HomeMy WebLinkAbout30139812 - Permit (2)City of Santa Ana 20 civic center Plaza (M-19), santa Ana, cAg27o2 Plumbing
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 30{398{2
Pin #: f 59V
Project Address: 2321 E Fourth St
Assessor'sParcel: 400-031-07
Unil: G
Block: NA
Bldg: Address Range;
Tract FELIPE YORBA Historic: No
Suite Range;
Zoning: C2
Owner:
Address
Phone:
Tenant Name:
Conlractor:
Address:
Fee Type
011'16002 5'1602 Revision
01116002 5160C General Plan Update
Amount
222.16
22.O8
Fee
$222.16
$0.00
Qty
1.00
0.00
I
Phone
State Lic #: 726629
Lic Type: C-36
Bus. Lic #: 173736
Workers' Compensation lnsurance:Carrier: StateCompensationln8uranceCompany
Policy #: 1862590-2018
Expires: 0l/01/2019
Building Use:
Job Type:
Nature of Worki
Planning Conditions:
Planning Approval By
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Commercial
Tenant lmprovement
Revision
Occupancy:
Constr Type:
Code:
B
V B, SPK
cPc 2016
Notes: Revision 30139566. lnstall grease trap
CSG Consultants
ZuniSa, Allissa $/
Date
Date
Date
04n412018
04n4t2018
Account#
Misc. Receipt: 71326
Misc. Receipt:
Misc. Receipt:
Total
Every permit issued shall become invalid unless the work on tho site
authorized by such pemil is commenced within 1 80 days aftet its
issuance, ot if the wo* authoized on the site by such pemit is suspended
or abandoned tot a peiod of180 days after the time the wo* is
commenced.
$222.',t6
$222.'t6
s0.00
lnspector MID#: 2018-143942
Fee Total
Paid to Date:
Balance Due:
Lot: NA
Creekside Retail ctr, LLc
949 South Coast Orive, Ste 600
Costa Mesa, CA 92626
(714) 481-5081
Noodle Place
R & C Plumbing
4548 Phelan Ave
Baldwin Park, CA 91706
(626) 813-6899
PLUMBING-INSPECTOR RECORD
APPROVALS DATE ID/SIG.o\INER NUILI}ER DTJT,CARA'I]('N
liusircs frl lk lisio O\!.) Any Ciry or (irtrry *hi.h rcquncs r lanni n, .onNru.r, rltcr. irn0rovc. .lcmoli\h or rcprn trny
l,! rhc r.visionr oI rhc Cotrlruclors l,ir.n\cd liw (Chrplcr 9. (bnntncirrs rirh sc.rion 7fiD ol Divirion 3 ol'rlt tsu\i'rrs\ rf(l
Pr.l.\sionsCodrrorrhrrtuorsh.L\rxcrlrrhcrcrrhrdrhchl\ntnrhcrllctL\lcx.N nnr.Anyvnnrli{nr.fSc.ri,n70.r15hyrty
rtfli. roi. fci,n sublc.rsrhc rlpli.dr ri n.irilpcoiIr.l Nr Dntrc rlrD li!d hurltuJlolh^ l55uD
I. tr\ osncr or rhc lRrFdy. or ry .nrdoyes sth sitcs \ rh.r slc .on{r-n$rnnr. r ill d., rie x olt u lh.ntuh n nur
i .ftlcrl or oftcrcd hr srlc (S{ ?O!l. Dusi.c$ nnd ftolcssions Codc:'l hc Conrn tn s l-iccns.ljw docs.orapply lo aD o$n .ol
llrc pmDcny who huilds or inDr)vcs rhcrs .:urd who dos {cn Fo* hin$dll.r h.rsclror rhtough his or hcr ow. cnDloyct\.
Il(*idcd rharsurh inlxohmnr aE fln inrclldcd.ronard r(, \rL ll k,wcvo. rhc hlil,lir3 or inDft)vcmnr is $ld wirhin otu tlrr
oi conrtldion, rh. O*Nr ltuiucr trillhrvr rlr $lrdrn ofrn,ving rhsr h. or shc dki mr hurld or imJror. thc poFny tn rhf, puqx,v of
l. N owncr or rh. F,p.rry, am .xclusivcly conrracring wnh lkcnsd connldoF
'o
oisrtucr rh. l'.ixr (S.c. 7044. Busmsr
lnd h!6shn Codc: Ttu Conrra.tor'* Lic..* trw do.s ftr lpplr ro & owncr of pm!. y*ho builds or imDrows rhenon.
and vho .ontE.!s for such pmjets wilh a Coirmcro(9 licnscd ,'u6@t to rh8 Conractols Laccos. Liw).
I rm.rcnrtl utrdcr Sc.lir
UOBtrEII]I:OMIINSAIION
DECLAMIIA!
I h.r.by affirm undcr Fnahy of pcrhry onc of lhc followinS dcclnrlions:
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h!{ drd will minr0in a Cenific c ol'Conscnt r. Sela lns!rc lor *orksi c.np.n\d t r,al ,tuvnhd tur by Scctbn :l7m o, rhc
Lnhor codc. lor
'hc FriornEna of
'h.
rork lor which rhc pcnril t hsucd.
-lhdca.dsilld.inlairworl.ricom!.nsdionisuBmc.&.cq!ir.nbySdion3?00oflhctiborCodc.rorthcFrfom@ofthc *o* ror shth rhir pcmr ie isoed. My sorksC omlEnelion i.su.m. ceir ud F,lty tudbrt @:
o ,,o
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c.nify lhll in rh. Frforn[m. otllE wort for which ttt Frmn is is*d, I shdtl nor .nploy any p.Kon ih rny .Mmt
e as lo bccotu slbjccr to rlt wo*c6 dn{rBdion L*s ofcllitomia. r.d !e@ lhr' if I slEuld b&om so$j&l ro rh.
workeN omr..sarion pmvhio.s orScfion]700or.he Lrho. Code I shll. fonhwilhcomrly wilh lho* ps!isio6..
*Al.NlN(i: Fuilurc lo scN mrtcrs ompctrsstion coven8c is unloqtul. and sndl subjer d .nploy.r ro dif,inal I'.mllix and
civil lincs up lo onc hun&ed tlsuend d(Uss ($100.000). in add nn ro rhc co( of ..q*Nrion. drru8.s as provAcd for lhc
DECI,AIAIIQN
I hcrcby afirn undcr rcnoltyofperjury lhlr I a'n lien$d undcr Imlisn,n.fChaplo 9lom'refti68 *ith Scclion 7000) olDivnion 3
of rhc Burimss and Pbfcssians Codc. dd m, liccn* k in tull fore nd cfae!.
qO!$&UI.IIO!.IENDNIi.A(iINCI
I hcrby !flirn rndc, pcnllryof,*rjfiyrhd !hs. isa.onsrrudhn lcndinS aBcmy for lhc lcrf"rmarcc oarhc*o lor Phich Ihis Frmil ir
issucd {Sa. 309?, Civ. C.)
APPI,IIANfDESJAAION
I hr'6y afm under pcnolty of pcrjury onc olrhc lblboin8 drcl,rarion\:
D..n,lirio. Pcnnirs^sh.{osNolinc ion Fcdcrol Rceul ioos(rn,c $- Pd6)
R.qutcd t (cr of Norif .olion
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ccniiyrhar r hc lcdcrul rcsrlar io trs rslrdinsa\bcsrosrcmo\aluc nor aprlkrhL ro rhis p(&.r
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ccnify rhd I hnvc rad rhh ap ic,r ion dr, salc rhln rhc ,$o$ inlormtion is con(l. I sgE ro comtly wirh lll Ciry and Coun!,
oilnr Q\ Md Srm. l,'r\ rulnrinS nr in8 .otrtudion. ,i hcEby lurhornc rcrrcsntarncs of rhis Cir y and Coumy 16 .nl.r trF)n rlx
ltn,vc mnrioncd pmncny for ins
I 7/rlt c '4ly/l-/- ]k )
Water-Under lloor r
Gas-Underfloor
Building Sewer llrtlte t 'X^bt4/V rl
Area,/Storm Drain
lnterceptor/ Clarif ier
Waste & Vent 4/rrl@ r 'nlata- ,k'>--
Water Piping
Gas Piping
Roof Drain
Tub/Shower Test
Rouqh Water Heater
POOL/SPA
P{rap/Drain Line
Main Draini Pool Pipinq
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Water Service
Lawn Sprinkler
Sanitary Sewer/Cap
Back Flow Device
Rouqh Plumbinq
Final Gas Test
Meter Release
FINAL s lrs lt{ (,4ndk/+ft
Notes, Remarks, Etc
COMMENTS
UNDER GROUND
Waste & Vent
TOP OUT
Gas Service
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l.ndcl. Addrc*
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