HomeMy WebLinkAbout10196116 - Permit (2)cify of Santa Ana 20 Civic Center Plaza (M-'lg), santa Ana, cAg27o2 Building
Permit Counter (714],647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit#: {O196116
Pin #: 96594
wProject Address: 1517 3/4 N Fairview St
Assessor'sParcel: 198"133-14 Lot: NA Block: NA
unit: MET01 Blds
Tract: NA
Address Range: 1515-1517
Historic: No
Suite Range:
Zoning. c2
Building Use: Other Occupancy: N/A 1st FL Area: Patio:
Job Type: Alteration Constr Type: N/A 2nd FL Area: T.l.Area:
Nature of Work: Antennas Code: CBC 2016 Other Areas: yards Req,d:
Existing Bldg. & Use: Ce Site Flood Zone; X-0602320144J GarageArea: Valuation: $25,000.00
Proposed Use: # of Stories: Total: O
Description of Work: lnstall (1) antenna in new delta sector, relocate existing antennas, adjust azimuths, install(1) hybrid cable, replace (2) DUS41 with
885216. lnstall new SPD box in sholter for (2) new SPDS.
Planning conditions 9rrt,:hi:4437?
Owner:
Address:
Phone:
Tenant: T-Mobile
Tracy Pulliam
P O Box 6410
Santa Ana, CA 92706
Contraclor: Metro RF Services lnc
Address: 2320 S Archibald Ave
Ontario, CA 91761
Phone: (909) 2304920
State Lic #: 895235
Lic Type: B, C-7, C-10
Bus. Lic #: 345346
Workers' Compensation lnsurance:
Carrier: California lns Co
Policy #: 7387533301
Expires: 05115/2018
Engineer
Address
Phone:
License #
Architect /
Designer:
Address:
Phone:
License #
Planning Approval By
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'
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
Brodowski, Teri
Misc. Receipt
Misc. Receipt
Misc. Receipt
07775002
otttsooz
07776002
08907001
017760 0 2
o777600 2
o777600 2
Permit Fee
Plan Check Fee
lvlicrofilm Records
SMIP - Category 2
Bldg. Stds. Revolving
General Plan Update
lssuance
n
Account#
70831
Total
57607
53 600
577?0
240 00
57672
s7600
s7607
$617,04
$213.86
$3.62
$7.00
$1 .00
$21.25
$52.98
n
o
No
No
No
$9'16.75
$213.86
$702.89
lnspector MID#: 2018-1413'17
01 1 16002 51600
01 1 16002 51601
o1116002 51612
o1116002 57770
08901001 24000
$2'1.25
$670.02
$1 .00
$3.62
$7.00
Fee Total:
Paid to Date:
Balance Due:
Paul J FordECompany
Brian Kenneth Kormode
250 E Broad Str€et, Suite 600
Columbus, OH 432'l5
(614) 221-5579
Crown Castls
Richard Boelter
200 Spectrum Conter Drive Suite '1700 t
lrvine, CA 92618
Dale:0411212018
Date: 05/30/2018
Date: 06/19/2018
Subject to Field:
Every pemit issued shall bocome invalid unless the wo* on the sito authoized by
such permil is commenced wilhin180 days aftor its issuance,ot if the work authorized
on the site by such permit is suspended ot abandoned for a period of180 days aftet
the tine the wo* is commenced .
BUILDING- INSPECTOR RECORD
IDiSIG.COMMENTSSITE.WORK DATE
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loorivenVl nsulation
Roof Sheathin
Shear Wall
Frami
wallD
Ext./lnt. Lath
Brown Coat
l\,4asonr
T-Bar
Handic R
De Final Reut rt
En ineer Final Re rt
Flood Zone Certif .
FINAL
Certif icate ol Occu nc
Notes Remarks Etc.
r)rrNr-:R Ir]!t.DIaR DUL(',1R,\lr()N
l hcrehy artr unlcr pcmlry of rc.juty lhar l am excnpl ri.m rhc Conrr$r'6 Liccnsc La{ tur rhc lollo*irrg r"hn rqa Tlrl l 5
8lsinoss an,l ltotsnrn Codc): Any Ciry or Cotnty which rcqutcs I Frnii ro on\l 'r. {rrcr' inrPro!' d'nnlkh r rcndn rnv
srucrurc.lIk'rt,irsksuancc.nl$rcqutcslhclPrlicnft,srchIErnilofilc!siSncdshrcmnrrhdh'otrhcnliccna\lPunuonr
lolhc|mvisiomolllsco.kncl.rsLi.ci\.dljwlchlPlc'g.conlmcncnlEwilhscclnlnTfl]oolDivi\ion]otlhcBu\illc$l.d
potcssions Codcr oi rhJth. o. shc ir.xcmDr rhcrctrod iit rh. hasis ftn ihc allcgcd cxcnrtriotr Anyvi{,hrionofSccrionT0ll.5$vinv
omliclnr td a rcrmil suhjsh rhc llllicsnr ru,civilpen0lryoahor trxtrcrhan livc hundrcddollaN (55uJ)'
I. !s osNrorrhc tmlEny. ot myc'n,bye1wirh wr8c( as rhcir n,lc compcn\s!idn. willdo rhc woA di lhc {murc t ft
irrrc.a"a moncrca rm.ic lia.?oi4. Busi.cs md Pruicssionr cod. ll* conrdols Licen\c bw d€s i'! lpPlv ro ar ownd ol
rh pmpcny who builds or i'rrl)rord rlfmn. ond wlr d*\ su.h qo* hnns.lror hcnclfor rhou8h hh " hcr owncdpbvc's'
pn;ided rh,r s.h inlt,orcmnr\ dc nol inlcndcd or ond{ ror sle. lt k'scvs. lbc huilding or inDmkftnr is soh *irhin m ,!
;rc.mpl,jriotr. rhc O*;r Briu.r willhlw Ih. hud.n of!.ovins rhDr hcorshc did n t{ild or inDt'vc lhc pmFnv tor tnc PUIIrY or
1..\oBncroflhcpn,Pcny.ancx.lurvcly.onlrrclinswirhli.cn\cd.ont,croftb'onfirclrhcomi'r(Scc'70&r'Bx\i"c(
atrd tt,r$sih cod.: ih; co ri.rorsLiccnscLawd..snoroPPlvronnowncrorProl.nv*hobuildsori pntrtrlicrcon'
ud sho conrrack for such Dmjck wnl a Conta.lo(r ) li.c.sd lurlusnr o rhc Conlractn\ Li'cns tiw)
I nnrcxctr,fl u"dcr Scdion-. B &P( lnrrli{rcrson
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DECLABAIION
I hc.ctyafln ruidcrrcnllryorp.rjuryoNofrhcroll.RmEdccla,arions:
lltlvclldwillmi.rlin!ccnific,lcofconsnlt,scl(.lnsurclin$olkds.comFnsaliol.lspolidcdlolhysslionlT(x}oflh.
ljtrtr Codc, for lhc perrorffcc of I hc work for whth rh. Pcnnn i! nsucd
-l
h!!c and willroi rirr*orkctr.ory)cnsarn,ninsuamc..srcl]undhvSccrionl?0oolthc|ihorG'dc-ltrrhcP'rfonBncc'f
rhc work td which rht Frn,ir is issucd My{ork.s conl,cnerion insurana cadicr.Rl tslic, nlnhct {c:
Cari.r =
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cen ilr rhrr h rhc l}crt)lr,n.c .i thc *ork ftn $hn'h rhi\ l{nnir i\ nsucd. ! \hrllnorcr'plov ryl{6'nin tynanrcr
I&rst tciom ur,1..ih lrc *orhcs comFtrsrlion [ws orcnlitornir. ]nd 4rcc ttur if I sbuld b'toN \rl+'r k) rh'
\kfkcrs.oDrp.i.ii({f.ovi\ion\orsc.ri.n:17(DotrltlrlrnCfllc-l\halllnnh*irhon\nvsilhrho$!n'vi\ion\
Wi!RNIN(i i lurc r,, *nr. wotkcr'comp.Dsdor c.vcrulc is unls\ful. atrd shill strhjL'r rrl c$Dlovcr ro di iml Pcfulr.l I
cieil nmr up lo onc hundrtd I
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I hcrchy olfirftxndn pcnrlrY ol
h.u\xntl,lollx^ iS (xr.txr ot comp..stin. dfl'Meps as Pnlided for the
I
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DTCI.\RATIoN
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Set Backs
lnsu lation/Enerqy
Pool Fence
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APPLICANT I'TTCLATIATI(tN
I hcrl),aninnu s pcoxhy orPcrjury otu orrhc Llloui.B rlihnri'ns:
Dctrnliri(,n Pcirnir!Astinos Nolifi.ilion Ijcdcrrl RceulrlionslTirlc (]. Prn6)
-ltc+ir.dLxcrofNorifi.
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