HomeMy WebLinkAbout101106398 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
Permit Counter: (714) 647-5800 lnspection Requests: (7'14)667-2738 lnspector Section: (714)647-5853
Permit #: 1O1106398
Pin #: 14 40
Project Address: 2800 N Main St
Assessor's Parcel: 111-111-11 Lot: 1 Block: NA
Unit: 24T Bldg: Address Range: 2800-2890
Tract: RESUB OF SHAFER Historic: No
Suite Range.
Zoning'. C2
Euilding Use: Commercial Occupancy: M lsl FL Area: Patio:
Job Type: slgn. Consh Type: ll B, SPK 2nd FL Area: T.l.Arce:
Nature ofwo*: tttumin.ted Slgn code: cBc 2019 OtherArcas: yards Reqd:
Existing Bldg. & Use: CommorclalrR.tail Flood Zone: X.0602320163J
proposed r.rse: # of stories: Garage Area: v'lu'tlon: $5'000'00
Total 0
O.rcription ot WoJki lnside mall - lndellation ot (l) lllumin.tcd Wall Sign and (1) proi.cting blsde lign for "Beth E Body Workr". Bond paid with permit.
Owner:
Address.
Conditions:
Centennial Real Estate
2800 N. Main Street
Santa Ana, CA 92705
Phone.
Tenant: Bath and Body Works
Contractor: RNF Signs, lnc.
Address: 309 S. lrwindale Ave.
Azusa, CA 91702
Phone: (626) 991-9049
State Lic #: 1004002
Lic Type: C-45
Bus. Lic #: 377905
Workers' Compensation I nsurance:
Carrier: State Compensation lnsurance Fur
Policy #: 9138410
Expires: 0712412021
Engineer
Address:
Phone:
License #
Architect /
Designer:
Address:
Phone:
License #:
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd: No
PWA !nsp. Req'd: No
Planning lnsp. Req'd: No
Landscaping lnsp. Req'd: No
Amsden, Julie
Chavez, Dav?,C .
Date:
Date: 0411312021
Date: 0510412021
Subject to Field:
07776002 57607
07776002 s3600
07776002 57770
07776002 57672
07776002 57600
0s376002 s3635
Permit Fee
Plan Check Fee
Microfilm Records
Bldg. Stds. Revolving
Genera! Plan Update
Bond
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
$172 64
$1 19.67
$24 30
$1 00
$23 7e
$200 00Fire lnsp. Req'd:
Police Insp. Req'd
No
No Account#Total
Flood Zone Cert. Req'd: No 01 1 16002 51600
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days after ifs issua nce,or if the work authorized
on the site by such permitis suspe nded or abandoned for a period of 360 days after
the time the work is commenced.
01 1 16002 51601
01116002 s1612
01 1 16002 53600
01 1 16002 57770
0s316002 53636
$23.79
$172.64
$1 00
$1 19.67
$24 30
$200 00
Fee Total:
Paid to Date:
Balance Due:
$5+1 40
$0 00
$541 .40
lnspector MID#: 2021-165450
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enErnI
t I 1'St-tt:
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hqcby aflirm undd poalty of pcrjury that I m cxcmpt 6om the Cootracto6' LiccN Law for thc followiog tten (Se.7031.5
Bwirs dd Profsion Codc): Aoy City or County which require a pomit to construct, alts, improvq dmolish or rcpair ay
structuc, prior to its issuucc. also rcquirc thc applicmt for such pcmh to filc 8 signcd stst@ot that hc or shc b licoed plNet
to thc provisioG of thc Contractor's Liccnscd [:w (Chaptc 9, Comcncing with Sation 7000 of Division 3 of thc Buincs ud
Prcfsions Code) or that hc or shc is aempt thsefrom ud thc besis for thc allcged cxopion. Any violation of Serbn 7031.5 by a!
applicantforapcmitsubjotsthc applicmttoacivilpmltyofnotmorcthilfivchundreddollm($500).
-1,
as owner of the prope'rty. or my employees with wages as thcir solc comp€nsation, willdo the work and the structure is not
intended or offered for sale (Sec.7044, Business and hofessions Code: The Contractor's License [aw does not apply to an owner of
the propoty who hrilds or improves thereon, and who does such work himself or herself or through his or her own employees.
provided that such improvanents are not intended or offerod for sale. If, howwer. the building or imp,rovement is sold within one ]cur
of complaion, the Orvner Builder will have the hrden of proving tha he or she did not build or improvc the propo'ty for the purpose of
sale).
_1. as owner of the propaly. am exclusively contracting with licensed contractors lo construct the proje.ct (Sec. 7044, Brsiness
and Proftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thcreon,
and who contracts for such projects with a Contracto(s) licorsed pursuant to thc Contractor's License Law).
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am exempt under B. & P.C. for this reason.
WORKERS' CONT PI'NSATION
DE(]I,ARA'I'ION
I hereby affrm under penalty of perjury one ofthe following declarations:
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have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the
I-abor Code. for the performance of the work for rvhich the perrnit is issued.
_l have an<i will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code. for thc performance of
which this permit is issued. My workers-' compensation insurance carrier and policy number are:
S*r*B -Wthe work for
I
Carrier:
poricyN"rrb"r, l qfZruUO^2O2o Expires:
b9'241?Ozl
-l
certi& that in the performancc of the work for which this pcrmit is issued, I shall not employ any person in any manner
so as to become subject to the workers'compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code. I shall. forthwilh comply with thosc provisions.
WARNING: Failurc to secure workers'compansation coveragc is unlawful, and shall subject an anployer to criminal pcnalties and
civil fines up to one hundred thousand dollars ($100.000).
Section 3076 of the labor Code, intcrest and attorney's fecs.
in addition to the cost of compensation. damages as provided for the
F
o*", e5'C{'b2 I
I hereby affrm under poralty of perjury that I am licensed 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code, and my license is in full force and effect.
License
o c Nurnber:. /OOct@2_t
I
I hwby affm unda paslty of pcrjury thst th6c is a @Etruclion lcoding ag6cy for thc pcfomucc of thc work for which this pqmit b
isued (Sa. 3097, Civ. C.).
Lender's Name:
Lcndcr's Ad&css:
APII.ICANLDECI.aSAIION
I h*by affm undq pcnalty of pcrjury onc of thc following delrations:
Dqnolition PmitsAsb6tos Notifi€tion Fedgal RegulatioN (Titlc 40. Pan6)
-Rcquircd
Lrtt6 of Notification
-l
cdiry thst the fcdcal rcgulatiore rcgrding rbctos moval uc not eplicablc to this projet,
ldirolry ,n", f Urc md this applietion md statc rhar th€ abovc itrfomdion is concl. I agre to @mfly with all City ud Couty
odillffiG and Statc IiB rclding to huilding con*ruaioq and hccby authoriz rcprffit8rivG of this City ed County to otq upon thc
above mcntioned property for inspection
Applicant or Agent
Pernrilec nflme
t
Drt",
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bfloor/Ve nul ns u latio n
Roof Sheathing
Shear Wall
Framing
Insu lation/Enerqy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
1
FINAL ?,z9z,l (LclS^'tif.t,B "2rl
Gertificate of Occupancy
Notes, Remarks, Etc.
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