HomeMy WebLinkAbout40132099 - PermitCify of Santa Ana
Permit Counter: (714)- 647-5800
20 Civic Center Plaza (M-19), Santa Ana, CA92702 Mecha n ical
lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Project Address: 419 N Broadwav Bldg: Address Range: 41i-419.
Tract: TOWN OF SANTA Allisloric: Yeg
Suite Range:
Zoning: SD84
E
Assesso/sParcel: 398.257-01 Lot: 7,10
Owner:
Address
F€e Typs
01116002 51604 Alter Vent Sys
01116002 51600 General Plan Update
01116002 5'1604 lssuance
Amount
41.99
21.25
52.98
Qty
2.00
1.00
1.00
Fee
$83.98
$21.25
$s2.98Phone:
Tenant Name:
Contractori
Address:
Owner-Builder
Phone 0ff ice: CTYH
Ac.t+:
Rcpt+ ! lt?265(154
Tnonecct ion To
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
FR inb(re IU
6enerql plon Llr: r:r,
t:r1I I6r-r[t?- SI { r:!,r r:,
'.nfle:hon i ,:ol
rrll l6':rr:?- :1 1ii,:!'.,rl./isi
Building Use:
Job Type:
Nature of Work
Commercial
Miscellaneous
Elect Tl
B
VB
cMc 2016 Notes
a a , i +r+**rII++ri !'
auth on file
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
\&\r",nano",, x"tny 05/16/2018
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Every pemit issued shall bocome invalid unless the work on the site
authoized by such permit is commenced wilhin 1 80 days after its
issuance, or if the wo* aulhoized on the site by such pemit is suspended
ot abdndoned fot a peiod ol 1 80 days after lhe time the work is
commenced.
$'158.21
$0.00
s158.21
lnspector MID#: 20'18-143349
$21.25
$136.96
Fee Total:
Paid to Date:
Balance Due:
Permit #: 4O132099
Pin #: 54359
Unit;
Block: 13
Fainbarg lV LP
129 W Wilson St #100
Costa Mesa, CA 926271586
19491722-7400
Long Beach Tattoo co LLc
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
01 1 16002 51600
01 1 16002 5'1604
MECHANICAL-INSPECTOR RECORD
APPROVALS DATE ID/SIG,COMMENTS OWNAf, DUILDER DELCARATION
I hcreby a,Iun undcr Fnahy of !..jury lhar I m crcm frch rhc conr*lDu LkcnE tiw fo. lhc tolk wag usn (s(.?oll.t
Blsincs nnd Pmfcasion Codc)r Any Cir, o. Co!.ry which EluiEs . Fmn ro @trnul, ald, ialpovc, (bmlisnlr E?ln My
sldcle. |rb ro ni ir.u!e.,Lso mquiEs lh. spplisr tor such Fml ro lilc. riSned sdecd lnll hc or shc i liccfl$d IJur$Ml
ro rhc lrovisions of rhc Conlrecbr.. Lien*d Llw (Chlptcr 9. Comftrins wnh Sccrion 7m0 ol Divi.ion 3 of ttrc Business eld
Pbf.ssioN Codc) or th{l lE o, shc is e&nDr th.Efron r.d rhe bask for ftc {lleg.d cr.mplion. Any viohli.rn of Selk n 701 L5 by !.y
lpplicld for ! Fmil suhjch llE ltpltunl to !.ivil p.Mhy of ml Drc tho fivc hundtd dollus (t500).
I.r\ usicrorrhrl,n)F*nt.ornrycn oy..swirhwiscsdsrhcnvrbconrpensJrior,*illdo f,workurlrht(mtucisnor
i' cd.n or on'cicd tu qrlc ( SN 7OH. Businc\\ rnd Pron\\tnN Con. Ilr cl,ntrrlm s I -iccn\c I js doc\ noi trpdy ro rtr owrr ol
rhclfr|xny *ho hikl\ .r nrrrn*$ rlr6n n,xl whh tu\ u(h qllt lrnn\clr or hcr{ll o. rhrcugh his or hcr ou n cnrpk,rcc\,
pruri{lcd rlur such iqrr^rm.h rrc nor inic Lrl r oficql tur {t lf. h'*orr. rh. huitliry or inll]n*ornr i. r)ti wirlrir ortr }rd
of$nrplcrk r rhL()*trcr Buitlcr sill hnvc rhc hu cnofl)n)vir$rhdr h.or$cdil norbuill ornnpn,vc rhc pmr^-ny finrhcptrry){oI
Ll r\ n*trs or rhc rr)ltny, r r crclu\ir.ly c!fta.un! *irh li..n\cd .otrrr.kn n, ..trnrud rlr pr+cr lscc. '7(Itl- BunNs
xl Pn)larsi'nco c lhcContra.ttr \ Liccrsc l-uq docs nolrppllri N ouncr ol nn'nc(r sho hlil \ or nnprt,vc\ rhcr.oD.
rnJ wlD corrr \lbrsu.hpn)lcc(wirlraCo ra.k(\rlic.iscJ,trAutrtrrk,rhcO fu.rofst-Nnschq)
I hcrchv xhnn uf cr
^-nllry
of Eaury om of rh lalb$i',!
-l
huve ard *ill minldin a C.nifrdrc of Cotr{ (, Self lBure tor workdc omFnslior, I p6vid.d for by S*tion 3700 of lh.
Llbot Codc for thc Frfomtue of tu adl aor whi.n lh. Ilmn k isslcd.
,! hlvc ondwillm0inroi. workcn compcnsutkn insDran... as EqDircd h, Sstion 3700 ofltc L,tor C.dc.lor rhe pc.ro.nrec of
rhc work lor which lhh l,emil is issu.d Mywork.* .onFnsrion insurlnc. @ic. !d policy nlib.r e:
-l
ccniry lhat ir lhc pdforMnc ollhc wo forvnichlhhF nil is irsucd,I shlll not cnptoy lny I,c6on in any m.n.r
s !s ro bcom slbirl ro rlE *o*.a clmFnsdion hws ofcllifomi!, and asd |hll if I shotrld bccoB.ubirl ro th.
wortcs' conwns.lion povtiotrs ofSelion 3?00 of lnc t,bor Codc.l nElL fontwirh$hrl, snh rh.e povhions..
WARNI|i(; frilur t, {curr workcB'.u rt'cisJrt!1 co\crrf. i\l. &d sh0ll subirl an cmplorr x, oidinll ltuUi* utul
civil fiic\ rp b oic hrndrcd rhou\ dolles (SIm.O(X), in dir to lh. .osl of coq,.nsalion. dam8.s as ,rotided fot'thc
Sc.rn 1076 ofrh. trtlr Codd. iNcrcst.nd nrkxncy\ f.c
DECTAIAIIII!
I hcrcb, .oim un&r Fndly of pcriury rl[l I m lienssd und.r Fovision olctuprs 9 (onmeing wth Serbn 7000) of Divlsion 3
of th. Busircss .nd Pmfssims Codc. ed my li:.ns ir in tull foE .,n cfiel.
l,xrr
CONSIf,JJqIIONIEIDINIi.AII'NII
I hcrciyritmuDdcr F-.!lly ot Frjury rhi rnerc i\ rco.{tucri,n kndins sli.ytur rlrtf,rronnr.c ofihc $ort lnr whi.h rhi\ pclnrir h
issucd (Sc..3097, Civ. C.)
ll[fllcaNfDlict B,ura!
I hruhy dlnmundrr p.nrlry ofp!rturrotr. ulrlt foll.$i"g {lrlffari,,n\:
l*trFIiri, l,{nnir1 \h.Ioi Nohicdtrin l.dcril RcgtrhrMr\ ( rirlc 10. Prnr)
-Rcqtrtcd
l,crlcr or Norir,crrii,n
-l
enify lh,r rlt f.ddl Eglldions Egarding aibcsros rcmal e mr rpplt,bh lo lht lmic{l
\l c€rrily rhsr I h."c rcod rhis aprlicarion and surc rhar lhc otnvr inlormrio. is corel. I r8,e ro.onply wnh sll Cit, lnd Couly
ordnrmcs and SbE kss ELrine ro build rucrion. ! hcrcbyauthrnc rcPrssntaliecs ofrhisCny.nd Counryto cnl.r ul[n lhc
abovc mnlioEd pmp.ny Lt
Aprliclnl or &cnl Si8nolurc:l) r
*T(',:
?>eooo,,.t
{fttleu
Appliances
Evaporative Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-lnsulation
lnsulation
Smoke Detectors lnstalled
Rough Ductwork
Vents
Toilet Room / Clothes Dryer
Residential Ranoe
Other
Hood
Type I Hood
Type ll Hood
Grease Duct
Fire Damper
Openinos
lnstallation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rough Mech.
Final Test
Meter Release
FINAL ( -t-t-tb J)"t:ft/t0
Notes, Remarks, Etc.
Metal Fire Place
I
-, qfraf\
LiarcChs: I tce Nu,[er:
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