HomeMy WebLinkAbout101105178 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #: {01105178
Pin #: 8{ 644
Project Address: 515 E Dyer Rd
Assessor's Parcel: 411-052-26 Lot: NA
Unit:Bldg: Address Range:Suite Range:
Zoning: MlBlock: NA Tract: 43 Historic: No
Building Use: Commorcial Occupancy: NrA 1sl FL Area: Patio:
Job Type: lliscellaneou3 Constr Type: NrA 2nd FL Area T.l-Area:
Nalurc of work OT lnsp code: cBc2013 otherAreas: yards Reqd:
Existing Bldg. & uso: commorcial Flood zone: x.o602320276J carage Arear vatu.tion: go.ot
PropGed Use: # of Stodes:
Totat:
D.acdption of Work: Ovedine in.p.ctlon tor Wodnssday, 11rl f2020 - permlt 101103329, code 34. lnspeclor ls Davld Appel, 71+24G3583; conlact 16
Alex Rodriguoz, 562-25+lil,l2 OK per John Pham,
Planning Conditions:Ltg c
Owner:
Address:
Phone:
Tenant:
MDD PARTNERS
17'111 RED HILL AVE
lrvine, CA 926145607
Contractor: Oltmans Construction Co.
Address: 10005 Mission Mill Rd
Whittier, CA 906080985
Phone: (562) 9484242
State Lic #: 86393
Lic Type: B, A
Bus. Lic #: 175797
Workers' Compensation Insurance:
Carrier: Travelers Property Gasualty Co
Policy #: UBlN1629892025
Expires: 0710112021
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
Planning Approval By
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA Insp. Req'd:
Planning lnsp. Req'd:
Amsden, Julie
Date:
Date:
Date: 1111012020
Subject to Field.
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07776002 57770 Microfilm Records
07776002 57507 O/T lnspection
07776002 s7572 BIdg. Stds. Revolving
07776002 57600 General Plan Update
Fee Total:
Paid to Date:
Balance Due:
$4.05
$690.56
$0.00
$0 00
No
No
No
Fire lnsp. Req'd.
Police lnsp. Req'd:
No
No Account#Total
Landscaping lnsp. Req'd:Flood Zone Cert. Req'd: No 01 1 16002 51601
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days afterifs issuance,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.
$690 s6
$4 05
$694 61
$0 00
$694.61
lnspector MID#: 2020-15821 1
01116002 57770
BUILDING- INSPECTOR RECORD
SITE-WORK DATE ID/SIG,COMMENTS OWNER BUILDER DELCARATION
I hcrcby affirrn under penalty of pcrjury that I am cxcmpt from thc Contractors' License [:w for the following rcason (Scc.7031.5
Business and Profession Codc): Any City or County which rcquires a permit to conslrucl. altcr, improvc, &molish or rcJrair any
structure. prior to its issuancc. also rcquircs thc applicant for such pcrmit to lilc a signcd stalcnrent lhat hc or shc is licenscd pursuant
to thc provisions of thc Contractor's Liccnsed Law (Chapter 9, Commencing with Scrtion 7000 of Division 3 of thc Busincss and
Prol'cssions Codc) or that hc or she is cxempt thercfrom and the basis for thc alleged exemption. Any violation of Section 7031.5 by any
applicant for a Jrcrmit subjcrcts the applicant to a civil pcnalty of not morc than fivc hundrcd dollars ($500).
_1, as owncr of thc propcrty, or my enrployees with wages as their sole compcnsation, willdo thc work and the suucturc is rct
intcndcd or offered for salc (Sec.7M4. Busincss and Prol'cssions Code: The Contractor's Liccnse law does not apply to an owner of
thc proprty who builds or improves thcrcnn. and who docs such work hirnsclf or hcrcelf or through his or hcr own employees,
providcd that such improvcnrcnts arc not intendcd or oflbrcd for sah. If. howcrrr. thc building or inprovcnEnt is rcld wilhin onc )trr
of comphtion, thc Owncr Builder will havc thc burdcn of proving that hc or she did not buih or improve tlrc propcrty for thc purposc of
sah).
_1. as owncr of the pnopcrty. am exclusively contracting with licenscd contractors to construct thc pro.icrct (Sec. 7W, Busincss
and Protcsskrn Code: The Contractor's License Law does not apply to an owner of property who builds or improves thcrcon.
and who contracts for such projccts with a Contractor(s) liccnscd pursuant to the Contraclor's Licensc Law).
I am excnrnt under Scction . B. & P.C. for this rcason.
Date:- Owner:-
WORKER.S' COMPENSATION
DECLARATION
I hcreby affirrn undcr penalty of perjury one of the following dcclarations:
_l have and willmaintain a Certificate of Consent to Self-lnsurc for workcrs'compensation, as providcd for bySection 3700 of the
labor Codc, for thc pcrfornunce of the work for which the permit is issued.
_l have and will maintain workers' com;rcnsation insurance, as required by Scction 3700 of the l,abor Code. for the lrcrformance of
thc work for which this permit is issuod. My workcrs' coq)ensalion insurancc carricr and policy numbcr arc:
Policy Numbcr: Expires:
_l certify that in thc pcrformance of the work for which this pcrmit is issucd. I shall not cmploy any pcrson in any runnncr
so as to bccomc subject to the workcrs' compcnsation laws of California, and agrcc that if I should bcconrc subict to thc
workcrs' corrrpcnsation provisions of Scction 3700 of thc [:bor Codc. I shall. forthwith comply with those provisions.
WARNING: Fhilure to sccurc workers' compcnsation coverage is unlawful, and shall subjcct an employcr to crirninal grcnaltics and
civil fincs up to onc hundrcd thousiurd dollars ($100,000), in addition to thc cost of compcnsation. damages as provided for lhc
Scction 3076 of lhc l-:bor Code. intercst and attorncy's fccs.
Date:__ __
LICENSED CONTRACTOR
DECL TTATION
I hcrcby alfirm under pcnalty of perjury that I am liccnscd under provision of Chapter 9 (comnrcncing with Soction 7000) of Division 3
of the Busincss and hofessions Codc. arxl my license is in full force and cffcct.
Liccnsc Number:Liccnse Class: l
Date:___( 'ortl r:tt'lrlr.
W
I hcrcby afhrm urdcr lEnalty of pcrjury that therc is a mnsruction hnding 8gcrcy for the Isformc of thc work for which this lErmit is
issucd (Sec. 3097, Civ. C.).
lrndcr's Nanrc:
APPLICANT DECLARATION
I hcrcty affirmundcr pcnalty of prjury onc of thc following declarations:
Dcmolition Permits-Asbcstos Notilication Fcderal Rcgulations (Titlc 40. Part6)
-Requircd
lrtter of Notification
__l ccrtity that thc fedcralrcgulations rcgarding asbcstos rcnxrvalarc not applicablc to this projcrt.
_l certity that I havc rcad this application and statc that thc atnvc' infonnation is corrcct. I agrec to comply with all City and County
ordinances and Statc laws rclating to building construction and hcrcby authorizc
abovc rncntioncd proJrcrty for
Applicanl or Agent
Permitee nanre
ivcs of this City and County lo cntcr upnn lhc
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loo rlY enV Insulation
Roof Sheathins
Shear Wall
Framing
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
[\Iasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enoineer Final Report
Flood Zone Certif
,1
FINAL tt Ir -@ -D*d-fl
Certificate of Occupancv ,a
Notes, Remarks, Etc.
Rev. 08-07-201 5
Applicant:
_Dare: lt/to/zr/,