HomeMy WebLinkAbout30141170 - PermitProject Address: 2122 N Main St
Assessor'sParcel: 399-102-02 Lot: 5
Unit:
Block: NA
Bldg: Address Range: 2122-2124
Tract: E. M. SMILEY'S SUBlistoric: No
Suite Range:
Zoning: Cl
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Plumbing
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #:3lJ14117lJ
Pin #: 4E38O
Owner:
Address
Phone:
Tenant Name:
Contractor:
Address:
Phone:
ORANGE COUNTY TEACHERS
PO BOX 11547
Santa Ana, CA 927111547
(714)466-8665
Broadway Building Group, I
4590 MacArthur Blvd. Suite
Newport Beach, CA 92660
(949) 335-7183
Fee Type
01116002 51602 Cap Sewer
01116002 51600 GeneralPlan Update
01 1 1 6002 5't602 lssuance
Amount
103.84
22.95
57.20
Qty
1.00
1.00
1.00
Fee
$103.84
$22.95
$57.20
Botch*:51111 - 7/21/?t|l9 I0: omors
0f t ice: CTYH lrsns,f ! 79 3 ofAccti: Reft: 3[1{1170
Rcpti:02704408 - 7/21/2(ttg 1:29 PH
Trsnsoction Totol ttr4J?.67
Broodunc Building 6roupr LL(:
State Lic #: 1005485
Lic Type: B
Bus. Lic #: 370469
Workers' Compensation lnsurance:Carrier: State Fund
Policy #: 9142275-18
Expires: 10/05/2019
Generol Plon Updote Fee
rr1116002- 516u000rr-
P lurb i ng
011l6tr02- 51602(t00-
ICL Check 002951
Cap sewer. Bond posted on M-73247. NOTE:
REFERENCE 2115 N BROADWAY, BLDG #10198745 &
47 FOR NEW PARKING
LOT/GRAD|NG/STANDARDS/APPROVED PLANS.)
$183.99
$0.00
$183.99
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
Cap Sewer
Occupancy:
Constr Type
Code:
Date:
Date:
Date:
N/A
N/A
cPc 2016
07t2512019
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total:
Paid to Date:
Balance Due:
7 01 1 16002 51600
01 1 16002 51602
$22.95
$161.04Every permit issued shall become invalid unless ,he work on the site
authorized by such permit is commenced within 360 days after its
issuance, or if the work authorized on the site by such permit is suspended
or abandoned for a period of 360 days after the time the work is
commenced.
lnspector MID#: 2018-148433
PLUMBING.INSPECTOR RECORD
ID/SIG.COMMENTSAPPROVALSDATE
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underfloor
Building Sewer
Area/Storm Drain
I nterceptor/ Clarifier
TOP OUT
Waste & Vent
Water Piping
Gas Pipinq
Roof Drain
Tub/Shower Test
Rouqh Water Heater
POOUSPA
P-trap/Drain Line
Main Drain/Pool Piping
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary Sewer/Cap
Back Flow Device
Rough Plumbing
Final Gas Test I
/MeterRelease J .,1
FINAL L/ 1/71 ))b /-/u//L rOY
Notes, Remarks, Etc.I
o\\'NuR Ill'il.|)llR l)El.( ,,\RA Il()N
IherebynmrmunderpenaltyofpcrjurythatIamexemptlh)mthc('ontfttctors l,icense[.as'lirrthefollowingreav)n(Sec.7031.5
Business and Profession Cale): Any City or County which requires a pcrnil lo conslrucl, aller. improve. rlentolish'i,r ,"pn,, nnyt
slructure,priork)its issuance,alsorequiresthealplicanlforsuchperrnitkrfileasrgnedstalemenl thathcorsheisliccntd pur;uart
Io lhe pmvisions ofthe ('ontractor's l,icensed l.aw (Chapter 9. Commcncing with Seclion 7000 of Dirision -1 ofthe Dusine{ aitl
Professions code) or that he or she is eiempl lherefrom and I he hasis tor th€ alleged exemPl bn' Any f iolal ion o f sst bn 7l)l I 5 h' iny
applicant for a pemit subjects the applicant lo a civil penallyofnot nmre lhan five hundred dollars (55001 , '(,
_1, ns owner of lhe pnrpeny, or my etnployees wilh wiges as lheir sole contpensation, will do the work and the structue is ml
intended orofl'eredforsle(Se.TO44.BusinessandProfessionsCode:'lhe(bntractor'sLicensel-awdosnolapplyloanoq'nerof
lhcpmntny wk)huildrorimprovstlrrqro,nmlwhrdoessuchuorkhimselforherselforIhnrughhisorhero$nemployecs,
provided that such improrcmenls are nol intemlcd oroflbsl firr sle. ll. howcver, llr huildirg or inlnrovetrent is sokl within one year
ofcomplelion, thc Cr{ner Builder will hlve the hurden ofpreving thal hc or she did ml buiki or impmve the pmFrty fi)r th€ lur[ns of
salc).
_1. fls owner of lhe pmpeny, am exclusively conlracliDg u'ilh licens<l conlrnclom lo conslrucl the pmjftt (S(. 7(X4, ltusiress
anl Pnrlission Code: 'l hc Co[lractor's License Law docs not apply to {n owner ofpropeny who huilcls or improves lhereon,
and wlro coillracls for such pmjills with a ('onlmcb(s) licensed Pursuanl h lhe Conlraclor's Licensc La*').
_l am cxempl under B. & P.C. for lhis reason.
l)nte:()$iler
IvoRKERS' COillPf,NSA'l lON
D&g& 8AI!!)!
I herehy a lfirm untler pcmlty of perjury one ol l he folk)wing (leclar.l i(rns:
_l have nml will maintain a Certificate of Consenl to Selllnsure lirr workers' conlpensali(rn, as prrvided fur by Section 370o ol lhe
l-ntxrr Code. frrr lhe perlrrrrnancc ofthc sork lirr which lhe pcnlit is issued.
_lhavrnndwillmaintainworkers'comnensalioninsurancc,as requiredhySeclion3T00oftheLoborCode,firrlhepcrformanceof
theqrrrkf(rru'hichthispemilisis$ed.Myrvorkers comPensalioninsuralEecaricraftlFxllicynumherare:
Policy Number Expires:
_l cenify thar in the performance of the work for which this permit is isrued, I shall noI cmploy any pcmon in any mnnner
m as to hccomc wbjct lo the works' @mpcnetion laws of Califomia. and agrc lhat if I should hecom subjrct to thc
workem' compcnsation pmvisions of Sction 1700 of the Latnr Code, I shall, forthwith mmply with tlnrc pmvisions..
WARNIN(;: l;ailure to wurc workem'
civil fincs up to one hundred thousand
is unlawful, and shall sbjcrt an mploltr to qimiml ,rroltiq and
in addition lo the cost ofcompcnsalio!, damages as provrded for lhe
t4og;tM APsetion 3076 ofthc Llhr Codc, inlercat and fes.,\44,T
CD
I bcrcby affrm under penalty of pcrjury that I am liccnsed undcr pmvision 9 (mmrencing with Setion 7000) of Division 3
of the Business and Professions Codc, and my liccnse is in full forcc ard efTect
b icense Numtrr:Lo@,CTKTLiccmc
Dstc:r \,6t*'( B:t LI-DNA c-oW
I h.Eby amrm under fEmhy of pcrjury that
issucd (Src. 3097, Civ. C.).
isa lerding agercy for the pofirmrce of the work for *'hich this Jrmit is
Lender's Name:
Lehder's Addrccr:
ATfJ.ICANLI'ECLABAIIQN
I hoe$y afim under penalty of perjury one ofthe following declarations:
[)enmliton Permits-Asheslos Nolificalon l;ecleral Regulations ('l itle 40, Pan6)
-Required
l.elter ol'Notifi cfllion
with all City and County
and County lo cnltr uFrn lhc
Perniaee ti^ta YY MO55
+lLsf ,?
ou., T lzfft?
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