HomeMy WebLinkAbout40130134 - Permit1.
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Mechanical Permit#: 40130134
Permit Counter: (714) 647-5800 Inspection Requests: (714) 667-2738 Inspector Section: (714) 647-5853
Project Address: 1979 E Seventeenth St
Assessor's Parcel:
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone :
State Lie#:
Lie Type:
Bus . Lie#:
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 51604 O/D Pkg H/C
01116002 53603 P/C -65%
01116002 51600 General Plan Update
01116002 51604 Issuance
1 l
M
Pin#: 87173
Suite Range :
Zoning :
Amount Qty Fee
105.46 6 .00 $632.76
0.65 632.76 $411.29
20.56 1.00 $20.56
51.26 1.00 $51 .26
Job Type: New Constr Type:
Nature of Work: New com bldg/Roof mtd equCode:
Ill B, SPK
CMC 2013 Notes: FEES PD IN FULL ON M-68841
Planning Conditions:
Planning Approval By:
Plan Checked By: ([West, Glen
Permit Issued By: Amsden, Julie
Subject to Field:
Date:
Date:
Date:
07/31/2016
12/13/2016
Account#
Misc. Receipt: 68268
Misc. Receipt: 68841
Misc. Receipt:
Total
Building Permit #: 10190033 N/A -No Balance
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
Fee Total:
Paid to Date:
Balance Due:
$1,115.87
$1,115.87
$0.00
MECHANICAL-INSPECTOR RECORD
• APPROVALS DATE ID/SIG. COMMENTS Owncr-Buildi::r Declaration
I hericby affirm under pena lty of perj ury that I am exempt form the Contractors' License Law for the:: following reason (sei;.703 l.5 liusLnc:ss•
Appliances and Profession Codi::): Any C ity or Cou nty which rcquir~ 11. permit lO construct, a lter, improve, demolish or repair any structure, pr\f'r to Us
issuance, also r equires the applicant for such permit to file a signed stale ment that he or sht:: is licensed pursuant to the provisions of the
Metal Fire Place Com:ractor's Licensed Law (Chnpter 9 , Comme ncing with Section 7000 ofOi't'ision 3 of the Business and Professions Cuth:) or thal h,c o r
she is exempt therefrom and the basis fo r the alleged exemption .Any violauon of Se ction 703 1.5 by any applicant for a permit subj ects tht:: Evap Cooler applicant to a c ivil penalty of not more than five hundrl!d do llars (S500).
Furnace _1, as owner of t he property, or my employe(!S with wages as their sole compc::nsation, will do the work and the structure::~ not intended
or o ffered for sale ( Sec. 7044, B ll:iin ess and Professions Code: Thi: Contractor's Licensi: Law does not apply 10 an owner of the property Compressor who builds or impro vi:s thereon, and who does s uch work himself or herself or t hrough his o r her own employees, provic.h:d that such
improvements are no l intended or offered for sale. Jf, however, the building or improve ment is sold wit hin one year of complet ion, the
Misc. Equipment Owne r-Builder w ill have the burden of proving that he o r she not build or impro ve for the purpose o f sali:).
_J, as owner o f the propeny, a m exclusively contracting with licensed contracto rs to construct the project ( Sec. 7044, Busim:ss and
Profess ion Code: The Contractor's License Law does not a pply to an owner ofpropeny who builds or improves diere.on. u.nd who
Duct Work contracts for such proje cts with a Contractor(s) licensed p ursuanl to lhe Comractor's License Law.),
Pre-Insulation _I a nt exempl under Sectiou B. & P.C. fo r this reason.
Insulation Date: Owni:r:
Smoke Detectors In stall ed WORKERS COMPF.NSATION llF.C I.ARATION
I hereby affirm under penalty of perjury one o f the following d eclarat ions:
Rough Ductwork
-l have and will maintiiii n a Ce rtificate of Consent to Sdf-l nsure for workers' compensation, as provided for by Sec1ion 3700 o f the
Labo1 Cod e, for thi: performance of the work for which the pcrmiL is l:isucd.
_I have and will,main1~m• compensation insurance. as requir<d by S«1ion 3700 of1he Labo r Code. for the performa nce of the
wo rk '2Wch ,;is permit s issuro~~111'ier and policy n r are. c1 Vents
Carrier: .7J Cl / Cl/, -\\: -Toilet Room I Clothes Dryer
Policy Numbe r: Expires: Residential Range (This .iection need not be completed if the permit is for One ~J.Jndred d<ffl• rs {$100} o r less)
_t ce~ify 1ha1 in the performance of the ".'ork foitcf'is permit is is ued. I .shall 1101 employ any person in any mann_er so as to Other
became subjec t to the workers· compensauon laws o a llfo rma, a nd agr ~ t t 1f l should become subJt;ct 10 the workl.!rs
compensa~:visions of ::,on 3700 of 1he La r Code, J shall, fo'}i w~ with those provisions..
Hood Dai~\ ( "5'": ( b Applic.m -' -.
Type I Hood WARN ING: Failure to secure workers' compe nsation coverage is unlawful, and shall subject an 1.!mployer to crimimd p~nallil!S and c ivil
fines up 10 o ne hundred thousand dollars ($100,000),in a ddition to the cost of co mpensation, damages as provided for tht.: Section 3 076 of Type II Hood the Labor Code, interest a nd atto rney's foes.
G rease Duct LIO:NSl:D CONTRA!:;T ORS llEC:1.ARATtON
I hereby affirm under penalty of perj ury 1h•1 I am lice nsed under pr~~::,hapler 9 (commencing with Section 7000) of Division 3 of
the Business and B ns Code, and my licen.se is in full for and effect G 6 04 tJ. L/
Fire Damper L1ct.:ns c C lass: . L icense Number
,~-,~,,./ 6 ( _L IX. Date: Conlracrn,. -~-w -Openings
··-..
Installation C ONSTRUCTION u :NDING AG ENC"Y
I hereby affirm undl.!r penalty of pe rj ury that there is a construc tion lending agency for the performance of tht: work for whic h 1his permit is F.D . Drop Test issued (Sec 3097, Civ. C.).
Lender's Name.
L1.!nd1!1 's Address:
Above Hard Lid
APPLIC ANT'S Dt,:CI.ARATl(JN Above T-Bar Demolilion Permits-Asbestos N otifi cati on Federal Regula 1ions (Title 40, Pan 6)
_ Required Leth:r of Notificatio n _, _,, ..... z·ij·-.. ·--···-·--"·" .. ~ •·""" Rough Mech. II\-\ a..-\ l UJ,~~ /~)
_ l certify •11::; ve read this applica11on d state 1ha1 the above mfo rmauon is corr«L I agree 10 comply wllh all Cny a nd Cuumy Final Test -ordinances and late Laws rela1mg lo buildi :;;;;t,,• and hereby authorize representatives uflhis City and County 10 en1or u&
above ment ion d property for inspection p O:"-'· -c9 r ~ -I Meter Release
-Applicant or ag ·· • -..,._,,. ../ ---. / J Dale:_~
FINAL :@,,-2,9,-,/7 Jdek;;. i:.:;:w 'f'II ~ lO(_ la_,.e./7 , Permiu ee name (print}: --
M:\WP51\Perm,t-lnspecUon Forms\Mechamcal-lnspector Record doc 03.31.06