HomeMy WebLinkAbout101107407 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: {O11O74OT
Pin #: 4O3OT
At"\
)-Project Address: 1241 E Dyer Rd
Assessor's Parcel: 411-131-36 Lot: NA Block: NA
Unit: 200 Blds:
Tract: NA
Address Range: 1231-1241
Historic: No
Suite Range.
Zoning: SD63
Building Use:
Job Type:
Nature of Work:
Existing Bldg & Use:
Proposed Use:
Phone:
Tenant
Commercial
Revision
Revision
Commercial/Office
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories:
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation ! nsurance.
Carrier:
Policy #:
Expires:
B
V B, SPK
cBc 2019
x-0602320278J
1st FL Area
2nd FL Area
Patio:
T.l.Area:
Description of Work: Revision to 101105453 - revised seating layout at the Public Area.
D inI [Jne tl indour Rep lncement 5p
Pl.nning Condltion8i
Engineer:
Ownar: Gr€enlaw Pa.tne6, LLC Contraclor: Owner€ulldet
Address: 1231 E oye. Rd, Suite 24t) Address: Addr$s:
Santa Ana, CA 92705
(949) 331-1 316
Other Areas: Yards Req'd
Garage Area Valuation:
Totat 0
SAA
Nelson Algaze
6083 Bristol Parkway
Culver City, CA 90230
(310) 553-3252
c21090
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Arabe, Jill
Scott Fazekas & Assoc.
Misc. Receipt: OPS_4
Misc. Receipt:
Misc. Receipt:
Account#Total
07776002 57770 Microfilm Records
07775002 s3600 PIC - Revision
07776002 57600 General Plan Update
Fee Totat
Paid to Date:
Balance Due:
Date: 08/1 212021
Date: 08/09/2021
Date: 09/1 412021
Subject to Field:
Yes
$202.50
$71 8 02
$0 00
%^msden,
Julie
(-^" Fire Insp. Req'd
Planning Insp. Req'd: No Police lnsp. Req'd: No
Landscaping lnsp. Req'd. No Flood Zone Cert. Req'd: No
Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 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.
$920 52
$71 8 02
$202.50
lnspector MID#: 2020-163257
01 1 16002 57770 $202 50
,
BUILDING. INSPECTOR RECORD
ID/SIG.COMMENTSSITE.WORK DATE
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf Ioor/VenVl nsu lation
Roof Sheathinq
Shear Wall
Framinq
lnsu latio nlEnerqy
Drywall
Ext./lnt. Lath
Brown Coat
[\Iasonry
Pool Fence
T-Bar
Handicap Req.
Deoutv Fina! Report
Enqineer Final Report
Flood Zone Certif
oI -r tl ,
FINAL rfl \nK V,\ftNI -/
Certificate of Occupancv \r
Notes, Remarks, Etc
\
\
OWNER BUILDER DELCARATION
I hcrchy aflirm undcr JEmlly of pcrjury that I dtr crcmpt fmm thc ContractoN' Liccnsc law for thc following rcasn (Scc.7031.5
Busincss and Profcssion Codc): Any City or County which rcquircs a pemir to construct. altcn impmvc. dcmlish or Epair any
sIruclurc, prior lo ils issuarcc, also rcquircs thc applicant for such lErmit to filc a signcd statemnt thal hc or shc ir liccnsd pusant
ro lhc pmvisions of thc Contractor's Liccnscd law (Chaptcr 9, Comncing with Sation 7000 of Division 3 of thc Busircss and
PrcfcssionsCodc)orthathcorshciscxcmptthncfromandthctxlsisforthcsllcgcdexcmption. AnyviolationofscclionT03l.5byany
opplicanl for I pcrmil subjets thc applicant lo a civil pcnahy of nol mrc lhan fivc hundred dolltrs ($500).
_1. as owncr of thc prof,crty, or my employccs with wagcs as thcir solc compensation. will do thc work and thc stnrcturc [s not
inten{cd or offered for salc (Sec.70++. Business and Profcssions Code: Thc Contractor's License Law docs not apply to an owner of
thc propcrty who builds or improvcs thercon. and who docs such work himsclf or hersclf or through his or hcr own employecs.
providcd that such improvcnnnts arc not intended or offcrcd for salc. lf, however. the buitding or improvcrrcnt is sold within onc year
of complction, thc Owncr Builder will have thc burden of proving that he or she did not build or improve the propcrty for the purpose of
salc).
_1. as owncr of thc propcrty. am exclusivcly contracting with liccnscd conlractors to construct thc projcct (Scc. 7W. Busincss
ancl Profcsskrn Code: Thc Contractor's Licensc Law docs not apply lo an owner of pro;rcrty who builds or inrprovcs thcrcon,
and who contracts for such projccts with a Contractor(s) liccnscd pursuant to the Contractor's Liccnsc hw).
lamcxctnptunderScction-.B.&P.C.forthisreason'
f t..a,..
WORKERS' COMPENSATION
DECLARATION
I hcrcby affirm under pcnalty of prjury onc of thc following dcclaralions:
_l havc and will maintain a Ccrtificatc of Conscnt to Sclf-lnsurc t'or workcrs' compcnsation. as providcd for by Scction 3700 of the
Labor Codc, for thc pcrformancc of thc work for which thc Jrcrmit is issucd.
_l havc and witl rnaintain workcrs' compcnsation insurancc. as rcquircd by Scction 3700 of thc l.abor Code. for lhc pcrlbrmance of
thc work for which this pcrmit is issucd. My workcrs' compcnsation insurancc carricr and policy nuntbcr arc:
_l ccrlily thrt in rhe pcrformncc of thc sork for which this Frmil is issucd. I shall nol cmploy ony lrc]sn in any manrcr
$ as ro b€om subixt to the workm'@mpcnstion laws of California, and agrc that if I should bccom subjfft to thc
workcs'comlrcnsationpDvisionsofScrtion3T0OofthekborCodc,lshall,fonhwith@mplywiththosprcvisions,
WARNING: Failurc to sre workcrs' omlrcnsation mvcnge is unlawful, a]d shall subjct an cmplo)cr to qiminal FMltics ud
civil fincs up to onc hundrcd thousdd dolhs (S100.0m). in addition to thc cost of comlrcnsation. damScs as providcd for thc
Scction 3076 of Ihc lrbor Codc. iilerest sd altomy's fes,
Date: Applicant:
I ICFNSED CONTRACTOR
Dn ct lRATroN
I hcrcby aflirm under pcnalty of perjury that I am licenscd undcr provision of Chaptcr 9 (comnrcncing with Section 7000) of Division 3
of thc Busincss and Professions Code, and my liccnse is in full force and effect.
Liccnsc Nurnbcr:
I 1... ,..
Policy Number: ExPires:
W
I hcrcby afftrn undcr lEmlty of pcrjury rhor rherc is a construclbn hnding agcncy for thc JErformrcc of thc work for which this Frmit Ls
issucd (Src. 3097, Civ. C.).
[-cndcr's Addrcss:
APPI ICANT NECLARATION
I hcrcby allinn undcr penalty of ;rerjury onc of the following declarations:
Dcrnolition Pcrmits-Asbestos Notification Fedcral Rcgulations (Titlc 40, Part6)
-Rcquircd
lrttcr of Notification
_l ccrtity that thc fcdcralrcgulations rcgarding asbcstos rcrttovillarc not applicablc lo this projcct.
-l
certify that I havc rcad this application and statc atxlvc
ordinanccs and Statc Laws relating to
for
is corrcct. I agrcc to comply with all City and County
r represenlativcs of this City and County to cntcr upon the
l.
Carrier:
Contrncklr:
-r/