HomeMy WebLinkAbout101103142 - PermitProject Address: 3110 W Lake Center Dr
Assessor's Parcel: 414-272-10 Lot: NA
Unit:Bldg Address Range: 3100-3120
Historic: No
Suite Range:
Zoning: SD58Block: NA Tract: NA
city of Santa Ana 20 civic center Plaza (M-19), santa Ana, cA927o2 N Building
Permit Counter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #:101103142
Pin #: 42547
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Use:
Commercial
Demolition
Demo
Commercial/Offices
Occupancy:
Constr Type:
Code:
Flood Zone:
# of Stories:
B
lilB
cBc 2019
x-0502320258J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Totat
Patio:
T.l.Area:
Yards Req'd
Valuation:
Description of Work: lnterior soft demo only-non structural
Planning Conditions:
$30,000.00
Btrtch*:54402 - 2/L+/?t7?lt ID: NfiAR(:Iri
Off ice: CIYH Transi; S I cii'lAcct*: Rel*: 1r:rlll:r.jt41:
Ficpt+;1f2893571 -- 2/t4/2lt2lt g:59 i'rl
Owner:
Address:
Phone:
Tenant
C J Segerstrom
3110 W Lake Center Dr,
Santa Ana, CA 92704
(714) 438-32s0
Optum Health
Contractor: Deb Construction
Address: 2230 E Winston Road
Anaheim, CA 92806
Phone: (714) 632-6680
State Lic #: 372419
Lic Type: B
Bus. Lic #: 159001
Workers' Compensation I nsurance:Carrier: OLD REPUBLIC INSURANCE COM
Policy #: MWC31521819
Expires: 0513112020
lteb i:onstru,-t ion
Gener'nl Plcrn Updctter Fee
r:r1 I l6ttt-r2.. l:il 6tj[il:rutl-
lru i 1d ins
r_r1 I I Sr-]U?- l:il 6r:l I l:lt:tit-
trlds St dE fievolv ing
RSP Arcl$fqqh:rr_r:Z- I I 6 I trr:ruu-.Joseph 4ilttqd4l, i D'cur,enrr.
r:11 1 I 6r:[:r2- 57;/7r:lLrLrJ-
I (:[- i:hricl( itg?.{ 4,r
(480) 889-2000
c-27560
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #;
{??
$??i
.Ii4 6
s.: 7 .-l
95
r:ilJ
6fr
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
Soto, Ricardo Dale: 0211412020
Date:
Dale: 021'1412020
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002
07776002
07776002
07776002
07776002
57607
57770
57672
57600
57607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
Fee Total
Paid to Date:
Balance Due:
$166.53
$46.92
$2.00
$22.9s
$s7.20
$29s.60
$0.00
$295.60
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Ce(. Req'd: No 01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01116002 57770
Account#Total
Every permit issued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days after its issuance,or if the work authorized
on the site by such permit ls susperded or abandoned for a period of360 days after
the time the work is commenced.
lnspector MID#: 2019-156548
$22.95
$223.73
$2.00
$46.92
Zuniga, nffirr"Nj
BUILD!NG. !NSPECTOR RECORD
Rev.08-07-2015
SITE-WORK DATE ID/SIG.COMMENTS ()wNI.:R ttuil,l)uR t)1.:l.cARAl t()N
I hereby nffirnl under penalty of perjury that I arn excnrpt fronr the Contractos' l-icense [jw for thc following rcasn (Sec.7031.5
llusincss and Prolcssion Codc)r Any Cily or Counly which requircs a lErmil to conslrucl, ahcr, irnprovc. dcmolish or repair any
stnrcture, pri(r &) its issuance. also re<Nires the rpplicnilt tbr such pernil lo fil€ a signed slatcmnl that he or she is licensd pursuanl
to thc pmvisions ol lfu'Contractor's l-iccnsed l,aw (Chaplcr 9, Comrncncing wilh Scction 7(I)0 ol l)ivision 3 ol thc llusincss and
ProfessioDsCotle)orthalheorshcisexempttherefrl)matrdthebasisfortheallegedexenrption. AnyviolattnlofSectionT03l.5hyany
rpplicxntlbrrpennitxubj.ctsthe applicantloncivilpenaltyofnotmorethrtrlivehundreddolhrs($5(xl).
_1. as owncr ol lhc proFny. or my employccs with wagcs as lhcir Fl. compcnsation, will do the work and thc (MW is mt
inrcrxled or oiTcrcd for ulc (s6.7(x4. Busincs5 .nd PNfessions Coder The Conlrachis Licensc Law d(rcs not apply to an owncr of
the pruFdy wl& lNilds or im0rows thcN[ and wlxr dGs such wo* hinrself or lrcrself or thrcugh his or hcr own employces,
providcd lhat such impNvermnts rc mt intcndcd or ollcrcd lor sle. ll. howcvcr, th! building or improvcmnt is sld withio one )rar
ofconrplelinr, thc Owner Builder will havc the burdcn ofprcviD8 llut lE or shc did not build or imprrrve thc prupcny for lhc purpose of
sale).
_1. as owner ofthe proncrly, am €xclusively conlrsclilg with licensd conlrnck)rs lo conllruct lhe prcject (Scc. ?(N4. Busincss
and PnrllssirrrCode:TheColtrilctor'sLicenseLawdoesnotapplyloanowneroIpropemywhohuildsorimproveslheaoil.
and rvho contracls for such projecls with a Conlmctor(s) liccnsed pursuml to thc Contraclor's Liccnsc [iw).
-IanrexemPlunderSectitrn-'B'&P,c,tbrthisrcason'n---.
woRKHRS', COt\IPUNSA1 l()N
DECLARATIoN
I hcrchy allirm undcr pcnaltyof pcrjury onc of lhc li'llowing (lcclarntions:
_lhaveildwill DaintainaCenitlcalcofCoDsenttoScl[-lnsurcforworkers'11)nrpeNation,as providedforhySeclionST00ofthe
hbor Cdlc, lbr thc pcrlorrurcc of thc work lilr ahich thc pcrmit i\ i\sucd.
X:;hy Sccrion 3700 oflhe bhorand will nlrirnain workes'K[ trtsurance, as Code, for the 1rcrfomrrce of
lir whrlr is canicr axl
o-i(.1 /=-ol)olicv 1/
_l ccnity that in thc pcrtbrnunce of rhc work for which this pcrmit is issucd, I shull not cmploy aoy pcrson in {ny mmner
$astohccoDEsubjccttothcworkcrs'coilrpcnsllionlawso[CaliforDia,andagrcclhatiflstsuldbccorNsubjccltolhc
wodiers' con)pensxlion provisions of Section 1700 of the Labor Code, I slull, funhwilh comply wilh lhos provisions.
)
WARNING: Fililurc k) $curc workcrs' conrpnsation unlawful.shall m cmploycr to triminal peMhics , n(l
hccivil finer up to onc hundr.d thousand dollnrs (Sl(X).(Xxl).ir)n to darrrges rs provided fu
Section J076 ofthc inlerest and s
I hercby al-lifln undcr pcnalty ofperjury lhal I Arn un(lcr ol Chaplcr 9 (cornrrencing with Scction 7ff)0) of Division I
of the Busincsr and Profcssions Codc. el nrv liccnsc is in full fbrcc and clli'ct.
7z /7l-ic!'nse Classl
CONS'TRT]CTION I,I:NI)IN(; AGT:NCY
I heEby aftrnr under rtnalty of perjury rhal lh€re is ! conslruclion lendirg agency ti)r the perfomarEe ofrhe work tbr which this Jrmit is
issucd (Scc. -l(197. Ci!. C.).
knder's Nrilre:
lxndcr's A(ldress:
-
APPI,ICANT DECI,ARATI0N
I lxreby uflirnr unrler peralty of perjury one of the lollowiDg declarnt ions:
Den)olirion Pcrnrils-Ashe\los Ndification Fcderrl Reguhtio[s (Title.l0, Parl6)
_Required of Norili.illion
-I
that tlD federalrcgulatiofls EgarJing astEsbs rcmvrl are not applicable to this pmj*-(.
cenify thal I have rerd thi\ applicalion infornralior
nild Slrtc [-xws relilti,lg to
rtx,vc mcnlionc(l p(,pc(y tirr
Applicnnt or Agcnl
['rnilile( nanre
thnt rhe
attlrrrirc
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/VenVl nsu lation
Roof Sheathinq
Shear Wall
Framing
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
[Vasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Beport
Engineer Final Report
Flood Zone Certif.
//\
FINAL 3-a-a Y.W16t)
Certificate of Occupancy
Notes, Remarks, Etc.