HomeMy WebLinkAbout101104194 - PermitCify 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 #: {O110,4194
Pin #: 43518
Project Address: 2710 W Edinger Ave
Assessor's Parcel: 408-041-02 Lot: POR 1
Unit:BIdg Address Range: 2700-27 10
Historic: No
Suite Range:
Zoning: C1Block: NA Tract. 1024
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use.
Proposed Use:
Commercial
Parking Lots
Parking lot
Commercial
U
N/A
cBc 2019
x-0602320257J
'1 st FL Area:
2nd FL Area:
Other Areas:
Garage Area:
Total:
_
Patio:
T.l.Area.
Yards Req'd:
Valuation: $59,000.00
Occupancy:
Constr Type
Code:
Flood Zone'.
# of Stories:
Description of Work: Reslurry & restripe (70) spaces.
Planning Conditions:
:i5rJt6
(:TYH
Lt*i[t?36i 6
lr nn so':t i c,n T st n I
Idi6i
a
Owner:
Address:
Phone:
Tenant:
Mary C Axelson Trust
P O Box 2683
Costa Mesa, CA 92628
(7141 349-1 620
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Engineer:
Address:
Phone:
License #
Architect /
Desiq ner:
Address:
:
McWatters'
McWatters
l- il6ullJlll:l-
s Revo1v i ns:- i1612r-rtrr.r-
d ins
536ultttLt0-
m & 0scufiients
177 7[r[tlr[r-
s (: Axe I son Tr ust
oI l-'I0n Upd0te
Lru2- 5l6LtLlLilJ[t-
LILI I
Lrl t
Bld
Sta cy
Stacy
Phone:
License #
Iln st er (:crr d
(:(:t : -r**r***r*#r*t:t3? 1
Planning Approval By:
Plan Checked By:
Permit lssued By: \
NPDES lnsp. Req'd, )Ao
PWA lnsp Req'd: ( ) No
Planning lnsp. Req'd:\ / No
Landscaping lnsp. Req'd: No
Gomez, Pedro
Kwak, Jason
Amsden, Julie
Date: 0713112020
Date: 0713112020
Date. 0713112020
Subject to Field:
Misc. Receipt.
Misc. Receipt:
Misc. Receipt:
07776002
0L776002
07776002
07776002
0LL1"6002
0 77760 0 2
57601"
53600
57770
57672
57600
5L607
Permit Fee
Plan Check Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssu a nce
Fee Total:
Paid to Date:
Balance Due:
$260.00
$300.00
$8.1 0
$3.00
$23.79
$5e.30
$654.1 I
$0.00
$654.19
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 01 1 1 6002 51 600
01 1 1 6002 51 601
01 1 16002 51612
01 1 16002 53600
01116002 57770
Account#Total
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within360 days afterifs issuance,or if the work authorized
on the site by such permitis suspended or abandoned for a period of 360 days after
the time the work is commenced.
$23.7e
$31 9 30
$3.00
$300.00
$8 10
lnspector rv ID#'. 2020-1 60 137
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS ()WN I.lR Il t, I l,DI.,lt I)F:LCA RAl'l( )N
I hereby affrrnr under penalty of perjury that I am exempt fronr the (:ontraclo$' l-icense l-aw for the following reason (Sct'.7031.5
Busincs.s and Prolbssion Codc): Any City or County rvhich rcquircs a 1o-rrnit to construct. altcr. irnprovc, dernolish or rcpalr any
structure. prior to its issuance. also requires the applicant fi)r such permit to file a signed slalenrenl lhat lrc or she is licensed pursuanl
to thc provi.sions of thc. Contractor's l,icenscd l.aw (Chaptcr 9, Comrncncing with Scction 7(XX) ol' l)ivision 3 ol'thc Bu.siness and
Prol'essionsCrxle)ortlratheorsheisexemptthereftonrandthcbasislirrtheallegedcxenrptiou. AnyviolatiortofSectionT03l.5byany
appliclnt for a pcrrnit subjects the applicarrl to il civil penalty oI not rnore thurr five hundred dollars ($5tXt1.
,/fr.as owncr ol'thc properlv. or my crnployccs with wages as rhcir solc cornpcnsation, wilt do the work ard thc stnrture is nnt
- fntenderl or offeretl for sale (Sec'.7O1.1. Business and Prcfessions Cotlc: The Conlractor's License Law ttoes not apply to an owner of
the pnrpcrly wlm builds or improves lhereor\ und who does suclr work hinrself or herself or through his or her owu enrployees.
providcd that such irnprove'nrcnts arc rnl intcndcd orollbred l'or sah. Il. houcvcr. thc building or improverrEnt is sold withinone ycar
of conpletiun, the Owrrcr Builtler will lurve thc burden of proving that hc ur she tlitl not build or improve the propcny for tlrc purlnse of
%-.ilxs:'J:Tii'llr;r};l;rillr;"ili'il:,xriffil::l:::iff::':li:rilfilil::r,::]ff.f,ri;liTl;m'ffi:
and who conlracts lor such projccts with a Contracto(s) liccnscd pursuant to thc Contracl()r's Liccnsc Law).
-l
anr excnlpt under B P.C. lirr
t
l)r:('l,ARAI'l( )N
I hcrcby all'irm undcr penalty of pcrjury one of the ttrllowing dcclarations:
-lhaveantlwill
nuintainaCertificateofCormenttoSelf-lnsuref<rrworkers'compensation,as prcvidedforhySection3T00ofthe
Lahor Ctxlc, [<rr thc Jrcrformancc ol'the work lirr which thc pcrmit is issucd.
_l have and will nraintain workers' compersation insurance, as required by Section 3700 of the Labor Code, for lhe perfornutrce of
thc work tbr which this pcrmit is Lssucd. My workcrs' c'omJrcnsation insurancc carricr urxl plicy numbcr arc:
Carrier:
Policy
eAccrrity that in thc 1^-rtirrnunce of thc work for which this pcrnrit is issucrl, I shlll not cmploy any pcrson in any manner
so aslotrccornesubjccttothcworkers'corlrpcrrsationlawsofCalil'onria.andagrccthatil'lshouldbecotncsubjccttothc
workers' conr;rcnsation provisions of Section 3700 of the Labor Cotle, I shall, forthwith conrply with thosc provisiorts.
IVARNING: Failure ro sccurc workcrs' contpcnsation covcftrgc ls unlawful. antl shall subjcct an cn4rloycr to criminul Jrcnahics antl
civil lirres up to onc hundred lhoustnd dollars ($l(X),(XX),1. in addition to lhe cosl ol'ion. damages as provided lbr the
allorney's
I
DECT,ARATION
I hcrchy al'lirrn undcr pcnalty ol'pcrjury that I arn liccnscd undcr provision ol Chaptcr 9 (cornrnencing with Scction 7(XX)) ol'l)ivision 3
of thc Busincss and Profcssions Crxlc. antt nry liccnsc is in full lirrcc urul clll'ct.
License Class: License Nurnbcr:
CONS'I'RT)C'TION I.}:NI)ING AG T:NCY
I trereby aflirnr under pnalty of per.iury that there is a c()nstnrction lerxliug agerrcy lbr the pertirrmarrce o[ lhe work lirr which this pmtit is
issuctl (Scc. 3097, Civ. C.).
Lcrdcr's Narnc:
Lcnrlcr's Arklrcss:
APPI,ICANT DECI,AR,,\TI0N
I hcreby affrnr under pnalty of prjury one of the following decluratiorrs:
f)enrolitiorr Permits-Asbestos Notification Fetleral Regulatiorrs (Title 40, Part6)
_Rctluircd Letter of Notilication
with all City and County
and County to enter up)n tlE
irhor,c rrrcntirlncrl propcrry firr
(,\pplicant or ltgcnt
('rnnitce nanre
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/VenVI n su I atio n
Roof Sheathing
Shear Wall
Framing
lnsulation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
lt/asonrv
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif
-t I ^
F!NAL il'lZ,E ILC$tt le(*g vLll
Certificate of Occupancv
Notes, Remarks, Etc.
Rev.0B-07-2015
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