HomeMy WebLinkAbout101103321 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana. -A g2JO2 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #:1O11o3321
Pin #: 5548.2
Proiect Address: 200 S Harbor Blvd
Assessor's Parcel: 188-041-05 Lot: NA
Unit:Bldg Address Range: 200-220 *
Historic: No
Suite Range:
Zoning: SP2Block: NA Tract. NA
Building Use: Commercial Occupancy: N/A 1st FL Area: Patio:
Job Type: Signs Constr Type. N/A 2nd FL Area: T.t.Area:
Nature of work: Sign code: cBc 2019 other Areas: yards Req,d:
Existing Bldg. & Use: Commercial Flood Zone: X-0602320256J Garage Area: Valuation:
Proposed Use: # of Stories:
Total:
Description of Work: lnstall (1) non-illuminated foam letter wall sign for "Home Expo Building Supply", bond paid on M-74237
$1,500.00
Ent
ntfPlanning Conditions:
t Owner:
Address:
Phone:
Tenant:
Ken Nguyen
2502W. Rowland Ave.
Santa Ana, CA 92704
(714) 934-8083
Home Expo Building Supply
Contractor: Discount Printing & Signs
Address: 14861 Moran Street #B
Westminster, CA 92683
Phone: (7141 910-7267
State Lic #: 1001210
Lic Type: C-45
Bus. Lic #: 324929
Workers' Compensation lnsurance:
Carrier: State Compensation lnsurance Fur
Policy #: 9163738
Expires: 0712912020
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
l.r'onsact ion ToL,
Bu i ld it
r:rl I l6iri
Genrr n
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
Guevara, Jerry
Amsden, Julie
Chavez. Dave
<2.?'
Dale: 0211212020
Dale. 0212812020
Date: 03/03/2020
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002
07776002
07716002
0L776002
07776002
07776002
5760L
s3600
5777 0
57672
57600
57607
Permit Fee
Plan Check Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
$166.53
$1 15.44
$3.91
$1.00
$22.95
$57.20Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 0i 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 53600
011'.t6002 57770
Account#Total
Every permit issued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days after its issuance,or if the work authoized
on the site by such permit is suspended or abandoned for a period of 360 days after
the time the work is commenced.
$22.95
$223.73
$1.00
$1 15.44
$3.91
Fee Total:
Paid to Date:
Balance Due
$367.03
$0.00
$367.03
lnspector MID#: 2020-157710
!NG.INSPECTOR RECORD
Rev.08-07-2015
SITE.WORK DATE ID/S!G.'COMMENTS
Set Backs
FormsiSteel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/VenUl nsulation
Roof Sheathinq
Shear Wall
Framinq
lnsulationiEnergy
Drywall
Ext./lnt. Lath
Brown Coat
[Masonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
\'rtr/s.€4, (Z? )F!NAL 6-//-2a lzcl
Certificate of Occupancy
Notes, Remarks, Etc.
+
oWNItR BT]II,I)l]R I)EI,CARA'TION
I hereby affirm under pcnalty of perjury thal I m exenrpl from the Contraclos License l:w for the following rcasn (Sec.70ll.5
llusincss and Prolcssion Codc): Any City or County which rcquires a Jcrmit kr constnrct, altcr, improve, dcmolish or rcpair any
slnlctu.e. prior () its issuailce. also requires the applicaot tbr such p€rmit t) filc a signed slalerncnl lhat he or she is licenscd pursuant
lo lhc lmvisionr of the Conlraclor's Liccnscd lrw (Chaptcr 9. Comrnencing wilh Scction ?(xxl ol Division 3 ol the Lusincss and
ProtessionsCo(lc)orthatfuor\heisexempttherehomandllEbasislbrtlEallegedexemptiq!. AnyviolatiurofSectionT03l.Shyany
rpplicrntforapcmritsubjecrslhe dpplicanrtoncivilpelnltyofnormrethullvchundrcddolhrs($5{n).
_1, as owncr ol'thc propny. or rny employccs wilh wagcs as thcir solc compcnsation, wil, do thc work md tlE strclurc is nol
inerxled orofTcredforule(Se.7Ol.l.BusinessilndPmfessionsCqle:TheContrncbisLiccnscLawdoesnotnpplyloanowncrof
rhep&pedy wlx,fuildrorimprowsll)@[axlwlDd(rssuchwrrkhimselforlErsclforthroughhisorherownemployees.
providcd thal such improvcrEnts ec mt inlendcd or ollered for sab. Il. howe vci lhc building or ilnprovcmnt is sold within onc )!tr
ofconplelknr, (lE Owner Buildor will have thc burden ofprovin8 lhd he or she tlid ntl build or impmve the pmpdy for Ih€ puqis of
sule).
_1. as owner of the prcpe(y, am exclusivcly conthcting wilh licenpd conlrhck)rs lo conslrucl llE pmjel (Scc. ?(X4, Busincs{
arxl PrrllssinCode:Th€Conlrack)r'sLicenseLawd@snotapplytoanownerofprolE(ywhobuildsorinrproveslhereon.
trnd who contrdcls for such projects with a Conlracto(s) liccn$d pu(suMt to lhc Contraclor's Liccnsc Law).
_l anr exempt under Section , B. & P.C. lbr this reaq(nr.
D.lc:-
\voRKl.RS', ( Out'uNs,\'l t( )\
I)U( t.AR,\t t()N
I hcrchy allirm undcr pcnahy ol pc'rjury onc oi lhc lirll()wing (lcrlxrrl i()ns:
_lhavearxlwillnuintainaCleril'icateofconscnttoSelf:lnsureforworkers'compensalioo,as pruvidedforbyScctionS?00ofthc
LatFr Codc, for rhc pcrformrcc oflhe work for which thc pcrmil i\ iisucd.
_lhrverndwillnuintxirrworkcrs'compeDsali(xlinsurance,as requiredbySecti(n3700oftheLahorCode,li)rlheperfbrnrance<rf
thc w(trk li)r whielr pcrnril issucd.insutanrc crnicr arul;xrlicy nunrbcr uc:
/zoaPolicy
_l cotili lhrt in thc pertornuncc oftlre work lirr which this lrcrnlil is issucrl, I shall not cnrpkry any pcrson in lny manncr
$ as to bccotrE suhjcct to thc workcrs' cofipcnsat ion laws ol Cali lirnlia. and agrcc I hal i t I slnuld bccoE subjccl to I he
worker!'conrpnsationprcr'isionsofSectionST00oftheLabor(ixle,Ishall,fonhwithtrcnrplywithrlrcsprovisions.
WARNINC: Failurc to wcurc workcrs'conrlrcnsatt)n covcragc is unlawful. and shall suhjccl an cnrployer (r fiminal lrnaltics md
civil liDes up to onc huDdrcd thousand dollars ($l00.UX)), in addition to the cost ofconfcnsrlion, dama8cs as provided for thc
Srelir)n of Cixlc, iilerest and atbrney's fees.
I hcrcby al lirn utrdcr pcnalty ol pcrjury lhal I arn lict'nscd undcr ol Chnptcr 9 (cornmcncinS wilh Scclion 7(Xn) ol Division 3
ol lhc Busincs\ ud Profcsri(,ns Co(lc.:fr| n)y liccn\c is in full Ii)rcc and cf,i'cr.
l,iccnsc 60 to
( o\s't til'(-tt()N LI.]Nt)t\(;.\(;t,t\( \
I hcreby atlirm uflder lrnaly of pcrjury thal therc is a constructiol leildilg aSency tbr the perfirmnce of the xrrk lbr which this pemir is
issucd (Scc. 3097, Civ. C.).
[Indcr's Nanrc'
It'n(lcr's Ad(lrcs\:
APPI,ICAT.IT DECLARATION
I hereby uffm undcr pcnalty of perjury one of thc followinB declariilions:
DcnDlition Pernlils-Asbcstos Notification Fcdcral Regulations (Tille.l0, Pan6)
-Requir.d
lrttcr of Nolificalion
thut thc federrl rcgulrtions regardi,rg ilrhesk)s renxrval are not applicrble tr this pruiect.
_l cenify that I hnve read this afplicalion and stntc lhal thc nbove infomralion is corect. I agree to comply with rll City and County
(rdirHnces and State Laws rehtilg k) tililding curstructior, rnd herehy authorizc represeiltatives of this City and Cotrnty to uFnl llE
ahovt nrcntirrred lropcfly li,r iflspcclion
Appli.{nt or Agcnt
Itrrtrritft nilil)r
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