HomeMy WebLinkAbout40134584 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Mechanical
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 4o^134584
Pin #: 97{88
A/'^//Project Address: 3260 S Susan St
Assessor's Parce!: 414-241-08 Lot: 5
Unit:
Block: NA
Bldg:
Tract: 10908
Address Range:
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 797-2396
Cannavision
IMC Professiona! Building C
12155 Magnolia Ave, Unit 10
Riverside, CA 92503
(s511 27e-770s
01 1 1 6002
01 1 1 6002
01 1 1 6002
01 1 1 6002
01 1 1 6002
01 1 1 6002
01 1 1 6002
01 1 1 6002
01 1 16002
01 1 1 6002
01 1 1 6002
51 604
51 604
51 604
51 604
51 604
51 604
51 604
53603
51 600
51 604
57770
Qty
1.00
1.00
6.00
1.00
1.00
1.00
3.00
959.22
1.00
Fee
$97.1 7
$37.e3
$281 .94
$61.20
$66.1 4
$202.92
$21 1.92
$623.49
$23.79
$5e.30
$4.05
Fee Type Amount
Compressor 97.17
Envir. Air Other 37.93
Vent Fan/Comm 46.99
61.20Fan Coi!
Vent System - Not Part 66.14
Exhaust System 202.92
Appliance Not Listed TO.O4
Ptc - 65% 0.65
General Plan Update 23.T9
I ssuance
MicrofilmState Lic #: 962294
Lic Type: B, C-61 , C-21
Bus. Lic #: 376552
Workers' Compensation lnsurance:Carrier: Compwest lns Co
Policy #: WCFSS03S60
Expires: 0712712021
1$472
CTYH
i2
1.00.,.i
1'.bO
Accb*
Rcpti
Trnns
Ref*:
6/2tt2l\tto
Generol Plsn Urdabe Fer
01 I 160tt2- 5l 6trtrttlt(t-
Ilicrof ih & 0ocurenbs
trl I 16tru2- 577701r0[t-
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
lnd ustrial
Tenant lmprovement
Tl/Roof Mounted Equip
CSG Consultants
Amsden, Julie
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
F-1
VB
cMc 2019
10t22t2020
03/1 6t2021
Account#
Misc. Receipt: 74338
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total:
Paid to Date:
Balance Due:
.Applidnces not listed = CS-1 exhaust system =
CCB-OMS
Tl-Remove and instalt partition walls and t-bar ceiting,
install a pre-fab freezer, a pre-fab ClD2 lab, a pre-fab
post process lab roof mounted equipt
$1 ,669.85
$6s0.59
$1 ,019.26
-,1 01 103498
Every permitissued 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 permit rs suspended
or abandoned for a period of 360 days after the time the work is
commenced.
01 1 16002 51600
01 1 16002 51604
01 1 16002 57770
$23.79
$991 .42
$4.0s
lnspector MID#: 2019-155300
M ECHAN ICAL.! NSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCANATrcN
I htrby aflim ud6 pf,alty of pcrjury that I m q@pt &om thc ContractoF' Licce t w for thc follo'wing trc&n (te.7031.5
Bwines aad Profsion Codc): Any City or Courxy which rcquirc a po'rnit to @nslruct, sltq. improvc, dmolishrrr rtpair uy
struchrq prbr to its issuucc, also rcquire thc eplicmt for such p6mit to filc a signcd statoot that hc or slrc b licoscd pumam
to thc provisioE of thc Coot &tor's Licoscd taw (Chapt6 9. Comacing whh Setion 7000 of Division 3 of thc Bsin* ed '
ProfsioNCodc)orthsthcorshcbqmpthcfrommdthcbqsisforthcalbgcdqmption. AnyviolaionofseliotrT03l.5byuy
applicstforapdnitlubjctsthc applicetto8civilp@ltyofnotmorcthofivchutrdrcddoll6($500).
-1.
as owner of the properly, or my employees with wages as their sole compensation. will do the work and the structure is not
intendod or offered for sale (Sc.7O44. Busincss and hofessioru Code: The Contraclor's Licorse l-aw does not apply to an owner of
the p,roperty who builds or improv€s ttrcroru and who docs such uaort himsclf or hcrself or through his or her own cmployees,
provided that such improvancnts re not intcnded oroflbrcd for sale. I(, howcvcr, ttrc hilding or improvement is sold wilhin one yetr
of complaion, the Orrner Builder will havc the burden of proving thd he or she did not hrild or improve the property for the purposc of
sale).
-1,
as owner of the propertyi am exclusivcly contracting with licenscd contraclon to construct thc p,roject (Sec. 7044, Btsiness
and Proftssbn Code: The Contractor's Liccnse Law does not apply to an owncr of property who builds or improves thereon,
and who cofficts for such projcds with a Contracto(s) licenscd pursuart to the Contractor's Liccnsc law).
-l
am excmpt under Section-, B. & P.C. for this reason.
I)o I r.'
WORKERS' COMPENSATTON
DECI.ARATION
I hereby affrm under pcnalty of perjury one of the following declarations:
){mrc ua *itl msintain a Cenificate of Comt to SclfJrourc for workc'compffation, 6 provided for bysetion 37OO of thc
Yabbr Codc for thc pqfommce ofthc wort for which thc pqrnit b hsued.
-p!i[ou.
una *itt raintain workc' compcrcation ircuilcq 6 rcquircd by setion 3?00 of thc Labor Codc. for the pqformcc of
the rvork for which this pcrmit is issuod. My workers' compcnsation insurance carier and policy number are:
n
not anploy any p€rson in any manner
if I should bccome subject to the
comply with those provisions..
/
WARNING: Failurc to sccure workers' compensation coverage is unlawful. and shall subject an onployer to crimind penahies and
cMl fines up to onc hundrcd thousand dollars ($100.000). in addition to the cost of compersation, damagc ali provided for the
Section 3076 of the l-abor Codg interest and attorncy's fe6.
u 1-
LICFNSED CONTRACTOR
DECII\RATION
I hereby aflirm under pcnaltyof pcrjury that I am lic€nsod undcr provision of Chaptcr 9 (commancing with Sation 7000) of Division 3
of the Busincss and Profesions Code, and my license is in fu[ force and cffect.
Licersc Nunrbcr:
I
cl !'\, LLC-W
t hcnby arfm ud6 paulty of pcjury that thG is a @ostruclbr lcndhg agtry for thc pcfome of thc wort 6r which lhb psmh is
isucd (Sc. 3097. Civ. C.).
Lender's Name:
Lender's Address:
APPLICANT DECL
I herdry aftirm under penalty of perjury one of the following declarations:
Dcmolition Permits-Asbcstos Notification Fcderal Regulations (Title 40. Part6)
-Requ
ired Letter o f Not ilication
-I
qtiry thst thc fcdqal regulatioro rcgrding sbctos moval e not eplicablc to this pmjEl.
-.$\1-i-'l cdiry thd I lEvc rBd thi! appliotion dd statc thd Oc sbovc informdion b cotrEl. I tSrc to ornply with all City and Couty
ordimcB ed Statc Lm Elding to buildiDg coNt uclioG ad h6cby authorirc rcprsnais of thb City ed Couty to 6tc upotr thc
above mentioned property for inspeaion purposes.
Applicant or Agant
IPennitec name
C..\-/
Appliances
Metal Fire Place
Evaporative Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-lnsulation
lnsulation
Smoke Detectors Installed
Rough Ductwork
Vents
Toilet Room / Clothes Dryer
Residential Ranqe
Other
Hood
Type I Hood
Type ll Hood
Grease Duct
Fire Damper
Openings
lnstallation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rough Mech.
Final Test
Meter Release ,4
FINAL ,ollglel -n tr^rffi
Notes, Remarks, Etc.I U\
I
2