HomeMy WebLinkAbout102102969 - Permit (2)I
City of Santa Ana
Permit Counter: (714) 64
20 Civic Center Plaza (M-19)l SantaAna icngzzoz Building
7-5800 lnspection Requests: (714)667-2798 lnspector Section: (714)647-5853
Permit #:102102969
Pin #: 22292
Project Address: 309 W Third St
Assessor's Parcel: 398-591-07 Lot: NA
Unit:Bldg: Address Range:Suite Range:
Zoning: SD84Block: NA Tract: NA Historic: Yes
Building Use:
Job Type:
Nature of Work.
Existing Bldg & Use.
Proposed Use:
Commercial
Tenant Improvement
TI
Com rne rc i a l/Resta u ra nt
B
VB
cBc 2019
x-0602320276J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Totat
Patio:
T l Area: 1295
Yards Req'd
Valuation: $10,000.00
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories:
Description of Work: Replaces expired permit #10496982
Tl-Legalize walls and ceiling, seating area (interior and exterior), kitchen equipment
Planning Conditions:
Bcrbch*:541?9 l/2?/?tt2t-t ID: H{iAlt(:IA
Off ice: {:TYH Traris*: 13 I t"rf' I
Acct*: Rel*: 1l:r21r:l??6ii
licpt*:u2g$47:i$ l/29/?il21t i1:lIi r:i11
Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #.
urs
Liil;l lt'u i ldet'r.
{ien er ct I [:' I ctri Urrditt. e Ferri
t:t I I 1 5t-tt-tl?..-';i 1 6t-tt-tt-tt"tl-t--
liu i l d i rrlt
Lt I I I 6t-tt-t1l- 51 6l:l I t-tt-tt.t-
ttldsi Stds [tevci]v iris
Blair Des[Srl Htffh l; I ri 1 2t-tt-tt-t-
1'1 ir::r'oliIm & [tclcttmerit,:i
p.O. Boxl4hbl 6t-tt-t? - i77;Il:ll:llJl:l-
Laguna atfile t{ tB[19 2652 l Lrltii
(e4s, 2s0-0100
ci
-
Owner:
Address:
Phone:
Tenant
Borba Realty
309 W Third St
Santa Ana, CA 92701
(562) 371-2212
El lndio
Contractor: LSR Builders
Address. 225 North Broadway, #216
Santa Ana, CA 92701
Phone: (858) 4374247
State Lic #: 964743
Lic Type: B
Bus. Lic #: 343456
Workers' Compensation lnsurance:
Carrier: Falls Lake
Policy #: FLA005713
Expires: 0 511212020
$?2. ?5
$1 r Ll5lJ. 56
$1.[l[r
$54 ,7 4
$1r1.??.?5
t
Planning Approval By.
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd: No
PWA lnsp. Req'd. No
Planning lnsp. Req'd: No
Landscaping lnsp. Req'd: No
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 01 1 16002 51600
01116002 51601
01116002 51612
01 1 16002 57770
Graham, Jeffery
Kwak, Jason
Hernan dez, Kathy
Date: 0112912020
Date: 0112912020
Date: 0112912020
Subject to Field.
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
077760 0 2
07776002
0 77760 0 2
0777600 2
0 77760 0 2
0 7776002
07776002
Permit Fee
Microfilm Records
lnvestigation
Penalty
BIdg. Stds. Revolving
General Plan Update
lssuance
$640.1 0
$54.7 4
$100.57
$2s2.69
$1 00
$22 9s
$57 20
$1 ,1 29.25
$0 00
$1 ,129.25
Account#Total
57607
57770
57607
57607
57672
s7600
57607
Every permit issued shall become invalid unless the work on the site authorized by
such permit is commenced within360 days afterifs issuance,or if the work authorized
on the site by such permitis suspended or abandoned for a period of 360 days after
the time the work is commenced.
$22.9s
$1 ,050 56
$1 00
$54 74 Fee Totat
Paid to Date:
Balance Due:
lnspector MID#: 2O1 8-141277
,l f-:
BUILDING- INSPECTOR RECORD
SITE-WORK DATE ID/SIG.QOMMENTS o OWNER BUILDER DELCARATION
I hcrcby afllrm undcr FEnahy of pcrjury thfl I am cxcmpt fmm thc Contraclon' Liccnse law for lhe followinS rca$n (Str.70.j1.5
Busincss anl Profession Codc): Any City or County which rcqui.es d lErmit lo conslruct. {lter. improvc. dcmlish or rcpair any
structurc. pri)r k) its issuarcc. also rcquircs thc applicrnl firr such lrernrit to fih r signed sldcmnl lhal hc or shc is liccnscd pursuunl
to thc prcvisions of lhc Conlrrclor's Liccnrcd hw (Chtrplcr 9. Comrncncing wilh Scclion 70fi) of Division 3 of thc Busincss and
Pmtbssions Codc) or thdt hc or shc is cxcmpt thcrcfrom und thc basis for thc alhgcd cxcmilion. Any violation of Scclion ?0.1 I .5 by any
applicrnlforalrermitsubjcclslhc applicantloacivilpcnaltyofnotnxrrcthilnfivehundrcddollars(3500).
_1. as owncr of the propcrty. or my enlployccs with wagcs as lhcir solc conrpcnsalion. will do thc work ilnd lhc slnrcture is n()l
intendcd or ofl'crcd lbr sale ( Scr.7044. Business and hol'cssions Code: Thc C--ontraclor's Licensc Law docs not apply lo an owncr of
thc prcpcrty who builds ()r improvcs thcrqrn. and who docs suclr work himsclf'or hcrsclf or through lris or hcr own cnlployecs.
providcd that such inrprovenrcnls are lmt intcndcd or oflt'rcd for sah. If. hrwcvcr. thc buildirtg or improvenrcnl is sold within onc ycar
of cotnplction. thc Owncr Buildcr will havc tlrc burdcn of proving that hc or she did rxrt build or irnpnrvc the pnrprty ftrr thc purplse of
salc).
-1.
as owncr of the propcrty. amexclusively contracting with liccnsed conlraclors lu conslruct lhc pnrjccl (Scc. 7041. Busincss
and Profcssion Codc: 'l'hc Contractor's l-icensc [-aw docs not apply to .ul owncr of propcrty who builds or intprovcs lhcrcott.
and who conlracts for such projccts with a Contract<l(s) liccnscd pursuant lo thc Contractor's Liccnsc [aw).
-lanrexcmptundcrSection-.B.&P.C.forthisreason.I)alt:( )rvner.
WORKERS' COTTTPENSATION
DECLARATION
I hcrcby alTinrr undcr ;rcnalty of pcrjury onc of lhc folkrwing dcclarations:
-lhavcandwill
rnaintainaCcrtificatcofConscnttoSclf-lnsurclbrworkcrs'cornpcnsali()n.as providcdlbrbyScclion3T(X)ofthc
Labor Codc. ltrrthe pcrlbrmancc of thc work ftrr which thc pernrit is issucd.
A:.lbr is issuccl. My cornpcnsalion insurlncc carricr and policy nurnhcr iuc:
Policy *2o-b
_l ccrtify that in thc pcrfornunce of thc work lbr which lhis pcrnrit is issucd. I shall not crttploy any pcrson in arty manncr
so as to bcconrc subjccl lo lhc workers'comJrcnsalion laws of Calilbrnia. and agrcc lhat if I should bcconrc subjcct to lhc
workcrs' colrrpcnsalion provisions of Scction 37(X) of thc Lahrr Code. I shall. tbrlhu'ith conrply with thorc provisions.
WARNING: f;ailurc to sccurc workcrs' colnpcnsatioll covcragc is unlawl'ul. and shall subjcct an crnploycr to crirninal Jrcnaltics and
civil lines up to onc hundrcd thousand dollars (SlU).(ruO). in addition lo lhc cost ol'cornpensalion. darnagcs as providcd for thc
Section 3076 of the Labor Codc. intercsl and attorney's fccs.
,^r,. l-21 -,4) Appricanr:
I hercby affirnr undcr Jrcnalty of pcrjury that I arn licenscd under provision of Chaplcr 9 (conrnrcncing with Section 7firu) of Division -1
of thc Busincss and Professions Codc. and rny liccnsc is in full force and cffect.
Licensc ,ro".' 'L Lice.sc
D^r", f - H'- 2>U) conrracror*
I hcrchy uff rrrn urrdcr pcrralty ol'pcrjury lhat thcrc is a agency ltrr thc pcrlorrnuncc of thc work for which this pcrtnit is
issued (Sec. 3097. Civ. C.).
lrndcr's Name:
[.endcr's Addrcss:
APPLICANT DF'CLARATION
I hcrcby affirnr undcr pcnalty of pcrjury onc of thc fbllowing dcclaralions:
Derrxrlition Pcrnrits-Asbcstos Notificati<xr Fedcral Regulalions ('I'itlc 40. Part6)
-Rcquircd
lrtter of Notification
_l ccrtify lhat thc fcdcral rcgulations regarding asbcslos renxrval arc nol applicablc to lhis projccl
stalc that lhc atxrvc itrtbrrrmtiorr is corrcct. I agrcc to conrply with all City and Courtty
authorize rcpresenlalivcs of this City and County to cntcr uf)n tlrc
abovc nrcrrtioncd propcrty for inspcction
Applicant or Agent Sign"tr..X-
Permilee name @nntlz L
*r", l*21 -fu)
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/Ve nt/l n s u I atio n
Roof Sheathinq
Shear Wall
Framing
Insu lation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
JVlasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif .
FINAL /ZA-D tLCte rur*s -,
17
Certificate of Occupancy
Remarks Etc.
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