HomeMy WebLinkAbout40133943 - PermitProject Address: 1570 E Seventeenth St unit:
Assessor's Parcel: 4OO-251-O7 Lot: NA Block: NA
Bldg:
Tract: NA
Address Range:
Historic: No
Suite Range:
Zoning: C5
<2
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA)27O2 Mechanical
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 4A{33943
Pin #: 50250
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
Easter Seals of Southern Calif
1063 McGaw
lrvine, CA 92614
(7141 724-91s7
Easterseals Southern Callfornla
JLC Associates lnc.
3198-A Airpod Loop Drive
Costa Mesa, CA 92626
(7141 2414430
01116002 51604
01 1 16002 51604
01 1 16002 53603
01 1 16002 5160C
01 1 16002 51604
01 1 16002 5777C
Fee Type
Air Handling
Alter Vent Sys
P/C - 650/o
General Plan Update
lssuance
Microfilm Records
Amount
46.25
45 33
065
22.95
57.20
3.91
Qty
3.00
18.00
gil.69
1.00
1.00
100
Fee
$138.75
$81 5 94
$620 ss
$22.e5
$57.20
$3.9 t
I
State Llc # 645576
Lic Type: B
Bus. Lic #: 177A48
Workers' Cornpensation I nsurance:
Carrier: INSURANCE COMPANY OF THE WEST
Policy #: WSD5045216
Expires: 0110112021
Building Use
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By: CSG
Perrnit lssued By: Zuniga, Allissa
Subject to Field:
Building Perrnit #: 10199148
Commerclal Occupanc}.
Tenant lmprovelnent Constr TYPe:
Chg of Use/Tl/Card ReaderslCode:
Date:
Date:
Date
A-3, l4
V B, SPK
cMC 2016
Notes: Mechanical for-Change of use from offlce to an adult
day care.
12t18/2019
04141t2020
Account#
Misc. Receipt' 73454
Misc. Receipt:
Misc. Receipt:
fotal
Every permitissued shall bxome invatidunless the worton the site 01116002 51604
auhoiized by such permit B cornmenced within 360 days afler its 01 1 16002 57770
issuance, or if the work authorized on the site by such permit is suspended
or abandoned for a pertod of 360 days after the time the wort is
commerrced.
lnspector MtD# " 2019- 1493s2
01 1 16002 51600 $22.e5
$1,01 1.89
$3 91
Fee Total
Paid to Date:
Balance Due:
$ 1 ,659.30
$620.55
$1,038.75
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M ECHANICAL-INSPECTOR RECORD
APPROVALS DATE IDISIG.COMMENTS (r\vFrElt Bt,It.Dt:R Dr.t.('Att vnoN
I hcrcby aflirrn unrlcr puralty cf lrrjury thrt I un c.rcn4lt linru tlrc ('ontnclors' l.tcenre Lmv for the follorvirry rcos(rn (Scr 70J1.5
lltrlrnesr onrl ttofesrion Crxle): An1' City or Couru1 s'hich regurer a pcrnri lo conttrucl. alts. tmFlrove. dcmulrsh or rclnr rurv
strucluL^. [rilrr to ils ]rqnmc. uhro rcqurs thc rpplrtanl ltrr rrr,ch FErmrl to lilc n stgncrl 3lilctu$ll tha lr or shc tr hccnrc{ purcuanl
lo lhc pursiors of thc ('olrtr.rlor's Lrtgtr*tl l-rrrr' {(Jralrtcr 9. ('olrurrcrrirrg rvith Sostion 7000 of Divsron J of thc Butircs arrd
f\'ofersionr Codc) or lhal hc or shc rE Gtcrlpl thscfronr and thc bcss for thc allegcd rsunpr(to Any violstxrn of Scrtion T0.l l S tr-v Rrt1
upplicnnt firr u Jrannit xuhc'ctr thc rJrplrcartl t.! u civilpcrurltv rrf rrot mor€ thul livc hurdrcrl dollars (3500)
-1.
os olrncr of tlte proFnr\,. ot uty crplo.\'ccr $ rtlr ruagl: ns llrcir xlle curn;rrrstiorr. rrill dr tlr uurt und ttrc slnrlu€ Ei rrrl
rnrcn&l orollercd firr mle (Scc 70.la. lltrsinrss rmtl ltofcsskrnr Codc' 'l'hc ('onltrclrn's Liccrut'Lsrv dorr D(tt s1Trl'' io on ouner of
tlrc pmgrzty sln builds o( tn{x$vcs ltrcroo. nnd uln rkrr; nuch srrt hlrntclf or hcrsclf or tlnough hrs or trer osn employcts.
por idal tlrar such iulxororxr[r ac oot &rtordsl or cil'll'rsl (r rulc. l[. lrosocr. tlrc hrildirry ot itnplot'errrrrt is rold ntthtn onc )tru
of conqrldbu. thc Otrrcr ttuilJer rlill lnuc thc hrrdcn of proving tlrar lr or ihc drd not blld or impuvc the popcrtl' ftrr tlrr prrps of
salc).
_ .1. is orwlcr of t hc F(rlxrly. lrrrr cr(ltr$rlcly colttrurlrrrg rt ilh lrcelrrl currlrlrlors lo cottrltu('{ t lrc ;xo1rt (Str 71X4. Busrn<'ss
urxJ Pnrfi-:rrrirCrrr.le 'Flrc('orttractor'sLiccnscL.rrvdor:rnorrpplyt(,iul()nnuufpolxtlvtrlrotlurldsorintprovestlrcicr.rtr.
arrd rvho conlr'ocls for guch llrojocts rvIh n ('otrlroclor(.$) lrcrucd prnsu&rl ltr the ('ontrt(rot's l.uensc I art I
B &PC ftrrtltrsrcarxlu
I )irtt On nrr'
\\'{ }lt K t. l!.S' ('()r\ I I'l'."\ Srt'l' I ( ll.
I)T:( L,\RA I loh
I hcrcg rlTir ru urrdo potolty of Jn.iurl'onc of tlrc follorr irrg dcclar otionr
__ -l har.e end rvill mrirraio r CorrficateofConrrrt ro SclGlmus3 f97 nrrrkar'conpct[rtton. Blr povidol fol by Scctiort.r?fl) of tlr
Labor ('odc. for thc Frctfonrrmcc of iltc rtorit for uhich tlrc putrit b lroucrl.
_l
thc
hate and rvill rn.ruttgin rvorkot' cotntlctuntton insurlnce. as bv Scctron -\7UO o, the I Htxrr Crxle. for the pttfrxrrmrrc o(
rrnrk frrr rlhich this pernru rs rssuod. lly rrortels'trlcc carrler nnd polrl'nrrrnbcr re
Polio I
-*ptr*:
t t
_l cerrif) that in thc pcrbronrrc of thc s'ork lor *'hrclt thrr ]rcnnrl is issue<|. I shell n(rt snpk)y sny ptrvJn rn sny nlrtrurtT
$ as to bccomc arbtoct to thc so*crs' compensation lnws of Cohfornin. and $llrcc lhil if I sh:ukl hxortrc sutrlcct to thc
ruxkcrs' conlpcrrsrlton pror irions of Scstrrn -1700 of rhe Labor ('odc. I rlurll. furthrrrth cornpll u rth llrurc pulistotts.I
IVARNING: l;nrlurc lo arcurc rlorkclt'comFfl*uron cr'\'erogc s unlnsful. antl slurll rutlctt ou onpkryr to crirnrnal pctnlttcrpnd
crvrl frnes up to one hunrlred lhousantl dollrr (Sl()0.0t)0). rn co( of cornpensatton. darnagcs rt Jroridcd for the
lio'tion 1076 ol'('cxlc. iutcrcrt and rtrorne1"I t
(I-
l)ate:
I hcrcr,! aflirnr undu' penthy o[ Jrrpry thut I arn liccrBed untlcr pulilion ol'('hoptcr 9 (comrtrcncing tith Sccrion 70(U) of Divtlnn .1
of rtrc Lttrrinsr and Profcssioru ('odc. nnd tuy licauc Lc in full forcc ald c(fecl
b 4
;;'"" q,!jlTota $L A9+
perforrnolre of the rrork hr rr hrh lhis grrmrt sI lrcrttr. allirnr urrdc pomlty'of pr.iury thet lhcrc rs o conslructirn Lndrog a6cnc)
rssuctl(Ses. l0)7. Crv. C.).
l-cnrlcr's Irnc
-_t.crxlsr'r Atl&c:r
A,,Pt.l('Alilt t)1.:('t..rRATloN
I tnehy.nlfrnn unrltt lnrnlty of pmlury one of thc follorvrrrp rlct'lnraions
Llanolilion Pcrruir-r\sbcrtor Notificaton liedcrnl Rqgolationr (l itlc 40. Part0)
Required Later o[ Notilicatron
rcguding osbcstor rcrnolal arc n()t ryplictrtrlc lr"l lhrs proJ6ct
inforrrurtion it comt{ I ngrcc to ctvtrttrlt rr ith all ('it.v nnd ('ounl1
rbove mcrrrnncd po6rty' for
sulhor uc r cprclcnld r.'..1 f thrs ('rly rnd
A;r;tlrralt or Agtrrt Signnturt
Itcr rurlcc narrrc (prtntl.N
Appliances
Metal Fire Place
Evaporative Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-lnsulation
lnsulation
Smoke Detectors lnstalled
Roush Ductwork I
Vents
Toilet Room / Clothes Dryer
Residential Ranse
Other
Hood
Type I Hood
Type ll Hood
Grease Duct
Fire Damper
Openings
lnstallation
F.D. Drop Test
Above Hard Lid \
Above T-Bar \\ rot\r.r tap{nrtlr
Rouqh Mech.
Final Test
Meter Release I I as u
FINAL tO\W/l hI\"H 't/
Notes Remarks Etc.
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