HomeMy WebLinkAbout30137478 - PermitCity of Santa Ana 2 0 Civ ic Center Pl aza (M-19), Santa A na, CA 9270 2 Plumbing Permit#: 30137478
Permit Counter: (7 14) 647-5800 Inspecti on Requ ests: (7 14) 667-2 738 Inspector Secti o n: (714) 64 7-5853 Pin#: 29394
Project Address: 2865 S Pullman St
Assessor's Parce l: 430-181-17 Lot: POR 107
Owner:
Ad dress:
Ph one:
Tenant Name:
Contractor :
Address:
Phone:
St at e Lie #:
Li e Type:
B us. Lie #:
Chris Brown
2865 S Pullman St
Santa Ana, CA 92705
Knights Plumbing
1547 West Struck Ave #G
Orange, CA 92867
(714) 476-5290
983763
C-36
363922
Worke rs' Compensa tion In surance:
Ca rri er : Norguard Insurance Company
Poli cy #: JEWC711771
Expires: 06/01/2017
Bu ilding Use:
Job Type:
Occupa ncy:
Constr Type:
Unit:
Bloc k: 9
F-2
Ill B
Bld g:
Tract: IRVINE SUB
Address Ra nge: 2851-2875
Histo ric: No
Suite Range:
Zonin g : M1
0111 6002 5 1602
0 111 6002 5 1602
0 111 6002 51600
0 111 6002 51602
Fee Type Amount Q ty Fe e
Sewer Alter/Repa ir 4 1.46 1.00 $4 1.4 6
Min Fee Adj 26 .88 1.00 $26 .88
General Plan Updat e 20.56 1.00 $20 .56
Iss ua nce 51 .26 1.00 $5 1.26
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Natu re of W ork:
Commercial
Miscellaneous
Clean Out Code : CPC 2013 Notes:
Planning Conditions:
Plannin g Approva l By:
Plan Checked By :
Pe rm it Issu ed By:
Subj ect t o Field:
D ate:
'-Q\ \ He rn and ez, Kathy
D at e:
Dat e: 11/16/2016
Account#
Buildin g Perm it#: 01 116002 5 1600
Every permit issued shall be come invalid unless the work on the site O 111 6002 5 1602
authorized by such permit i s commenced with in 180 days after its
issuance, or if the work authorized on the site by such permit is suspended
or abandoned for a period of180 days after the time the work is
commenced.
Inspector MID#: 2 016-132858
Misc. Rec eipt:
Misc. Receipt:
Misc. Receipt:
Tota l
$2 0.56
$11 9 .60
Fee Total:
Paid to Dat e:
Balance Du e:
$140.16
$0.00
$140.16
APPROVALS DATE ID/SIG.
UNDER GROUND
Wast e & Vent
Water-Under floor
Gas-Underfloor
Building Sewer
Area/Storm Drain -
Interceptor/ Clarifier
TOP OUT
Waste & Vent
Water Piping
Gas Pipinq
Roof Drain
Tub/Shower Test
Rough 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
Notes, Remarks, Etc.
PLUMBING-INSPECTOR RECORD
COMMENTS OWNER IIUILllER DF:LCARATION
I hereby affirm under penalty of pe1ju1y that I run exem pt from the Contrnctors· Li cense Law for the followi ng rl!nson (Sec. 7031.5 *
Business and Profession Code): Any City or Cou111y which requires a permit to constmct. alter. improve. demoli sh N repair any
s tructure. prior to its issuance. also requires the applicalll for such permit to file a signed statcmenl that he o r she is licc11scd pursuant
lo the provis ions of the C'ontrnctor's Licensed Lnw (Chapter 9. Commencing with Sectio n 7000 of Div ision _, o f the Business and
Professions Code) or tha1 he or she is exempt 1herefrom and the basis for the nllcgc<l exemption. Any violatio n of Section 70] 1.5 by any ~
applicmu for a penn it subjects the applicant to a civil penahyof not more than ri ve huncll'ed dollrin; ($500).
_I, as owner of the propc1t y. or my employees with wages n~ their sole compensation. will do the work and the strm:turc is not
intended or offered for s.-1.lc (Sec.7044, Business and Professions C'ode: The C'ontrnctor·s License Law docs no t .ipply 10 .in owner of
the pmpeity who builds or improves thereon. and who docs such work himself or herself or th rough his or her own employees.
provided that such improvements are nol intended orofft..,-t..'U for s.-1le. If. however. the buikling or im1}rovement is sold with itl one year
of completion. the Owner Builder will have the burden of pro\'ing tlmt he or she did not build or irn pr·o,·e the propc11y for the purvose of
sale).
_I. as O\vnt::rofthe propctty. am exclusi,1ely contrnc1ing with licen!.ed contractors to conslruct the project (Sec. 70.M. rl11s iness
.ind Profession Code: The Con1rnc1or's License Law does not apply 10 nn owner of properl y who builds or impnwr.:s th r.:rcon .
.ind who contracts for such projects with a C'ontraclor(s) licen sed pursuant 10 the Con1 rn c1or·s Li cc11se Law).
_I am exempt under Section ________ . B. & r .C. for this re:-isun
U:llc : __________ Owner: _______________________ _
WOIU<ERS' CO,\I l'ENSATION
DEC L ARATION
I hereby affirm under pctmltyof pcrjury one of1l ,e fo llowi11g dcclarntinns:
_I have and will maint ain a Ce11ilicnte of Consent to Self-Insure for workers· compens~11 io n. ns provided for by Sect inn .noo of the
Labo r Code. for the perfonmmce of the work for which the permit is issued.
_1 ha ve and wil l nrnin ta in workers· compensn ti on insura nce. ns required by Sect ion ., 700 of the Ln bor Code. for 1hc pt·rfon nance of
th e work for which this pennit is issued. M y workers· compcnsntion ins urnnce caiTicr mid policy number are:
Ca11icr: )j ....5",o:J:N,,( "-:J: /1..s.
Po licy Number:~ 1:;-lJ_Q_~7 __ i _/_"7_7~~/ ________ Expires :
_I ce1til)' 1ha1 in the pcrlOnnance of the work for which this permit is issued. I sh.ill no t employ ;rny person in nn y mmmcr
so as 10 become subject to lhc workers' compensal ion lnws ofCnlifornia. a nd ag ree that if I should become subject tu the
workers' eompcm.atio n provisions ofScc1ion 3700 o f the Lnbor ('ode. I shall. fm1 hwith comply with t hose pro\"isions ..
WARNING: Fai lure to secure workers' compensation rnvcrng.c is un lnwful. an d shall subject an employer to '-,·i111 i11:1l 1ximhics and
civil tines up to one hundred thousand dollars ($100.000). in addi 1ion 10 the cost of compensation, Ja1 11agcs as pm\'illed for the
Section 3076 of the Labor Code. interest nnd attomcy·s fees. ~ ... ~
Date: ___________ A1>1>lic.1nt:i •~;/~= /?,~ --~cr.-~,-~-~=::=----------
LIC:El"Sn-·oNTR-v'TOR
IV◄ 'I A (tA'.ffl)N
I hereby affirm under penalt y of perjury th at I run licenselunder r><1'vlsion of Chapter 9 tcommcncing with Sect ion 7000) of Divis ion 3
of the Business and Professions Co<le. and my license is in full force and effect.
License Ckiss: ______________ ,Liccnsc Nur::;nbc~·e."..----------------
Dalc: ___________ Co nlraclor:_}_P(~i.~:=_~_,A<'.'.'.':::::::_:~__..-;:;?:;;;::;~::..,,C:::::::==::::------
CONSTIIUC~~GENC\0
I hereby affi rm under pcnnlty of pe1juiy 11ml there is n constn1ct ion lending .ig.cncy for the pt.i·fonmmce oft he work fo r which I his pL·nnit i.-.
issued (Sec. 3097. C'iv. C'.),
Lcndcr·s Name: _________________________ _
Lender's Address: _________________________ _
A rrLICANT DECLARATION
I herebyaffim1 under penalt y of perjury one of t he following dcclarnt ions:
Demolition Pcrm it s~Asbcstos Not ification Federnl Regu lations (Title 40. Pm16)
_Required Letter of Notification
_I cet1ify 1lrn1 the fcdernl rcg ulnlions regarding asbcs1os rcmovnl nre 1101 .ipplicnble to this project.
_I CL.11ify that I have read this application and state that the alxwc info rmatiun is co n-ect. 1 agJ cc to comply wi lh :-i ll Ci1y nml Counly
01dmanccs and Strite Lm\S 1clatrn g to bu 1ld 111g constrnctmn. mid he1eby <wthonze 1ep1ese111.i11,cs ofth1s C'1ty aml Coun ty lo e111 er upon the
above men11011ed p1ope11y for mspect~oy"puq;,~ .
Appl1 c,mt or Age nt Signnl u re: f'.!./' / ~~ Da te // ... / 6 · / 6
Pcrmilce name (IH'int): ~ er~ ~L/ Lrl.LLt;,· "f---'''-'·,_,rc.._ __________________ _
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