HomeMy WebLinkAbout10489282 - PermitCity of Santa Ana
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20 Civic Center Plaza (M-19), Santa Ana, CA 92702 · Building Permit#: 10489282
Permit Counter: (714) 647-5800 Inspection Requests: (714) 667-2738 Inspector Section: (7 14) 6 47-5853 Pin#: 81716
Project Address: 121 E Washington Ave Unit: Bldg: Address Range: Su ite Ra ng e:
As-;;essor's Parcel: 398-132-06 Lot: POR 10 Block: G Tract: GOODWIN ADD Histori c: No Zoning : SP3
Building Use: Commercial Occupancy: B 1st FL Area: Patio:
Jo b Type: Tenant Improvement Constr Type: VB 2nd FL Area: Tl.A rea: 600
Nature of Work: Tl/Demo/Restrooms Code: CBC 2013 Other A reas: Yards Req'd:
Existing Bldg. & Use: Commercial Flood Zone: X-0602320163J
Garage Area:
Proposed Use: Dental Office # of Stories: 2
Total: 0
Valuation: $30,000.00
Description of Work: Remove illegal demising wall that created Unit B. New partitions to create (2) new accessible restrooms, waiting area, & hallway on
1st Floor. New partitions to create storage, billing, & chart rooms on 2nd Floor. e.atch~:36247 _ 1l/l'.:i/:20.l 6 ID: F'LOPEZ::,
Planning Conditions:
Owner:
Address:
Phone :
Rosalva Garcia
121 E Washington Ave
Santa Ana , CA 927013779
(714) 392-1276
Contractor:
Address:
Phone:
Sky Blue Construction
24000 ALICIA PKWY #17367
Mission Viejo, CA 92691
(949) 422-3419
Ofi ice~ CTYH Tran st: i6 2 of 5
ikd.:: Ref~: .l u429282
Engineer: Jeffrey JtjnsJ_J ~ ~fji}~i~' -: 1l / i ':,/2016 .-q: ~•i-. erl
Jeffrey Cra i§1!n)ffss'di1' iot.a.l !bU6/.IJ . .1
Address: 946 Call 8i:~gt a9ns:~r Construct.ion
San Clemente, CA 92673
Phone: (949) 412 4aS5th ,1 Plan UP date :=ee
Li cense #:
~
Tenant: Dr Rosalva Garcia, DDS State Lie#:
Lie Type:
987832
B
01116002-51600000-
Buildins ·Vi17.:l2
Planning Approval By:
Plan Checked By:
Permit Issued By:
NPDE S lnsp. Req'd : No
PWA ln sp. Req 'd: No
Planning lnsp. Req'd: No
Lan dscaping lnsp. Req'd : No
Bus. Lie#: 350542
Workers' Compensation Insurance:
Carrier: BENCHMARK INSURANCE COMPJ
Policy #: CST5007918
Expires:
Escamilla, Manny
So.Anson ~ /
Zuniga, Allissa I \V
03/16/2017
Date: 11/09/2016
Date: 10/27/2016
Date: 11/15/2016
Subject to Field:
Misc. Receipt:
Mi sc. Receipt:
Mi sc. Receipt:
Fire lnsp. Req'd: No
Police ln sp. Req'd: No Account#
Flood Zo ne Cert. Req'd: No
Every permit issued shall become invalid unless the work on the site authorized by
such permit is commenced within 180 days after its issuance,or i f the work authorized
on the site by such permit is suspended o r abandoned for a period of180 days after
the time the work is commenced.
01116002 51600
01116002 51601
01116002 5161 2
01116002 53600
01116002 57770
Inspector MID#: 2016-128828
Architect/ Salemi &1:P.i'eiz:ti@stgrfs\.60i000-
8ids 3tds Revolving $2. 00 DesiQner:
Address:
Phone:
Li cense #:
68028
Total
$20.56
$517.12
$2.00
$204.00
$52.50
73 Garrisob~~cS8~2-. 51.· 61201.10-
r· I t,l -n l .d..i r ~ Lad era R~~Ch,, c.~.:1..:~-::1:4 . . . ,-
(949) 320'~'13 3's:i UU..:-':.1 ~".l.!Utt1.1,_t-
fT 1 ,_rot d m e. Do,:un'1er. ts
·$204. 00
01116002-57770000 -
:p,._ "'-07 ~ _ ._(
01116002:'s,p00:1H Permft-Feei 38
01116002 53600 Plan Check Fee
riuthi': U$'Mi M 25
01116002 57770 Microfilm Records
01116002 5 1601 Investiga tion
01116002 51601 Pena lty
01116002 51612 Bldg . Stds. Rev olvi ng
01116002 51600 Genera l Plan Upd ate
01116002 51601 Iss ua nce
Fee Total:
Pa id to Date:
Balance Due:
$396.00
$52.50
$90 .14
$226.47
$2.00
$20.56
$5 1.26
$988.18
$192.00
$796.18
SITE-WORK DATE ID/SIG.
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subfloor/Vent/lnsulation
Roof Sheathing
Shear Wall I
Framinq
lnsulation/Enerqy I
Drvwall
Ex t.lint. Lath f
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req . ,
Deputy Final Report
Enqineer Final Report
Flood Zone Certif.
I I
FINAL
Certificate of Occupancy
Notes, Remarks, Etc.
_BUILDING-INSPECTOR RECORD
COMMENTS OWNER BUI LDER D EL CARATION
I hereby affirm under penalt y or perjury that I run exempt from the Contractors· License Law for the following reason (Sec.703!.5
Business and Profession Code): Any City or Cou nty which requ ires a pennit to cons1ruct. alter, improve. demolish or repair any '
structure. prior to its issuance. also requ ires the applicant for such pennil to file a signed statement that he or she is licensee'. pursuant
to the provisions of the Contractor's Licensed Law (Chapter 9. Commencing with Section 7000 of Division 3 of the Business and
Professions Code) or th at he or she is exempt t herefrom and th e basis for the all eged exempt ion. Any violation of Section 703 1.5 by any
appl ica nt for a pcnnit subjects the applicant to a civil penalty of not more than five hundred doll ars ($500). 6
_I. as owner of the propeny, or my employees wi1h wages ac; their sole compensation, will do the work and the stnicture is not
intended or offered fo r sale (Sec.7044. Business and Professions Code: The Contractor's License L,w does not apply to an owner of
the property who bu ilds or improves thereon. and who does such work himself or herse lf or through his or her own employe~
provided that such improvements are no t intended or offered for sale. If. however. the building or improvement is sold ,~thin one year
of comp letion, the Owner Builder will have the burdc;..11 of proving that he or she did nol buikl or improve th e property for the purpose of
sale).
_l. as owner of the property. am exclusively contracting with licensed contractors to constnict the project (Sec. 7044. ,Business
and Profession Code: The Contractor's License Law does not appl y to an owner of property who builds or imp roves I hereon.
and who co ntracts for such projects with a Contractor(s) licensed pursuant to the Contractor's License Law).
_lam exempt under Section, ________ . B. & P.C. for th is reason.
Date : __________ Own e r : _______________________ _
WORKERS' CO~IPENSA TION
D ECL A RA TION
I hereby afflrm under penalty of perju ry one of th e following declarations:
_I have and will maintain a Certificate of Consent to Self-Insure for workers' compensation. as provided for by Section 3700 o f the
Labor Code, for the perfonnance of th e work for which t he pcnnit is issued.
_I ha ve and will maintain workers· compensation insurance. as requ ired by Section 3700 of the Labor Code, for t he perfonnance of
the work for which this pe11nit is ,issued. M y workers' compensation insurance carri~r and policy ~bcr are:
Carrier 'i" t e, YJCh }tjar JC -~Sv 'f"CW1L e, (__{lvV ~ .
Policy Num ber c 5 r S:-00 -::f 91 f: Expires~U ~//5,/; 7
_1 cenify th at in the perfonnance of the work for whic h this penn it is issued. I shall 1101 employ any person in any manne r
so as to become subject to the worktTs' compensation laws of Cali fomia. and ag ree th at if I shou ld become subjecl to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall , fonhwith comply with those pro visions.
\VAJtN ING: Fail ure to secure wo rkers' compensation coverab~ is un lawfu l. and sha ll subject an employer to crim inal penalt ies and
civi l lines up to one hundred thousand dollars ($100.000). i~l ~ddition to the co.st of compensation. damages as provided for the
Section 3076 of 1hc Labor Code. interest and attorney'\ fc;5.
Date; :!oU✓ it;' -[ l Appli can .. t.:a, X~-'c::\J;J\:-::::=-7==,--------------,f!/J ,;.~NSED ~ NTRACTOR
DEC LARATION
I hereby affinn under penally o f perjury that I run licensed un der provisi on ofChapler 9 (commencing wil h Sec1ion 7000) of Division 3
of the Business and Professions Code, and my license is in full force and effect.
:-,.,,.___,,..,.,<'2 >'7 tfOJa--:1.02"
Li cense Class:~µ.-L_I_>L_·..:::...7~(h=c__----'r-License Number: __ .._/ __ , __ C>---'CJ;;...._'-' ______ _
Contrae10Y J-zry(..-{; I/) <-C,j,_ i} -V 7
CONSTRUCTION LENDI NG AGENCY
I hereby affirm under penally of perjury t hat there is a construction lending agency for the perfonnance of the work for which this pennit is
issued (Sec. 3097, Civ. C.J.
Lender's Name: _________________________ _
Lender·s Address: _________________________ _
APPLICANT DECLARATION
I hereby affinn under penalty of perjury one of the fo llowing declarat ions:
Demo li1ion Permits-Asbestos Notification Federal Regulations (Title 40, Pan6)
_Required Letter of Notificatio n
_I certify that the federal regulations regardi ng asbestos removal are not applicable to this project.
_I cen1fy that I have read tlus apphcauo /'Jnd state t hat the above mfonnauo n 1s correct I agree to comply wuh all Cny and County
ordmanccs and State Laws relat;fng buil d,~}-constru cuon. and hereby authonze representatives o f th1s Cny and County to enter upon the
above mentmned prope1ty for lfl ct1on Ir _ ,r
Applicanlor Agent Signalure ~~ . Da le ,{/C1(; -/[-/£, '7' ,;-: /'·(·
Permitee name (p rint): ,,,,..,,-,· Z6J ,I. Vi l-C(II. { )
C. J