HomeMy WebLinkAbout101103076 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 N(Building
Permit Counter. (714) 647-5800 lnspection Requests. (714)667-2738 lnspector Section: (714)647-5853
Permit #: 1O1{ 03076
Pin #: 41873
Proiect Addressi 1302 E Seventeenth St
Assessor's Parcel: 400-231-01 Lot: NA
Unit:A Bldg: Address Range:
Tract: NABlock: NA Historic: No
Suite Range:
Zoning: C4
Building Use: Commercial Occupancy: N/A 1st FL Area:
Job Type: Signs Constr Type: N/A 2nd FL Area:
Nature of Work: Sign-illuminated Code: CBC 2019 Other Areas:
Existing Bldg. & Use: Commercial Flood Zone: X-0602320163J
Garage Area:
Proposed Use: Dunkin Donuts # of Stories:
Total:
Description of Work: lnstall (1) led-illuminated channel letter wall sign for "Dunkin", bond paid on M-74116
Patio:
T.l.Area:
Yards Req'd:
Valuation: $2,500.00
Planning Conditions:
Owner:
Address:
Phone:
RGA Group, LLC
4685 MacArthur #375
Newport Beach, CA 92660
(949) 675-5206
Dunkin
Contractor: PS Services
Address: 1320 N. Red Gum Street
Anaheim, CA 92806
Phone: (714) 683-1120
State Lic #: 1039455
Lic Type: C.45, C-10
Bus. Lic #: 163033
Workers' Compensation lnsurance:
Carrier: lnsurance Company of the West
Policy #: WSA504745000
Expires: 0410112020
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
Tenant:
t
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd: No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Landscaping lnsp. Req'd: No
Soto, Ricardo
Amsden, Julie
Chavez. Dave /€€Y
Dale: 0210512020
Date. 0210612020
Dale: O2l'lOl2O2O
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
o7776002
01175002
071_76002
07775002
07776002
0L776002
57607
53500
57770
57672
57600
57607
Permit Fee
Plan Check Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
Fee Total:
Paid to Date:
Balance Due:
$166.s3
$1 15.44
$11.73
$1.00
$22.95
$57.20
$374.85
$0.00
$374.85
Fire lnsp. Req'd:
Police lnsp. Req'd:
Flood Zone Cert. Req'd: No
Every permit issued shall become invalid unless the work on the site authorized by
such permit is commenced wtthin 360 days after its issuance,or if the work authorized
on the site by such permit ls suspended or abandoned for a period of 360 days after
the time the work is commenced.
lnspector MID#: 2020-157575
ffi Account#Total
01 1 16002 51600
01 1 16002 51601
0'l'1't6002 51612
01 1 16002 53600
o1116002 57770
$22.95
$223.73
$1.00
$1 15.44
$11.73
I
BUILDING. INSPECTOR RECORD
SITE.WORK DATE !D/SIG.COMMENTS OWNER BUILDER DELCARATION
I herebl'aflinn undo pmalty olpqjury that I dn exempt fiom thc Contrach6' License Law for th€ following rcasn (Se.7011.5
lhsirres md Profssicrn Codc): Any Cily or County which require a pmnit to conslrucl. ah6. irnprove, donolish or rqrair my
stnlchue, frior t\] ils i$umcc. also requirBlhe applicant for such penili( to filc a signcd slalsn@t lhat he or she is licemed pmumt.
to lhe provisions ofthc (lontractor's Licensed Larv (Chapter 9, Colnmencing with Section 7000 of Division 3 ofthe Business an,l
Prof6ionsCodc)orlhatheorshe isexcrnpllhqcliomandthebdisfortheallegedermption. AnyviolationofstrtionT0ll.5byany
applicantforapmitsubjectsthc applicanttoacrvilpcnaltyofnotiltorethmlivehundrcddollus($500).
I. as orvner oflhe profEl), or my enrploys with $'ags a their *rle compensation. will do the work ed the struduc is not
intoded oroffercdforsle(S@.T044,BusinesmCProfessionsCode'l'h€Conlractor'sl-icoscLawdocsnotapplytomownerof
thcpRIEty rvhobuildsorimprovsth6@n,ildwhodo6suchuorthtnselforhoselforthroughhisorhsownemploycB.
provided that such improvqnenls ee nol intmded oroffsed for $le. I[, horvflq, the building or improvernmt is rcld within one ]w
ofcompletion. rhc Owncr l]uildq will havc the burdm ofproving tha he or she did not build or irnprove the prcpoty for the purpow of
sl<).
l. d\ oMer (,fihe property, dn exclusively conlracling with licensed contrackrs to conslruct lhc prcisl (Str. 7044. Busins
ard Proti:sionCode:TheConrraclor'sl.icenscl-awdoanotapplytouownoofpropenywhobuildsorimproveslh6eon.
and rvho conlracts for such projccts with a Contmctor(s) licensed pursumt to the Contractor's Licosc Law).
I a1r cxempt unds Swtion . B. & P.C. for lhis remon.
l)a le
WORI(ERS'COMPENSATION
DECLARATION
I herehy aflim und6 penalty oIgujury one ofthc following dwluatioro:
I have md rvill mintain a Certificatc of CoEot to Self-lroure for workm' compmstion. a providcd for by Setion 3700 of the
labor ( odc. for the psfommce of the work for which the ptrnit is issued.
!/hare and will maintain workm comp€Nation insurance. c required by Sation 3700 of thc Labor Codc. for thc psfommce of
the work for which this pmit is issued. My workm comptration insurmce cmiq dd policy numbq re:
Carier::/lg P2 lCE Co a P4 L. /-o rZ.s.= L{Esl
P,,ti"y N un bo,'. WlL5ll W g Q oo 2-z'Expires: _
I .enify that in the psfonnance ofthc work for vhich this pornit is issued. I shall not qnploy any p€rson in any mmner
s 6lo tffome subjsl to the u'orkqs' compsstion larvs of Califomia. dd Elre thal if I should becorne subjst to thc
workds'compcnsationprovisionsofSection3T00oftheLahlrCode,lshall.fonhwithcornplywiththoseprovisiore.
WARNING: Frailure lo &{ue workss'compmsalion coveragc is unlawful. md shall subject m mploya to oiminal psraltie and
civrl fines up to one hundred lhousand dollus ($100.000), in addition to lhe cosl of compemtion. dmages a prolided for thc
Scction 1076 oflhc Latrr Code. intercsl and athmc) s fes
l)s(r::!4ul-e o
I hcreby amrm under pcnalty ofpsjury that I an licen*rl 9 (commqcing wirh Secrhn Toolltuf Division 3
of the Busins md Profssions Code. md my licmse is in full forcc md eflecl
l.rcensc
.c to Numbs:
(billraclor:
hcreby amm unds penalty ofperjury thal th6e is a co[slruclion loding agmcl' for thc pofonnance ofthe work for which this perrnit is
issued (Se. -1097. Civ. C.).
Lcndq s Name:
Lender's Address:
APPLICAN'T DECLARA'I'ION
I hqd:) affm unds pmalty ofperjury one ofthc lollorving dalaations:
Dernolition Permits-Asbcstos Notification Fedcral Regulations ( Iitle 40. Pat16)
Required Lettq of Nolificalion
J ccrtify thal lhe fdlsal regulatiom reguding cbeslos ronoval ue not applicable to this prejet.
-/l
\4 c*ify rnat I have rcad rhis applicalion ild slale that lhc above infonnation 6 conet. I agre to comply with all City and County
ordinancd ed Sralc Lau's relaling to conslnrclioD. md authorizc rcprBmtalivc of this City ad Counly to mt6 upon the
above rnmtioned propeny for purms6.
Applicanl or Ag6rl
l'. rnrillc ilrnrc €f a
D,t" 'C)J2o/&t
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subfloor/VenUl nsulation
Roof Sheathing
Shear Wall
Framing
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
A
FINAL )lo 1.t)I Lr-
Certificate of Occu
Notes, Remarks, Etc.
->
rtrr", ' O ,ay' nr/€l a