HomeMy WebLinkAbout101101971 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA92702 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: 1O11O1971
Pin #:38e69{
Project Address: 1410 E St Gertrude Pl
Assessor's Parcel:014-273-24 Lot: 9,1 0, 11,12,13 Block: NA
Unit.Bldg:Address Range: 1410-1424*
Historic: No
Suite Range.
Zoning: MlTract: 4450
Building Use: lndustrial
Job Type: Revision
Nature of Work: Revision-Slot Cutting
Existing Bldg & Use lndustrial
Proposed Use:
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories:
N/A
N/A
cBc 2016
x-0602320276J
1st FL Area
2nd FL Area
Other Areas:
Garage Area.
Totat
Patio:
T.l.Area:
Yards Req'd
Valuation: $20,000.00
FROM THEDescriptionof Work: Revisiontol01101378-Slotcuttingforremediation/excavationtoincreasearea.ALLTREeOfllMENDATlOMl
STRUCTURAL ENGINEER SHALL BE FOLLOWED. SEE APPROVED PLAN WITH THE 7 RECQi'MENDATIONS
Planning Conditions:
Rel *
L/4l?trlt
-| i^-^ Tr-
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
(:h ar I es Pr'nd n
Innovot i ve (:onstrur:t i sn ScOwner:
Address:
Phone:
Tenant
Allen Campbell
PO Box 44B-
Newport Beach, CA 926620644
Contractor: lnnovative Construction Sol
Address: 575 Anton Blvd., #850
Costa Mesa, CA 92626
Phone: (7141 893-6366
State Lic #. 764815
Lic Type. A, HAZ, C-21
Bus. Lic #: 195842
Workers' Compensation I nsurance:
Carrier: ZURICH AMERICAN INSURANCE C
Policy #: WC551 375104
Expires. 10/01 12019
11 icrof ilm & Do,:.Lrnrents
Lt 1 1 I 61102 - 7-i777t-tt-t[tt.t-
I'la g I er (:n r' d
C(:*: **t**r*tt** +i i iS
Planning Approval By:
Plan Checked By.
Permit lssued By:
NPDES lnsp. Req'd.
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd:
McCann, Melanie
Heidari, Fred
Zuniga, Allissa
Date: 1012412019
Date: 1012912019
Date: 1110412019
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
7367 1
Total
07776002 57770 Microfilm Records
07776002 53600 Revision
07776002 s7672 Bldg. Stds. Revolving
07776002 57600 General Plan Update
Fee Total
Paid to Date:
Balance Due:
$27.37
$461 .74
$0 00
$0.00
No
No
No
No
Fire Insp. Req'd: No
Police lnsp. Req'd: No Account#
Flood Zone Cert. Req'd: No 01 1 16002 53600 $461 .74
$27 37Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days after ifs issua nce,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.
$489.1 1
$461 .74
$27.37
lnspector MID#: 201 9-152583
01 1 16002 57770
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I h6eby aflim und6 poalty of perjury that I m cxmpt ftom thc Coriltaclos' Licre law for thc following r@n (Sc.7031.5
Busins md Prcfeion Codc): Any City or County $'hich rcquirs a po'mit to construct. alts. improvq donolish or rcpair uy
structuq prior to its isumcc, also requirs thc applicmt for such pcmit to lilc . sigocd stdmot that hc or shc b licas{d plBet
to thc provisioE of thc Contrrctor's Licoscd law (Chapt6 9. Commcncing with S6tion 7000 of Division -l of the BBins aod
prcf6ioN Codc) or that hc or shc is ompt thqefrom md thc basis for thc allcgcd cxmption. Any violation of Sccrion 7031.5 by any
applicantforapmitsubjctsthc applicanttoacivilp€naltyofnotmorethufivchundrcddollas($500).
__1, I om6 of thc propcrty. or my cmployc with wag6 a thcir mlc ompcmtion. will do thc wolt atd thc structuc is not
intmded or olfcred for slc (Se,7044, Busin6s md Prcfcssiom Codq 'I hc Conlraclor's Lictre Law do6 not spply to o oMa of
thc popoly who huilds or imprcu th@n. ed who do6 such wrk himsclf or hmelf or thrcugh his or hc om cmployc.
providcd that such improvffits rc not intodcd orofH for slc. lf. howo(. thc building or improvmot is sld within onc )ar
ofsmpldio]l the Owno Buikkr will havc thc budq ofproving tha hc or shc dlJ not hriH or imprcrc the prcpqty for thc pupos of
ule).
_1. u ornq of the propqty. m cxclusively contracting sith licffcd conlracloB to coGtruct the proj{t (Sa. 7044. BEinE
ud Proftssim Code: Thc ContBctor's Licosc Law do6 not apply to u ownc ofpropa'ly who builds or improv6 ths@n.
and who otrtnds for such projds wirh a Contnclo(s) licqEcd puBwt to thc Contraclor's Licffi [rw)
-l
an excmpt undq Sstion---, B. & P.C. for lhis rcen,
Il.rI n.()n lter:lra!tt'
I hereby affirrn under penalty of perjury one of the follorving
__-l have and will maintain a Certificate of Consent to Self-lnsure for workers' cornpensation. as provided for by Section -3700 of the
l-abor Code, for the performance of the work for which the permit is issued.
_t have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code, for the po'fonnance of
the work for which this pennit is issued. My workers' compensation insurance catrier and policy numhr are:
,*x,, \Zrrfch hrWr;foX CnSVtahcA LO
poricy *,^*,2 u)LS5tT-|SIO5 Expires:t
--l certify that in the perforrnance of the work for which this perrnit is
stl as to become subject to the workers'cotnpensation laws of Califcrrnia.
issued. I shall not employ any person in any lnanner
antl that if I should becotne subject to the
rvorkers' compensation provisions of Section 3700 of the those provisions.
WARNING: Failure to secure rvorkers' compensation and employer to criminal penalties and
civil hnes up lo one hundred thousand dollars of compensation. damages as
Section 3076 of the Labor Code. interest and
I)ate:ll4-rq
I
of Chapter 9 (comrnencing with Section 7000) of Division 3I hereby affirm under penalty of perjury that I am
of the Business and Professions Code. and my is in full force and effect.
.%qKE
I hereby affrrm under penalty of pcrjury that there a lending agency for the perfonnance of the work for rvhich this permil is
issued (Sec. 3097. Civ. C.).
Lcnder's Name:
Lender's Address:
APPLICANT DEC LARATION
I herclry affrnn under penalty of perjury one of the follorving declarat ions:
Demolition Permits-Asbestos Notification Federal Regulations ('Iitle 40. Parl6)
-Required
Letter of Notification
_l certifu that the federal regulations regarding asbestos removal are not applicable to this project.
I certi$ that I have read this and state that the above inftrnnation Ls corre'ct. I agree to comply rvith all City and County
ordinances and State Larvs relating to and hereby authorize representatives of this City and County to errter upon the
above mentioned property for
Applicnnt or Agent
l'crnritee n:une (print):
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bfloo r/Ve nt/l n s u I atio n
Roof Sheathins
Shear Wall
Framincr
lnsulation/Enerqy
Drvwall
Ext./lnt. Lath
Brown Coat
J\Iasonrv
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif.
lr
FINAL t1,ha l(,Dffr'')64 Wtrl
Certificate of Occupancy lt tl
Notes. Remarks, Etc.
lo.70 lq - fhftatYt I t'License r ro,,, --[ ) l-lAZ'-CL)
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