HomeMy WebLinkAbout20170553 - Permit (2)Permit #:2O170553
Pin #: 95768
Project Address: 300 W Fifth St
Assessor's Parcel: 398-255-30 Lot: POR 16
Unit:
Block: NA
Bldg:
Tract BIRCH ADD
Address Range: *420424N
Brdwy/300,
Historic: YettO
Suite Range:
Zoning:SD84
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
Building Use:
Job Type:
Nature of Work
S & A Properties
300 w Fifth st
Santa Ana, CA 927010000
(7141949-7227 ext. 4OO
La Riconada Mexican Restaurant
Athos Group lnc
10775 Business Center Dr #
Cypress, CA 90630
(7141713-6311
Commercial
Tenant lmprovement
TI
01 1 16002 51603
01 1 16002 51603
01 I 16002 51603
01 1 16002 51603
01 1 16002 5160C
0't116002 51603
01116002 5777C
Notes:
Fee Type Amount
125 Volt Receptacle 1 .51
Light Switches, Occ. Se 1.64
Light Fixtures 1.09
Min Fee Adj 31.97
General Plan Update 22.95
lssuance 57.?0
Microfilm Records 3.91
Qty
4.00
1.00
30.00
1.00
1.00
1.00
1.00
Fee
$6.04
$1.64
$32.70
$31.97
$22.95
$57.20
$3.91
Botch* : 5381-t4 - ! /, / ?t-t'lt'-l
ut'f i ce: CTYH Iran ri*: 32Accti; ftef*:
Rcpt*: t-t28613::ili - 1/1 / ?it?i-l
Trgnssrt i on Tolnl
ID: i.liil
?[rl;rr
i37r, .7
State Lic #: 997813
Lic Type: B
Bus. Lic #: 374686
Workers' Compensation lnsurance:carrier: National Liability and Fire lnsurance Co
olicy #: V9WC052597
Expires: 1OlOBl202O
Athss 6roup Inc
Planning Conditions: lnterior work only. No exterior alteratons or modifications.
Occupancy:
Constr Type:
Code
Date:
Date.
Date:
A-2
VB
cEc 2019 Electrical for Tl includes the installation of a new bar
$156.41
$0.00
$1s6.41
Planning Approval By:
Plan Checked By:
Permit lssued By: Zuniga, Allissa
Subject to Field:
Buirding Permit#: 101100907
01t09t2020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
lssuance, or if the work authorized on the site by such permit is suspended
or abandoned for a period of 360 days after the time the work is
commenced.
01116002 51600
01 1 't6002 51603
01116002 57770
$22.95
$129.55
$3.91
Fee Totat
Paid to Date:
Balance Due:
lnspector MID#: 2019-153236
A iity of Santa Ana 20 civic center Ptaza (M-19), santa Ana, cA927o2 Electrical f
COMMENTSAPPROVALSDATEID/SIG.
Site-Work
Underqround
Pole Bases
Liqht Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm i Dampers
Communications Cable
Building
Under Slab / Floor
Bondinq / Groundinq / UFER
Transformers
Torqueinq
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilinqs (Hard & Soffit Rough
Ceilings (T-Bar Rough)
Meter Release
Rough
Service Meter i. ".\
t
I
FINAL t{\\iil},l)Wi\wrr v \
'l INotes, Remarks, Etc.
OWNER BUILDER DI]I,CARATIOFI
I hereby affrm under penalty of pffjury that I an exernpt frorn the ContractoN' Licmse Law for the following reale (Sec.70-l l.t'
Busines md Proission Code): Any City or County shich requirs a pmil lo constnrct. alt6. improvc. denolish or repair any
structue. prior Io its isuance. also require the applicml for such permit to file a signed statmot lhat he or she b liccnsed pursuml
to the provisions of lhc Conlractor's Licenscd larv (Chaptq 9. Commencing rvilh Sction 7000 of Division 3 of the Busincs md
ProfessionsCode)orthathcorsheisexempllhqcfrommdthebasisforthcallcgedcxmption. AnyviolalionofsectionT0-1l.5byany
applicantforapmnitsub.i((sthe applicanttoacivilpenaltyofnolmorelhanfivehundreddoll&s($500).
I. m owno ofthc propcrty, or my employces with wags 6 lheir solc conpensation. will do the work md lhe structue is not
intoded or olTered for slc (5€.7044. Busines and Profsiom Code: l he Contractor's Licrue Law do6 not apply to an ownq of
theprep€rty rvhobuildsorimprovsthqen.mdwhodossuchworthirnselforhenelforthroughhisorhoownemployes.
provided that such imgrovonmts re not inlfldql oro{Iqed for sle. lf. horvos. the building or imprormot is mld rvhhin one }a
ofcomplaion. the Orvns BuiHs $'ill have the btrdm ofgnoling thal he or she did not build or impove the preJuty for lhe purlnsof
mle).
l. 6 ou,ne oflhe propfiy. an exclusively contracting wilh licmsed contractoG lo coNtmcl the prejd (Sec. 7044. Busins
ad ProfssionCode:TheContraclor'sLicenseLawdoesnotapplytoanownsofpropertywhobuildsorimprovesthoeon.
and u,ho contracls for such pojects wilh a Contmctor(s) licensed pursuanl lo the Contraclor's l-icose Law).
. I m e\empt under Sation-_. tt. & P.C. for this reNon.
l)ale:Orvncr:
lvdnkins corr ren.s,r i'iiin
DECLARATION
I hseby amrm under penalty ofpqjury one ofthe following dCldalioNi
_l have md will maintain a Certificate of Consmt to Selflnsur€ lor rvorkos' cornpmsation, d provided for by S(tion -3700 of thc
Labor Code. for lhc pqfomdce of the work for which the pmit is issued.
I have ild will maintain u'orkm' compensalion insurance. d required by Scction 3700 of lhe Labor Code. for the pgfomdcc of
lhe sork for rvhich this pcnnit is issued. My rvorkm'imurmcc cmio md policy nunrbe ue:
Cmis:-
Iblicl
-Expirc:
-'1"certify lhat in lhc perfornrance ofthe rvork which this pcrmit is issued. I shall not empkry nny person in any manrer
so m to become subjecl lo lhe Nork6s'laws ofCalifomia. and agree that ifl should becomc subjet to the
workm'compmsalionprovisionsofSrlionlT00otlhetaborCode,lshall.fonhrvithcomplyrviththorprovisions..
WARNING: Failurc lo sure workm' compqEalion is unlas'ful. and shall subjrt an enployq lo and
thecivil finc up to one hundred thousmd dollan ($l in additkrn lo the cost of compcNation, dmag6 6
Setion 1076 ofthe tibor Code. intqBt
Date: tl-?-za
l)l!( 1.,\lt,\ I l()N
I hreby aflim undo penalty of pcrjury thar I un licmsed undo provision of Chapto 9 (commmcing with Sation 7000) of Division 3
of the BusioN md Profsiore Code, md my licrue is in full force od cfTct.
t
CONS'TRUCTION LENDTNC AGENCY
I hoeby affirm undo ptrally of psjury that thse is a construclion loding agmcy for the pqfomacc of the work for which this ponit is
issued (Se. 3097. Civ. C.).
Lends's Nme:
l-ends's Addressr
A PPLICAN'I DECLARATION
I hottry affnn under pmalty ofpojury one ofthe following delaations:
Demolition Pmnits-Asbeslos Notification Fedqal Regulations (Title 40. Pd6)
_Required t-etts of Notification
I cdiry that the fedsal regulations reguding asbeslos remolal are not applicable to this prejet.
that the above is corecl. I rvith all City and (bunty
and County to entq upon lhehereby
above ilrenlioned property for
Appliraill or Agcnl Sigilstu
Permite nsme (prinl):
l)nlc:
ELECTRICAL.INSPECTOR RECORD
A"ryrr{I*'-- A) ^Q,J
License Clasr
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