HomeMy WebLinkAbout104102900 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 52702 Building
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lnspection Requests: (7 1 4) 667 -27 38 lnspector Section: (7 1 4) 647 -5853y
Permit #:1O41O29OO
Pin #: 95993IPermit Counter: (714) 647-5800
'Froiect Addressi 421 S Bristol St
Assessor's Parcel: 008-232-36 Lot: 16, 17
Unit:Bldg: Address Range:Suite Range:
Zoning: SPIBlock: D Tract:610 Historic: No
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Commercial
Demolition & Clear Lot
Demo & Clear Lot
Commercial/Driv-Thru
Occupancy:
Constr Type:
Code:
Flood Zone:
# of Stories:
N/A
N/A
cBc 2019
x-0602320257J
,l
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area
Total:0
Description of Work: Demolish bldg & clear lot. AQMD posted. Bond posted on M-74041. No penalty fee per lnspectorY. Portugal.
Planning Conditions:
Patio:
T.l.Area:
Yards Req'd:
Valuation:$4s,000.00
It
,7
il
li
Owner:
Address:
Phone:
Tenant:
Bristol HC Dev Partners LLC
13800 Arizona St., #101
Westminster, CA 92683
(714) 2s1-3060
Contractor: Art Gautreau lnc dba AGI Gr
Address: 8210 Katella Av #1
Stanton, CA 90680
Phone: (714) 934-8066
State Lic #: 370609
Lic Type: B, A
Bus. Lic #: 0001239
Workers' Compensation lnsurance:
Carrier: Zurich
Policy #: WC106094600
Expires: 0412112020
Engineer
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
f, f eLrLI iric dbn AGI fiqner
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Twinsteps: rr\' :.;, r r.:.r:i
PeterMorris . r: ,,,i,..r,
15615 Alton:Plrwy; Suite 125ri .I :
lrvine, CA 92618
(949) 383-5382
c-32096
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Planning Approval By:
Plan Checked
Permit lssued By:i, Teri
NPDES lnsp
PWA lnsp.Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No
Planning lnsp.
Landscaping lnsp. Req'd:
Every permit issued shall become invalid unless fhe 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 rs suspended or abandoned for a period of360 days after
the time the work is commenced.
Date. 0112212020
Date:
Dale: 0112212020
Subject to Field:
Misc. Receipt
Misc. Receipt
Misc. Receipt
0L7L6002
07776002
0711,6002
07776002
07776002
07116002
57607
5777 0
51601.
57672
57600
57607
$166.53
$11.73
$100.s7
$2.00
$22.95
$57.20
Permit Fee
Microfilm Records
lnvestigation
Bldg. Stds. Revolving
General Plan Update
lssuance
Fee Total:
Paid to Date:
Balance Due:
No
No
No
Account#Total
01 1 16002 51600
01 1 'l 6002 51 601
01 1 16002 51612
01116002 57770 $360.98
$0.00
$360.98
lnspector MID#: 2019-153021
$22.95
$324.30
$2.00
$11.73
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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/Enerqv
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
---\
FINAL 2l?/617p tu?9/</Certificate of Occu
Notes, Remarks, Etc
BUILDING- INSPECTOR RECORD
I hcrchy allirm undcr pcnully of pcrjury thsl I am cxcmpl lion lhc Conlracmrs' Liccnsc [rw for lhc following rcaso[ (Scc.?0Jl.5
Busincss antl Profcsshn Code): Any City or CouDly which rcquircs a Jrcrntil lo conslrucl. altcr. improvc. dcmolish or rcpuir any
structurc. pri(tr Io its issuancc. rlso rcquircs lhc applicant li)r such Frrnlil lo filc a siglcd slalcnrcnl lhat hc or shc is licc[scd
lo thc provisions of thc Contrack)r's l,iccnscd tiw (Chaplcr 9. Conrrrtcncing with Scction 7(x)0 of Division .'] of the Busincss
P()lcssiotrsCodc)orthalhcorshciscxcmplthcrefromandlhchasislbrlhcallcgcdcxcnrpli(D. AnyviolalionofScctionT03l.5by
ilpplicrntli)rrpcrmitsuhjcclslhc applicantloacivilpcnrllyofDotmorclhanfivchundrcddollars($5U))i
-1.
as owncr of thc proJEny. or my cmployccs w ilh wxgcs ns lhcir so lc con{rcnsnt i()n. will do lhc work and tlrc slruluc ri not
inlcrdcd orollcrcdlorsalc(SN.T044.llusircssundProfcssionsCodc:lhcConlrrctor'sLiccnscLawdocsnolapplyk,anowncrof
lhc proFny who huilds or hnpro\es thcmn. md who dms such trr)rk hinr\cll or hcrscll or Ihrough his or hcr own cnrployecs.
providcdthxlsuch improverrcntsarcnolintcndcdorolltrcdl'()rsillc.ll.howcvcr.lhcbuildirrgorimprovcrrcnlissoklwilhinrnlcycilr
ofconr|)lctknr. thc Owncr Buildcr will havc thc burdcn ofprovirrg thd hc or shc did nol buikl or hnprovc thc prolffiy l-or lhe purfx)sc of
salc).
_1. as owncr ol thc pro1rcny. anr cxclusively contrdclirg trilh liccn\cd conlrack,r\ lo con\lrucl lhc pr)jccl (Scc. 70.1.1. Busirrcss
and F\ofcssi)n Co(lc: Thc Conlruclor's Liccrrsc Law rloes nol apply lo an owncr ofpropcrty who builds or itrlprovcs thcrcon.
and who conlrncts lilr such [)r+cts with a ('orilrilctor(s) liccnscd pursuanl k) lhc Cuilruck)r's Liccnsc hw).
lamcxcilrDlundcrscclioD-.B.&P'C.forthisrcas0[.
I)illr ()s o(,r:"*ffiffi
I hcrchy afllnn undcr penally of Frjury one ol thc folk)wing dcclarrlions:
!f huvc unrl will rroinrrin a Ccf,ificutc o[Consent lo self-lnsurc for x'orkers' conrpcnsllion. as provided lbr by Scclior 3TtX) ol the
t tx)r Codc. lor lhe pcrforiluncc of lhc work for which thc lcrmit Ls issucd.
4auc anl *lll maintain workcrs' coilrpensation insurarrc. as rcquircd by Scclion l?(X) ol the Libor G)dc. lbr lhc pcrfornmncc of
lhc work for which this pcrmit is issucd. My workcrs' compcnsation insurnncc cnfficr ild policy numbcr uc:
,.^r,",,2 Uf iCl.-
,",,,yt"^*,, lPc l0boQ4626 t.pi,*, o{-Zl- Zazc)
-l(l ccnify that in thc pcrfornuncc of thc work for which this permil is issucd. I shall nol employ any person in any nunncr
so as lo bccornc subject b lhc workers' compcnsation laws ofCaliforoia. and a8rec thal if I should bccome suhjccl k) lhc
workcrs'conrpcnsationprovisionsofScclion3TU)oflhctntnrCrxlc.lshall.fonhwilhcomplywilhlho*prcvisions.
WARNING: Failurc to scurc workcrs'compcnsation coverage is unlawful. and shall subjccl an employcr to oiminal lEnahics and
civil llnes up to onc hundrcd tholsand dollars ($l{n.fiX)). in additiotr lo thc cost ofconrpcnsation. dailugcs a$ providcd for the
Seclt)n -3076 ofthc t tx)r Codc. intcrcsl and attoflEy s fccs-
ou.", 1/l=
I)FCL{RATION
I hcrchy allirrn undcr pcnahy of pcrjury that I lrn liccnscd undcr provision of Chtrptcr 9 (connrtncing wilh Section 7(Xx)) of Division -l
of thc Busincss and Proltssio0s Codc. imd rny liccnsc is in lirll forcc iurd ctltcl.
t-ic""."ct"*, ,{+ B l-iccnscNunrhcr:oq
o,r",OI-ZZ-?
CONSTRUCTION LENDING A(;ENCY
I hcrcby afllrm undcr pctralty of pcrjury that thcrc is a construction lcnding agcncy for the pcribrroncc of thc work for which this pcrmit is
issucd (Scc. 3097. Civ. C.).
knrlcr's Nurnc:
l-cntlcr's Arldrcss:
APPLICANT DFCLARATI(IN
I lnruhy alfirm uDdcr penalty of pcrjury onc of thc lbllowing dcclaral ions:
Denx)lition Pcrmits-Asbcslos Notificalion Fcdcral Rcgulati([s (Tillc 4(]. Pail6)
_Rcquircd [.Icr of Notilicali{)n
_l ccaify rhat thc fcdcrsl rcgulalions rcgtrding ashcstos rcrnoval arc nol applicrhle k) this prejccl./
-lzl ccnify rhxl I havc rcud lhis applicalion and slalc that thc iltnvc informatkil is corcct. I agre to cotrlply wilh flll Cily dnd Counly
ordin{nccs and Slatc hws rclfllinS lo building construction. ilnd hcrcby authorizc ivcs of lhir City an(l Counry to cntcr uFrn thc
ilbovc nrcnti()ncd pft)l)crty li)r inspcct
Applicilnl or Ageilt
I'crnrilrr trxtrrr (l)ritrl):
iort
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