HomeMy WebLinkAbout30141856 - PermitCity 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 #: 3O{ 4{ 856
Pin #: 69759
Proiect Addressi 2107 E Seventeenth St
Assessor'sParcel: 396-321-04 Lot: NA
Bldg: Address Range:
Tract: A.B. CHAPMAN Historic: No
Unit:
Block: A
Suite Range:
Zoning: Cl
Owner:
Address:
Phone
Tenant Name:
Contractor:
Address:
Baja Fish Taco lnc
3674 S Bristol St
Santa Ana, CA 92704
(714) 486-6904
G A Demolition
,I3603 KINGS CANYON CT
Fontana, CA 92336
(909) 343-9634
01 'r 16002
01 1 16002
01 1 1 6002
01 1 16002
51602
51 6od
51602
57770
Fee
$103.84
$22.95
$57.20
$3.91
Fee Type
Cap Sewer
Geheral Plan Updaie
lssuance
Microfilm Records
Qty
1.00
1.00
1.00
1.00
Botch+:t4133 -
0f f ice: (:TyH
Acct*:
Rcpti: tt2884962
Transoct ion Totsi
G A Denolition
Generol Flnn Updote Fee
tJl 1 l6L1L12- 5 I 6LllJtJ0rJ-
cunents
r:lLu:10-
Plurb i ng
0l 1 161102- 5l602ttt1(r-
V iso
CC+ r *xr**i**xxx*99
morales I i4ot 4Phone
State Lic #: 1025003
Lic Type: C-21
Bus. Lic #: 374970
Workers' Compensation lnsurance:Carrier: State Comp
Policy #: 9205835
Expires: O3l2Ol2O2O
3111{ t gE6
1?:39 PH
Slr743.{t
llicrof i 1r*
Ltl l l6llt:r2-
&uo
1.777
$3.?1
Occupancy:
Constr Type
Code:
Date:
Date:
Date:
A-2
VA
cPc 2019
Authi:(
5161,04
$l r 743.69
r76?93
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
01102971
01t29t2020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total:
Paid to Date:
Balance Due:
Cap sewer. Bond paid on M- nqO"VS.i
en, Julie
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within360 days after its
lssuance, 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.
011't6002 51600
0'1116002 51602
01116002 57770
$22.95
$161.04
$3.91
$187.90
$0.00
$187.90
lnspector MID#: 2020-157417
Amount
103.84
22.95
57.20
3.91
PLUM BING.INSPECTOH RECORD
APPROVALS DATE !D/SIG.COMMENTS OWNER BUILDER DELCARATION
I hereby affirm under penalty of perjury that I m exempt frcm thc Contractors' License ljw for the following rcarcn (Sec.7031.5
Busincss and Profcssion Code)r Any City or County which rcquires a Jrcrmit to conslruct, alter. improvc, demolish or repair any
structure, prior to its issuance, also requires the applicBnt for such pcrmit to file a signed slatement lhat he or she is licensed pursuml
to thc provisions of thc Contractor's Licensed Law (Chaptcr 9. Commcncing with Section 7000 of Division 3 of lhe Business and
PmfcssionsCodc)orthatheorsheisexemptthqefromandthebasisforthenllegcdexemption. Anyviolslionofsection?03l.5byany
applicunt for a pennil subjects the applicanl to a civil pcnslty of not morc than five hundrcd dollars (9500).
-1.
as owncr of lhc propcny. or my cmployees wilh wagcs as their solc compcnsation. will do thc work Md ttE slructm is not
intcndcd oroffcredforslc(Scc.7{X4.BusincssandhofcssionsCode:ThcContraclor'sLiccnscLawdocsnotapplytoanowncrof
thcprcfrcrly whobuildsorimprevcsthcrsn.andwhodocssuchworkhimsclforhcrselforthroughhisorhcrownemployecs.
providcd that such improvcmnts m not intcnded or offercd for sle. If. however. lhe building or irfrrorercnt is sold within one ycar
ofcomplclion. the Owncr Builder will have thc burden ofproving thd he or she did not build or impmve thc profErty for lhc purlnsc of
elc).
-1.
as owner of thc pmperly. am exclusively contracting with licenscd conlracloF to construct the prejcct (Sec. 7044, Busincss
and PmfssbnCodc:ThcConlraclor'sLicenseLawdocsnotapplytoanowncrofpropcrtywhobuildsorimprovcslhercon.
and who contracts for such prejccts with s Contmctor(s) licensed pursuant to the Conlractor's License [aw).
I arn cxcnrnt undcr Scction . D. & P.C. for lhis rcason.
Date:_
WORKERS' COMPENSATION
DECLANATION
I hercby affirm u ndcr penalty of perjury onc of thc folbwing dcclaralions:
-l
havcar[lwill nrainlailaCe(ificaleofConscntloSclf-lnsurcforworkcrs'conrpcnsatknr.as providcdfi)rbyScclion3T00ofthc
l-abor Codc. tirr thc pcrlormrncc oflhc work for which thc pcrnlit is issucd.
t!!havcanciwillnrainloilworkcrs compcnsxtioninsurancc.as rcquircdhyScction3T(X)oflhcLahorC:odc.tbrlhcfcrl-ornranccof
the work li)r which this pcrmil is issued. My workers coilrpcnsnlion insurancc canicr and lmlicy nuillhcr $c:
('u.i"r,'rtse,tc Co.-ot-<*!rsvt, \rt<. G. ^.\
<PoricyNumbcr: q? oB y35 * I n Expires:3 I zl zazo
h9t ccrrify rlat in thc performance ol thc work for which this permit is issued. I shall not cnlploy any pcrson in any munncr
so as to bccorc subjcct lo thc workers'conpcnsrtion laws ofcalitbrnia, and agrcc that ifl should become subject to the
workers'compcnsationprovisionsofSection3T00ofthcLatprCode,lshall.fbrthwilhcomplywithtlnkprovisions..
WARNING: Failure k, rccurc workers'conlpensotion covcrage is unlawful. arrd shall subjcct an cnrploycr to criminal pcnalties and
civil fincs up lo onc huDdred lhousand dolhrs ($100.000). in addition to thc cost ofcompensation. daroges as provided for the
Section 3076 of thc Lali)r Codc. iDlcrcst and 0lbrncv's fecs.
r)l lhc lJusirc\s an(l Prrrltrsions Crxlc. anrl rny liccrsc is in Iull li,rcc rDd cllccl
(r,""n,"Nu.t", l O 1€ oo 3
(o"t.,\l url'L"l' conrracror: f', 14 gzn''to lih'uva
CONS'II{UC'I'ION I,ENDINC ACtrNCY
I hcrchy rtllrm undcr pcnally ol pcrjury lhrl thcrc is a constnlction lcndirg rgcncy frrr the pcrfornlrincc of thc w()rk for which this perrlit is
issucd (Sec. .1097. Civ. C.).
lcndcr's Nrnr:
kndcr's Addrcss:
APPLICAN'I' DIICT,ARA'IlON
I lrrchy alliur uutlcr pcnrlty of pc{ury o[c (,f lhc li)lk)wing dcchrntk)ns:
Dcnnrlition Pcrnrjt\'Asbcsk)s Nrilillcrtion Fedcrrl llcgulalioils ('l-illc 40. Parl6)
-Rcquir
cd l-cltcr of Nolillcation
_l ccrlily that llt ltdcrnl rcgulaliurs rcgardiDg flsh(stos rcnr)vitl arc not npplicnhlc k) lhis prcjcct.
(11 ccrlily lhill I havc rcad this applicirlk)n aDd slalc lhrt thc atnvc inlbmulio0 is comcct. I ngrcc kr crnrply with rll City xnd County
above rcnthned propcny for inspeclion
I appticanr or ,lgent
l1'r"'iloo nxnro
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underfloor
Buildinq Sewer
Area/Storm Drain
I nterceptor/ Clarif ier
Ap+ OkP zlrcltotu W4lxe *r
TOP OUT
Waste & Vent
Water Pipinq
Gas Piping
Roof Drain
TubiShower Test
Rouqh Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Pipinq
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
Meter Release
FINAL ?l plZotu lMz*u sg
Notes, Remarks, Etc.
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