HomeMy WebLinkAbout40127043 - PermitCity of Santa Ana
Permit Counter: (714) 647-5800
20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Mechanical
lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853 at
Permit #:4lJ1270,43
Pin #: 5'15'18
Proiect Address: 2130 N Grand Ave
Assessor'sParcel: 396-19144 Lot: POR G.L. RUSSE
Unit:
Block: A
Bldg: Address Range:
Tract:A.B. CHAPMAN Historic: No
Suite Range:
Zoning: Rl
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
Alliance Church of Orange
2130 N Grand Avenue
Santa Ana, CA 92705
17141542-0777
Alliance Church of Orange
Rindtek
'1440 E 28th Street
Signal Hill, CA 90755
(310) 696-8271
01 1 16002
01 1 16002
01 't 16002
01 1 16002
01 1 16002
01 1 1 6002
01 1 16002
01 1 16002
01 1 16002
01 1 16002
01 1 1 6002
01 1 1 6002
01 1 1 6002
51604
5'1604
51604
51604
5'1604
51604
5'1604
51604
51604
51604
53603
51600
51604
Fee Type
Compressor
Compressor
Air Handling
Air Handling
O/D Pkg H/C
Type I Hood
Bathroom Fan
Envir. Air Other
Gas Piping lncidental
Cooking Equip
PIC - 650/o
General Plan Update
lssuance
Amount
79.50
95.07
39.24
57.80
99.82
99.82
26.89
31.04
19.73
37.75
0.65
19.46
48.52
Qty
6.00
4.00
6.00
4.00
4.00
1.00
3.00
4.00
1.00
2.OO
2,077.39
1.00
1.00
Fee
$477.00
$380.28
$235.44
$231.20
$399.28
$99.82
$80.67
$124.16
$19.73
$75.50
$1,350.30
$19.46
$48.52
State Lic #: 966844
Lic Type: B
Bus. Lic #: 346862
Workers' Compensation lnsurance:Carrier: Benchmark
Policy #: CST5004911
Expires: 0211912015
Building Use:
Job Type:
Nature of Work
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
other occupancy:
New ConstrType:
New Church/Roof Mtd EquipCode:
A-3
VB
cMc 2013
Notes:
Fee Total:
Paid to Date:
Balance Due:
ell
\,*
Date:
Scott Fazekas & Assoc. Date:
Hernandez, Kathy Date:
0911'il2014
10t02t2014
Account#
Misc. Receipt: 61837
Misc. Receipt:
Misc. Receipt:
Total
Buildins Permit #: 10180945
Every permit rssued sha// become invalid unless the work
on the site authoized by such permit is commenced within
180 days after its rssuance, or if the wotu authoized on the
site by such permit is suspended or abandoned for a peiod
d 180 days afterthe time the work is commenced.
01 1 16002 51600
01 1 16002 51604
$19.46
$2,1 71 .60
$3,541.36
$1,350.30
$2,191.06
lnspector MID#: 2014-113352
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onsoct ion Tot,ol
M ECHANICAL.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COM]ViENTS Own6-Buildcr Dcclsral ion
I heteby affirm undcr plnrlty of perjuty lhat I sm cxcmpt form the Contrsdors' License Law for thc followinS r@son (se.7o3 1.5 B6in6^r
md Profcsion Codc)r Any City or Counly which rcquiro a pmit to coNtruct. altcr. improvc. dcmolish or rcprir uy siructuc-. prioJ ro its !
issuncc. also rcquirc thc Epplicstrt for such pcmh to filc a signcd stEtemcnt that hc or ahc is liccrucd punuut to thc p@r'isii* oLlc
Contrsctor's Lic€6ed Llw (Chspter 9, Commcncing with Saion 70OO ofDivbion I ofthe Businrs and Profesio$ Cod.) or thlr.hc or
Ehc is crcmpt thsc&om and thc b6fu for thc sllcgcd cxcmption .Any violation of Scction 7031.5 by my rpplicail for I p€mil subjcls thc
applicant to a civil pcnalty ofnot morc than fivc hundrcd dollm ($500).
a
_1. $ owncr of thc propcriy. or my cmployco with wagcs as thci, solc compcnsation. will do thc work and thc structuc is not intcndqd
otoffcredforule(Sec.T044.BusinssandProfcsrionsCodc TheContractor'sLicenscLawdoesnotapplytoanomerofthcprcpdly
who builds o, imp.ov6 thd@n. md who do6 such work himsclf or hmclf or through his or hs own cmploycs. providcd that such
imprcvcmcnts ue nol intcndcd or offqcd for salc. lf. howcvcr, thc building or improvcmcot is sold within onc ycr ofcomplaion. thc
Owofi-Builds will h.vc rhc bwdcn ofprovitrg that hc or shc not build or improvc for thc purposc ofralc).
_1. I owns of thc propcty. am cxcluivcly contraciif,g with liccNd contmctoE to coGtruct thc prcjcd ( Sc. 7M4. Buinas md
P.ofcasion Codc: Th. Contr.dor's LiccNc [rw do6 not lpply to e owffi ofproprty who builds or improvcs thssn . and who
contracls for suqh projccis with 8 Contractor(s) liccnscd pursuant to th. Contruclor's Licensc kw.).
I flrn c\crDl)l {rndcr Sccli,rn .l} & l} ( li)r lhis rcason
I)ste:( \\ I(r
WORKT:RS COIIPENSA'IION DECLARATION
I hcrcby aflirm undcr pcnslty ofperjury onc ofthe following declralions:
_l havc and will maintain a Ccrtificatc ofConscnt to Sclf-lBure for workers compensation, as provided for by Section 37OO oftho
labor Codc, for thc pcrfomancc ofthe work for which thc permit is issued.
_l have and will maintain workets' @mpcnsation iniursnce, 6 required by Section 3700 ofthe lJbor Codq for the perforroncc ofthc
work for which this permit is i$ued. My workers' compcn$ton iNursnce orricr and policy numbcr arc:
('mier;
Policy l.rpir cst
('l his section nced not be completed ifthe perrnit is lbr One hundrcd dollars {$I001 or less)
.,_l ccfrify lhat in the pcrl'urnance ofthe work for which Ihis pennit is issued. I shall not employ a,1) pcrson in any manner so as Ir
becamc subject nr the workcrs ' conlpenslron larvs of ('alifornia. and agree lhnl rf I should beconr suhJecl lo thc workers'
compcnsation ofScction -1700 ofthc kbor Codc.
WARNINC: Failure to secure workers' compensation coverage is unlawful, and shall air emplover to criminal penalties and civtl
fincs up to onc hundrcd tho6and dollm ($100,000),in addition to the cost of
the Lsbor Code, interest and sttorney's fees.
damages d providcd for the Section -1076 of
LICENSED CONTRACTORS DECLARATION
I hcrcby affm udq pcmlty of pcrjury rhat I m liccnscd unds provision of Chaprcr 9 (comencing wirh Scclion 70OO) of Division 3 of
thc B6ine$ and ProfosioN Codc. 8nd my liccNc is in full forcc md cffect.
Liccmc Liccnse Number I
Dste:
I hcreby affim under penalty ofpcrjury that thcrc is a co$lruction lending agcncy for thc pcrfonnancc ofthc rvork for which this pcmit is
issucd (Scc. 3097. Cn'. C.).
Lender's Name:
Lender's Address:
APPLTCANT'S DECLARATION
Dcmolition Pemits.Asbcstos Notification Fcddal Rcgulations (Titlc 40. P8n 6)
_ Rcquircd lrttcr ofNotilication
_l ccnify that thc fcddal rcgulatioN rcg.rding sbGtos removal arc not .pplicablc to this prcjmt.
_ I ccniry thd I havc rcad lhis applicstion md shtc that thc abovc information is corcct. I agrcc to comply with sll City and County
ordinancs and Ststc Lsws rclating to 8uthorizc rcprGentatilcs ofthis City and County to mlcr
above mentioncd prope(y for
Applicant or agenl
Pennillce name (print)i
and
o OZ
upon lhc
Appliances
Metal Fire Place
Evap Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-lnsulation
lnsulation
Smoke Detectors I nstalled
Rough Ductwork
Vents
Toilet Room / Clothes Dryer
Residential Range
Other
Hood
Type I Hood
Type ll Hood
Grease Duct
Fire Damper
Openings
lnstallation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rough Mech
Final Test
Meter Release A
FINAL L/*4/t/,VU/, /)rnnhd t/ / w V-/
Forms\Mechanical-lnspector Record.doc 03.3,l.06