HomeMy WebLinkAbout30139938 - PermitCity of Santa Ana 20 civic center Plaza (M-19), santa Ana, cA 92702 Plumbing
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 3O139938
Pin #: 3E365
Proiect Address: 1412 E Borchard Ave
Assessor'sParcel: 014442"10 Lot: 3
Unii:
Block: NA
Bldg:
Tract: 6629
Address Range:
Historic: No
Suite Range:
Zoning: Ml
q
Owner:
Address
Contraclor
Address:
MARTIN INVESTMENT CO
P O BOX 15532
Santa Ana, CA 92703
AMS Construction
1215 Columbia Ave.
Riverside, CA 92507
(909) 496-12r2
Fee Type
01'l'16002 51602 Primary/Secondary Roo
01116002 51600 General Plan Update
01116002 51602 lssuance
Amount
44.51
22.O8
55.04
Fee
$'t78.04
$22.08
$55.04
Qty
4.00
1.00
1.00Phone:
Tenant Name: Not Specified
Phone
State Lic #: 992388
Lic Type: B
Bus. Lic #: 370484
Workers' Compensation lnsurance:Carrieri State Compensation lnsurance Fund
Policy #: 9211809
Expires: OGl02l2O19
Botchir{5775 - I /6/2(118
off ice: CTYH Trone+: 74Acctlt Refi 3
Rcpt+;02379?16 - 9/6/2i18
Transnct ion Totcl
IOI N6ARCIA5of 7
3013993S
2:46 P[
31 r 782. ii6
l'
Generol Plan updote Fee
01116002- 51600000-
PIUID i ns01 6002- 51602000-
iloster Cond
CC+: ******Ir**xr321$
J22.iJV
t?33.08
-llt7B?.16
Auth+!05?2gSBuilding Use:
Job Type:
Nature of Work
Planning Conditions:
Planning Approval By
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
lndustrial
Reroof
Reroof
F-t
VB
cPc 2016
Occupancy:
Constr Type
Code:
Chavez,Dave
Dale:
Date:
Date:>(-09/06/2018
Account#
Every pernit issuad shall become invalid unless lhe wo* on the site
authoized by such pennit is conmenced within 180 days aftet its
issuance, or ilthe work authoized on the site by such permit is suspended
o. abandoned lot a petiod of 180 days afret the tifie the wotu is
comnenced.
MID#: 2018-'145946
01116002 51600
01116002 51602
$22.08
$233.08
Fee Total:
Paid to Date:
Balance Due:
Notes: Reroof. Holmop. 60 squares. Handout given. *"8
LICENSE CONTRACTOR PERFORMING 2 ADDITIONAL
TRADES.*'
l\4isc. Receipt:
i,4isc. Receipt:
lvlisc. Receipt:
Total
$255.16
$0.00
9255.16
lnspector
PLUMBING.INSPECTOR RECORD
APPROVALS ID/SIG.COMMENTS OWNET BUILDER DELCAIATION
I h@by llitrn ufldcr pcnalry ot n rjury lh.l I d crcnfl iiom $. CrDradoE Litn* Las for rlE followirS eMn (5&.7011.5
Busimss atd Pof6lkn Cod.): An, City or Colnry shkh rcquiG r Fmn lo onsd.L .16. inprorc. dcmlBh o. EFn sv
slruclurc. I,rbr m irs ilium. !t$ Eqli6s llr apdter tor such F ftil lo filc ! sigmd 9sl.B ln r lE or th. b liccMd poMt
io rlE Fovisions ot rn Conr&rois Lic.ned L.* (Ctaptcr 9. Co.mEinS *ilh Scdion 7000 of Division I of lh. Bnsiftlr .nd
Pmfcssi'ns Codc) orlllfl lE d sn is srctrpl ficrchon rnd ih. basis for lhe alL8.n €rctplion- Any violdion of Sdion 7031.5 b, o,
lppli.a for a lcnul $bj(ls thc cpPli.i m a civil ,c.ally of ml mrc lha. livc hundEd dollds ($5@)
-1,
!\ o*tur of rl[ E.icnt. or ry ctrU,loycc\ *ir h srgcs tr\ rlrn $[ .onrB n\d nrn. wi]l do ihc worl Md rh. (MIU$ s nor
ntrflk]rl .r.f.r.d r'.r srf i S\.- 7(!4. arsnr$ $d Proltxion\ clnlc: t hc G lrnclds l-iccn\c l-dw doc\ or tDnlv b rn ownd of
rhcInipcny *ho hrild! or i$t]nivc\ th.rs,n. tr *hodoc\nichsorkhnn\cllorhcr\clforrhnrllhhisorhcrownc t orcc\.
0nrv dcd thll snch i,n[ncnt rs rrc mr i.rcndcd or olliEJ ktr sL l I ho$Er. rh! S{iklinA or i'r{ovcNrr h {rld *irlri" "nr ttr
ol..tr.ridr, rhc Owns Buiklcruillhi\c rh. burdctrolDovirrg rh:[ ln ornrdilnor t{ildorimpmrc rhc Pn,txtr ldrtu qr,*.1
l. is owncr oi ric pro|Enr. rn cr.tu\ntly (oftacr in8 wirh liccn\sl .ontdnF x, cotrdflcr rhr Pi'JN l Sc( ?Olr. 8trnN$
rn.l PmlssinCodc Thc aonk!.nr'\ l.iccn{ l-dw d,{\ nor rDply b u oq ncr of ln)F y*ho6uild\orinrProvc\rhcrcotr.
und sh..onrfl.kli,r\u.hlrojcctssirhICodnctnG)liccn\c Nsurd n) r hc Coitr'ktr \ LnTn\c lrtr )
-l
m crcno undc, Sedior- B. & P.C. for lhir rcMn
D.r€. owner
WORKrTTS' C(TMPENSATION
DEII.AIAUON
I h.rcby omm undcr pcnulr, ol r.rjury om of thc lblloviry dccle.lirns
t hnvctuiwill m{inti r Ccniftlrc .l C.trscfl h Scll ln\urc aor $otk.s- ..rry.nsd ion r\ fn,!id.d tor hl Secrion:}?00 ofrh.
htior Codc. ror $c NrrornnnEc of Ihc trolk ror whi.h thc Pcnnir i! ilslcd
-lh.vcundtill
Einrtrirr workcs compcnslrion in !rm., n\ rcrluircd by St.r idn r7m ofuhc tjb.r Codc. lu rtE ,.rfonMrcc ol
rhc {ork for*hkh rhirFnnir is i\ud Mytrdrkes .omp.n{rii,n insumrcccrdi.r d polty numh{r dc
9t
zlr zotg lz-31- /8
I{ARNING: Failurc lo sue *ort K conpcnsalion otEsc ic unl,wf!|. and shrll slbjirr D .mploJry lo aidna! FMni.s.
.ivil 6n.s up lo onc hurdEd ltouend dollm (SIOO.OOO). in addilbn to rh. on of.onll!.n$tion. d.nE8.s !s lbvided for th.
S€rion 1076oflh.t tor Codc. jnrctc.r Md atomyt fes.
,,,,,.- 1-b-r( noou*^.
I herby aflirn undc, Fnaht of p.rjury lhd I m liensd undcr ,,mvi{oi of Ch,!r.r 9 (s,lmm ins unh s..riin 7ux)) ofDivision l
of $e Businc* snd PDfc$iors Codc. e my li.cM ii in tull foEc ur' cfisl.B 192=*K
o*, I a -b-t ? -.- .-,.*".,X?
coNsTlltl(:t IoN t.fNt lNc acFNCY
I hcBhy,rfirnundcr Fn.llyolncrjuryrhdr rhcr. is d uon{Dcr6o Lltnirs lrrn.y tr rhc lslormucc otrhc wort fot,hich rhi\ Fmn t
issuci tsc. ll)97. Civ C.)
lxtrJcrs Nrm.
lxnJfl\ Ad'l'c-
-
AITLICANLDEII.ATAIIAN
I hdt$y afljm undcr p.n.hy oipcrjury onc otthc folloainS dccls.lnns:
D.nDlition Pcrnn s- Arb.xros Nol i licat ion FedcralRcCuldrionq(Tirlc 40. PIn6)
_Rcq!i6d trkr of Nolificolion
-l
cen ify lhar rhc fcd$al E$l.lions E8ardins sshc{63 ,c@vrl m rct !p!li.sl,lc t rhic Imjct.
\,
AI+nlfy thr I ha\. rcld rhn lnnlraltr oJld {orc rharrhc alnvc iflaomrion is.ml.l.ste loco'ryly $nh 0I Cnvad Cohr,
drdftftes rnd sr.r. tjlsElalup ro hxrld
'nB
.onshd'on, sd hcrcby t!'lrtrlc rcPrcsc ulivcsoflhirCiry".dCounlyroc.tcruponrh.
rlx'lc mnrioncd ,n,p.ay r{tr
Apt,lictrnl or Agenl signrlu Je-
UNDER GROUND
Water-Under Iloor
Gas-Underfloor
Buildinq Sewer
Area,/Storm Drain
lnterceptor/ Clarif ier
TOP OUT
Waste & Vent
Water Piping
Gas Pipino
Roof Drain
Tub/Shower Test
Rouoh Water Heater
POOL/SPA
P-trap/Drain Line
It/ain Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary Sewer/Cap
Back Flow Device
Bough Plumbing
Final Gas Test
Meter Release
FINAL ?a7-6 3),
Notes, Remarks, Etc.
DATE
Waste & Vent
esff s--l .
al4D.t. - I -L- t811