HomeMy WebLinkAbout101100240 - PermitProject Address: 1717 N Old Tustin Ave
Assessor's Parcel: 396-311-04 Lot: NA
Unit: B Bldg: Address Range:
Tract: A.B. ChapmanBlock: B Historic: No
Suite Range:
Zoning: Cl
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702
PermitCounter: (714)647-5800 lnspection Requests (714)667-2738 lnspectorSection. (714)647-5853
Building
d
Permit #: l Ol 1OO24O
Pin #: 74245
Building Use: Comm.rciel Occupancy: B lst FL Arear Patio:
Job Type: Tonant lmprovement Constr Type: V B 2nd FL Area: T t.Area: 961
Nature of work rt-cHANGE oF coNTRAcroR code: cBc 2016 other Areas: yards Req,d:
Existing Bldg. & use: Commercial Flood Zone: X-0602320164J
proposed rJse: chiropractic orfice # of storiesi Garage Area: valuation: 134'000 00
Tolal:
D$criPtion of Work Chenge of ContractorrFoga tEnaiErrodrLgttor on Iilo. lntedor remodel includes new €strooms, reception countgr, intgdor dgmo and
new partitiona
Planning Conditions:
Owner:
Address:
1717 OLD TUSTIN RD LLC
PO BOX 473
Silverado, CA 926760473
Contractor: Pacific Landmark Creation I
Address: 268 Via Matador
Mission Viejo, CA 92591
Phone: (714) 981-0003
State Lic #: 1028746
Lic Type: C-6
Bus. Lic #: 372939
Workers' Compensalion lnsurance:
Carrier: exempt
Policy #:
Expires:
Engineer:
Address:
Phone:
License #:
Architect /
Desioner:
Address:
Phone:
License #.
Phone:
Tenant: Orange Coast Dental t
Oldham Architects
Ryan Oldham
550 S Brea Blvd
Brea, CA92821
(7',t41482-8296
c-29715
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd: No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Landscaplng lnsp. Req'd: No
Pezeshkpour, Ali
Scott Fazekas & Assoc.
Brodowski, Teri
Date:08/1412018
Dale. 1111312018
Date:05/28/2019
Subject to Field:
Misc Receipt:
Misc. Receipt:
Misc. Receipt:
07776002 57607 Change Owner/Contr
07776002 s7572 Bldg. Stds. Revolving
07775002 57600 General Plan Update
Fee Total:
Paid to Date
Balance Due:
$66.11
$0.00
$0.00
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No
Account#Total
01116002 51601 $66.11
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 authorized
on the site by such permitis suspended or abandoned for a period of360 days after
the time the work is commenced.
lnspector MID#: 2018-145364
$66.1 1
$0.00
$66.11
IhcrchyallirnrundcrpcnrlryofpciurythatIamc\cmptli)mthcContruek)rs Liccnsc[-awlirrrhclblkrwirigrcas)n(Scc.70-11.5
Busilcss nnd Prolassion C(xlc): Any City or Connly which rcquircs a lL.*rnlil t() conslnrct, allcr, improvc. dcm()lish or rq)air uy
struclurc.p[]rloit\ issrancc,!l$rcquircslhcapplieanlli)rsuchl-*rfiilk)lilcasigncdstalcnrnl thalhcorshcisliccnrcd pursuanl
b thc provisir)ns ol thc Contraclor's l-iccnscd Law (Chaptcr 9, Comntncing wilh Scciion 7000 of Divisi(u li of lh" Busurcss and
Pro,tssions(ilde)orthallEorshcisexcnllnthcrclilrnandthchdsisli)rth(-rllc8cdcxcmplion. AnyviolalionolScctionT0-ll.5hyany
rpplicnnt li)r a Frnrit suhjects thc rpplicrnt k) d civil pcnaltyofnot ntlrc lhdn fivc hundrcrl dollars (5500).
_1. rs owncr of thc proFEny. or my cnlployccs with wagcs as lltir sole conlFEnrat ir)n. will do thc work url the s(mtuc r\ frn
iilenrjcd oroll'cred lirr salc 1Scc.7(X4. Business nnd Prolcssions Codcr Thc Cinilraclor's Liccnsc l-aw docs nol apply t) rn owncr oi
the F)Frcf,y wlx) hililds or inrlF)vcs thcru\)n. :ukl w[K) d(rcs such wo* himscll or hersclfor lhff)ugh his or hcr own cmpl()yccs.
providcd th{l such improvcrRnts rc nol ntcndcd orotlcrcd l'or salc. lt. howcvcr, thc huilling or improvcnEn( is solJ within onc y('il
ofcomplcti(nr. thc Owncr Ruilder will havc tlrc hurdcn ol pR)vir8 lhal hc or shc did not huild or improvc thc pR)fEny ti)r thc puryxrsof
sah).
_1. i\ owncr ol lhc l)ropcny. rnr c\clusivcly conlrdcling with lircnscd conlraeors k) construct llE projcct (Scc. 70214, Busincss
tnd Pn)lbssi[Codc:_[hcConlrack)r'sl,iccnscl,trwdocsn(ilapplyl)anowncrolpropcrlywhobuildsorimprovcsthcrcon.
and who contmcts fi)r such pr)jccts wilh a Conlrnalo(s) liccnscd pursuanl k) lhc Conlrack)r's l-iccnsc Jiw).
_l atrr cxctrrpt unrlcr Sccl U. & P.C. li)r lhis rcisoD.
}VORKERS' COI\IPENSATION
DECl,ARATION
I h.r!-hy al'l irnr undcr pcnillly ol pcrjury onc ol't hc li)llowirg (lcchral ions:
_l hrvc and will nlaintrm a Ccf,ilicutc ol Conscnt k) Scll:lnsnrc fi)r workcrs conlpcnsalion, as providcd li)r hy Sccti()n .17U) ol lhc
hlx)r (ixlc, li)r thc Frli)rnrancc ol lhc work li)r which thc pcmril i$ issucd.
_l h{vc and will nlain(ain workcrs comlrcnsatt)n insurdncc, ns rcquircd hy Scction 37Ul oftlt l.ahor Cl)de, li)r thc pcrli)rmancc ol'
lhc work lor which lhis pcrmit is issucd. My workcrs eonrlcnsali()n insurancc cafricr uxl Fllicy numbcr sc:
Policy Nu :\pirc\:
_l ccdif y thnt iD thc l^-rli)rnlnnrc ol'lhc work lbr which llris pcrnril is issucd. I shall nol crnpl()y any F-rson irr any mn0ncr
\o rs lo h(conr suhjcct k) lhr w()rkcrs'compenration laws of('llili)mia. {nJ aprcc thrt if I shoukl auconrc subjcct lo lhc
workcrs'corrpcn(rri(DprovisionsofScctirrr.lT(l0ol(hcl-ahnCodc,lshall.lbnhwilhcomplywilhthoscprovi\ions.
IVARNING: l-ailurc'to sccurc workcrs'c()nrl^-nralion covcrrgc is unlawlul. and \hall suhjcct rn cnTkrycr t) crimiral fEnrllics and
Scclxrn J07(, ol lhc Lxhr'(i)dc. irrlcrc( lDd xlftnncy s lccs.fitt*
I-i(cnsc Cla\c:-Ltccnsc Nunrhcr:
Applient
t-t( ENsEr) coN'rRA('l oR
DU(-1,ARA'ilON
I hcrchy ailirm unrJcr penalty of pcrjury thrt I am liccn*d\ndcr p()vist)n of Chaplcr 9 (comnrcncine with Scc(ion 7(X)0) of Division -l
of thc Busincss dnd Proltssions Code, dd nly liccnsc is in llll forcc.ukl cllcct.
'ot)u(
I)ale n L //-
CONSTRUCTION LENDING A(:ENCY
Ihcrl'hy{llir[]undcrlEniltyof l-*rjuryth{tthcrcisrcon\trucl()nlcnJingaScncyli)rlhcpcrli)rmancc(}llhcworktbrwhichthi\FnrmitLs
issuL\l tScc. 1l)()7. Crv (.).
[-cnder's Nltrrc:
knrlcr's Ad,lrcs(:
APPI,ICANT DET]LARATION
I hcre-by allirm untlcr 1^-ndlly ol I--rjury onc of lhc li)llowinE Jcclnral x)[s:
Denx)lrtion Pcrnril\-Ashcsl{)s N(}tilicatiur Fcdcral Rcgulatiotrs ('l'illc 40, Pdrt6)
-Rcquircd
ktlcr of N(*ilicattrr
_l ccnily thal lhc fedcrrl regulations (..8uding ashcslos rcmrval uc ntl applicahlc b this pn)jcct.
X-l (cn ify tlrr\l hrvc Rd thrs epplreation drl stalc that the atxrve inli)rmalion is corccl. I agrcc b conrply with all City and County
irrdinan(cs nnd Shtc kws rcliting to huilding c(ustruclion, md hcrcl,y uulhorizc rcprescntativcs of this Cily and County lo entcr ufnn thc
atx)vc nrnti(trtcd pruFny lbr insprclion putFx)scs.
LI u,," flt6tlApplicnnl or Agcll
I'enrilcr namr
SITE.WORK DATE ID/S!G.COMMENTS
Set Backs
Forms/Steeli Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/VenVl nsu lation
Roof Sheathing
Shear Wall
Framino
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
tl \r ?
'Nhlht/d 4>1FINAL\hbru
Certificate of Occupancv
Notes, Remarks, Etc.
BUILDING. INSPECTOR RECORD
u^",i/7Xl'\
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