HomeMy WebLinkAbout101105179 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: {O11O5 179
Pin #: 38141
Project Address: 515 E Dyer Rd
Assessor's Parcel: 411-052-26 Lot: NA
Unit:Bldg: Address Range:Suite Range:
Zoning. M1Block: NA Tract: 43 Historic: No
Building Use:
Job Type.
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Commercial
Miscellaneous
OT lnsp
Commercial
Occupancy:
Constr Type
Code:
Flood Zone.
# of Stories:
N/A
N/A
cBc 2019
x-0602320278J
1st FL Area:
2nd FL Area:
Other Areas:
Garage Area:
Total:
Patio:
T. !.Area:
Yards Req'd:
Valuation: $0.01
Description of Work: Overtime inspection for Saturday,1111412020 - permit 101103329, code 34.
Rodriguez, 562-254-1442. OK per John Pham.
Planning Gonditions:
lnspector is David Appe1,714.240-3583; contact is Alex
...:
'
Owner:
Address:
Phone:
Tenant:
MDD PARTNERS
17111 RED HILL AVE
lruine, CA 926145607
Contractor: Oltmans Construction Co.
Address: 10005 Mission Mill Rd
Whittier, CA 906080985
Phone: (562) 948-4242
State Lic #. 86393
Lic Type: B, A
Bus. Lic #: 175797
Workers' Compensation I nsurance:
Carrier: Travelers Property Casualty Co
Policy #: UB1N1629892025
Expires: 0710112021
Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
U 1t ffiflrr S t ror
Build ins
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Planning Approva! By:
Plan Checked By:
Permit lssued By:
Date:
Date.
Date: 11l1Ol2O2O
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002 57770 Microfilm Records
07776002 57607 O/T Inspection
07776002 57672 Bldg. Stds. Revolving
07776002 57600 General Plan Update
Fee Total:
Paid to Date:
Balance Due:
$4 05
$690.s6
$0.00
$0 00Amsden, Julie
NPDES lnsp
PWA lnsp. Req'd Fire lnsp. Req'd:
Police lnsp. Req'd Account#Planning lnsp. Req'd:
Landscaping lnsp. Req'd Flood Zone Cert. Req'd: No 01 1 16002 51601
Every permit rssued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days afterifs issua nce,or if the work authorized
on the site by such permit is suspe nded or abandoned for a period of 360 days after
the time the work is commenced.
No
No
No
No
No
No Total
$690.56
$4.05
$694.61
$0.00
$694.61
lnspector lvllD#: 2020-158211
01 1 16002 57770
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNBR BUILDER DELCARATION
I hcrcby atfirm undcr pcnalty of perjury that I iun excmpt from the Contractors' Licensc law for thc following reason (Sec.7031.5
Business arrd Profcssion Codc): Any City or County which rcquircs a pcrmit to construct, altcr, improve. demolish or repair any
structurc, prior to its issuance. also rcquircs thc applicant for such pcrrnit to tile a signed statemcnt that hc or she is licensed pursuant
to the provisions of thc Contractor's Licensed Law (Chapter 9, Commencing with Scctiott 7000 of Division 3 of thc Business and
Profcssions Code) or that hc or she is exempt therefrom and thc basis for the alleged exemption. Any violation of Section 7031 .5 by any
applicant tbr a perrnit subjects thc applicant to a civilpcnalty of not more than t'ivc hundrcd dollars ($5001.
_1. as owncr of thc propny, or my cmployccs with wagcs as thcir sole comJrcnsation, willdo thc work and the structurc is not
intcndcd or olTcred for salc (Scc.7044, Busincss and Professions Codc: The Contractor's Liccnsc [:w does not apply to an owner of
thc prcperty who builds or inrprovcs thcrcon. and who does such work himself or hersclf or through his or her own employees.
providcd that such improvcments arc not intcndcd or offerod for salc. If, howcvcr. thc buikling or inqrrovcrncnt is sold within onc yeir
of complction. the Owner Builder will havc thc burdcn of proving that hc or shc did not build or improve the property for the purynsc of
salc).
_1, as owncr of thc propcrty. am cxclusively contracting with liccnsed contractors to construct the projcct (Scc. 7044. Busincss
and Profcsskln Codc: The Contraclor's Liccnsc Law docs not apply to an owner of propcrty who builds or improvcs thereon,
and who contracts for such projccts with a Contractor(s) licenscd pursuant to thc Contractor's Liccnsc t aw).
-l
anr cxempt under Section-. B. & P.C. for this reason.
lt^r -.
WORKER.S' COMPENSATION
DECLARATION
I hcrcby affirrn undcr pcnalty of perjury onc of the following dcclarations:
_l havc urd will maintain a Certificate of Conserrt to Sclf-lnsurc for workers' compcnsation, as providcd for by Section 3700 of the
l,abor Code. for thc pcrformance of thc work for which the permit is issucd.
_l havc and will rnaintain workers' compensation insurance, as rccluircd by Section 3700 of the Labor Codc, for the perfornunce o[
thc work for which this pcrrnit is issucd. My workcrs' conrpensation insurancc carricr and policy number arc:
Carrier:
Policy
_l certify that in thc grcrformancc of thc work for which this prrnit is issued, I shall not employ any pcrson in any manner
so as to bccomc subjcct to the workers' compensation laws of California, and agree that if I should bccome subject to thc
workcrs' corrrpcnsation provisions of Section 3700 of thc L:tnr Codc. I shall. forthwith cornply with those provisions.
WARNING: Failure to sccure workcrs' compensation covcrage is unlawful. and shall subject an employer to criminal ;rcnalties and
civil fines up to onc hundred thousand dollars ($100.0tt01, in addition to the cost of compensation, darnages as provided for the
Scction 3076 of thc Labor Code. intcrest and attorncy's fces.
Aonlicanl:
LICENSED CONTRACTOR
DTCLARATION
I hercby affirm undcr pnalty of perjury that I arn licenscd under provision of Chapter 9 (comnrcncing with Section 7000) of Division 3
of the Business and Professions Codc. and my licensc is in full force and effect.
License Class: Liccnsc Number:
Date:
W
I lrcrcby affirm undcr Fnalty of Frjury thar thcrc is a construction lcndif,g agcncy for thc lrcrforlllmc of the work for which this Fnnit is
issucd (Scc. 3097, Civ. C.).
l,cnder's Namc:
lrndcr's Address:
APPI ICANT DECLARATION
I lrcrcby allirm under pcnalty of pcrjury onc of thc following declarations:
Dcmolition Pcrmits-Asbestos Notification Fcdcral Regulations (Title 40. Pan6)
-Rcquired
lrtter of Notification
_l ccrtify that thc fedcral rcgulations rcgarding asbcstos rcmovalarc not applicablc to this projcct.
-l
certify that I have rcad this application and state that the
otdinanccs and Statc laws relating
abovc mcntioncd properly for
Applicant or Agent
Perrrrilec na[re
construction,the
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/VenVl nsu latio n
Roof Sheathinq
Shear Wall
Framing
lnsulation/Eneroy
Drywall
Ext./lnt. Lath
Brown Coat
[\Iasonry
Pool Fence
T-Bar
Handicap Req.
Deputv Final Report
Engineer Final Report
Flood Zone Certif
FINAL t(?
Certificate of Occupancv I
Notes, Remarks, Etc
Rev. 08-07-201 5
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