HomeMy WebLinkAbout10196863 - PermitProiect Address:1622 3/4 N Main Sta
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Assessor's Parcel: 005-153-20 Lot: NA Block: NA
untt:WCC02 stos
Tract: NA
Address Range:Suite Range:
Zoning: SP3Historic: No
.j I
City of Santa Ana
Permit Counter: (714) 647-5800
20 Civic Center Plaza (M-19), Santa Ana, CA 92702
I nspection Requests: (7 1 4) 667 -27 38 I nspector Section: (7 1 4) 647 -5853
Building Permit #10196863
Pin #:
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Commercial
Miscellaneous
Cell Site
Occupancy:
Constr Type:
Code.
Flood Zone:
# of Stories:
U
N/A
cBc 2016
x-0602320163J
1st FL Area:
2nd FL Area:
Other Areas.
Garage Area:
Total:
Patio:
T.l.Area.
Yards Req'd
Valuation:$120,000.00
0
Description of Work: Modifications to (e) cell site-add (2)cabinets, (16) antennas, (16) RRUs
Planning Conditions: Screening required
Owner:
Address:
Phone:
Tenant
Santa Ana Arts Collective LP
1640 S Sepulveda Blvd 11425
Los Angeles, CA 90025
(310) 575-3s43
Contractor: R L Clotworthy Constructiot
Address: 26079 Jefferson Avenue
Murrieta, CA 92562
Phone: (951) 693-5130
State Lic #: 803626
Lic Type: B
Bus. Lic #: 197398
Workers' Compensation lnsurance:
Carrier: Old Republic Genera lnsurance Cc
Policy #: A1WC1144170'|
Expires: 1010112019
Peyton-Tomita & Associates
Mark Tomita
28562 Oso Parkway D-407
Rancho Santa Margarita, CA 92688
(e4s) 842-6000
s-3304
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
{'lt:ln
llr.
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:
Police lnsp. Req'd:
No
No Account#
Pezeshkpour, Ali
So, Anson
Chavez, Dave
47a"
Date:06/26/2018
Date:07/09/2018
Date:01/02/2019
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Ivlisc. Receipt:
07776002
07776002
07776002
08907007
07776002
07776002
07776002
Permit Fee
Plan Check Fee
Microfilm Records
SMIP - Category 2
Bldg. Stds. Revolving
General Plan Update
lssuance
71175
Total
57607
si600
57770
24000
57672
57600
57607
$641.00
$88e.64
$90.24
$33.60
$5.00
$22.O8
$55.04
Flood Zone Cert. Req'd: No 01 ,116002 51600
Every permit issued shall become invalid unless the work on the site authorized by
such permit is commenced within 1 80 days after its issuance,or if the work authorized
on the site by such permit rs suspended o r abandoned for a period of 180 days after
the time the wo* is commenced.
lnspector t\IlD#: 2015-124429
01 '1 16002 51601
01 1 't 6002 516'1 2
01 1 16002 53600
01116002 57770
08901001 24000
$22.08
$696.04
$5.00
$33.20
$90.24
$33.60
Fee Total:
Paid to Date:
Balance Due:
$1,735.60
$855.44
$880.16
SITE.WORK DATE ID/SIG COMMENTS
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/Vent/l nsu lation
Roof Sheathinq
Shear Wall
Framinq
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
JMasonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif.
FINAL qr-a2d //Ci 5Nt za) 2/)
Certificate of Occupancy
Notes, Remarks, Etc.
-1f,-lozb't (
Tt2 a
2 -20 z <--t /e
L
OWNER BUILDER DELCARATION
IhcrehyallirmundcrF-nallyolpcrjlrylhalIamcrcn]ptli1)mlhcC{)ntracloF LiccnseLawlbrthcli)llowingrcason(Serj.70-11.5
Business and Prolcssion Codc): Any Cily or C()(nty which rcquircs { pcrmit lo c()nstrucl. altcr, inlprove. dcmolish or repat any
sltucturc.pd)rt)its issuincc,alsorcquircslhcapplicnnllbrsuehlrcrhitk)lilcasigncdstxtcnrcnt thathcorshcisliccnscd pursuant
k) thc provisions of thc Contrack)r's l-iccnscJ Law (Chrptcr 9, Commcncing with Scction ?Uru ol Division .] of the Busincss md
P()ltssionsCoJc)orthathcorsheiscxcmptthcreft)mandthcbasisforlheallcgcdcxcmptil)n. Anyv()lationolScctionT0,ll.5hyany
applicanl li)r a pcrmit suhjccts thc applicant k) a civil pchdlty o[ not morc than livc hundrcd dollars (S5m).
.J
_1, as owncr ol'thc p(rpcny, or my cmployccs wil h wages as t hcir solc conrpcnsation, will d() thc work Md thc strucluc is not
incndcd orotltrcdti)rsalc(Scc.T044.BusinessandProlassionsC(rlc:'lheContrack)r'sLiccnsellwdocsnotapplyk)ilowncrof
lhc pnlJtny who huilds or impmvcs lhcrcon. md who d(Es such work himsclf or hcrself or through his or hcr own cmpkryccs.
providcd thal ruch improvcnEnls re ftil iilcndcd orollcrcd tbr salc. If, h)wcvcr. thc builling or impmvcmnt is soLl within,,nc ,td
ol comflction, thc Owncr Builder will hdvc thc hurdcn ofprrving lhat hc or shc did not huild or itnprovc tic pn)frcay lbr thc puryDrc of
salc).
_1, as owncr ol'lhc lrropcdy, anr exclusivcly eontrarling with liccnsed qrntractors k) constnrct thc p()jcct (Scc. 7044. Busincss
afrl Pnllbssiln Codc: fhe C()n(r!ck)r's Liccnsc l-aw docs not apply k) rn owncr ol property who builds or improvcs thcrcon,
and who conlracls li)r such projccll with a Contrack)r(\) liccnserl pur(uanl k) thc Contrack)r's Liccnsc [aw).
_l atrl crcntpt uDdu'I1 & P (l li)r lhis rcr\on
/)-.-...
lvonrBns' cottrrns,ttF
DECLARATION
I hercby alfirm u mlcr pcnalty of pcrju ry onc of the ti)llowing dccltral ions:
_l have ud will maintain a Ccnificale of Conscnl k) Sclf-ln:ure li)r workers comlcnsation. as proridcd lirr hy Scction J700 of thc
Lak)r Codc, tilr thc pcrlormancc of thc work tor which thc pcmit is issucd.
_lhavcandwill maintainworkcrs compcnsalioninsurancc,as rcquircdbySeclion-lT00ofthcljborc()dc,forlhclertbmanccol'
thc work ti)r which this lrcmrit is issucd. My workers comfrensrtion insurance cuicr and grlicy numbcr uc:
Policy N c6 ,07^/0- t-/ I
_l ceilili lhal in thc t--rlornunec ol lhc work li)r which lhis pcrilrit is issucd. I shall r()t cnrploy rny pcrson in any mrntrcr
s() as k) hceorrc subjccl k) thc w()rkcrs' conrpcnsal ion laws of CrliforDix. and rgrcc l hat if l should hcconr suhject t) thc
wr)rkcrs'c(nlt^-n\ali(mprovisirmsol'Scctir)n.17(X)olthckhrrCrxlc. Ishall, lonhwithcomplywiththoscprovisions.
IVARNIN(ir Fiihrre k) s('curc wrn'kil's'eompcnsali()il eovcrr{c rs shall suhjcct rn cmphycr k, crinrindl fEnaltics and
civil Iincs up k) ()nc hundrcd thousxnd dollds ($lm.0m), in (,1 conrpcnsrtion, rlanragcs as lrovklcd i'r)r lhc
Scclion .107(, of lhe Lahrr (ix.lc. iilcrcsl and xlt)rney s lccs.
r>^r".' /' 1' I 7
I hcrchy allirm unrler 1)cnalty ol pcrjury thtl I am liccnscrl ( hillcr 9 (eomnrcne rn8 with Sce(io0 7(xX)) ol Division .l
ol thc Bu\ircss and Prolcssi()ns Crldc. and mv licensc is in llll lorcc and clli.c(.
t0l
t)ure:' /-Z- t "l
CONSTRUCTION t,ENDIN(I AGENCY
issucd (Scc. .1097. Civ. C.)
I"cnrlct s Nanrc:
[rndcr's Addrcss:
APPLICANT DECLARATION
I lFrchy rtliin undcr pcnalty of pcrjury rnc of thc li)lk)wir)g dcclxrrtir)ns:
Dcn()lilion I'crmils-Ashcslo\ Notification llcdcral RcSulations (Titlc 40, Pan6)
_Rcquircd [-cttcr ol' N({ilicali(tr1
_l ccdili that lhc lcdcrrl r(-gulati(nrs rcgrJing ashcsnrs rcrnoval nrc nol ipplicahlc to this proicct.
/il ectity rhtr I hrvc r('rd rhis apphcat
ordrninecs and Stalc Laws rchting lo bul
ion ilxl statc thrl lhc ali)vc rnli)rnult)n is conecl. I agrcc lo ()mply with all City and County
aulhr)rizc rcprcscntutivcs ()l this ('ity and County to cntcr uF)n thc
rtx)\'c rlNntt)ncd pr)l--dy li)r uspccli(nr
Applicnnl or Agent
I'ernrilcc Dailrr (pilnl )
rldrng
{
-2-r
BUILD!NG. INSPECTOH RECORD
Date:_