HomeMy WebLinkAbout101105574 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: {01105574
Pin #: 7922
Project Address: 1911 E Carnegie Ave
Assessor's Parcel: 430-222-12 Lot: NA Block: NA
Unit: B Bldg:
Tract: NA
Address Range: 1901 -192'l*
Historic: No
Suite Range:
Zoning: M1
Building Use: lndustri.l Occupancy: B, S-2 1st FL Area Patiol
JobType Ten.nl lmpbyemont ConstrType VB 2nd FLArea T.l.Area: 6EOg
Nature ofwo*: Tl Code: cBc 2ol9 Oher Areas yards Reqd
Existing Bldg. & usq tndustrtat Btdg Flood zone: x.08o2320279J carage Area vatuation: g5o,ooo,oo
Proposed Use: # of stodes:
Total
Dgscription of Worh: Oemlslng wall to croate uniE A E B on 101105.573 Unlt B -tenant lmpovemsnt includ6 adding new inteaior slalrway to mezzanlne
lavsl, modlfy brsakroom.
..r Planning Conditions:
+Owner:
Address:
Phone:
Tenant
Olivos lntegrity, LLC
P O Box 27964
Santa Ana, CA 92799
(949) 93e-1 733
Tarantino Landscape, lnc
Contractor
Address:
Owner-Builder
Phone.
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation ! nsurance:
Carrier:
Policy #:
Expires:
Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone.
License #:
Sterling Consulting Engineers
Bashar Abdelfattah
23392 Madero, Suite G
Mission Viejo, CA 92691
(949) 2s2-3340
c053024
Ron Witteveen Architect
Ronald G. Witteveen
20032 East Santiago Canyon Road
Orange, CA 92869
(7141 642-3248
c30197
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
Fire !nsp. Req'd:
Police lnsp. Req'd
No
yes Account#
\N\\No
No
No
No
Arias, Fernanda
Le, Tung
Hernan dez, Kathy
Date. 0412112021
Date: 0411412021
Date: 0412112021
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Permit Fee
Plan Check Fee
Microfilm Records
SMIP - Category 2
Bldg. Stds. Revolving
General Plan Update
!ssuance
$1,529.44
$2,350.79
$4 05
$ 1 4.00
$2 00
$23 79
$s9 30
$3,983.37
$2,270.50
$1 ,712.97
75089
Total
077760 02
0 7776002
0 77760 0 2
08907007
07776002
0 77760 0 2
07776002
57607
53600
57770
24000
57572
s760 0
57607
Flood Zone Cert. Req'd: No 01116002 51600
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within360 days afterils 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 commenced.
01 1 16002 51601
01116002 51612
01 1 16002 53600
01116002 57770
08901001 24000
$23 7e
$1 ,588.74
$2 00
$80 2e
$4 05
$14 00
Fee Totat
Paid to Date:
Balance Due:
lnspector MID#: 2021-163545
BU!LDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG COMMENTS OWNEN BUILDER DELCARATION
I hcrcby affrm undcr pcnahy of Frjury tlEt I m crcr{rt frcm thc ContEctoE' Liccns lnw for tlrc fotlowing Men (Ss.7031.5
Busincss rrxl Prcfcssion Codc): Any City or County which requircs a trcmil to qinstruct, altcr, imprcvc, demlish or rctEir my
stNcturo, pri)r to iIs issumc, also rcquircs thc a0plicant for such Frmit lo file a signcd strtcmnt thst he or slE Ls liccnsd pusuut
to thc lrcvisions of lhc Contnctor's Liccn$d lrw (Chapter 9, Comrcing with Sclion 70m of Division 3 of the Busiress md
PmfcssionsCodc)orth.thcorshciscxcmptthcrcfromsrdtheb6sisforthcallcgcdcxcmption. AnyviolationofSeclionT03l.5byany
applicmt for o lrcmit subiEts thc rpplicant to s civil pcmlty of not mrc thm fivc hundrcd dolles ($500).
_1. as owncr of thc Fnopcrty, or my cmployces with wagcs as their sole comlrnsation, will do thc work and the stnrcture is not
intcndcd or ofl'crcd for sulc (Sec.7M4, Busincss and Prolbssions Code: Thc Contraclor's License law docs not apply to an owncr of
the pnlJrcrty who builds or improvcs thcreon, and who docs such work hirnself or hersclf or through his or hcr own employecs.
providcd that such improvcrncnl.s arc not intendcd oroflbrcd for salc. lf, howcrtr. thc building or in{rrovenrnt is sold wilhin one }rcar
of complction, lhc Owner Builder will have thc burdcn of proving that hc or shc did not build or improve thc property for the purynsc of
sab).
-1,
as owncr of thc propcrty, am cxclusivcly contracting with liccnscd conlractors to construcl thc projcct (Sec. 7(}14, Busincss
and ltofession Code: Thc Contractor's Liccnse Law docs not apply to an owner of propcrty who builds or improvcs lhercon.
and who contracts for such projccts with a C-ontracto(s) liccnsed pursuant to thc Contractor's Licensc [:w).
_l arn cxcnlpt undcr Scction_. B. &for this rcason.
,",", Y lt^/u
I hcreby affirm undcr pcnalty of pcrjury one of thc following de.clarations:
_l havc and will maintain a Certificatc of Conscnt to Self-lnsure for workcrs'compcnsation. as povidcd for by Scction 3700 of thc
l.abor Code. for thc performance of thc work for which the permit ls issucrl.
_l havc and will rnaintain workers' compensation insurance, as required by Scction 3700 of thc Labor Code, for thc performance of
the work for which this Jrcrrnit is issuod. My workcrs' compensation insurancc carrier ard plicy number arc:
4.,
Policy
_l cerrify that in thc pcrformancc of thc work for which this permit is issued. I shall not enploy any pcrson in any rnnncr
so as lo bcconrc subjcct to thc workcrs' comlrcnsation laws of California. and agrce that if I should beconrc subject to the
workers' conqrcnsation provisions of Section 3700 of thc labor Code, I shall. forthwith comply with thosc provisions.
WARNING: Failure to sccurc workcrs' cornpcnsation coveragc is unlawful. and shall subjcct an employer to criminal pcnalties and
1
civil lirrcs up to onc hundrcd thousarrd
Scctiorr 3076 of thc Latxrr Code. irrlcrcst
Dare: rl /ulh;
dollars ($100.000), in
and attorncy's fees.
to thc cosl o[compcnsation. darnages as providcd for thc
t
It
I hcrcby allirrn undcr pnalty of pcrjury that I arn licenscd Chapter 9 (comnrncing with Scction 7000) of Division 3
of the Busincss and Profcssions Code, and my license is in full force ard effcrt.
Liccnsc Class: Liccnse Numbcr:
l)atc.
W
I hcrcby atlirm under ;rcn8lty of pcrjury thar thrc is a onsiructhn hnding agercy for the pedormcc of the work for which this pcrmit is
issed (Src.3097, Civ. C.).
[:ndcr's Nam.
l.endcr's Addrcss:
APPLICANT NT'CLARA TION
I hcreby aflirm under pnalty of pcrjury one of thc following declarations:
Dcmolition Pernrits-Asbestos Notificalion Fedcral Regulations (Titlc 40. Part6)
_Required l.cttcr of Notifrcation
_l ccrtify that thc fcdcral rcgulations rcgarding asbcslos rcnxrvalarc nol applicahlc to this projcct.
-l
ccnify that I h.vc rcad Ihis applic.tion and statc thil thc abovc informlion is conct. I agre to omply wilh all Cilyand County
ordinanccs and Strlc laws rclaling to building constrctiotr and hcrcby aulhorizc rcp]csnlatires of lhis Cily and Counly to stcr ulbn thc
abovc nrcntioncd propcrty for
Applicant or Agertl
I'erntilee nanre
ptq)oscs.
I
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/VenVl nsu latio n
Roof Sheathinq
Shear Wall
Framinq
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
A
/^
F!NAL t-Ztr-V \JrlD,{
Certificate of Occu
Notes, Remarks, Etc.
Rev. 08-07-201 5
Applicant:
o,,", llLt fzt
o