HomeMy WebLinkAbout10189069 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building Permit#: 10189069
Permit Counter: (714) 647-5800 Inspection Requests: (714) 667-2738 Inspector Section: (714) 647-5853 Pin#: 49946
Project Address: 2121 N Grand Ave Unit: Bldg : Address Range: Suite Range :
Assessor's Parcel: 396-201-04 Lot: SEE COMMENTSBlock: A
Building Use:
Job Type:
Other
Alteration
Nature of Work: Roof Mtd Equip/Screening
Existing Bldg. & Use: SCHOOL/CHURCH
Proposed Use:
Occupancy:
Constr Type:
Code:
Flood Zone:
# of Stories:
Tract: S.A. GRAND AV
N/A
N/A
CBC 2013
X-0602320163J
Historic: No
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area:
Total: o
Zoning: R1
Patio:
T.I.Area:
Yards Req'd: O@O
Valuation: $151,200.00
Description of Work: Install (12) new roof mounted HVAC systems on 2-rear buildings for school. Per contract price. Auth on file.
Planning Conditions: Paint metal to match stucco
Owner: Santa Ana United Methodist Churc Contractor: Owner-Builder
Address: 2121 N Grand Ave Address:
Santa Ana, CA 927057021
Phone: (714) 542-2219 Phone:
Tenant: River Springs Charter School
State Lie#:
Lie Type:
Bus. Lie#:
Workers' Compensation Insurance:
Planning Approval By:
Plan Checked By:
Permit Issued By:
NPDES lnsp. Req'd: No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Landscaping lnsp. Req'd : No
Carrier:
Policy#:
Expires:
Guerra, Pamela
So,Anson \CV
Zuniga, Allissa
Date: 04/26/2016
Date: 11/20/2016
Date: 12/19/2016
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Fire lnsp. Req'd: No
Police lnsp. Req'd: No Account#
Flood Zone 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 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.
01116002 51600
01116002 51601
01116002 51612
01116002 57770
08901001 24000
Inspector MID#: 2016-128374
Engineer:
Address:
Phone:
License#:
Architect/
Desii:iner:
Address:
Phone:
License#:
68763
Total
$20.56
$648.26
$7.00
$7.00
$42.34
:!ic ~1..:;·1:i; :3,s1sg7 ~2/1 'i /2016
Uff":._e: (-.Yl-i ·,rGns:;!c: 60
A~:ct~: Ref~:
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ID: ERIJB.lL
1 of
1013':iO/)'/
Anderson,~tf,U§t_1,1_r;~I <;rgi!J~~i;_ ·$3, 041 . 6 ·,
Craig R Anderson
24632 San.;Juan ~v.em:ie.i#.240 net hod i st
Dana Point, CA 92629
(949) 4 70!~~?3•' ':'; ,}" l i.l.l) /~;~, ~. 0 t. r; F ;~r:,
SE 2609 ;:.i O :···:•JU,,· ·-'· c,,_11_,1_,1_11_1-•
,~•.-· . .:.t! I f13
;iJ.l1G002·
l' .. ' .. : : 1;,,
I, .. : .. : .,(,(12
1J.6(1]. )1)0-
~' Doi::urn,~n ts
_, 7T/U:J00 ··
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fl_;_ l .,•.)C,02· .. J.6J.'.2:JOO··
Chu
-· ' ·'
Autb;: ci~ti oo
$827.64
$7.00
$42.34
01116002 53600 Plan Check Fee
01116002 57770 Microfilm Records
08901001 24000 SMIP -Category 2
01116002 51612 Bldg . Stds . Revolving
01116002 51600 General Plan Update
01116002 51601 Issuance
Fee Total:
Paid to Date:
Balance Due:
$7.0 0
$20.56
$51.26
$1 ,552.80
$827.64
$725.16
BUILDING-INSPECTOR RECORD
SITE-WORK DATE ID/SIG. COMMENTS OWNER B UILDER DE LCARA TION .
I here by a ffi rm und er penalty o f perjury that I am exem pt from the Con1ractors· License Law for the following reason (Sec.703L5
Set Backs Business and Pro fession Code): Any City or County wh ich requires a pcnnit to const ruct. alter, improve. demolish or repair any
Forms/Steel/Holdowns
structure , prior to its issuance. also requires the ap plica n1 for suc h pennit to file a s ig ned slalemcnt that he or she is licensed pursuant
to the provisio ns o f the Cont ractor"s Licensed L1w (Chap1er 9, Commencing wi1h Section 7000 of Div is ion 3 of the Busine~ and
Erection Pads Professions Code) or that he or she is exemp t therefr om and the basis for the alleged exemption. Any violat ion of Section 7031 .5 by any
:lpplicant fo r a pennit subjects the appl jcant to a civi l penalty o f not more than fi ve hundred dollars ($500).
UFER Ground \
_I. as owner of the property. or rn y e mployees with wages as the ir sole compensation. will do the work and the structw·c is not ~
SLAB Floor intended or o ffered for sale {Sec. 7044, Business and Pro fessions Code: The Contractor·s License Law does not apply to an owner of
SubfloorNent/lnsulation
lhe pro perty who builds or improves thereon . and who does such work himself or herself or through his or her own employees.
provided that such impro vements arc not intended or offered for sale. If. hO\~ever, the building or improvement is sold within one year
Roof Sheathinq o f co mpletion, the Owner Builder will have the burden of proving that he or s e did not build or improve the propeny for the purpose of
sale).
Shear Wall _I. as owner of the propmy. am ex clu sive ly contra cting with licensed co ractors to construct the project (Sec. 7044. Business
Framino ~ -~-• '"• ~"'-'°'' Uroo" ,,. a,. om ''"'' •• '":\_r""' oOO .,,. "'Omero•«"'"-and who contracts for s\1ch projects with a Contractor(s) lict-nsed pursu to t he Contractor's Lic ense Law).
I nsulation/Enerqy
_t run exen/~her Sectio n \ . rfor th is re n.
Drvwall Da te : f c/j L~ Owner:\
Ext.lint. Lath • '( \V 'H'K F.I Ai:J:IO N ......
'-DE!;;L ARATi'QN
Brown Coat I hereby affirm under pe nalty of perjury one of the fo ll owing declarations:
Masonrv _I have and wi ll main tain a Certifi cate o fConscnl to Self-Insure fo r workers' compensation. as provided for by Sectio n 3700 of the
Po o l Fence Labor Code. fo r th e pcrfonnance o f th e work for whic h the permit is issued.
T-Bar _I ha ve and w ill main tain work ers · compensat ion insuranc e, as requ ired by Section 3700 of the Labor Code. for the pe..,-formancc of
the work for which this pennit is issued. My workers' compens ati on in surance carrier and policy number are:
Handicap Req. Carrier: r
Deputy Final Report Policy Nu mber: \ Expi res:
Enoin eer Fin al Reoort
_I certify that in the performance of the work for which this pcnnit is i ued . I shall not employ any person Ln any manner Flood Zone Certif. so as to beco me subject to the workers' compensation laws ofCalifom ia . .u agree that if l should beco me subject to the
workers' compensation provisio ns of Sect io n 3700 of the LaOOr Code. I shal forth with comply with !hose provisions.
w""'"' "''"" " = '••~• --~ """'"'· ~ ,~, _.,~ • -•~" """"' ~•"'" .a
I
civil lines up to on e hund red tho usand do llars {$100.000 in addition to th cost o f compensation. dama ges as prov ided for the
Sectio n 3076 o f •;1;bor Code, interest and nttom, v·s
FINAL li,f('/ J'J,,., -;_~-1.1.J-Date:' /'2-/ / '/ ( A pplica . ,.. ~ ' Certificate of Occuoancy , . -,.-v1...., I I I ICENSE . . T O R u --
DE!;;LA RATION
Notes, Remarks, Etc. I hereby affirm un der penalty o f perjury that J run Iii ~nsed under pmvision o f Chapter 9 (commencing. with Section 7000) of Divisio n 3
of the Business and Professions Code. and my lie !nse is in full fo rce and effect.
Lic ense Class: License Number:
Date: C ont ractor:
C O NSTRUCTION LENDING AG EN!;;Y
I hereby affi mt under pena lty of perjury that there is a construction lending agency fo r the per fo n nanc e o f the work for which this pennit is
issu ed (Sec. 3097. Civ. C.).
Lender's Name:
Lender· s Address:
{
~rrl 1cANT DE C LARATION
I hereby affirm under penall y of perjury one o f the follO\t ng declarnt ions :
Demolition Permi ts -A sbestos Notificat ion Federal Reg la1io ns {Title 40. Part6)
_Required Lett er o f Noti fication
-' =•'''"" .. ,-~"'""" ~ ;--·" ••• , ~, •• ,'" '"" """'
_I cert ify that I have read th.is applicat10n cl state that the bo \•C in fonnallon is correct l agree to comply with all City and County
~,o-.a So•o ~~ Oo ~,, _M ,o. • ... , ••·•-•~••--•= oCO~ '""" ="'' <o 000 """'"
above ment io ned p1o pc11y for u pcctton pu scs • ~fa.-
Applmrnl or Agent Signa h Da te -Z.. -
Permilcc na me (print ): ,
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