HomeMy WebLinkAbout30441834 - Permitcity of Santa Ana 20 civic center Plaza (M-19), Santa Ana, cA 92702
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Plumbing Permit #z 3O441E34
Pin #: 41122
t Project Address: 421 S Bristol St Unit:
Block: D
Bldg:
Tract: 610
Address Range:
Historic: No
Suite Range:
Zoning: SP1Assessor's Parcel: 008-232-36 Lot: '16, '17
Owner:
Address:
Phone:
Tenant Name:
Contraclor:
Address:
Bristol HC Dev Partners LLC
13800 Arizona St. #101
Westminster, CA 92683
(714) 2s1-3060
Art Gautreau lnc dba AGI Gr
8210 Katella Av #1
Stanton, CA 90680
(714) 934-8066
01 1 16002 51602
01 1 16002 51600
01 I 16002 51602
01116002 57770
Fee Type
Cap Sewer
General Plan Update
lssuance
Microfilm Records
Amount
103.84
22.95
57.20
3.91
Qty
1.00
1.00
1.00
1.00
Fee
$103.84
$22.95
$57.20
$3.91
Phone:
State Lic #: 370609
Lic Type: B, A
Bus. Lic #: 0001239
Workers' Compensation lnsurance:Carrier: Zurich
Policy #: WCl06094600
Expires: 0412112020
BoicirirSiOZZ' i;22i202tt I0: amorolestF
frif ice; uTi'ii Tnonsi: 99 2 of 2
Accti: Ref*: 30{41831
t(CPE;;Ul6rur/,
Tnonsoci ion IuLu
- iizzl1tt2Lr 3:14 Pllri t5{S.88
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Commercial
Demolition & Clear Lot
Demo & Clear Lot
1 02900
01t2u2020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total:
Paid to Date:
Balance Due:
Occupancy:
Constr Type:
Code:
Date:
Date:
N/A
N/A
cPc 2019
Ani Gnuiruuu i uc tibo AGI '.:":rier'
deneroi Fiorr ijpriute Fee i?-'j. "?i
r.ri i iouu2- f,ioi,[rt(i[t-rriulbing 'h161 ..!+
r.ri r i.6uir2- f,idi,lr.r(r,.t-
iiicnof iir i i,ut-gmenuE t:i"t;l
i,i i ioirti- J77 7ir[r[ttr-
ii.L (.her-ir r.,,.,iJio $li4g " r'li
Demolish bldg & clear lot. AQMD posted. Bond posted
on M-74041. No penalty fee per lnspector Y. Portugal.
$187.90
$0.00
$187.90
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within360 days after its
issuance, or if the work authorized on the site by such permit is suspended
or abandoned for a period of 360 days after the time the work is
commenced.
01 1 16002 51600
01 1 16002 51602
01116002 57770
$22.95
$161.04
$3.91
lnspector MID#: 2019-153021
PLUMBING.!NSPECTOR RECORD
APPROVALS DATE !D/SIG.COMMENTS
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underf loor
Building Sewer
Area/Storm Drain
I nterceptor/ Clarif ier
TOP OUT
Waste & Vent
Water Pipino
Gas Pipinq
Roof Drain
Tub/Shower Test
Rouoh Water Heater
POOL/SPA
Ptrap/Drain Line
Main Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heater/Gas Line
Misce!laneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary Sewer/Cap
Back Flow Device
Rough Plumbinq
Final Gas Test
Meter Release 0
FINAL (fipCet
Notes, Remarks, Etc.
YeYnn,r vnt/,\tA 21Alplor N,/
OWNI]R BTIII,DER I)I:I,('ARA'I10N
I hcrchy alfirnr un(lcr Jrcoxlly of pcrjury lhal I anl cxcnrpl liom lhc (inilructor\' l-iccnsc Lrw lbr lhc folk)sing rcn$n (Scc.7{)-11.5
llusincss arkl Profcssion Crxlc): Any Cily or County tr'hich rcquircs a lrcrrril t() con\truct. rltcr. iuprovc. dcnplish or rcplir uny
\lruclurc.priorloils issurncc.dhorcquircslhcafplicanltbr\uchpcrnliltrlilcasigncdsl{tcnrcnl thathcorshcisliccnscd pursuvl
lo lhc provisions of lhc C(,nlrilctor's l-iccnscd Lrw (Chaptcr 9. (i)tr]nrcncing $,ith Scclion 7(n0 of t)ivi(k)n I of rhc Bnsincss al(l
Profcsst)n\Codc)orlhrlhcor\hciscxcnlfllhcrclioilandthchrsislirrthcallcgc(lcxcnulion. AnyviolationolScctiorrT03l.5byany
apnlictrnlforrpcrnrilsuhjcclslhc rpnlicanlloilcivilpcnflltyo[nolnn)rclhlnlivchun(lrcddollars($5U]). r
-.-1. as owncr ol lhc prI)pcrly, (n'illy cilrnk)yccs wilh waScs as lhcir solc conlpcnsiltion. willdo thc work and lhc stnrcturc is]xl t
lhc profrny who buikls or iillp(rlcs lhcunr. and who docs such sork hinrsclf or hcrsclf or lhrough his or hcr orvn cnrpkryccs.
o, .onnlction. lhc Os icr Buiklcr will hrvc thr hurdcn of proviiS lhat l* or shc tlitl noi build or improvc thc prfrny lirr thc fuqx)$ ol
$lc).
-1.
as owrer of lhe proJrny. am exclusivcly conlracting wilh liccnsd conlrockrF lo conslrud thc rtroj$t (Ss. 7(X4. Busincss
snd ProfsshnCodc:TheContractor'sLiccnseLswd@smtapplyloanowncrofpropcrtywhobuildsorimprovcsthcrcon.
and who contnctsforsuchpmj6lswithaConlmcto(s)licenrcdpursuantlothcConlraclor'sLicenseLaw).
-lilnlcxeillplundcrsc(li(ln-.B,&P,C,forthisrcason,
WORKEIIS' CONIPENSA'IION
DECLARA'I'ION
l hcrcby atlirrn undcr pnalty of pcrjury rrrc ol thc follorvirg dcclilrnlk)trsl
6hrt" rA nilluuintairr a ('cnillcatc ol Conscnt to sclf lnsurc lir $<rkcrs' con1)cnsalion. as provirlcd lirr hy Scctir)n 37{X) ol thc
l,atx:r Crrde. lor thc pcrlorilfincc ()f thc sr)rk li,r shich lhc pcrnrit ir issucrl.
frrcandu'ill mainlritr$()rkcr\'coilrJtcrsuli([iIsurancc.ar rcquircrl hySccln)n.17(X)oflhcLahorCodc.forlhcpcrfornrnccof
lhc utrrk for which lhis;rcrrril is issucd. lvly workcrs corllrcnsxlir)n insurrncc canicr axl p)licy nunlbcr ilrc:
civil fincs up to onc hundrcd thousand dollars (S in addition k, lhe cosl of lor thc
Scclion -3076 ofthc L{tbr Codc. intcrcst fccs-
o,r".ol-27-b
I)tict,Ali,|It0N
I hcrchy allirrr undcr pcnally of pcriury lhnt I am liccn*{ undcr provision ol Chlllcr 9 (connrcncing with Scction 70fi)) of Divisi{)n -1
of thc Busincss and Prolc\siols (ildc. and rny liccnsc is in lull lorcc rnd cfltct.
l-iccnsc 'a6aa--
I hcrcby affrm under lEnally ofp.rjury Ihal
issued (Sa. 3097. Civ. C.).
[.nder's Name:
is a conslruction lcndinS agcncy for thc lrcrformrce of thc work for which this Imil is
kodcr's Addrcss:
APIIJCANIjECI,ABAIION
I hcrcby affim under pen8hy oftEqiury onc ofthc following dcclarations:
Dcmolition Pcrmits-Asbcstos Notification Fcderal Regulations (Titlc 40, Pfft6)
_Rcquircd Leltcr ol Notificrli(nl
-l
certify that thc fcdcral rcgultlions rcgarding astEstos rcnovnl arc not upplicablc to this projcct.
I lhis application and state thal the ak)vc infonmtion is corct. I 09re to comply with all Cilyand County
' rcFescnlBtives ofthis Cily and County lo cnts utnn lherclating lo building construction. ard herehy
atnvc mntioncd lirr
Applicatrt or Agent
lrernrilee nDfirr ry"o,rL
o^,", o l'Zz !2
paxy*, *,, u,JC l 06 o? ?6 OO E pn"", a7- 4'bb
6".r'tity *utin thc perforroncc of thc work lbr which this pcrmit is issued. I shall not cmploy any person in any manncr
so as to becom subjcct lo lhe workers'compensation laws ofCalitbrnia. and agrce lhat ifl should becom subjcct to thc
workcrs'comp€nsotionprcvisionsofScction3T00ofthekborCodc.lsh{ll.fodheilhcomplywiththorcprovisions..
l)alr: