HomeMy WebLinkAbout30142584 - Permittra City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Plumbing
Permit Counter: (714) 647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714) 647-5853
Permit #: 3O1425E4
Pin #: 529z,
Proiect Address: 3901 S Main Sta
Assessor's Parcel: 411-121-08 Lot: NA
Unit:
Block: flA
Bldg:
Tract: NA
Address Range:
Historic: No
Suite Range:
Zoning: Ml
Owner:
Address:
Phone:
Tenant Name:
Contractor.
Address:
Phone:
SACHER FREDERICK ROBERT TR
301 Forest Ave
Laguna Beach, CA 92651
(949) 497-3371
EWMI Earthwork and Pavinc
1898 S Union Ave
Bakersfield, CA 93307
(661) 3s6-e633
01 1 16002 51602
01 1 16002 51602
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
Fee Type
Cap Sewer
Cap Gas Outlet
General Plan Update
lssuance
Microfilm Records
Amount
107.65
9.12
23.79
59.30
4.05
Qty
1.00
1 .00
1.00
100
100
Fee
$107.65
$e.1 2
$23.79
$59.30
$4.05
a
State Lic #: 978096
Lic Type: C-21
Bus. Lic #: 376002
Workers' Compensation I nsurance:Carrier. Zurich American lns Co
Policy #: WC4G0909601
Expires: 0912712021
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit !ssued Amsden, Julie
Subject to Field:
Buildins Permit #: 1 01 1 05143
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 sife by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
Building Use:
Job Type:
Nature of Work:
Commercial
Alteration
lnterior demo
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
B
V B, SPK
cPc 2019
o
11t05t2020
Account#
Misc. Receipt:
Misc. Receipt.
Misc. Receipt:
Total
a
Notes: Cap sewer & gas line for remediation.
Fee Tota!:
Paid to Date:
Balance Due:
01 1 16002 51600
01 1 16002 51602
01116002 57770
$23.7s
$1 76 07
$4.05
$203 91
$0 00
$203.91
lnspector MID#: 2020-162614
PLUMB! NG.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underfloor
Building Sewer
ArealStorm Drain
I nterceptor/ Cla rifier
TOP OUT
Waste & Vent
Water Pipinq
Gas Piping
Roof Drain
Tub/Shower Test
Rough Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Piping
Fill Line/Back FIow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary SewerlCap
Back FIow Device
Roush Plumbins
Final Gas Test
Meter Release -,/ /lt /2aMoFINAL5fi4/N (Wa
Notes, Remarks, Etc.I
OWNER BUTLI'ER DELCANATTON g
t hacby affm undo pcnalty of pojury thal I m qmpt tom thr ContractoB' Licm t:w for thc following tq$n (Sc.7031.5
Bsin6s atd Prcfeion Codc): Any City or County which rcquim a pcmil to @rdruct. alts, imFovq (bnolist or Epair m/
structurq Fior to its isureq slso rcquiG thc spplkmt br such Fmit to filc s signcd std@ot tha hc or drc ir licqucd plmarn
to thc FovisioB of thc Contr8ctor's Licmscd t w (C-h8pt6 9, Comacbg with Sction 7000 of Division 3 of thc BNitrs md
Prcfasioro Codc) or that he or shc b qcmpt ths.from ud thc basis for thc allcgcd qmption. Any violation of Setion 7031.5 by uy
applican for a pcmit subjtrts thc applicot to a civil pcnalty of not morc thu fivc hun&cd dollus ($500).
_1. 0s owner of the property, or my employccs with wages as their sole compensation, will do the work and the structwe is not
intended or offered for sale (Sec.7M4. Business and hofessions Code: The Contractor's Liccnse [^aw does not apply to an owner of
thc propcrty who builds or imp,rove thereon, and who docs such work himself or herself or through his or her own cmployces,
provided that such improvanents are not intended or offcned for sale. I(, howel/er. the building or improvcment is soH within one ),tar
of compleion, the Orvner Builder will have the hrden of poving ttra he or she did not build or improve the propcrty for the purposeof
sah).
-1.
as o$mer of the prop€rty. am exclusively contracting with licensed contraclors to construct the project (Sec. 7044. Buiness
and Pr,oftssbn Code: The Contraclor's License Law does not apply to an owner of property who builds or improvcs thereon,
and who contracls for such pnojecrs with a Contracto(s) licaued pursuant to the Contractor's Liccnsc l-aw).
-l
am exempt under Section-. B. & P.C. for this reason.
O*ner'
WORIGRS' COM'ENSAT
DECLARATION
I h@by affm under pcnalty of po'jury onc of thc following dcluatioro:
-l
havc md will rointain 8 Ccrtificatc of CoMt to SclfJEurc for workc'compqsation, c povidcd for bySetion 3700 of thc
tabor Codc for thc pcforocc of thc wo* for shich thc psmit b issucd.
y'A t mrc ua *itt maintain work6' compcmation i6uracc, I rcquircd by Sction 37OO of thc lrbor Codq for thc psbmecc of
th. srk for which thb pcrrnit is issucd. My workc' compcnsaion immcc mia ad policy numbo rc:
z q
s,1,
poricy *"^*,UlCUb 6 9O9€ctl Expires:ZI
drcertiff that in the performance of the work for which this permit is issued. I shall not employ any person in any manner
so as to become subject to the worlccrs' compensation laws of California, and agree that if I should become subject lo the
workers' compensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with those provisions..
WARNING: Failure to sccure workers' compensation coverage is unlawful. and shall subject an ernploy€r to criminal pcnahies
civil fines up to one hundred thousand dollars (3100.000), in addition to the cost of compensation, damages as provided for
Section 3076 of the tabor Code intercst and attorney's fees.
o*", tt 19(ZoZO
DEC'I ^ RATION
I hereby affirm under pcnalty of perjury that I am licensed under provision of Chapter 9 (commencing rvith Scction 7000) of Division 3
of the Business and Professions Code, and my license is in full force and effect.
?TtoctC
and
the
(hf,.
Liccnse Nurnbcr:
ort", t I (9lZsl-o contrecto t Fw/t furlravtcrfr **fr ilavi nt
W
I hcby affirn unda paalty of pqjury thd th@ b I @ostructbr lcodirg agacy for thc psfomc of thc mrL br which this pqnit ir
isucd (Se. 3097. Civ. C.).
lrnder's Name:
lcnder's Address:
APPLICAIIT DEC LARATION
I herebyatrnn undcr penalty of pcrjury one of the following declarations:
Dcmolition Permils-Asbcstos Notification Fodcral Regulations (Tille 40. Part6)
-
Required lrtter o f Notifi cation
-l
csrify rhar thc ftdgal ruaulatioro rqrding ubctos moval rc not eplicablc to this projEl.
ktt cariry tmr t Urc rad this rpplication ,td ststc thd thc abovc infomdion is coner. I agre to @mply with all chy ud coury
ordimcB and Statc Law Glaritrg to building corgruction md hftby authorizc rcprsmrivc of this City ed County to atc ulDn thc
above mentioned property for inspeclion purposes.
,,r", n(i(ZtlsApplicnnt or Agent
Permitee nRme
Drte:_