HomeMy WebLinkAbout30141715 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Plumbing
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #:3O141715
Pin #: {474.$\
Proiect Address: 3230 S Standard Ave Bldg: Address Range: 3220-3250
Tract SECCOMBE Historic: NoAssessor's Parcel: 411-152-06 Lot: POR 3 & POR 4
Unit:
Block: NA
Suite Range:
Zoning: Ml
Tenant Name: Tesla Motors
Darin Gilchriese
673 E Young Street
Santa Ana, CA 92705
(714) 556-0408
Lakeview Construction lnc t
10505 Corporate Dr #200
Pleasant Prairie, Wl 53158
(850) 699-04s9
Owner:
Address:
Phone
Contraclor:
Address:
Phone:
01 I 16002 51602
01116002 51602
01 1 16002 51602
01 1 16002 5160C
01116002 51602
01116002 5777C
Fee Type
Clothes Washer
Sewer Alter/Repair
Min Fee Adj
General Plan Update
lssuance
Microfilm Records
Amount
14.52
46.25
1 1.58
22.95
57.20
3.91
Qty
1.00
1.00
1.00
1.00
1.00
1.00
Fee
$14.52
$46.25
$1 1.58
$22.95
$57.20
$3.91
State Lic #: 571201
Lic Type: B
Bus. Lic #: 7722
Workers' Compensation lnsurance:Carrier: National Union Fire lnsurance Company of Pitts
Policy #: 5082945268
Expires: O9lO1l2O2O
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
lndustrial
Tenant lmprovement
T.t.
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
B, S-1
VB
cPc 2016 Notes: New clothes washer for Tl. Permit fees paid on
M-74019.
$ r"rnrnoez, Kathy 01t1712020
Account#
Misc. Receipt: 74019
Misc. Receipt:
Misc. Receipt:
TotalSubject to Field:
Buirdins Permit #: 101100549
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 is suspended
or abandoned for a period of 360 days after the time the work is
commenced.
N/A - No Balance
N/A - No Balance
Fee Total
Paid to Date:
Balance Due:
$156.41
$156.41
$0.00
lnspector MID#: 2019-152449
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PLUMB!NG.!NSPECTOR RECORD
APPROVALS DATE ID/SIG.GOMMENTS OWNER BUILDER DELCARATION
I hereby affrm undcr p.mhy of p€dury that I m exempt fmm the Contractors' Licensc Law for tlrc following remn (Se.7031.5
Business aod Pmf6sion Codc): Any City or County which rcquircs a lEmit to @ndrud, altet imprcvg dmlish or rcJmir any
strocturc, prior to its iisarcc, also rcquircs thc applicant for wch pcmit to file a sigrcd statemcnt that tE or shc i! licensd pursant
to the pmvisions of thc Contractor's Licensed Law (Chapter 9, Commcncing wilh Scction 7000 of Division 3 of thc Busincss and
PpfessionsCode)orthath€orsh.hcxcmptthcrcfmmandthchdsisforrhcallcgedcxcmption. AnyviolationofSelionT03l.5byany
applicantforspcmitsubjctsthc appli@nttoscivilpcMhyofmlmorcthanfivehundrcddollars($500).
_1, as owner of thc rrmFerty, or my employes wilh wages as lh€ir sle compcnsation. will do the work atd tlE struhue is mt
intsrdcd or offcred for slc (Sc.7044, Busircss and Pmfessionr Code: 'l h. ConlEctor's Liccme Law docs mt apply lo an owM of
thc pmpny wln buildr or impmva ttssr1 ord who dod sch wort himsclf or hemlf or thrcugh hii or hcr own cmployecs,
providcd that ruch impmvmnts rc mt intcrdcd or offcrcd ftrr slc. lf, lnwwr, the building or impmvcrent is rld within onc )qr
ofcon{,letior! the C)wner Buildtr will have thc budcn ofpreving that he or shc did mt build or irpmvc thc pmp€rty for thc purfnse of
sh).
_1, as owrcr of thc pmpeny, am exclusively contracting with lice[sed contmclom to conilruct thc pmjcrct (Sec. 7044, Business
and PmfssionCodc:'lheContractor'sLicenseLawdoesnotapplytoanowncrofpropertywhobuildsorimprcvesthcreon.
and who contmcts for such pmjftts with a ConlEcto(s) licenscd puBuant to the Contractor's Licensc L6w).
-l
m cxcmpt undcr Setion-, B. & P.C. forthis twn.
Datc:_
1I'ORKf, RS' COI\I PENSAl'ION!4UB{r0!
I herehy allirrn undcr penalty ofperlury one ofthe [olkrwing cleclarations:
_l havc arl will mainlniil a Cerlilicnte of Consent to Self-lnsure for rvorkers contpensalion, as pr)vi(led for hy Section l7(l(l of the
Lohor Code, fi)r lhe perfirrnunce ofthe work for which the pcmrit is issuetl.
fu/hnvc cnrl will nrarntarn rvorkers compensati()n iilsurnncc. ils requircd hy Section J700 oflhe t-ahor Code, for the perfonnance of
tte work lir q'hich this pennit is rsscd. My workers compensxlion insurance canier lml policy nunther are:
F)
Policy
-:-l ccnify lhat in thc pcrformmc of the work for which this permit is issucd, I shall mt cmploy any pcMn in any manrcr
m as to beore sbjct to th€ worteN' compensalion laws of Califomia, 0nd agrc that if I stnuld tEomc subjet to thc
workers'compensationpmvisionsofSection3T00oftheLaborCode,tshall,forthwithmmplywilhlhorcprcvisio[s..
WARNING: failurc to sure wod(ca'compc[stion ovcmgc is unlawful, and shall subirct an mplolcr to simiml tEhhi6 and
cMl fincs up to orc hundred thousnd dollsB ($100,000), in addition lo the cost of compe[etion, damgcs as provided for the
Seclion.1076 Code, inlerest and aftorney's fees.
I
t)t(l,ARAIl()N
I hercby aflirm undcr pemlty of pcrjury thBt I am liccn*d under pmvision of Chaptq 9 (mmmncing with Sction 7000) of Divirion 3
of thc Busircs and Pmfasions Codc, ard my licerk is in full forc ard cflcct.
1.71eo /l-iccnsc Nuurhrr:
Cotrlr{c(or:
W
I herchy affirnr under penalty of perjury that thtrc is a conil ruct ion lending rgency for the perfomancc of lhe qrrrk ftrr u'hich this pemit is
issued (Sec. 1097, Civ. C.).
l-ender's Nanre
Lender's Address:
APPLICAN'I DECLARA'I'ION
I lmby aflim under penally ofperjury one ofthe lirllowing declorations:
Demlilion Permits-Ashcstos Nolificalion l:edcral ReSulalionr ( lille 40. Pan6)
-Requircd
Lettcr of Notification
-l
cqaify thlt the federnl relrulations rcgardinSr asheslos renmval are not applicable lo this preject.
ff crnrfy that I have read lhrs apllication ard stale that the atnv. infonnal ion is cor(t. I alTe to comply u'ith nll Ciry an<l County
odinances nnd State Laws relating to huilding construction, and hereby authorize representatives orthis City and Counly to enter upon the
atnve mnlioncd pmperty for
Appllcant or Agent
Pernritee name (prlnt):t
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underfloor
Buildinq Sewer
Area/Storm Drain
I nterceptor/ Clarifier
TOP OUT I I tl lt Ir- l.
Waste & Vent 2-4i-r-lr t
Water Pipinq (drm ') qL+rJ-g-'1
Gas Pipinq
Roof Drain
Tub/Shower Test
Rouqh Water Heater
POOL/SPA
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
Rouqh Plumbinq
Final Gas Test
Meter Release Ir
FINAL L !-70 \2qPfi 1s7rtrxt
Notes, Remarks, Etc.
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