HomeMy WebLinkAbout30141610 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA92702 Plumbing
Permit Counter: (714)647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 3O1416{O
Pin #: SOS951
'Project Address: 3400 W Warner Ave
Assessor's Parcel: 414-131-59
Unit: Fl
Lot: POR I/POR T|PO Block: NA
Bldg: Address Range: 331g-3SOO
Tract 101 U1O24rRS 3- Historic: No
Suite Range:
Zoning: Ml
Owner:
Address:
Phone:
Tenant Name:
Grove lnvestment Co
P.O. Box 1960
Newport Beach, CA 92658
(7141 545-2776
Newtonian Principles lnc
01 1 16002 51602
01 1 16002 51602
01 1 16002 51602
01 1 16002 5160C
01 1 16002 51602
01 1 16002 5777C
Fee Type
Water Closet
Sink
Appl Not Listed
General Plan Update
lssuance
Microfilm Records
Amount
14.78
13.20
68.1 4
22.95
57.20
3.91
Qty
1.00
1.00
1 .00
1 .00
1.00
1.00
Fee
$14.78
$13.20
$68.1 4
$22.95
$57.20
$3.e1Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation ! nsurance:
Carrier:
Policy #:
Expires:
8otchlt53l96 - L|l27l20f9 IDt cmclrt
Of f icrs CTYH Trons0l 66 I Bf IAcct*: Ref*: St:rl{1,110
Rcpti :02914886 II/27 / 21119 t? : 43 FH
Tronsoct i on Totol t 156 .4 1
6rc,ve Investrrt€Frt C:o
Plumbing for Commercial Cannabis - Adutt Use Retail.
Change out plumbing fixtures.
$156.41
$0.00
$156.41
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
issuance, or if the work authorized on fhe sife by such permitis suspended
or abandoned for a period of 360 days after the time the
commenced.
Building Use:
Job Type:
Nature of Work:
Commercial
Tenant lmprovement
Tl/Roof Mtd Equip
eri
1 01 865
Occupancy:
Constr Type:
Code:
Date:
Date.
Date:
M
VB
cPc 2016
11t27t2019
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total
Paid to Date:
Balance Due:
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
$22.e5
$129.5s
$3.91
athGatlnH s
lnspector MID#: 2018-141
PLUM BING-INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATTON
I hcrchy offirm under pnalty of pcrjury lhal I am exempt fmm lhc Contractom' Licens llw for thc following ca$n (Ss.7031.5
Busincss snd Profcssion Code): Any Cily or County which rcquircs r pemit to construct. allci imprcvc. demlish or rcpair any
slructurc. Irk r to ils issuarce. sls rcquircs lhe applicrnt for such ,Emit to Iile I sigred stalerent that he or slrc k licensd puKuant
to lhc pDvisions of the Contractor's Lkensd kw (Chrptcr 9, Comrcing wilh Setion 7000 of Division 3 of the Busircss ed
hofcssionsGrdc)orthathcorshciscxemptthcrcfrcmandthcbesisforthcallcgedcxcmption. Anyviofifiotrofsfftion703l.5byany
spplicsnt for I lrcrmit subjccts thc applicanl to I civil pcnslly of not mrc ther five hundrcd dollus ($500).
-1.
as owner of the propcrty. or my employoes with wages as their solc comfrcnsation. will do the work and the structurc is not
inlerxled or offercd for sale (Scr.7O44. Busincss and Professions Code: The Contractor's License l-aw does not apply to an owner of
the propcrty who builds or improves thercrrn. and who does such work himself or herself or through his or her own employees.
providcd that such improvcrrcnls anc nol interdcd or offered for salc. If. however. the buiHing or improvenrcnt is sold within one )rar
of conrplction. the Orvner Buildcr will have the burden of proving thal he or she did not build or inqlrove thc property for the purpsc of
sale).
-1.
as owrrcr of thc propcrty. am cxclusivcly contracting with liccnscd contractors to construct thc projc.ct (Sec. 7W. Busincss
and hofcsskrn Codc: Thc Contractor's Licensc Law does not apply lo an owner of property who builds or improves thercon.
and who contracts for such projccts with a Contracto(s) licenscd pursuant to the Contractor's License kw).
for this
7
I hcrcby al'firnr undcr pcnalty of pcrjury of thc
-l
havc and will maintain a Certifrcale of Consent to Self-lnsure for workcrs' compensation. as provided for by Section 37fi) of the
I-sbor Codc. for thc grcrformancc of thc work for which the pcrmit ls issued.
-l
havc and will maintain workcrs' compcnsalkrn insurance. as rcquircd hy .Section 37fi) of the labor Codc. for thc prcrformancc of
thc work lbr which this;rcrnrit is issucxl. My workcrs' comlrcnsation insurancc carricr and plicy numbcr are:
Policv Nu:ntrcr: Exnires:
-l
ccrtify thul in the Jrcrfnrnrancc of thc work for which this pcrmit is issucd. I shnll not cmploy any pcrson in any ranner
so as to bcconrc subjcct to the workers' co:npcnsalion laws of California. and agrcc thal if I should bcconrc subjcct to thc
workers' compcnsalion provisions of Scction 37fi) of thc Lahrr Codc. I shall. tbrthwith comply with thorc provisions..
WARNIN(i: Failurc lo sccurc workcrs'covcragc is unlawful. and shall subjcct an cmploycr lo criminal Jrcnaltics and
civil lincs up lo onc hundrccl thousand dollnrs addition to lhe cost of compcnsation. damages as providcd for thc
I hcrcby alfirrrr unrlcr pcnalty of'pcrjury that I arn provision of Chaptcr 9 (comrrrcncing with Section 7000) of Division 3
of lhe Busincss and Profcssiorts Code. and rny liccnsc is in full forcc and cft'cct.
Licensc
Date:
Nurrthc'r:
('oltl r:rclrlr
W
I hcrcby affirm undcr pnalty of trcrjury lhal thcrc is s @nslructbn lcodirg agcrcy for thc lrcrfomrcc of thc uork for which this pcrmil is
issucd (Src. .1097. Civ. C.).
kndcr's Nanrc:
Lcrder's Addrcss:
APPLICANT DECI ARATION
I hcreby affrnn undcr ;rcnalty of prjury orc of the following declarations:
Dcmolition Permits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40. Pan6)
-Rcquired
lrttcr of ]lotification
-l
ccrtify that thc federalregulations regarding ashcstos renrovalarc not applicablc to lhis project.
and slate lhat lhc atnve information is correct. I agrc= to comply with all City and County
and hcrcby authorizc reprcscntatives of this City and County to entcr uJnn lhc
IApplicant or Agent
Permiteer@
il 71
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underf loor
Buildinq Sewer
ArealStorm Drain
! nterceptor/ CIarif ier
TOP OUT
Waste & Vent
Water Pipinq
Gas Pipinq
Roof Drain
Tub/Shower Test
Rough Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Pipinq
Fill Line/Back Flow
Poo! Heaterlcas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary SewerlCap
Back Flow Device
Rough Plumbing
Final Gas Test
Meter Release I
FINAL l"f tt !t4 Xf.,Z-tr+el \/4/>/
Notes, Remarks, Etc.\) \ \-'
Carricr:
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