HomeMy WebLinkAbout30139595 - PermitPermit #: 3O139595
Pin #: 94572
q
Assessor'sParcel: 396-16'l-03 Lol: POR G.L. RUSSE
Unit:
Block: A
Bldg: Address Range:
Tract: A.B. CHAPMAN Historic; No
Suite Range:
Zoning: C4
Owner:
Address
Phone:
Tenant Name:
Contractor
Address:
Justin Strom
777 S. Harbor Blvd.
La Habra, CA 90631
(916) 893-1s36
CVS Pharmacy
Eleven Western Builders lnc
2862 Executive Place
Escondido, CA 92029
(760) 796-6346
0 t 1 16002
0'1 1 16002
01 1 16002
0'1 1 '16002
01 1 16002
Fee
$28.44
$25.40
$ 19.54
$22.08
$55.04
51602
51602
5160'
5160C
51602
Notes
Amount
14.22
12.70
19.54
22.O8
55.04
Fee Type
Water Closet
Sink
Min Fee Adj
General Plan Update
lssuance
Qty
2.OO
2.00
1.00
1.00
1.00
P hone
Slate Lic #: 439908
Lic Type: B
Bus. Lic #: 364156
Workers' Compensation lnsurance;Carraer: Twin City Fire lnsurance Company
Policy #: 72WEAZR0733
Expires: 1Ol31l2O1A
Botchi:46032 - I /29/?Ol8
0f I i,:e: CTYH Tronsl: 15Accti: Ref;:
Fcpti:02387676 - 9/2$/2fi19
Tronsoct ion Totol
I0: sdl
30139
1:11
t1 rQ0l
Occupancy;
Constr Type:
Code:
M
V B, SPK
cPc 2016
Eleven llestern 8u ilders IncBuilding Use:
Job Type:
Nature of Work:
Commercial
Tenant lmprovement
T.l. - Accessibility
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:ernandez, Kathy
Subject to Field:
Buildins Permit #: 1 0196303
Every permit issued shall become invalid unless the work on the site
authoized by such pemit is commanced within 1 80 days aftet its
issuance, gr if the wotk authoized on the site by such pemit is suspended
ot abandoned for a period of 1 80 days aftet the time tho wo* is
commencad.
09t20t2014
Account#
Date:
Date:
Date:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
lnspector MID#: 2018-'143055
01 1 16002 51600
01 1 16002 51602
$22.08
$128.42
Fee Totat
Paid to Date:
Balance Due:
City of Santa Ana 20 civic center Plaza (M-19), Santa Ana' cAgz7o? Plumbing
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: i.714),647-5853
Project Address: 1750 N Grand Ave
Generol Plan uodote Fee
01116002- s1600000-
PIUlb ins
Lul 160tr2- 5 16t'r2060-
ICL Check 2129
$150.s0
$0.00
$150.50
PLUMBING.INSPECTOR RECORD
OWN!:R AUILDER DELCARATION
I lrcrcby rllirN u.dcr !.n,hy 0l pcrjury rhd I m cx.,np' rn'n rhc G)nrr.ntrr Li.cnsc ltr$ ftr rtu f{,lhwing r.i$n (scc 7o,ll t
Br\nrss rnd Pro,!\snrn Gic) Any Cily or (i)utrly whi.h rcquncr a Annn lo .otrirldr. !lr.r. i pruvc. dcnmlirh or Npln rny
nrudurc. ri(* k, iN i\surncc, dn, rcqun.\ihc t'ppli.ant lor nEh rEnn (, rilca sisncd slor.mnt rhlt hco! \hc is lietr\cd ru6ulnr
k, rhc pnni\ion\ olrh. Contnclofs Licen*d L,w (Cha cr 9. conmrn.ir8 wirh SccrioD 7(xx) or Divtion I olrhc ausinc$ lnd
Pn,rcsnri\ C.dc)o.thlr hcorshc Gcic'.pr lhcrctromand lhcb$is n,lhcallc8edcrc.rflion. Any viollliotrotSsrbn'70.115 hr!n,
atnli.lnt lu r If,nnir subrc.hrhc atpli.rnrbacililtrnrlrrofnolmmrhrnfivchu.drcddoll3r(S5tu)
-1.
!. owN of th. pr6Fny, or oy .nphrr6 wirh wrgcs s rh.t $h @hpcnglion. eil do rl* so* ad tlr sEEfift is nor
irlc'i(H or oficEd for sh (Sa,?044- Busimss .nd Prcfcrshns Cod.: Th. C., Blols LitN trw d..3 mt +ply lo .n ower of
$c poFny wlD hikti n it9fts $c6i. drd qho .lo.s sh wrft himrlf or hcrslf or ttmuSn his or ltr o*n.mployes.
Imvidd lhlr 3uch inprcE@nti6 ml i c'id.d tr ofcrcd for $lc. r. ho$w, llE huildi,g m irp,DEmnt k sld wnhin om yr
oloirlclba thc Owmr Auiud *iI h.w dr h!d.n ofpmvinS ind h. o. rh. dil rcl bdld o, atr{ll@ tu pqsry for d* plrpoe of
-1,
as owmr oflh. pq,crly. am crclusivcly contrr.linS wnh leosd codraclo ro .otr(tuct ihe r.mr$l (S(. ,044, 8!sms
nd Eots\iln Crdc: Thc Contturols Lkcnrc Law des nor apply ro !n owncr of prcrcny *ho buids or improvcs $ceon.
and *ho €onlEcts for su.h tmirls w n a Conh.lo(, li@.sed puNuur ro rhc Con'n rofs Lieri. tis).
I mcrcm undcrscrion .B & Pc.Iortirr&sn
Ormr_ _
uQBrE&tglltfENsa.rr0ts
DECLAN-AAION
I icrchy oltirm undcr Dcnally of ncrrury otrcof'hc follopirn rlc.ld,rioni:
l halc md sillnuinruin aC.nificricolConscnrr, Sclilnstrc f.r wdkcr'co Fna(hn.0! !(,vidcdlhrhySccrnnrlTlx)olrh.
tlbor Aic- ior lhc I'. hrnuncc oflhc *orl tor which rhc Fnnir is hsxcd.
_l narc &d *ill nlinrain work * @mp.n!.tion insolee. as ftIlift{ b, Sdion l70O of lhe tjbor Co.!.. {or rhc pcrfomrce of
thc work for whhh rhir Fmit ii ilsri. My mrkch .ompcn{ion i.su@ @ic, rld lDlhy numh.r el
Pol'cv Nunhcr Jrni,€s
-l
c.nify lh.t in th. pcrfolmre ollhc wort for which fiir pemir is ir$cd. I rhru .or cn{loy aoy p.66n in rny mnmr
s as lo txsft mbj..i ro thc *odm oqxnerion laa! ofoliaornia. and aBr. Inll it I should hccom subjKr ro rtrqod(nl smrrcnsali.n pmvbions ol Scdio. l?00 ol lhc Lilx{ Codc. I nall fonhwirh onply wnh Uoe povi\i.B..
WARNINC: Flilurc lo $c!r wo*c6 conlcnsaliotr ovcm8c iq unhwtul. and sholl subirl .n cmplorr lo ain nd pcMllics and
civ nncr rp ro onc hund.d riolsnd dollus ($100.000). in oddirion ro rnc co.r of.ompcnstion. damgcs ss prcvijed for th.
Cdc. inrcesr und artorNy\ aes
2o a
DICI.EMI]ON
Ihcrehyrf,tmu.,lcrI'.tulryofpcrjuryth0tIanliccNnuM.rEovisi(.1chaFdr9(connftncinAwiihsc.ri,.?(x)l))olDiuisio.l
oI rlr Busir.\s and I'mfcrstrs Codc. md ny li.cn\c h in rull forcc rrxl.fl.rr
o,/z 6 D
CANEIBI,]qUONIINI}INC.AIiEN.CI
I h.(hy rlltd rndrr lcnxlry of p.rjurr rhar rnc,c is u c.tr{rucriotr htJirs iscEy ln rlt ncllolrttcc olthc wnrk nt wnich rhn n rnrir is
n\uc.l (Scc.1097. Civ C.).
I.cnifyrhor rhc fcdch, rcsularir,rr Egarding a\h.rlos rcn$val lrc nor amlicnblch lhix D(+cl
-l
ccnify lnal I hnvc rcrd lhis applicllion.nl $.rc lh.l rhc nhovc inf.rurion n cor.d.I lgr ro enpl, with allCnr&d Co!.ry
odimms.nd S{arc tlwrmbling ro building co ion. &vl hcrehya!$oriz. rcpree arive. of $h City&d Connry lo cmc upon rrE
dh)vc nrdiotrcd prcpcny lar inspc.r
Appllunl or Ascnl Slgnsture
APPROVALS ID/SIG.COMMENTS
UNDER GROUND
Waste & Vent
Water-Under floor
Building Sewer
Area/Storm Drain
I nterceptori Clarifier
TOP OUT
Waste & Vent
Water Piping
Gas Pipinq
Roof Drain
Tub/Shower Test
Rough Water Heater
P-trap/Drain Line
Ir/ain Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Waler Service
Lawn Sprinkler
Sanitary Sewer/Cap
Rough Plumbing ,l/Lx/ts 5t\tr$
Final Gas Test
Meter Release
FINAL l/)lu,/6 Ad
Notes Remarks, Etc.
P.mlle n.nelpnn()
4 /o
DATE
kdd.r'r ArtdM*
-
lrtllldttflfll,A.t,drto!
I h.d)y rflnm undcr pcrrlry ol rrrjuryonc oilhc nnhwin8 dc.hr.riotrs:
r).nmlirir,rcnnn\ A\h({os Norilic!li, l;.dcrnl R.!uhrn,nr (Tirlc-10, Pnn6r
R.qrnc{t l..rcr ol Notilicari{{
Gas-Underfloor
POOL/SPA
Back Flow Device