HomeMy WebLinkAbout10191610 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building Permit#: 10191610
Permit Counter: (714) 647-5800 Inspection Requests: (714) 667-2738 Inspector Section: (714) 647-5853 Pin#:
Project Address: 1902 W Chestnut Ave Unit: Bldg : Address Range : Suite Range:
Assessor's Parcel: 007-342-21 Lot: 21
Building Use:
Job Type:
Block: N.A.
Occupancy:
Constr Type:
Tract: 2752
A-3, 8, E, S-1
Ill B
Nature of Work:
Commercial
Alteration
Interior demo
Existing Bldg. & Use: Commercial
Proposed Use:
Code:
Flood Zone:
# of Stories:
CBC 2013
X-0602320257 J
Description of Work: Interior demo -non-structural. Tl submitted (10190964)
Planning Conditions: CUP 2016-35
Owner: K idworks Contractor:
Address: 1902 W Chestnut Ave
Santa Ana, CA 92703
Address:
Alliance Construction Team
26170 Enterprise Way Ste. 1
Lake Forest, CA 92630
Phone: (714) 834-9400
Tenant: Kidworks
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
Phone: (949) 685-4839
State Lie#: 994379
Lie Type: B
Bus. Lie#: 350787
Workers' Compensation Insurance:
Carrier: Wesco Insurance Company
Policy#: . WWC3216474
Expires: 06/30/2017
Fregoso , Vince
So, Anson ~ /
Zuniga, Allissa \ V
Date: 12/14/2016
Date: 12/14/2016
Date: 12/15/2016
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 com, '<:need.
01116002 51600
01116002 51601
01116002 51612
01116002 53600
Inspector MID#: 2016-133463
Engineer:
Address:
Phone:
License#:
Architect I
Desi!=lner:
Address:
Phone:
License#:
Total
$20.56
$200.51
$1.00
$206 .91
Historic: No Zoning: M1
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area:
Total:
Patio:
Tl.Area:
Yards Req'd:
Valuation :
.... ..:.U:.u
$14,700.00
' .1.U ~ ;. ...... .t.d
·. .)
i ~ • ~ .. 1 :r.. •;-11") J. l.
J: u ,·., i .. : ..:., l .. I .:::1 ... 6 ~-.:18 /, ;
;·
RLH Architects
Ralph Hastings
2745 Saturn St
Brea, CA 92821
(949) 250-1809
C-11600
11_! -
d
01116002 51601
01116002 53600
01116002 51612
01116002 51600
01116002 51601
\. I U lt •~,Uln
.. ~--· J e,,_
,Cil :1
1i.l , 11.i ·
.LU.1. •. 11:11
Permit Fee
Plan Check Fee
Bldg. Stds . Rev olving
General Pl an Update
Issuance
Fee Total:
Paid to Date:
Balance Due:
$149 .25
$206.91
$1 .00
$20.56
$51.26
$428 .98
$0.00
$428.98
BUILDING-INSPECTOR RECORD r--------------------,--------.--------.------------------..-------------------------------------------c:
OWNER BUI LD ER DELCARATI ON ]7 SITE-WORK DATE ID/SIG. COMMENTS
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subfloor/Vent/lnsulation
Roof Sheathinq
Shear Wall
Framing
lnsulation/Enerqy
Drvwall
Ext.lint. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif.
/".,.....
FINAL
Certificate of Occupancy V \....._...,
Notes, Remarks , Etc.
I hereby affirm under penalty of perjury that l run exempt fro m the Contractors' License Law for the fo llowin g reaso n (Scc.7031.S
Business and Pro fession Code): Any Cit y or County which requires a pcnni1 to construct, alter. improve. demolish or repair any •
stru cture. prior to its issuance, also req uires th e appli cant for such pennit to fi le a signed statement th at he or she is licensed pursuint
to the provis ions o f the Contractor 's Licensed Law (Chapter 9. Commencin g with S ection 7000 of Division 3 o f the Busin ess and• •
Profe ssions Code) or that he or she is e xempt there fro m and th e basis for the alleged exemption. Any v iolation of S ection 703 1.5 by any
appl icant fo r a pcnnit su bjects th e ap plic an t to a civil penalty of not more than five hundred dollars ($500).
_I, as owner o f the pro perty, or my employees with wages as their sole compensation. will do the work an d the stru cture is not
intended or offered for sale (Sec. 7044, Bus iness and Professions Code: The Contractor"s License Law does not apply to an owner of
the property who builds or improves thereon. and who does such work hi mself or hersel f or through his or her own employees.
provided t hat such improvements are not intended or offered for sa le. If. however. the bui lding or improvement is sold within one year
of complet ion. the Owner Builder will have the burden of proving that he or she did no t buil d or improve the property for th e purpose of
sale).
_I. as owner o f the property. am exclus ive ly contracting wit h li censed contractors to construct the project (Sec. 704 4. Business
and Pro ression Code : The Co nt ractor's License Law does not apply to an owner of property who buil ds or imp roves t hereon.
and who contracts for such project s with a Contractor(s) li censed pursuant to the Contractor 's License Law).
_I am exempt under Section ________ . B. & P.C. for this r easo n.
Dale: __________ Owner: _______________________ _
WORKERS' COMPENSA TION
D ECLARATION
I hereby affirm un der penalty o f perjury one of the fo llowing declarations:
_I have and will maintain a Cert ificat e o f Conse nt to SeJf.Jnsure for workers· compensatio n. as pr0\1ided fo r by Sec tion 3700 of the
Labo r Code, for th e perfonnance o f the work for wh ich the pennit is issued.
_I ha ve and will main ta in workers· co mpensatio n insu rance, as required by Section 3700 of th e Labor Code. for the perfommncc of
th e work for which this pennit is issued. My workers· compensation insurance carrier and policy number are:
Carri er:' ~\~~l..<::>6'1 ::I::r,.J~~CJ'i'.
Policy Num ber .,.3\.Nc:_'3 S:~ si-ci -Ex pi rcs:__G• 3 (:)~\ 7_
_l cert ify that in the perfomm nc e 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 ofCalifom~ia. and agree that ifl sh~ould become subject the
workers' co mpen sation provisions of Section 3700 of the LaOOr Code. I sha ll. forth with comply with those prov· ons.
WARNING: Failure to secure workers' co mpensatio n coverage is unlawful an d shall subj ect an emplo ' to criminal penalties and
civil fin es up to one hundred thousand dollars {$100,000),~in II n to the c of co ensnti o amages as provided for the
Section 3076 of the Labor Code. interest and attot· ·s fees. __,,
Date: -\2 • \ :S---) {._, Appl ant: _.,..._ ___ ~
• LICENQl;:ll CONTRACTOR
DECLARATION
I hereby affi rm under pe nal ty of perjury that I am licensed und er provision of Chapter 9 (commencing with Sectio n 7000) of Division 3
o f the Business and Professions Code. an d my license is in full force and e ffect.
I ,
License Class: ~ /License N umber: 99 L []79 /
Onie: -7-3)~\& Contrn\.J ./7 ./',:;--//A\..\ ,..r,.~ x__-/r " ?-eo....,~~vO\I('-'
CONSTRUCTI-ON L END I NG AGENCY
l hereby affirm un der pen alty of pe1jury that there is a constructio n lendi ng agency fo r the perfonuance of the work for which this pennit is
is sued (Sec. 3097, Civ. C.).
Lender·s Name: _________________________ _
Lender's Address: _________________________ _
A PPLICANT DEC LARATION
I haeby affinn un der penalty o f perj ury one of th e fo ll owing declarations:
Dem ol ition Permits.Asbestos Notificatio n Federal Regulat ions (T itle 40. Part6)
_Requir ed LctterofNotificat ion
_I certify that the federal regulations regardin g asbestos removal are not applicable to 1s project.
_I certify that I have read t'.t.rlus apphc:allon and~stat ve mfonnation is rrect I agree to comply with all City and County
ordma nces an d State Laws relating t butl~~m, truct1on . a auth representati ves ofth1s Cny and Count y to enter upon the
above mentio ned pro peit y for io n p s
1----------------------------------------------------~ App li cant or Agent Signatm -Da te .. \2-,s--1 k
Permitce 1rnn1c (print ): ,J,-/ \?....o'-,J '£_ \J ~_,~...,iS:')_,._,_:\~'\,"-"N,R_,,_....,,.._ ________ _