HomeMy WebLinkAbout101107849 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
PermitCounter: (714)647-5800 lnspection Requests: (7i4)667-2738 lnspectorSection: (714)647-5853
Permit #: 1O1107849
Proiect Address: 419 E First St-a-
Assessor's Parcel: 398-516-19 Lot: 5-9, PORS 14 & 'Block: 1/6
Bldg: Address Range: 315431
Tract BLEE'S/J&F ADD Historic: No
Unit.
Pin #:
Suite Range:
Zoning: C5
Building Use:
Job Type:
Nature of Work:
Existing Bldg. & Use:
Proposed Use:
Commercial
Alteration
Rf Mtd Equip
Commercial/Retail Sales
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories:
B
VB
cBc 2019
x-0602320276J
1st FL Area
2nd FL Area
Other Areas:
Garage Area
Totat
Patio:
T.l.Area:
Yards Req'd
Valuation:$20,500.00
0
Description of Work: Replace (1) roof mounted equipment.
Planning Conditions:Bqtch*:6r-1978 I$/4/2rJ71 ID: l1(:AZA
lCr'i ral r''TY[J Tnnnel I I
t
ROrC
11250 Edl Camino Real #200
San Diego, CA 92130
(888) 888-7642
Marshall's
Contractor. RE E Mechanical
Address. P.O. Box 1354
Temecula, CA 92590
Phone: (951) 296-0984
State Lic #: 940700
Lic Type: C-20
Bus. Lic #. 373559
Workers' Compensation I nsurance:
Carrier: Cypress lnsurance Co
Policy #: REWC226270
Expires: 05/01 12022
Taylor & Syfail Consulting En(
Amy D Maskal
553 S Oak Knoll Aveflue
Ref*: 1t:tltt:r784
Llt/+/7tt21 5':11 Afi
$2t tjg4.79
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone.
License #:
Owner:
Address:
Phone:
Tenant
Pasadena, CA 91101
(626) 7e3-7438
c81965
I . t-tu
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:
Machado, Miriam
Le, Tung
Hernan dez, Kathy
Date. 09/01 12021
Date: 0912712021
Date: 1010412021
Subject to Field.
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:\N
\o
Account#
oPS_44
75876
Total
077 ee $172 64
07776002,,53600 r plamOhec{c Fee i, , $239.34
0s376002 s3637 Plc - Accelerated ( $306.78
07776002 s7770 Microfilm Records $72.90
08e07007 24000 SMIP - Category 2 $5.74
07776002 s7672 Bldg. Stds. Revolving $1.00
07776002 57600 General Plan Update $23.79
07776002 57607 lssuance $59.30
No
No
No
Fire lnsp. Req'd: No
Police lnsp. Req'd. No
Flood Zone Cert. Req'd: No
Every permitissued shall become invalid unless the workon the site authorized by
such permit is commenced within360 days afterifs 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 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 57770
08901001 24000
$23 79
$231 .94
$1 00
$72 90
$s 74
Fee Totat
Paid to Date:
Balance Due:
$881 49
$546 1 2
$335.37
!nspector MID#: 2021-168575
t-t
607
Lil
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DET,CARATION
I hqcby affm undq psulty of pcrjury thst I m qmpt ftom thc Coilraclos' Licw kw for the following lwn (SS.7031.5
Busincs ad Profesion Codc): Aoy City or Couty which rcquirc a pcrnit to @Ntrucl, alta, imprcvq dqnolish or Ep8ir uy
structuq prior to its issuacc, also rcquirc thc applicet for such pcrmit to filc I signcd starmmt that hr or slE is ticcnscd p6wt
to thc prcvisioN of thc Contrrctor's Liccrocd Law (Chaptq 9, Comercing with Setion 7000 of Division 3 of thc Bsine 6d
PrcfcsioreCode)orthathcorsheisqcmptthscfrommdthcbssisforthcallcgcdqdprion. Atryviol8tionofSe,tbnT03l.5byey
spplicetforapcmitsubjetsthe appliciltloacivilpcnaltyofnotmorcthufivchundrcddollm($500).
_1. os owner of the property. or my employecs with wages as their sole compensation. will do the worl< ard the structure is not
intended or offcred for sale (Sec.7044, Businas and hofessions Code: The Contractor's Licerse Law does not apply to an owner of
thc propoty who builds or improves thcron. and who does such work himself or hersclf or through his or her own employees,
providcd that such improvancnts are not intended or offered for sale. lf, however, the building or improvement is sold within onc ycar
of compleion, the Orvner Builder will have the hrden of proving tha he or she did not build or improve the propaty for the purposeof
sale).
_1. 8s owner of thc propcrty, am exclusively contraciing with liccnscd contractors to construct the project (Scc. 7044, Business
and Pnofession Code: The Contractor's Liccnse Law does not apply to an owner of property who builds or improves thereon.
and who contracts for such projects with a Contracto(s) licaucd pursuant to the Contractor's Liccnsc l-aw).
-l
am exempt under Scction-, B. & P.C. for this reason.
Owner:
WORKERS' COMPEIISATION
DECI.A]TATION
I hcreby affrm under panalty of perjury one of the following declarations:
_l have and will maintain a Certificate of Conscnt to Self-lruure for workers' compensation, as provided for by Section 3700 of the
Labor Code, for the pcrformance of the work for which the pcrrnit b issued.
_l have and will maintain workers' compensation irsurance, as required by Scction 3700 of the Labor Code, for the performance of
insurance carrier and policy number are:
+*/J.7Lo{-O t
Policy
_l certi& that in the pcrformance of the work for which this permit is issued, I shall not employ any pcrson in any manner
so ils to become subject to the workers' compersation laws of California. and agree that if I should become subjoct to the
workcrs' compensation provisions of Section 3700 of the labor Codc, I slull. forthwilh comply with those provisions.
WARNING: Failure to secure workers' compensation coverage is unlawful, and and
civil fines up to one hundred thousand dollars ($100,000). in addition to the
Section 3076 of the Labor Code, interest and attomey's fees.
the
*Z
DECI"ARATION
I hereby affrm under penalty of perjury that I am liccnsed undcr provision of Chapter 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code, and my license is in full force and effect.
Liccnse c_-aD Number:
6?oO
-2[
W
I hmby affm utrd6 pcnalty of pcrjury that thsc is a co$truclion lcnding agdcy for thc psfomcc of thc work for which thb pqfiit b
Civ. C.).
Lender's Address:
APPLICANT DECLARATION
I herdry affirm under penalty of perjury one of the following declarations:
Demolition Permits-Asbcstos Notification Fedcral Regulations (Titlc 40, Pan6)
_Required Later of Notification
-l
certi$z that the lderal regulations rcgarding asbestos rernoval are not applicable to this project.
_l ccrti& that I havc read this application and state that the above information is correct. I agrcc to comply with all City and County
ordinances and Statc l-aws relaing to building constnrrction"reprcsentatives of this City and County to entcr upon thc
abovc mentioned property for purposes.
Applicnnt or Agent Ova
I'ernritee nanrc (print):fu\Br^t \.B 4-l\:..,
,rr". /0- 1-2J
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bfloor/Ve nul ns u latio n
Roof Sheathins
Shear Wall
Framing
lnsulation/Energy
Drlnruall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
FINAL /o*2.o -21 E--.Q .12
Certificate of Occu pancy
Notes, Remarks, Etc.
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