
Permit Counter (714) 647-5800 lnspection Requests (714) 667-2738 lnspector Section (714) 647-5853
Permit #: 1O11OO877
Pin #:3s8s$l
Project Address: 2122 N Main St
Assessor's Parcel:399-102-02 Lol 5
Unit Bldg: Address Range: 2122-2124
Tract: E. M. SMILEy,S SUB Historic: No
Suite Range:
Zoning: ClBlock NA
Euilding Use: Commercial Occupancy: N/A 1sl FL Area: Patio:
Job Type: Damolition & Cl€er Lol Constr Type: N/A 2nd FL Area: T.l.Area:
Nature of Work Demo & Clea. Lot Code cBc 2016
Other Areas yards Reqd
Existing Bldg. & Use: Comm€rciel-Crodit Union Flood Zone: X{802320163J
proposed lJser parking Lo1" # of stones: 0 Garage Area valuation: $45'000 00
Total:
DGcription ot Work: Oemoliah commgrcial building & clear lot. AOMD filed. Bo.rd posted on t{-73247. NOTE: REFERENCE 2115 N BROADWAY, BLDG
#10198745 & 47 FOR NEW PARKING LOT/GRADING'STANDARDS/APPROVED PLANS.)
Planning Conditiona:
Owner:
Address
Phone:
Tenant:
ORANGE COUNTY TEACHERS
PO BOX 1't547
Santa Ana, CA 927'111547
(714) 466-866s
Contractor Broadway Building Group, L
Address: 4590 MacArthur Blvd. Suite
Newport Beach, CA 92660
Phone (949) 335-7183
State Lic #: 1005485
Lic Type: B
Bus. Lic #: 370469
Workers' Compensatron lnsurance
Carrier: State Fund
Policy #: 9'142275-18
Expires: 10/05/2019
Engineer:
Address
Phone.
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
ThirdGen
Jason K.
Civil
Rolfs
Engineering
ness
Yorba Linda, CA 92886
(626) 390-9787
72300
H Hendy Associates
Susan D. Dwyer
4770 Campus Drive,
Newport Beach, CA
(949) 851-3080
c33724
#100
92660
Planning Approval By
Plan Checked By
Permit lssued By
NPDES lnsp
PWA lnsp Req'd
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
nny
Teri
Fire lnsp. Req'd No
Police lnsp Req'd No
Flood Zone Cert. Req'd No
Dale 07125120'19
Dale:
Date 0712512019
Subject to Field:
Misc. Receipt:
Misc Receipt:
Misc. Receipt:
07776002 51601 Permit Fee
01176002 s7612 Bldg. Stds Revolving
07776002 57500 General Plan Update
077L5002 51601 lssuance
Fee Total.
Paid to Date:
Balance Due:
$166.53
$2.00
$22.95
$57.20
$248 68
$0 00
$248.68
No
No
No
Account#Total
01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
$22.95
$223.73
$2 00Every permit issued shall become rnvalid unless the work on the site authorized by
such permit is commenced within 360 days after its issuance,or if the work authonzed
on the site by such permit is suspended or abandoned for a pertod of 360 days after
the time the work is commenced
lnspector MID#: 2018-148433
.l
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS O\\ \llll llt ll.l)l'.ll l)lal.( \l{'\I lO\
I hoeby affirrn undo poalty of psjury that I an exenlpl from the ('ontraclom- l-icmse l-as' for lhc follosing reon (54.70-11.5
Business and l'rofession Corle): Any City or County rvhich requires a pmnit to construcl. alto. improve. demolish or repair any
slmcture. prior lo ils issuance, also reauirs lhe applicml for such Frrnrit lo filc a sisncd stalonent lhal he or she is licorsed pulsuanl
to the lrovisions oflhe Contractor's l,icensed [.aw (Chaplcr 9. Connnencing rvith Smtion 7000 of Division 3 ofthe Business iind
professions Code) or lhat he or she is erenlpt thqefrorn and the basis for the alltled exernption. Any violBlion ofSection 70-1 1.5 ty any
applicanl for a pffilit slbj(ts the applicant to a ci!il penally ofnol tnore lhan five hundred dollils ($500).
l. m orvner ofthe proFrcdy. or tny eillployees wilh waScs as their sole corpensalion. \rill do lhe $ork ild the slruclue is nol I
irlqrdel or offsed for mle (Se.7Ol4. []usin6 and hofsstrns Code: l he ('onlrackn' s License [-aw do6 not apply lo an oNntr of
theprotEny $ht,btrildsorimprovsths6)n.ilrdwhodoL3suchuo*hirnselforherselforthroughhisorhffownenlployeG.
providedthatsuch itnprovonentsarcnotinlodedoroffqedforsle.lf.hou'evo.lhehuildingorimprovenrmtissolclrvithirtoneleu
ofconrplaion. lhc Orvncr Buildq S ill havc the bordo ofproling thal he or she did not t{tiltl or ilnprove the prefdy for lhe puqns of
sle).
l. as o$.ner ofthe propc'rly. on erclusively contracling \\ ilh liceilsed conlraclots to conslruct lhe project (S(. 7044. Busirrss
and ttofesion(irde: theContractor'sl.icense l.awdo6notapplyloano$nsofpropertywhobuildsorimproYesthocon.
and who conlracls for such projects rvith a Corilracto(s) licensed pursuanl to lhe (irntractor's l,icqrse l,arv).
I an exempt undcr S(tion
Date:
. Il & P.( . lirr this rcason.
(hr ner
\!!l!th!r!!511!ll L\!ll-!-(].\
t)1,( 1.,\ll,\ I IoN
I hereby aflirnr under penalty ofpqjury one ofthe follo$'ing declaralions:
Ihavemrlrvillmainlaina(enificaleofConstrltoself-lnsurcforworkqs colnpensalion.as [rcvideclforbySectionrT00ofthe
Lalxn' Code. for lhe prfomancc of the wo* for rvhich the pmit is issued
_lhaveandwillmaint.inworkers coillpensationinsurailce.as rcquiredbyScttion-1700oflheLabor('ode,forlhepofonnuceof
the Nork for \\'hich this pennit is issued. My rvorkos compcnsalion insumnce catiet md lblicy number tre:
Cariel
Polic) Nunrhq:Erpires:
I cetlify lhal in lhc performance ofthc \\ork ftn \!'hich lhis pernril is issucd. I shall nol emplo! any pqson in .nv manner
so as lo B*otnc subjfr.l lo thc \orktrs' conllmsation la\ s of Califrrrnia. and agree lhal il l should becontc subjccl lo the
$.orkcls' cornpensalion prorisions ofS<ticrn l7(X) otthe l.ah)r Codc. I shall. ftnh\\ ilh colnpl)'$ illt thosc provisions.
WARNIN(;: lrailure lo secure workeB'compc0snlion covcrage is trnla['[ul. and shall subiecl an snpk)vs lo aitDinal pstaltiG and
ciril lincs uP t) oile hrndred lhoilsan(l (lolla$in addilion b the cosl of compeilsation. danages as protided for lhe
Secti<r 3076 ofthe l,atnr Codc.fe6 .?/4fr- ft/VS,,llt4 x)
Ltu tt (a
Lt( t,.Nsl,.l) (1)N I It,\( l()ll
t)ucl-ARA iloN
rrrrlcr pr or ision ol'( hapld () (comrncnciD! $ ilh Scclioil 7000) oI I)i\ istrn lI hercby a{llrfi undcr lrenalty oI perjury I rrn
of the Busin6s and Prof*sions Code, md my license Iirrcc anrl cflcct.
Liccilse Classi b
l)rlc alzr&
I hoebl'aflirnr under ;mall).of pqjury thal
issued (Scc. .1097. Civ. C.).
l.srdcr's Nantc:
lclding agencl for the psfonnance oflhe rvork for \yhich lhis Fnnil is
l-ender's Addrcss:
,\PPl.t( ,\N.r I)t.( L,\ll,\ l'l()N
I horhy allirm under pcnflltl, of perjury one oflhe ft)llowinE declaralions:
Denrolition I'crrnits-AslElos Nolificatirrn Fedcral Regulations ('l ille'10. Pan6)
Rcquir c(l t-ellca oI Notifi calion
thc
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/VenVl nsulation
Roof Sheathinq
Shear Wall
Framing
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
I
///F|NAL 7_/ y /.2{b t v77W.0L{
Certificate of nc'
Notes, Remarks, Etc
too*8!>-
7 tsUtcltts1zt,o
E uttD/uqo*"+Jtln
u t F ff- fuzorz -lt But Lt>4)E- @.-.Kn-A*r-r ill S 5rL\ *tC