HomeMy WebLinkAbout40130536 - PermitCity of Santa Ana
Permit Counter: (714) 647-5800
20 Civic Center Plaza (M-'19), Santa Ana, CA 92702 Mechanical
lnspection Requests: (7 1 4) 667 -27 38 lnspector Section: (71 4) 647-5853
Permit #: 4o^{30536
Pin #: 17733
Proiect Address: 2647 N Grand Avea
Assessor's Parce!: 396-361-01 Lot. POR 10 AND 11
Unit:
Block: A
Bldg: Address Range: 26gr-2641
Tract: SANTA ANA Historic: No
Suite Range:
Zoning: Cl
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
7-Eleven
2647 N Grand Ave
Santa Ana, CA 927058707
(9721 828-7011
7-Eleven
Clima-Tech lnc
3610 Placentia Court
Chino, CA 91710
(soe) 613-5513
Fee Type
01 1 16002 51604 Compressor
01 1 16002 51600 General Plan Update
01 1 16002 51604 lssuance
Amount
84.00
20.56
51 .26
Qty
2.00
1.00
1.00
Fee
$168.00
$20.56
$51.26
t20.56
t219 .26
$61 4.23
Babch*:36003 - LrJ/27 i2gl6 I0: PLoPEZS
Off ice: CTYH Trons*: 18 3 of 3Acct*: Ref*: +0130536
Rcp [3;01654857 - Ltt/27 / 2(116 ?:3{ An
Tr'nrr soct i on Totol t6l I .25
State Lic #: 897094
Lic Type: B, C-20, C-38
Bus. Lic #: 346842
Workers' Compensation ! nsurance:Carrier: Employee Service Group
Policy #: RWCC48811565
Expires: 05/01 12017
Cl i nro- Iech Inc
Genenol Plon Updote Fee
trl I 16u02- $l600fitrlr-
Ile,:hon i co I
01 t I 6ir02- 5160+Lrtr[r-
I (:L Check Ctl {S23
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
\l( Hernan dez,Kathv 10t27t2016
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes: change out
Fee Total:
Paid to Date:
Balance Due:
Commercial
Miscellaneous
Roof mtd equip
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
M
VB
cMc 2013
Buildins Permit #: 10190883
Every permitissued shall become invalid unless the work on the site
authorized by such permit is commenced within 180 days after its
issuance, or if the work authorized on fhe site by such permit is suspended
or abandoned for a period of 180 days after the time the work is
commenced.
01 1 16002 51600
01 1 16002 51604
$20.56
$219.26
$239.82
$0.00
$239.82
lnspector MID#: 201 6-131974
I
M ECHANICAL-I NSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS Onns-BuildrDcclsntion . . .
I hercby aflirm undcr pcmhy of pcrjury that I .m cxcmpt form thc Contnclon' Licemc lrw for thc following remn (sc.7031,5 Buincs
ud Profqsion Codc): Any City or Couty uhich rcquiro a pcmit to satruct. rltff. improvc. dmlish or rcpsit my strucrm. prior to its
isuamc, rlso rcquire thc lppliqnt for such pcmit to filc r ligncd strtcmnt thst hc or lhc is licered puBurDt to thc prcvbioE of thc
Contrtclor'r Liamcd hw (Ch8ptcr 9. Commcncing with S@tior 7000 ofDivbbn 3 ofthc Busines and Profcssions Codc) or that hc or
lhc h dmpr thqcfrom snd lhc basb for thc rllcScd rxcmprion .Any violrtion of Sction 7031.5 by my lpplicrnt for ! pcmh tubjcct3 thc
spplicsnt to r civil pcmhy ofmt morc thso 6vc hundrcd dollan (t50O).
_1. I owtrs of thc prcpmy. or my cmployG with we86 B thcir slc compcNtion, will do thc work md thc structuc is not iotmdcd
or off.r?d for slc ( 5@.7044. B$in6! rnd Profcrsions Codc: Thc Contrrctoi's Liere Lrw dm not apply to u oms of thc prcpcrty
who buildt or imprcv6 th@on. md who dG !rch wort him$lf or h6clf or thrcugh hir or h6 own cmployc. prcvidcd rhrt iuch
improvcmcots rc not htcndcd or offcrcd for !sh. lf. howcvs, thc building or imprcvmat i! sold withir orc y6 of complction. thc
Ouna-Buildcr will havc thc bwdcn ofproving thlt hc or rhc not build or imprcvc for thc purpolc ofslc).
_1. as owner of the property. am exclusively contraoing with liccnscd contractors to construcl the project ( Sec. 7044, Busincss and
Profession Code: The Contractor's Licensc Law docs not apply to an owner of propcrty who builds or improves thereon . and who
contracts for such projects with a Contractor(s) licensed pursuant to the Conlractor's License Law.).
_l am excmpt under Section & P.C. for this reason.
Date:
I hqcby allirtn unds r.*n, orO"r1rry onffi
lhavcandwillmaintainaCcnificatcofComcnltoSclf-lnsurcforworkcrs'conrpenstion.as providedforbySstion3Tooofthc
Lsbor Codc. for thc p€rfomncc of thc work for which lhc pcnnit is issucd.
(lhaveandwillmaintainworkers'compenstioninsurance..s requiredbysection3T00ofthetaborcode,forthcperformnccofthc
work for which this permil is issucd. My workcrs' compcnstion insurance qrrier and policy numbcr arc:
c,nx,,flCf Ata?ricrq,, 9n 5
poricy *"^*, Rtr)ccl^gll ti bo) Expires: a' I ' I 1
(This secrion need not be completd if the pcrmit is for One hundred dollars l$1001 or less)
_l certi$ that in the performance of thc work for which this permit is issued, I shall not employ any person in any manner so as to
became subject to the workers'compensstion hws of California, and agroe that if I should become subject to the workers'
cotnpensation provisions of Section 3700 of the labor Code. I shall.rvith those provisions.
WARNING: Failure to secure workers' compensation is and shall subject an enrployer to crinrinal penalties and civil
fincs up lo one hundrcd thousand dollaE ($100.m0).in trddilion to lhc cost ofcornpcnsalion. damages as prol,idcd for thc Scction 1076 of
the tibor ('ode. rnterest and atornay's fees.
LICENSED CONTRAC ORS DECLARATION
I hercby aflirm undcr penalty ofpcrjury that I an liccnscd unds prevision ofChapter I (coormcncing lvith Sedion 7000) of Division -l of
lhe Business and Professions Code. and my license is in full force and cffcct.gq?oq '/Liccnse Clacc.Cu License
orr",/0,21 'l(2
conrracror:
I hcrcby aflinn undcr pcnalty of psjury thst lherc is a coNtruction lcnding agcncy for thc p€rfomncc of thc work for uhich this pcrmit is
issucd (Scc. 3097. Civ. C.).
Lender's Nanre:
[-ender's Address:
APPLICANT'S DECLARATION
Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part 6)
_ Required Letter of Notifrcation
__-l certify that the federal regulations regarding asbestos removal are not applicable to this project.
_ I ceniry that I havc rod this rpplicrtion rnd statc that thc sbovc infomation is conect. I s$e to comply wilh rll City rnd County
ordinances and State Laws relating to building and hereby authorize representatives of this City and County to enter upon the
abovc mentioned property for inspection
Applicant or agent
Perrnittce narne (print):9L
lo'2-l ' / b
Appliances
Metal Fire Place
Evap Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-!nsulation
lnsulation
Smoke Detectors lnstalled
Rough Ductwork
Vents
Toilet Room / Clothes Dryer
Residential Range
Other
Hood
Type I Hood
Type ll Hood
Grease Duct
Fire Damper
Openings
Installation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rough Mech.
Final Test
Meter Release AI J
FINAL It'I ,Y lJfdwt V/t/ fl
Record.doc 03.31.06
Applicant:
io