HomeMy WebLinkAbout40134676 - Permitt
City 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-{34676-
Project Address: Unit:
Assessois Parcel: 396-066-21 Lot: POR DAVENPOR Block:A
Bldg: Address Range:
Tract: A.B. CHAPMAN Historic: No
Pin #:
Suite Range:
Zoning: P
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Orangewood Foundation Contact: Johr
1575 E. Seventeenth Street
Santa Ana, CA 9270s
(7141 619-0202
Orangewood Foundation
K2 General Contractors lnc
19732 MacArthur Blvd, Suite
lruine, CA 92612
(949) 477-1047
01 1 16002 51604
01 1 16002 51604
01 1 16002 51604
01116002 53603
01 1 16002 51600
01 1 16002 51604
01 1 16002 57770
Fee Type
Alter Vent Sys
Type I Hood
Vent Fan/Comm
PIC - 650/o
General Plan Update
lssuance
Microfilm Records
Amount
46.99
122.00
46.99
0.6s
23.79
59.30
4.05
Qty
1.00
1.00
1.00
215.98
1.00
1.00
1.00
Fee
$46.99
$122.00
$46.99
$140.39
$23.79
$s9.30
$4.05
Phone:
State Lic #: 481058
Lic Type: B
Bus. Lic #: 7301
Workers' Compensation I nsurance:Carrier: lns Co of the West
Policy #: WVES04932B 01
Expires: 0710412021
Bntch*:5S57C
r qn sflr:
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Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Commercial
Tenant lmprovement
T.l. - Breakroom
Consultants
01 103797
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
B
V B, SPK
cMc 2019 Notes:T.l. - Breakroom and kitchen upgrades
07t08t2020
03t25t2021
Account#
Misc. Receipt: 74440
Misc. Receipt:
Misc. Receipt:
Total
Amsden, Julie
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 fhe sife by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
01 1 16002 s1600
01 1 16002 51604
01 1 16002 53603
01 1 16002 57770
$23.79
$275.28
$63.90
$4.05
Fee Total:
Paid to Date:
Balance Due:
$443.s1
$76.49
$367.02
lnspector MID#: 2020-1 59 187
.t
t
MECHANICAL.INSPECTOR RECORD a
APPROVALS DATE ID/SIG.COMMENTS OWNER BU]LDER DELCARATION
I hocby affm undq poaltyof perjury that I m exmpt from thc Contrscto6' Licce Lrw for lhc following r@n (Se.7031.5
Businas md Profcsion Codc): Any City or County which rcquim a pcmit to @Gtruct. altq, improvq danolishfr rcpair uy
structue, prior to its issuacc, also requirg thc applicilt for such pcf,nit to filc a sigoed statmot that hc or slrc b licqscd plNet
to thc provisioE of thc Contrctor's Licqscd lrw (Chaplr 9. Commcncing with Sction 70O0 of Division 3 of thc BNinN ard
PmfeionsCodc)orthsthcorshcisGrmptthqcfromedthcbasisforthcallcgcdq@ption, AnyviolationofsetionT03l.5bymy
applicilt for a pcrmir subjats thc applicut to a civil pcnahy of mt morc thil fivc hundrcd dotlas ($500).
_1, 6 omq of thc prcperty, or my cmploys with wagc c thcir mlc compcmation, will do lhc rcrk ad thc stnrtw is rct
intqded or oIM for sale (Se.7044. Buin6s ed Prcfsioc Codc: Thc Contraclor's Liccre lrw do6 not apply to e oms of
thc propsry who builds or improE thqp!, ed who dc srch wrk himclf or hcNlf or thrcugh his or hr om mployc,
provided that such imprcvmats @ not intqded or ollsod for slc. If, how. thc hriHing or irnpovmt b mld within onc )qr
ofcompl:tiot the Ownq Builda will havc thc hudor ofprcving tha lrc or shc dkl not build or inpIovc lhc Fopqty 6r thc prpo$ of
sle).
-1,
c omq of thc prepqly, m qclu5ivcly contracling with licef,scd contractots to construct thc prcjwl (56. 7044. Bsins
and Proftssbn Code: ThG Cootr&tor's Liccnse Law do6 not apply to il owos ofpropcrty who builds or improvG thssn,
and who ontBcls for such projsls with a Contracro(s) liccnscd pm@t to thc Contraclor's Licw law).
-l
an erempt unds Secrion-. B. & P.C. forthis reen.
Drte_ O*ner,
ya86E8[.CO![EENSAUAN
DECIdSAIION
I hqeby allim unds poalty of pcjury onc of the following delratiom:
_lhavcadwillmintainaCgtificatcofcotMtroSGlfJNUeforworkm'compcnsalion,r povidcdforbysetion3T00ofthc
labor Codq for thc pcfomcc of thc wrt for which thc pamit b isucd.
ff*"
the work
and will maintain workers' compensation insurance, as by Section 3700 of the Labor Code, for the pcrformance of
and policy number are:Ve*for which this permit is issuod. My workers' compensation carrier
-
(J - r/4
in thc performancc of the work for w'hich this pcrmit is issued. I shall not employ any person in any manner
so asto
workefs'
become subject
comp€Tsation
to the workcrs'compensation laws of California and
provisions of Sec-tion 3700 of the l-abor Code, I shall,with those provisioru..I
WARNING: Failure to sE workm' compqration covmge is unlawful, ud shall subjct u mployr to qiminal pmltics ud
civil lines up to one hundrcd thousdd dollm ($100.000), in addition to thc cost of comperoation, dmagc c providcd for the
Srction 3076 of thc Labor Code. intsct md attomey's f6.
o.,", ?l6h\ aopro*, lcL Lcw*qi C*uta&alr'Tz.r-
ffi*
I hercby affrm undo pcnalty ofpojury that I m licoscd undo prcvision ofChapts 9 (commmcing with Sstion 7000) of Division 3
of the Buins md Profsiom Code, md my licw is in full force and cfTct.
TVlo,t8
Licensc Number:
(
CONSTRUCTION LENDING AGENCY
there is a construction krrding agency for the performance of the work for which this pennit bI hereby affrm under peralty of pcrjury that
issucd (Sec. 3097, Civ. C.).
Lcnder's Name:
Lender's Address:
APPLICANT DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
Demolition Permits-Asbestos Notification Foderal Regulations (Tille 40. Part6)
-Required
Letter of Notification
.1'l-]-l cctiry that the Iederal regulations regarding asbcstos removal are not applicable to this project.
(, ccrtiry that I have read this application and state that the above information is correct. I agrec to compty with all City and County
ordinances and State Laws rclating to building authorize rcprcsertativcs of this City and County to erter upon the
T|LT/2 |
above mentioned propoty for
Applicant or Agcnt
Perrnitee
Ilate'
Appliances
Metal Fire Place
Evaporative Cooler
Furnace
Compressor
Misc. Equipment
Duct Work
Pre-lnsulation
lnsulation
Smoke Detectors Installed
Rouqh Ductwork
bn^yz Br ffi d
Vents
Toilet Room / Clothes Dryer
Residential Range
Other
A.
Hood
Type I Hood 4-kuzJ D-il,\t
Type ll Hood
Grease Duct \/
Fire Damper
Openings
lnstallation
F.D. Drop Test
Above Hard Lid
Above T-Bar lo4<,t t**ttt
Rough Mech.
Final Test
Meter Release
F!NAL /o-Lo-?-l >^P.lz
Notes, Remarks, Etc
J
I Alqfian
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