HomeMy WebLinkAbout30142062 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Plumbing
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: 301420,fi,2
Pin #: 5,57OT
Proiect Address: 3260 S Susan Sta
Assessor's Parcel: 414-241-08 Lot: 5
Unit:
Block: NA
Bldg: Address Range:
Tract: 10908 Historic: No
Suite Range:
Zoning: Ml
Owner:
Address:
Phone.
Tenant Name:
Contractor:
Address:
Phone:
Tom Broderick
3260 S Susan St
Santa Ana, CA 92704
(7141 7s7-2396
Cannavision
IMC Professional Building C
12155 Magnolia Ave, Urit 1C
Riverside, CA 92503
(9511 279-770s
01 1 16002 51602
01 1 16002 51602
01 1 16002 51602
01 1 16002 53602
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
Fee Type Amount
Sink 13.68
Floor Drain 17.39
Wtr Htr (Comm up to 50 23.97
P/C - 65% 0.65
General Plan Update 23.79
lssuance 59.30
Microfilm Records 4.05
Qty
1.00
3.00
1.00
87.28
1.00
1.00
1.00
Fee
$13.68
$52.17
$23.97
$56.73
$23.7e
$59.30
$4.0s
Bct r6/2{fi1 Il
Ref*:
/ I6/2tt2l
State Lic #: 962294
Lic Type: B, C-61 , C-21
Bus. Lic #: 376552
Workers' Compensation lnsurance:Carrier: Compwest lns Co
Policy #: WCF5503560
Expires: 0712712021
Acct+:
Rcpt*: (
Tr qn so,
t 87r
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
lndustrial
Tenant lmprovement
Tl/Roof Mounted Equipt
Occupancy:
Constr Type
Code:
Date:
Date:
Date:
F-1
VB
cPc 2019
10t22t2020
03/1 6t2021
Account#
Misc. Receipt: 74338
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total:
Paid to Date:
Balance Due:
.-
Tl-Rem'or" and install partltlon walls and t-bar ceiling,
install a pre-fab freezer, a pre-fab C1D2lab, a pre-fab
post process lab roof mounted equipt
$233.69
$56.73
$176.96
Planning Approval By:
Plan Checked By: CSG Consultants
Permit lssued By: a). Amsden, Julie
\t
Subject to Field' \ (
Buildins Permit #: \ 101 103498
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
rssuance, or if the work authorized on fhe site by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
01 1 16002 51600
01 1 16002 51602
01 1 16002 57770
$23.7e
$1 49.1 2
$4.05
lnspector MID#: 2019-155300
APPROVALS DATE ID/SIG.COMMENTS
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underfloor
Buildinq Sewer
Area/Storm Drain
I nterceptor/ Cla rifier
TOP OUT
Waste & Vent
Water Pipinq
Gas Piping
Roof Drain
Tub/Shower Test
Rough Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary SewerlCap
Back FIow Device
Rough Plumbing
Final Gas Test
-4 ,)Meter Release a
tID lz2(\lr f.Ol f )FINAL t?u'T)
Notes, Remarks, Etc.U\I
DEL('ARA'I'ION
I hmby affm undo poulty of pa;jury that I m qmpt from the CodactoB' Licoe trw for thc follo&ing lwr (5e.7031.5
Buincs ad Profissioo Co&): Any City or County which rcquirc a pamit to coGtruct. ahc. improvc danlid. or rpah uy
stucturc, pdor to its ismcc also rcquirc thc applicmt for such Fmit to filc s sigtrcd strrmat that hc or shc b licascd pmulnt
to thc FrovisioG of thc Contrrctor's Liccnscd Lrw (Chapt6 9. ComcrcinS with Sction 7000 of Division 3 of thc Buine ud
Prcfc$ioos Codc) or that hc or shc b qmpt th@from ed thc bcais for thc 8lkgcd qmption. Atry violatioD of Scrbn 7031.5 by ey
applicet for a pmit subjeis thc applimt to a civil paaly of not morc thu fivc hun&cd dollm ($500).
-1.
as owner of the property, or my ernployees with wages as their sole compensation. will do the work and the structure is not
intendecl or oflcred for sale (Se.7044. Business and Professions Code: The Contractor's License law does not apply to an owner of
the propo'ty who hilds or improves therqrn, and who does such work himself or herself or through his or her own employees.
provided that such improvoncnts are not intended or offered for sale. If. howwcr. the building or improvernent is sold wilhin one )car
of completion, the Orvner Buildcr will have the hrden of proving that he or she did not build or improve the propoty for the purpose of
sale).
_1. as owner of thc propcdy. am exclusively contracting with licensed contractors to construcl the project (Sec. 7044. Business
and Profession Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a Contractor(s) licenscd pursuant to the Contractor's License Law).
-l
arn e.\empt under Section-. B. & P.C. for this reason.
Owner:
WORKERS' COMPENSATION
DECLARATION
I hereby affrm under poralty of perjury one of the following declarations:
have and will maintain a Ccrtilicate of Conscnt to Sclf-lnsure for workcrs' compensation, as provided for by Section 3700 of the
Labor Code for the performance of the work for which the pennit is issued.
and will maintain workers' compensation insurance. as rcquired by Scction 3700 of the l.abor Code. for the performance of
the work which this pcrmit is issued. My workers' compeosation insurance carrier and policy numbcr are:
Ll
cerriff that tn the performance of thc work for which this pcrmit is
of California.
issued,shall not employ any person in any manner
if I should become subject to therui to become subject to thc workers'cornpensation laws and aSree that
workers' compensation provisions of Secrion 3700 of the l-abor Code. I shall, forthwilh comply with thosc provisions..
WARNING: Failure to sccure workers' compensation coverage is unlawful. and shall subject an onployer to criminal penalties and
civil fines up to one hundred thousand dollars (5100.000), in addition to the cost of compensation, damages as provided for the
Section 3076 of thc labor Code interest and attorney's fees.-\-,
U
I hcreby aflirm undcr penalty of perjury that I am licensed 9 (commencing with Sectbn 7000) of Division 3
of the Business and Professions Code, and my license is in full force and effect.
License Number:
qbLzq,q
contractor: I UL ?I o{rrStcna t $r-r'r \d 1'nc1
I hereby affrm under penalty of perjury that
issued (Sec. 3097. Civ. C.).
Lcnder's Name:
CLnr-rn v?r l--LL
CONSTRUCTION LENDING AGENCY
there is a construction landing agcncy for thc pcrformance of the work for which this pcnnil is
Lender's Address:
APPLICANT DECLARATION
I hcreby affinn under pcnalty of perjury one of the following declarations:
Dernolition Perrnits-Asbestos Notification Federal Regulations (Title 40. Par16)
-Recluired
lettcr of Notification
_l ccrtify that thc federal regulations regarding asbestos removal are not applicable to this project.
ordinance
with all City and County
and County to enter upon the
above rnentioned property for
Applicant or Agent
Pernritce nRnle
purposes.
C-.\-/
PLU M BI NG.I NSPECTOR RECORD
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