HomeMy WebLinkAbout30142640 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Plumbing
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) U7-5853
Permit #: 301426,4o-
Pin #: 598{6
Proiect Address: 2761 N Grand Avea
Assessor's Parcel: 390-171-11 Lot: POR 13
Unit:
Block: D
Bldg: Address Range: 27os-2761*
Tract: A.B. CHAPMAN Historic: No
Suite Range:
Zoning: C5
Owner:
Address.
Phone:
Tenant Name:
Contractor:
Address:
Phone:
Del Taco LLC
25521 Commercenter Dr, 2nd Floor
Lake Forest, CA 92630
(949) 462-9300
Del Taco
Lozano Plumbing Services I
PO Box 53137
Riverside, CA 92517
(s51) 6834840
01 1 16002 51602
01 1 16002 51602
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
Fee Type Amount
Tankless Water Heater 10.64
Min Fee Adj 4.13
General Plan Update 23.19
lssuance 59.30
Microfilm Records 4.05
Qty
1.00
1.00
1.00
1.00
1.00
Fee
$70.64
$4.73
$23.79
$59.30
$4.0s
State Lic #: 1001 021
Lic Type: C-36
Bus. Lic #: 376898
Workers' Compensation I nsurance:Carrier: lnsurance Company of the West
Policy #: WLVS03T701
Expires. 0911512021
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Commercial
Miscellaneous
Tankless WH Change out
Occupancy:
Constr Type
Code:
A-2
VB
cPc 2019
Chavez,
Date:
Date:
Date:12t03t2020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes: Tankless water heater change out.
Fee Total.
Paid to Date:
Balance Due:
Dave
Every permitissued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
rssuance , or if the work authorized on fhe site by such permit rs suspe nded
or abandoned for a period of 360 days after the time the work is
commenced.
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
$23.79
$134.67
$4.05
$ 1 62.51
$0.00
$162.51
lnspector MID#: 2O2O-1 63051
PLUMBING.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEI,CARATION
I hmby affrm undo poalty of pcrjury that I m cxmpt fiDm thc Crtrt rctoE' Licffi ls for the following rcmn (Sc.7031.5
Buincs and Profeion Codc): Any Cily or County which rcquirB a pqmit to snstruct, altc, imprcvc, danolish or rcpair my
strucluc Fior to its issumcc, also rcquiB rhc applicilt for such pcrmit to filc a signcd stamt thd hc or shc b licascd Fmatt
to thc provisioB of thc Contmtor's Licmscd Law (Chapt6 9, Comacing with Sction 7000 of Divicion 3 of thc Buiffi md
PrcfcsioB Codc) or that hc fi shc is qmpt thqcfrom ud thc bosb for thc 8llc8cd smprion. Any viol*ion of Sctior 7031.5 by oy
applicant for a pcrmit subjat! thc applicmt to I civil pcnalty ofnol morc tho fivc hundrcd dollm (3500).
-1.
8s owner of the property, or my employecs with wages as their sole comporsation, will do thc wo* and the sffincture is not
intendod or offered for sale (Sec.7O44, Business and hofcssions Code: The Contraclor's License law does not apply to an owner of
the propcrty who builds or inrprov€s thcron, and who docs such wort himsclf or herself or through his or her own employec,
provided that such improvorrcnts are not intended or offered for sale. If. however. the building or imp,rovement is sold within onc )ea
of complaiorL the Orvner Builder will have the hrden of proving tha he or she did not build or improve the propcrty for the prposc of
sale).
_1, as owner of the property. am exclusively contracting with licensed contractors to consruct the project (Sec. 7044. Business
and Proftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon.
and who contracts for such projecrs with a Contractor(s) licensal pursuant to the Contractor's License Law).
-IamexemptunderSection-.B.&P.C.forthisreason.l):rte
WORKER,S' COMPENSATION
DECLAR/ITION
I hereby affirm under penalty of pojury one of the following declarations:
_l have and will maintain a Ce.rtilicate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the
Labor Code. for the performance of the work for which the permit is issued.
_l have and rvill maintain workers' compcnsation insurance. as required by Section -3700 of the l-abor Code. for the performance of
the work for which this pcrmit is issued. My workers' compcnsation insurancc carrier and policy number are:
t-(/(..-
t ()-52/r-tf -trLlPolicy
_t certi& that in the pcrformance of the work for which this permit is issued. I shall not employ any person in any manner
so as to become subject to the workers' compensation laws of California" and agree thal if I should become subject to the
workers' compensation provisions of Section 3700 of the l",abor Codc, I shall. forthwilh comply rvith those provisions..
WARNING: Failure to secure workers'cornpensation coverage is unlawful. and shall subject an anployer to oiminal penalties and
civil fines up to one hundrcd thousand dollars ($100.000). in addition to the cost of compensation, damages as providq,l for the
Section 3076 of the labor Code. interest and attorncy's fees.
ll-r -Lc Lc Cln,
I hereby affrrm under penalty of pcrjury that I am licenscd under pnovision 9 (commorcing with Section 7000) of Division 3
of thc Business and Professions Code. and my license is in full force and effect.
Licensectrrr' ' CIL LicenseNumber:) trruloLl
W
I hcrc:by affm udr pqnlty of pajury thd th@ fu s onsruction lodiry ag@y for thc pcfomcc of thc md. frr whkh thb pqmit b
iscd(Se. 3097. Civ. C.).
I cltrler's )(irttte :
Lcnder's Ad&ess:
APPLICANT DECLARATION
I hcreby aflirnr under penalty of perjury one of the following declarations:
Demolition Permits-Asbcstos Notification Federal Regulations (Title 40. Part6)
-Required
Letter of Notification
-l
cstiry thd thc ftdcral rcgulatioro rcgrrding rbatos mval re not qplicrblc to thb polrl.
/ t -riry ,a, , ,ruc rqd thb applicetion dd statc thd tlE .borc inforEdion b @rcl. I agc lo omply with all City md Couty
oditlffic and Stac [:w abing to building orutru.rion ed h6cty authoriu rcprBmtativB of this City ed Couty to 6tq upotr thc
above mcntioned propcrty for
Applicnnt or Agent
Permitee nnme <-C-rt-2
t-lL-Lol-c
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underfloor
Building Sewer
ArealStorm Drain
I nterceptor/ Cla rifier
TOP OUT
Waste & Vent
Water Piping
Gas Pipinq
Roof Drain
Tub/Shower Test
Rouqh Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Piping
Fill Line/Back FIow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary SewerlCao
Back Flow Device
Roush Plumbins
Fina! Gas Test
Meter Release I ir .J
FINAL le.t+lu NILW 6IY
Notes, Remarks, Etc.t
b
,",u, P I L-)-)ou? conrrecto*X Pt,y^tr,^., /L'lcl'rt./-