HomeMy WebLinkAbout30136928 - PermitCity of Santa Ana 20 Civic Center Plaza (M-1 9), Santa A na , CA 92702 Plumbing Permit#: 30136928
Permit Counter: (714) 647-5800 Inspecti o n Requests: (714) 667-2738 Inspector Section: (714) 647-5853
Project Address: 1979 E Seventeenth St
Assessor's Parcel:
Owner:
Add re ss:
Phone :
Tenant Name:
Contractor :
Address:
Phone :
State Lie #:
Li e Type :
Bus. Li e #:
396-321-21 Lot:
Red Mountain Asset Fund LLC
1234 E Seventeenth St
Santa Ana, CA 92701
(714) 460-1563
Klaer Brittain Inc Dba KBI
2685 Dow Ave, Ste B
Tustin, CA 92780
(714) 832-5777
660424
B
4481
Workers' Compensation Insurance:
Carrier : State Compensation Insurance Fund
Policy #: 9039848
Expires: 01/01/2017
Building Use: Industrial Occupancy:
Unit: Bldg: Address Range:
Block: A Tract: A.B. CHAPMAN Historic: No
Fee Type
01116002 51602 New Sewer (First 100')
0 111 6002 51602 Gas System 1-"1
01116002 51602 Cap Gas Outlet
01 11 6002 51602 Water Service (Each 1 0
01 11 6002 5 1602 Primary/Secondary Roo
0 111 6002 51602 Backflo w > 2"
01116002 53602 P/C -65%
01116002 51600 General Plan Update
01116002 51602 I ssuance
M
Pin#:
S uite Range :
Zoning :
Amount Q t y
60.16 1.00
41.46 1.00
7.88 1.00
41.46 4 .00
41.46 2.00
41.46 1 .00
0.65 399.72
20.56 1 .00
51.26 1.00
Job Type : New Constr Type:
New com bldg/Roof mtd equCode:
Ill B , SPK
CPC 2013 Notes: FEES PD IN FULL ON M-68841
Nature of Work:
Planning Conditions:
Planning Approva l By: Date: Misc. Receipt:
Plan Checked By: West, Glen Date: 08/01/2016 Misc. Receipt:
Dat e: 12/13/2016 Misc. Receipt:
Accou nt# T o t a l
Pe rmit Issued By: (a Amsden, Julie
Subject to Field:
B uilding Perm it#· 10190033 N/A -No Balance
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 1 BO days after its
issuance, or if the work authorized on the site by such permit is suspended
or abandoned for a period of 180 days after the time the work is
commenced.
Inspector MID#: 2016-130088
68268
68841
Fee Total:
Paid to Date:
Balance Due:
18552
Fee
$60.16
$41.46
$7 .88
$165 .84
$82 .92
$41 .46
$259 .82
$20 .56
$51 .26
$731.36
$731 .36
$0.00
PLUMBING-INSPECTOR RECORD
APPROVALS DATE ID/SIG. COMMENTS
UNDER GROUND
Waste & Vent
Water-Under floor '1,,v ..
OWNER llUI LIJER IJELCARATION
I hereby affirm under penalty of perjury 1luu I am exempt from !he Contractors· License Lnw for the fo llowing reason (Sec.7031.5
Business and Profession Code): Any City or Coumy which requires a pt11nit lo construct. al ter, improve. dem olish or repa ir any
stmcture. prior 10 it s issuance. also requ ires the t1pp!icant for such permit to lilc a signed statement that he or she is fo.:ensed ' pursu ant
to the provisions of the Contrnctor's Li ce nsed Law (Chapter 9. Commencing with Section 70 00 of Divis ion .1, of the Busi ness and
Professions Code) or that he or she is exempt therefrom and the bas is for th e alleged c.xemp1ion. Any violat ion o f Sectio n 7031.5 by any
applicant for a pcnnit subjec ts the applicant lo il ci vil penalty of not more than fi ve hundred dolla rs ($500).
Ga s-Underfloor _, Ov"-"I \ / ~ )-1. as owner of the propcny. or my employees with wnges as their sole co mpens11tion. wi ll do the wo rk a nd lhc SlntC1lffC is oot
t--------------------1-------+------t--------+ .i.-.,-,a"l'--Fr--....-'J,/7 yb-'~r:,~'1rl'l,rJ int<,·ndt-d or orTered for sale (Sec. 7044. Busi ness rind Professions Code: The C'ontrnctor·s License Law docs not apply to an O\rncr or Buildina Sewer O .l ~JJJ' \·A~) '1:7 C O'f / the proJX.C>ftY who bui lds or improves thereon. am! who does such wo rk himself or herself or tl1rot1gh his or her own employees.
t-----""--=---'---=-----------1-------+------t-un--, 0.---.11,.l ,_le,~ 1/;.:.._ .-1id.,4'"'--:vl}'--"~, '\-t,;rl,'-->-£..-J provided that such improvements are not int~1ded or offered for sale. If. however. th e bui lding or im provement is sold ,,·it hin one year Area/Storm Ora in _.... ff.JI -\0 of completion. tl1c Owner Builder will have the burdt."11 of proving th.it he or she did not build or iin prove the pro1>e11y for the pltrpose of t----"--=-=--=-..:..:...:....:..:...:.-=...:....:=...:....--------1-------+-----'-l-------'-------~-,J.".:.._------I sr1lc).
lnterceotor/ Clarifier
TOP OUT
Waste & Vent
Water Pioina
Ga s Pipinq
Roof Drain
Tub/Shower Test
Rouah Water Heater
POOL/SPA
P-trao/Drain Line
Main Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heater/Ga s Line
Miscellaneous
Gas Service
Water Service
La w n Sprinkler
Sanitarv Sewer/Cao
Back Flow Device
Rough Plumbing
Final Gas Test
Meter Release
FINAL
Notes, Remarks , Etc.
I
I
I,
' \
_I. as owne r of the property. run exclu sively contrncting with licensed contrn ctors 10 construct the projcc.:t (St.'t'. 7044. I3us im.-ss
and Proft:SSion Code: The Contractor's Lice nse Law does 1101 apply to an ow11cr o f property who bu ilds m im prcwcs th ereon.
and who contracts for such projects wi1h a Co ntractoi1s) licensed pursuant to 1he Conlractor's License L1w).
_I am exempt under Section, ________ . 8 . & P.C. for this reaso n.
Date.; ___________ Owner ; _______________________ _
WORKERS' CO~I PENSAT ION
l>lcC L A RA TIQN
l hereby nffirm un der penalty of pc,jury one of th e fo llowing declarations:
_I have and will main tain a Certificate or Consent to Self-Insure for wof'kcrs· com1>e11s.1tio n. as pmvidcd fo r by Section 3700 o f the
Labor Code, for the pcrfon na nce oflhc work for wh ich the pennit is issued.
_I have and will m.tint~i}i.'';orkers· compensntion insurn ncc. a~ required bY. Sect io n 3700 of the Labor Code. ror th e perfonnance of
the wo2"ht this p~i ~~ iss11cd~My workJ\s _co~npcnsa~on insur"t~ carrier and poi!,numbcr ~
CmTicr .Fl r 6 . -,',M,+tJl/l~,,,,-;;f-f cv'l f-l.A1
\"' Policy Number:. _____________________ Exp ircs : __________ _
_I certify th al in the performa nce of the work for wh ich thi s permit is issued . I shn ll not employ ,my pe rson in any ma nner
so as to become subjccl lo the workcl's' co mpcnsnt ion laws of Ca lifornia. and .igree that if I should become subjecl to the
wo rkers' compensati on provisions ofSeclion .3700 of the Lnbor Code. t shall. forthwi th compl y with those provisions ..
WARN ING: Fai lure to secure workers' compeei~1s;11ion ·,n••.~:..ge Is . nlawfol. and shall subject an crnpl{'lycr to ai minill pcnalt~ and
civil fines up to one hundred tho usand dollars {$1 0 .000 ). in a z1tion to lhe ost of co mpensa tio n. da mages as pro\'ided for the
Sec1ion 3076 of the L~Cod~i,01 est and allorn s fees .
I ...-:)_ ,~, / -. I""-..
Dntc:c:7~ _,,_ Applicant:;_~P~--1-~'~,.·~--------------
LICENSEI> CONTRACT OR
DECLARATI ON
I hereby affirm under penalt y of perjur y that I am licensed under provision o rrh~pter 9 (commencing, wilh Sec tion 7000 ) of Division 3
of the Busm~nfessions Code, and my license i~~•nd effect._. ti~ u
Li ccnseC'loss~ A /L_Li censcJ:~ 6 -:,_
Date; ( ,:;;;-I L;,,-l 6 Conlrncto1 .. _ --= -_·w~_,:z_:.._==·---------------
CONSTRUCTI ON LENUING AGENCY
I he reby amrm under penalty of pe1j ury th.it there is a c<mstmction lendi ng agenc y for the pcr fonnancc o r1 hc work for which th is pcnnil is
issued (Sec. 3097, C iv. C.).
Lend er's Name: _________________________ _
Lendcr·s Address: _________________________ _
APPLICANT DlcCLARATI QN
I hereby aflinn under penally of perjury one or the fo llowing declarm ions:
Demolition Permits-Asbestos Notifica tion Federal Reg ulat ions (Title 40 . Pa116)
_Required Leller of Notificatio n
_I cer1 ify that~he federal regL ons re gardi ng a l:x:stos removal are no t app lic.ible 10 th is project.
_I ct.,1ify that I have re his application and st;II tha9 the i1 ', infonnation is co11"cct. I agree lo comply with all C'ily a nd Cou nty
ordinan ces and Stale L 1s relat in~ to build ing con. 11ctio11., •reby aut hor ize reprcscnl.llivt.-s of th is Ci ty and Co17?,n1y t enter uihe
above mentioned pro e11y for inspection purpos . '2' ' V
I · ~o
Applica111orAgenl ~1gm11u1 . // D:t le:...,,-~------
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