HomeMy WebLinkAbout10190034 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building Permit#: 10190034
Permit Counter: (714) 647-5800 Inspection Requests: (714) 667-2738 Inspector Section: (7 14 ) 647-5853 Pin#: 16835
Project Address: 1979 E Seventeenth St Unit: Bldg: Add ress Range: Suite Range :
Assessor's Parcel: 396-321-21 Lot: Block: A Tract: A.B. CHAPMAN
Building Use: Industrial Occupancy: u
Job Type: Miscellaneous Constr Type: VB
Nature of Work: Trash enclosure Code: CBC 2013
Existing Bldg. & Use: Flood Zone: X-0602320164J
Proposed Use: # of Stories: 1
Description of Work: Trash enclosure. FEES PD IN FULL ON M-68841
Planning Conditions: All materials to match existing
Owner: Red Mountain Asset Fund LLC
Address: 1234 E Seventeenth St
Santa Ana, CA 92701
Contractor:
Address:
Klaer Brittain Inc Dba KBI
2685 Dow Ave, Ste B
Tustin, CA 92780
Phone: (714) 460-1563 Phone: (714) 832-5777
Tenant: State Lie#:
Lie Type:
660424
B
Bus. Lie#: 4481
Workers' Co mpensati on In surance:
Carrier: State Compensation Insurance Fu1
Policy #: 9039848
Expires: 01/01/2017
Planning Approval By: Pezeshkpour, Ali Date: 10/28/2016 Misc. Receipt:
Plan Checked By : 0: Heidari, Fred
Permit Iss ued By: Amsden, Julie
NPD ES ln sp. Req' ~ No
Date: 10/27/2016
Date: 12/13/2016
Subject to Field:
Misc. Receipt:
Misc. Receipt:
PWA lnsp. Req'd : No Fire lnsp. Req'd:
Planning lnsp . Req'd: Yes Poli ce lnsp. Req'd :
No
Yes
No
Account#
Landscaping lnsp. Req'd: No Flood Zone Cert. Req 'd :
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.
Inspector MID#: 2016-130088
N/A -No Balance
NIA -No Ba lance
Engineer:
Address:
Phone:
Lice ns e #:
Archi tect/
Desi~ner:
Address:
Ph one:
Li ce nse#:
68268
68841
Total
Historic: No Zon ing :
1st FL Area: Patio:
2nd FL Area: T.I.Area:
Other A reas: Yards Req'd:
Garage Area: Valuation: $2,500.00
Total: 0
Tildin Engineering
S Tuileh-Kooh
26501 Rancho Parkway , Suite 203
Lake Forest, CA 92630
(949) 421-0144
32261
RED Arcliitectural Group
Richard E Dell
3436 N Verdugo Road, Suite 200
Glendale, CA 91208
(818) 957-7765
11875
01116002 51 601 Permit Fee
0 1116002 53600 Plan Check Fe e
01116002 51612 Bldg . Stds. Revolving
01116002 51600 Gene ral Plan Update
01116002 51601 Issuance
Fee Total:
Paid t o Date:
Balance Due:
$149 .25
$206.9 1
$1.00
$20.56
$51 .26
$428 .9 8
$428.98
$0.00
SITE-WORK DATE ID/SIG.
Set Bac ks
Fo rm s/Steel/Holdowns
Erection Pad s
UFER Ground
S LAB Fl oor }~.Lb
Su bfloor/V ent/1 nsu lation v v
Roof Sheathinq
Shear W a ll
Framinq
lnsulatio n/Enerav
D rywa ll
Ext.lint. Lath
Brow n Coat
Ma sonry
Pool Fence
T-Bar
Handica p Re q .
Deputy Fin a l Repo rt
Enq ineer Fin a l Rep ort
Fl ood Zone Ce rtif.
FI NAL
Certificate of Occu pancy
Not es, Rem a rks, Etc.
BU I LDI N G-INSPECTOR RECORD
COMMENTS OWNER B UILDER DELCARA TION
I hereby affirm under penalty of perjury that I am e:'<.empl from the Contractors· Li cense Law for the following reason (Sec.7031.5 ""
Business and Profession Code): Any City or County which requires a pennit to construct, alter, improve. demolish or repair any
structw-e. prior to its issuance. also requires the applicant for such pennit to file a signed s tatement that he or she is licensed J!Ursuant
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 that he o r she is exempt therefrom and the basis for the alleged e.,cmption. Any violation of Section 7031.5 by any
applicant for a pennit subjects the applicant to a civil pena lty of not more than five hundred dollars ($500).
_1. as owner o f the propeny. or my employees with wages as their sole compensation. will do the work and the structure is not
intended or offered for sale (Sec. 7044. Business and Professions Code: T he Contractor·s License L1w does not apply to an owner of
the property who builds or improves thereon. and who does such work himself or herself or through his or her own employees.
provided that such im provements are not intended or offered for sale. If. however. the building or improvement is sold within one year
of completion. the Owner Builder will have the burden of proving that he or she did no t build or improve the property for the purpose of
sale).
_I, as owner of the property. am exclu sively contracting \\1th licensed contractors to construct the project (Sec. 7044. Business
and Profession Code: T he Contractor"s License Law does not apply to an owner o f property who builds or improves thereon.
and who contracts for such p rojects with a Contractor(s) licensed pursuant to the Contractor's License Law).
_I am exempt under Sect ion ________ . 8. & P .C. for this reason.
Da te: __________ Own cr:_~--~~--~-~-------------
WOR KERS' COMPENSATION
DECLARATION
I h ereby affirm under penalty of pei j ury one of the following declarations:
_I have and w ill maintain a Certificate of Consent to Self-Insure for workers· compensat ion. as provided for by Section 3700 o f the
Labor Code. for the performance oft he work for which the permit is issued.
_I h ave and w ill main~a· ,•o rkers· compensation insurance. as requ~'red b)'. ection 3700 of the Labor CF;(de, fi r he performance of
the wor"')"t\th~his p nit is issued~1.:._ ,~o~k7\ compen~ ~uran c;gtrrier and po1?~1~ber are~
Carrier:--,/ r J 'CVJ,11'°~ Yc+t Hin _, --r
Policy Number: Expires: __________ _
_I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner
so as to become subject to the workers' compensation laws of California. and agree that if I should become subject to the
workers' compensation provisions of Section 3700 o f the~a de, I shall. forthwith comply with those p rovisions.
\VARNING: Failure to secure workers' compensation...,a erngef/ii.unlaw I. and 1a1l subject an c..>tnployer to criminal penalties and
civil fines up to one hundred thousand doll~2?·000). in a • itio n th t of compensation. damages as provided for the
Sectio\076 of the Labor Code. interest and attrey's fees. ~ __
Date: ,8-( ~-16 Applicii'iit: _ _,eU:__: __ '-:___--_ ~-------
LI CENSED CONTRACTOR
DECLARAT ION
I hereby affirm under penally of perjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) o f Division 3
or the Busin~ Professions Code. and my li cense 7.U,t.
License Class , Li cense Nu~f:h (j ti~ L/
Date: J;;) ; f,::;--) h Contrn,:1:0;,,::=~=~-~·::::::::::::... ___________ _
CONST RUCTION LENDI NG AGENCY
I hereby affirm un der penalty of pe1jury that there is a construction lending agency for the perfom1at1ce of the work for '\Vhic h 1his permit is
issued (Sec. 3097. Civ. C.).
Lender's Name: _________________________ _
Lender·s Address: _________________________ _
APPLICANT DEC LARATION
I hereby affinn under penalty o f perjury one of the following dec larations:
Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6)
_Required LellerofNotification
_I certify that the federal regulations_r_eearding asbestos remo,,al are not applicable to this project.
_I certify that~~have r th is appli catiognnd s le that the above infonnation is correct I agree to comply with all City and County
ordinances and Stal ws relating to building ~st:cti?d hereby authorize representatives of this City and County 10 enter upon the
above ment ioned . roperty ro, inspect ion p ~ (;;I rn-lb
Applican t or Agent Signature:... ~ ,--~ --. ..-J f ________ _ ,r--:--=. _j_j1,,,a
Permitee name (print):_~~),}_~~ -~--~~~'.SJV~ -"'Ad.,~~~~~-----------------•