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Home My WebLink About40430593 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana , CA 92702 Mechanical Permit #: 40430593 Permit Counter: (714) 647-5800 Inspection Requests: (714) 667-2738 Inspector Section: (714) 647-5853 Pin#: 32908 Project Address: 121 E Washington Ave Assessor's Parcel: 398-132-06 Lot: POR 10 Owner: 1 ddress: Phone: Tenant Name: Contractor: Address: Phone: State Lie#: Lie Type: Bus. Lie#: Rosalva Garcia 121 E Washington Ave Santa Ana, CA 927013779 (714) 392-1276 Dr Rosalva Garcia, DDS Sky Blue Construction 24000 ALICIA PKWY #17367 Mission Viejo, CA 92691 (949) 422-3419 987832 B 350542 Workers' Compensation Insurance: Carrier: BENCHMARK INSURANCE COMPANY Policy#: CST5007918 Expires: 03/16/2017 Building Use: Commercial Occupancy: Job Type: Constr Type: Unit: Block: G B VB Bldg: Address Range: Suite Range: Tract: GOODWIN ADD Historic: No Zoning: SP3 Fee Type Amount Qty Fee 01116002 51604 Bathroom Fan 28.42 3.00 $85 .26 01116002 51604 Penalty 226.47 1.00 $226.47 01116002 51600 General Plan Update 20.56 1.00 $20 .56 01116002 51604 Issuance 51.26 1.00 $51 .26 GiltLh~:362~1 -11/151/016 ID: PLOPEZ5 Uff1i.:e.; <.:-irH Tr-nn~;=~~ l.:::. ~:i of·~:; •~ccl ·t ~ !~eft: 40 ~,~1)~393 Rcri,~~U 1663~4.~ -1J:'l5/~Ci16 11::4 A!1 !1·f:.r,su,:t iof, ·icd.n.1 :L~:0,·)·t,,tJ:'.i 'k;,:-,r·u l f·.lar, Ui,dLil.•~ :~,~"= ·,~20 .. ':i:, u j_ J i 1~1 (1(1 L -~· -=,:i t ~-~U (i!J(i(I .. M i'lt:i:.!,,..1:1 i cnl ':fi31S2,, '?') Nature of Work: Tenant Improvement Tl/Demo/Restrooms Code: CMC 2013 Notes: 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. Planning Conditions: Planning Approval By: Date: Plan Checked By: Permit Issued By: Zuniga , Allissa Subject to Field: \>\) /Date: ·\ \'-' Date: 11/15/2016 Account# Building Permit #: 10489282 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 if the work authorized on the site by s uch permit is suspended or abandoned for a period of 180 days after the time the work is commenced. Inspector MID#: 2016-128828 01116002 51600 01116002 51604 Misc. Receipt: Misc. Receipt: Misc. Receipt: Total $20.56 $362.99 Fee Total: Paid to Date: Balance Due: $383.55 $0.00 $383.55 APPROVALS DATE ID/SIG. Appliances Metal Fire Place Evap Cooler Furnace Compressor Misc. Equipment Duct Work Pre-Insulation Insulation Smoke Detectors Installed Rough Ductwork Vents Toilet Room I Clothes Dryer Residential Range Other Hood Type I Hood Type II Hood Grease Duct Fire Damper Openings Installation F.D. Drop Test Above Hard Lid 11 I Above T-Bar Rough Mech. Final Test Meter Release I FINAL M:\WP51\Perm,t-lnspecuon Forms\Mechamcal-lnspector Record.doc 03.31 .06 MECHANICAL-INSPECTOR RECORD • COMMENTS Owner•Builder Declaration I hereby affirm under penalty of perj ury that I am exempt form the Contrnctors· Lice nse Law fo r the following reason (sec. 70 31.5 Business and Profession Code): Any City or County which requires a permit 10 construct. alter. improve. demolis h or repair any structure. prior to its issuance , also requires the applicant for s uch permit to file a signed statement that he or she is licensed pursuant to the provisiG.AS of the Contractor's Licensed Law (Chapt er 9, Commencing with Section 7000 of Divis io n 3 o f the Business a nd Professions Code) o r 1hn (hc or s he is exempt therefrom and the basis for the a ll eged exe mption .Any violation of Section 703 1.5 by any applicant for a pennit subjects the applicant to a civil pe nalty of no l more than five hundred d oll ars ($500). ' _I, as owner of the property. or my employees with wages as their sole com pensation, w ill d o the work and the structure is not intended or offered for sale ( Sec. 7044, Business and Professions Code: The Contractor 's License La w d oes not apply 10 an owner of the property who builds or improves th ereon , and who does such work himself or h erself or through h is or her own employees. provided "-Ii.al such improvements are not intended o r offered for sale. If. however. the building or im provement is sold within one year of~ompletion. the Ow ner-Builder will have the burden of prov ing that he or she not build o r improve fo r 1hc purpose of sale). _I. as owner o f the property, am exclusively contracting with licensed contractors to construct the project ( Sec. 7044., Busin ess and Profession Code: The Con tra ctor's L icense Law d oes not apply to an owner of property who builds o r improves thereon,., and w ho contracts for s uch projects with a Contractor(s) licensed pursuant to the Contrnctor·s License Law.). _I am exempt under Section ________ .. B. & P.C. for this reason. Date: _____________ Owner: _________________ _ WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perj ury one of the fo llowing dcclnrnt ions: _I have and will maintain a Certificate o f Consent to Self-Insure for worke rs' compensation, as provided for by Section 3700 of t he Labor Code. for the perfonnance of the work for whi ch the pcnnit is issued. _I have and will mainmin workers· compensat ion insurance. as required by Section 3700 of the Labor Code. fo r the performa nce of1hc =~~or,~;/:;;m~rti~;•? comp~~::•::;•;:po licy ;;~ p Poli cyNum:erC. $ ,r5QO"';:f-1/ 8 Exp ir~s: -0 3-//64 k (This section need not be compl ete d if th e pennit is for One hundred dollars {$100) or less)' _I certify that in the perfonnance of the work for which this pennit is issued. I shall not employ any person in any manner so as to became subject to the workers· compensation laws of California, 1 ~;:t 1 grc c tlm if l should become s ubject to the workers· compensation provisions of Section 3700 of the Labor Code, I sha~l/, rthwith comply wi1h those provisions .. Date: J)#IJ-/(-Jf, AppliY.¥,-, ·=-fl.''J=11 :::::' ~,::__ ______ _ -r I 11 WARNING: Failure to secure workers ' compensa tion coverage is unlawful. and shall subj ect an employer to crim ina l penalt ies and civil fines up to one hundred thousand d oll ars ($100.0()0).in addition to the cost of compensation. damages as provided fo r the Scct"ion 3076 o r the Labor Code, interest and attorney"s recs. LICENSED CONTRACTORS DECLARATION I hereby affmn under penalty of perj ury thnt I nm licensed u nd er provision of Chapter 9 (comm encing w ith Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force nnd e ffect. - License Class:_•_-'ff>"=.;,---------License Number 7 $, ;/-!3 5 L Date: AJ{JV -if:-/ b ContraJ 7 • J /J r{J..e_, //2i_ck ( ~ '.X-J~ CONSTRUCTION LENDING AGENCY I hereby aITinn under penalty of perjury that there is a construction lending agency for the performance of the work for which this pennit is iss ued (Sec. 3097. Civ. C.). Le nder's Name: _________________________ _ Lender's Address: _______________________ _ APPL ICANT'S DECL A RATION Demolit ion Permits-Asbestos Notification Federal Regulations (Title 40. Part 6) _ Required Lcttcro fNotifica1 ion _I ccrtiry that the fed ernl regulations regarding asbestos removal are not applicable to this project. _ I certify that I have read this application and stale that the above infonnation is correct. I agree to comply w ith all City a nd Count y ordinances and State L1ws ret·!~g to bu1 ldmg construction. and hereby authorize representatives ofthlS Cny a nd County to enter upon the :::~c:~n~~o:::n~~~/~,~~;c~o~~rp:ses 1 _ , -Da te. /llt/J,r/(-} 6 1;,, . I .Ii A l " ' Permitt ee name (printV:: • //J-,/1;. ./ (/) if ,//1 / -} /-.J'"'