HomeMy WebLinkAbout30137499 - PermitCity of Santa Ana 20 Civic Cente r Plaza (M -19), Santa Ana , CA 9 27 02 Plumbing Permit#: 30137499
Permit Counter: (714) 647-5800 Inspect io n Requ e sts: (714) 667-27 3 8 Inspector S ection: (714) 64 7-5 85 3 Pin#: 37916
Project Address: 2541 S Fairview St Unit: Bld g : Address Range: Suit e Ra nge:
A ss essor's Pa rc el: 414-051-14 Lot: POR 12 Block: NA Tract: 9505 Hist ori c: No Zoni ng: C4
Owner :
Add ress:
Ph one:
Tenant Name:
Contractor :
A ddress:
Phone :
St ate Li e #:
Li e Type:
Bus. Li e #:
FARMERS & MERCHANTS
1631 N BRISTOL ST 312
Santa Ana , CA 927063330
(714) 549-2288
Pizza Hut
Frassica Plumbing Services
580 Malloy Court
Corona, CA 92880
(951) 817-5252
519059
C-36
362974
W o rkers' Com pe nsati on In surance:
Carrier : Employee Service Group
Poli cy #: RWCC48807331
Expires: 04/01/2017
Building Use: Occupancy: B
Fee Type
0 111 6002 5 1602 Add'I Sewer Co nnection
0111 6002 5 1602 Grease/Wast e Interce pt
01 11 6002 53602 P/C -65%
0 111 6002 51600 Ge neral Pl a n Up date
0 111 6002 5 1602 Iss uance
Amo u nt
20.73
34.98
0.65
20.56
51.26
But ch~:?6633 -12/14/2016
Q t y Fe e
1 .00 $20.73
1 .00 $34.98
55.7 1 $36.2 1
1 .00 $20.56
1.00 $5 1.26
ID: iKiAF:CU:
Offi ce: CTYH Trans~: 41 1 o r 2
Acc t~: F:er~: 30137 499
RcPt~:01689235 -12/14/2 016 10:46 AM
Tra nsaction Total $155.49
Fr assica Plumbins Services Inc
Gen eral Plan UPdate Fe e
0 1116002-51600000-
F'lu ll'l b i ng
0 1116002-51602000-
P/C: Plumb ing
0 1116002-53602000-
11uster Cui'd
cc~:************6732
$106.97
$13. 1.;.7
J ob Type:
Nature of Work:
Commercial
Alteration
Grease Interceptor
Con str Type:
Code:
VB, SPK
CPC 2013 Notes : Grease interceptor
Planning Conditions:
Planning A ppro val By: Escamilla, Mann y Date:
Plan Checked rcr· W est , Glen
Permit Issued : y: Am s den , Juli e
Subject to Fie ld:
Date:
Date:
Building Permit #:
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 180 days after its
11/22/2016
12/08/2016
12/14/2016
A ccount#
0 111 6002 51600
0 111 6002 5 1602
01116002 53602
issuance, or if the work authorized on the site by such permit is s uspended
or abandoned for a period of180 days after the .time the work is
commenced.
Inspector MID#: 2016-1 3 3026
Mi sc. Rece ipt: 6888 7
Misc. Rece ipt:
Mi sc. Receipt:
T ota l
$20.56
$106.97
$13 .4 7
Fee Total:
Pa id t o Date:
Balance Due:
$163.74
$22.74
$141.00
APPROVALS DATE
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underfloor
Buildina Sewer
Area/Storm Drain
lnterceotor/ Clarifier
TOP OUT
Waste & Vent
Water Pioina
Gas Pioina
Roof Drain
Tub/Shower Test
Rouah Water Heater
ID/SIG.
I {I V
PLUMBING-INSPECTOR RECORD
COMMENTS OW NER BUILD ER D llLCAllATION
l hereby affirm un der penalty of pe1j ury th.it I run exempt from the CCln lrit clors· License Law fo r the fol lowing rcasCln (Scc.703 1.5
Business and Profession Code): Any City or County wh ic h requi res a pcnnit to construct. alter. im prove. dc111olish or repair any
stru cture, prior 10 its issu an ce. also req uires l hc .ippli ca rll fo r such pem1i1 to li le a s igned statement that he or she is li censed pu rsuant
to the provis ions of the C'ontrnctor's Licensed Lnw (Chapter 9. Commencing with Seel ion 7000 o f Divis io n ~ of th!! Business a nd
Professions CodcJ o r that he or she is exempt therefrom and the basis for the alleged C:<em pl i on. Any violation of Section 703 1.S by any
applicant fo r a permit subj t.--cts the applkanl to a civil penalty of not more than five hundred doll ars ($500).
_I, a.<; own er of the property. or my e mployees with wngcs ns IIH.:ir sole compensat ion. will do the work and the strucrnrc is not
intended or oITercd for sale (Scc.7044. Business an d Professions Code: The Contrnctor·s License Law d or .. "'S 1101 npply tu ;in ('lwner of
the pmpt,ty who builds or improves thereon, and who docs such wo rk h imself or herse lf or 1hrough his or her own c111plo)CCS.
provided l hnt such improvemenls .u-e not intended or offered for sn lc , If. however. the bu ildi ng or impro\·cment is sold \\'ith i11 011e year
of comple1 ion. the Owner Bui lder will liavc the bur d<;,-n of proving chat he or she d id no! build or i mprove the propcit y for the pu rpo se of
sale).
_I. as owner o f the propet1y, am exclusively contracting with licensed con1rac1oi-s to conslruct t h e p roject (Sec . 7044 . B usiness
and Pmfcssion Code: The Con1 ractor·s License Law does not a pply to an owner ofpropr11y who bui lds o r improves I hereo n .
and who c onlrncts for such projects w ith a Contrncl or(s) licensed pursuruH lo the Conlr:ic1o r·s License Law).
_I run exempt under Section, ________ • 8. & r .C. fo r this reason
O ,ue: __________ Own er: _______________________ _
WORKERS' CO~ll'E NSAT IO N
DECLARATION
I hereby affirm under penc1hy ofpt.'"ljury one of the fo llowing declarat ions:
_I have and will maintnin a Ce11ificate of C o n sent to Self-Insure for workers· com pensat ion. as provided for by Scr1 ion .HOO o f the
Labor Code. for t he perfonnance oft he work for which the permit is issued.
_kftrnve and will maintain workers' compensation insurance, as required by Sectio n 3700 oft he L.ibo r Code . for the pcr fonnance of
the work for which this pcnnit is issued. My workers· compcnsmion ins urance cnn·icr .ind policy number nre:
1-----------------i-----+-----1-------------'-',jVcanicr:l:k e A WI e,, C.Ct .,.__ \ V\ <;, V -i-c. "'' e ( o '"""-?'°'" • /
POOL/SPA , Po licyNum ber KW C CLf &<go 7 ?::>31 Exp ires 4/.../11 1--__;_.....;_;_;_;_..:.,_ _________ I--------I-------II------------------A I
P-trao/Drain Line _I ce1tify that in t he performance oft he work for which this permit is issued. ( shall not employ ,my per son in nn y manner
so ns to become subject to the workers' co mpens.uio n laws o f Cali fornia. and agree that if I should become subject to the Main Ora in/Poo I Pi oina workers' compensation provis io ns o f Section 3700 of lhc LnOOr Code. I shall , fo 11h wi1h co1nply with those provis iOl lS ..
Fill Line/Back Flow
Pool Hea t e r/Gas Line
W A R N I NG : Failu re to secure workers' compe nsation ccwern.gc is tmla\\'ful. and s hall subject an cmpk1ycr In c.,imina l fX.'.n.11\ies and
ci\1il fines up to one hundred thousand dollars ($100.0 00). in add ition to the y 1 of cc11npensation. damnges ns p nwided for the
Section 3076 of the Labor C'odc. inter est and attomey's fees. ,..-?' [;,' I;)../ / . -;::,::,,,-•/-y
t--------------------1---------if--------f------------------,I\. Dal e: I •t / f lo Ap1>li cant:. ____ ,..-:.,c:.·/ __ /~"--.::.·•_c_. __________ _
Miscellaneous , "· urnNs ED,e:6NTJMt:rnR
t--------------------1---------if--------f------------------l DEtLAIM JO N Gas Service I h ere by affirm under penally of perjury that I nm li censed under provision of Chapter 9 (conuncncing with Secti on 7 000) of D ivis ion 3
o f the Business and Professions Code. and my lic ense is in fu ll fo rce and effect.
Water Service c.. 1-_ r ~ 'QC. _,:-;-cl, Law n Sorin kier cense Class.:_ ----="---~~..c..._,1/4,=_ _____ Licensc Number: _ _..;:...,;;.....1e( _ _1_.,_-=.....;;a;_....:. ____ _
Sanitary Sewer/Cao / r\ IJnlc:
1
)_,/ \ '\ { \ \o Conlrnclo r .: ___ ·,,_~:,,_,·;,:_J-_,_7c_.'.;...-~---------l-=-=:.:::..:.....t.-=-=:....:..:...::..:..:....:=..=.c:.... ___ -l-------l-------1------------L-11 \ /_/--i
Back Flow Device coNsmun10; ;EN i~
1
Ac ENcv
Rouah Plumbina
Final Gas Test
Meter Release
FINAL
Notes, R e m a rk s, Etc.
I hereby a ffir m under penalty of petjury tlmt there is n cons1mctio11 lcndi11g .igency for the pcrfonuancc c,f the W(l r k fi.ir which this permit is
issued (Sec. 3097. Civ. C.).
Lender's Nmne: _________________________ _
Lender's Address: _________________________ _
A l'l'LJC A NT DEC LARATION
I ht..'"rcby affin n under penalty o f perjury one of t he following declarations:
Demolit ion Pcnnits-Asbestos Notificaiion Federal Regulation s (Tit le 40, P:ut6)
_Requ ired Leiter of No tificatio n
C, ·ys _, 7 -I A-14 J._, d. 1 A I I =-1..S . €) Cl~ ,t")+1,) £,.... { ..f<; t; n..l t I,) A-rev<-JL,f_.t:-_I ce,tify lhal 1he federal reg ul at ions regardi ng asbestos rcmov•I •re 11 01 app licable to t his project.
/,)..,,__r-,A_ ,Ao ..t J...J,,,,-· Lll-v /.:.~~£.... K ~ /_ -• J o' / '1.h J J.e <'1!2.../-,; M -' ce11ifythat I hnverend lh isnpplication and stnlclhal thc.iOOvc infonm1t io n is con·ect. I a grt"ClO comply with .ill C ity a nd County
~ -\..,/" mdmanccs and State Laws relating to bu1khng COll'>lrnctron. nndz 1ere y ;m lm1ize reprcsentall\cs of1l11s C it y .ind Cou nty 10 Clllt:r upon the
1--------------------1-------+------J-------------------~~ above 111e1111ont:d p1operty for inspection pm poses I t
\-....,_ • . ,-~ --· . l Z //,/ / {
1--------------------1-------+------t-----------------/--J(/A pplicanl or Agen t Sig 11 alure: J_../ V/ ~-~ ~. n Dal e ~
'ermilee m1111e (p rinl): ,.;•••''/..,. ~o. \)tr\ es ~c r &V\.e~
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