HomeMy WebLinkAbout30543456 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Plumbing
Permit Counter: (714)647-5800 lnspection Requests: (714')667-2738 lnspector Section: (714) 647-5853
Permit #: 3O543456
Pin #: 7ssffl
1'Z
Proiect Address: 416 W Fourth Sta
Assessor's Parcel: 398-593-02 Lot: 34, POR 33, POR
Unit:
Block: NA
Bldg: Address Range:
Tract BIRCH ADD Historic: No
Suite Range:
Zoning: SD84
Owner:
Address:
Phone.
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
,rExpires:
Lft Property Management Llc
414 W 4th St #M
Santa Ana, CA 92701
(7141 541-5820
Lava Kitchen and Bar
01 1 16002 51602
01 1 16002 51602
01 1 16002 5160C
01 1 16002 51602
01 1 16002 5777C
Fee Type Amount
Gas Line alter/extend/ar 70.O4
Tankless Water Heater lO.O4
General Plan Update Z3.Tg
lssuance 59.30
Microfilm Records 4.05
Qty
200
1.00
1.00
1.00
1.00
Fee
$141 .28
$70 64
$23.79
$59.30
$4.05
a
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Commercial Occupancy:
Miscellaneous Constr Type:
Water Heaters/Gas System. Code:
B
III B, SPK
cPc 2019
Zuniga, Allissa 08/1 8t2021
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total
Paid to Date:
Balance Due:
Date:
Date:
Date:
lnstall (2) interior tankless water heaters and
alter/extend gas system.- Applicant to provide
isometric information at the time of inspection. Owner
form on file.
$299.06
$0 00
$299.06
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 the site by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commi,nced.
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
$23.79
$271.22
$4.05
lnspector MID#: 2021-167103
PLUM BI NG.I NSPECTOR RECORD
APPROVALS DATE ID/S!G COMMENTS OWNER BUILI'ER DEI,CARATION
I hmby alfm und6 pcnrlty of pGjury thd I m qmp fiom thc ContracloB' Licre lrw for thc following rctr (Ss.7031.5
Buincs and Profeion Codc): Any City or County which rcquir6 I pqmit to construct, dtq, improvq damtish or npair uy
structurc. prior to its isumc, also rcquirc rhc eplicut for such pqrrit to filc 8 signad ststmt that hc or shc b licqEd plmail
to thc prcvisioB of thc Contr&tor's Liccnscd law (clEpt6 9. Comacing with Scrion 7000 of Divirion 3 of thc Buire md
PrcfesionsCodc)orthathcorshciscxmptthqcfiommdthcbosisforthc8ltcgcdqmption. AnyviolationofsctionT03l.5byey
applicsntforapqnitsubjctsthc spplicmttoacivilpmlyofmtmrcthulivchundrcddollm($500).
-1,
rs owner ofthe property. or my cmployeca with wages as their sole compansation, willdo the work and the structure is not
intended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's Licerse l-aw docs not apply to an owner of
the pmperty who builds or improvc tlrcreon, and who docs nrch wort himself or hcrsclf or through his or her own crnployccs.
provided that such impmovernents arc not intendod oroffcrod for salc. I[, howerrer. the building or improvanrcnt is sold within one ]car
of complaion. the Ovner Builder will have the huden of proving that he or she did not build or improve the propoty for the purposeof
sale).
_1. as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business
and Proftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improvcs thereon.
and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's Licensc l-aw).
-l
am exempt under B.&
DI'(]LAILt'TION
I hereby affirm under penalty of pcrjury one declarations:
_l have and will maintain a Certifrcate of Consent to Self-lnsure for workers' compcnsationr asi provided for by Section 3700 of the
I-abor Code. for the performance of the work for which the pcrmit b issued.
-l
have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code. for thc pcrformance of
the work for which this permit is issued. My workers' compqrsation insurance carrier and policy number are:
Policy Number: Exphes:
-l
certify that in the performance of the work for which this permit is issued, I shall not anploy any pennn in any manner
so as to become subject to thc rvorkers'compensation laws of California. and agree that if I should become subjoct to the
workers' compensation provisions of Section 3700 of the l-abor Code. I shall, forthwith comply wilh thosc provisions..s
WARNTNG: Failure to sccure workcrs'
civil frnes up to one hundred thousand
Section 3076 of the l-abor Code, intcrest
compensation coverage is unlawfuL and shall subject an to and
thedollars ($100.000). in addition of compensation.for
and attorney's fees.
7l
DECII\RATION
undcr provision of Chapcr 9 (commorcing with Section 7000) of Division 3I hereby affrm undcr pcnalty of perjury that I am licorscd
clf the Business and Professions Code, and my license is in full force and effect.
License Class: License Number:
flolo.
CONSTRUCTION LENDING AGENCY
I hcby affim undo pcnslty of perjury that th@ is a @nstruclion lcrding agmy for thc pqfommcc of the work for shich lhis psmit b
issucd (Sa. 3097, Civ. C.).
lrnds's Nme:
I crttlct 's ,,\rkltcss:
APPLTCANT DECLAfuITION
I hereby affirm under penalty of perjury one of the following declarations:
Dernolition Permits-Asbestos Notifrcation Federal Regulations (Title 40. Part6)
_Rcquired Later of Notification
-l
ccrtify thal the federal regulations rcgarding asbestos rcmoval are not applicable to this projed.
_l certify that I have read this application information is correct. I agree to comply with all City and County
r rep,resentatives of this City and County to ertcr upon theordinances and State l-aws relating to
above mcntionod property for
Applicnnt or Agent
Permitee nRme
and hereby authorize
b.a\
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underfloor
Building Sewer
ArealStorm Drain
I nterceptor/ Cla rifier
TOP OUT
Waste & Vent
Water Piping
Gas Piping
Roof Drain
Tub/Shower Test
Rough Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Pipino
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary SewerlOap
Back Flow Device
Rough Plumbing
Final Gas Test
Meter Release ^/ /I t I A
FINAL ,ru!/2-,htukfi '/av
Notes, Remarks, Etc.
Contraclor:
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