HomeMy WebLinkAbout101105577 - PermitCity of Santa Ana 20CivicCenterPlaza(M-19), Santa Ana,CA927O2 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: {01105577
Pin #: 58620
Project Address: 1241 E Dyer Rd
Assessor's Parcel. 411-131-36 Lot: NA
Unit.Bldg:Address Range: 1231-1241
Historic: No
Suite Range:
Zoning: SD63Block: NA Tract: NA
Building Use Commorci.l Occupancy: A-3, B 1st FL Area Patio
Job Type Tonar* lmprovom.nt ConslrType: V B, SPK 2nd FL Area T.l.Area: g5g3
Natue olwork TI-ADA Upgrad.. Code: cBc zll9 Oher Areas yerds- &qqg ror ELIZABETH
Existing Bldg. & Use Commedcel Flood Zone: X.060232
proposed use # or stories: 0278J c*"e" e.6;i1!i5[f{l ;"?iliiii'it r.-oi#ii
rorar'ni;iii*"r.;.. 2,.{ii:71 riirr.rttu
t}o.crlptlono'wo]kTlonfi6t'loorlncludosdoo]oxftmodlfc.tionE'o]ADAandTlon.ocondfloorincludecrii.tirudimIsdl"ao.
i'l ' 5 Congtru':Iiun ser,Jlree ll''
t?3'
Planning Conditions:
Phone:
Tenant
Greenlaw Partners, LLC
1231 E Dyer Rd, Ste #240
Santa Ana, CA 92705
(e4e) 331-1 316
Contractor: KPRS Construction Service:
Address: 2850 Saturn St
Brea, CA 92821
Phone: (7141 672-0800
State Lic #: 751130
Lic Type: B, A
Bus. Lic #: 188704
Workers' Compensatron lnsurance:
Carrier. Everest Premier lnsurance
Policy #: CAl0004028201
Expires'. 10/01 12021
Htlltiffi- *6ur1t'ilt-
sii?lf,U: [ilil]li*l:
t'riliidl,*il.[ffiiu checl
Updnte Fee
t
Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address.
Phone:
License #:
Ltl I 16ilil?-
Owner:
Address:
s2,r
tgl ,
$1r 133'
SAA
Dickson Oi
18600 MacArthur Blvd, Suite 100
lrvine, CA 92612
(e49) 724-8s58
c-32277
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA Insp. Req'd: No
Planning lnsp. Req'd: No
Fire lnsp. Req'd:
Police lnsp. Req'd:
No
No Account#
\t,h\No
Orozco, lvan
VCA Consultants
Hernan dez, Kathy
Date: 0110512021
Date. 0112512021
Date: 0210812021
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
077760 02
07776002
07776002
07776002
07776002
0 77760 0 2
Permit Fee
Plan Check Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
I ssuance
$967 41
$1,325.71
$81 00
$2 00
$23.79
$5e 30
$2,459.21
$1 ,325.71
$1 ,133.50
75090
Total
57607
s3600
57770
57672
57600
57607
Landscaping 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 within 360 days afterifs issuance,or if the work authorized
on the site by such permit is suspe nded or abandoned for a period of 360 days after
the time the work is commenced.
01 1 16002 51600
01116002 s1601
01116002 51612
01116002 57770
$23.79
$1,026.71
$2 00
$81 00 Fee Totat
Paid to Date:
Balance Due:
lnspector MID#: 2021-163553
'7
t
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELC]ARATION
I hcrchy allirm undcr IEnalIy of Frjury thrt I am cxcmpt h(rm lhc Grntractos' Liccn* kw tirr thc followitrg rca$n (Scc.7031.5
Busincss anl Profcssion Culc): Any City or County which rcquircs , Imit to construcl. ahcr. improve. &mlish or rcJEir uy .
structurc, pri(lr t() its issuance, also rcquircs thc applicant for such lrmit k file a sigrcd ststcmnt that he or strc is licinsd pusuant
Io thc provisions of thc Conlractor's Liccn$d liw (Chaptcr 9, Commcreing wilh Sccti.rn 70fi) of Division J of thc Busincss and
Profbssions Codc) or that hc or shc is cxcmpt thcrcfrom and thc hasis for thc allcged cxcmption. Any violation of Scction 703 1.5 byitry
applicant for a Frmit subjccts thc applicant k, a civil pcmlty of not morc thsn five hundrcd dolles ($500).
_1. as owncr ol'tlrc propcrty, or my cmployccs with wagcs as thcir solc compensation. will do lhc work and thc slruclurc rs not
intcntlcd or ()ll'crcd lor sale (Sec.7044, Busincss and hotbssiuns Crxlc: Thc Contractor's Liccnse Law drrcs not apply to an owncr of
thc pnrpcrty who buikls or improvcs thcrcon, antl who docs such work himsclf or hcrsclf or lhrcugh his or hcr own cmployccs,
prlvitlcd that such impnrvcrncnts arc mrt intemlcd or oftbrcd lbr salc. It. howcvcr, thc building or impnlvcnrcnt is sokl within onc yc:u
of complction, thc Owncr Builder will have thc burdcn ol proving that hc or shc did not build or improvc thc proJrcrly lirr thc puryrs'e o[
salc).
-1,
as owncr ol'thc prcJrcrty, am cxclusivcly contractfurg with liccnscd contractors to construct thc project (Sec. 7M4, Busincss
and Pnrlbssion Codc: Thc Contraclor's l-iccrrsc Law docs not apply lo an owncr of prcpcrty who builds or improvcs thcrcon.
and who contracts for such projccts with a Contractor(s) licclrscrl pursuant to thc Contractor's Liccnsc Law).
-IamcxcmptunderScction-'B'&P.C.tilrthisrcason'I\., r ^.
WORKERS' CONI PENSATION
DECLAITATION
I hcrchy all'irm untlcr Jrcnalty of Jrcrjury onc ol'thc lilllowing dcclarations:
_l havc and will maintain a Ccrtilicatc ol'Conscnt kr Sclt'-lnsurc tilr workcrs' compcnsation. as pnlvitlcrl for by Scction 1700 of thc
[:hrr CtxJc, tirr thc pcrformancc of thc work lirr which thc pcrmit Ls issucd.
_l havc and will maintain workcrs'comJrcrrsation insurancc, as rcquircd byScctionlT0Oof thc LahorCorlc, torthc Jrcrlirrmanccof
thc work tilr which this pcrmit is issucrl. My workers' comlrcnsatiorr insurancc carricr and pllicy numhcr are:
.tcuni"r. All;a*il lqlttttg,< 5cw;ccJ , lt*'
poricy Nun.,b"r. GA looo {o et ta I Expires:lO - I '?ott
-I
ccnity that trr thc Jrcrli)rmftc (r[Ihc work tbr which Ihis JErmil is issucd. I shall not cmpk y any Frson in eny manncr :'s as to heqrm subjcct to thc wortss' comlf,nsation laws of California, and 09rc lhal if I should bouom subjet k thc
workcrs' comlEnsation provisions of Setion 3700 of tlrc tahrr Cqlc, I shall, tbrthsith comply sith tho* prcvisions.
WARNING: Failurc to scuc rurkcrs'comlrcnsation covcmgc is unlawful, aftl shall suhjcct {n mployer kr qimiml Fmltics and
civil lines up to onc hundrcd thousanrl dollars ($100,(Xrc), in atldition to thc cost of damagcs as provitlcd tirr thc
Scction J076 ot'thc Latxrr Crxlc, intcrcst and attrlrncy's f'ces.
Da,". L'6 ' UZt
I hercby allrrm under pcnalty of prjury that I am liccnscd 9 (comnrcncing with Scction 7firu) of Division 3
of thc lJusincss and Prol'essions Codc, and my liccnse is in ltrll lirrcc antl cll'cct.
Liccnsc ctors FA Liccnsc Numbcr:rt ro
Dare: 2,-U' ZOl,
I hcrcby allirm undcr Jrcnalty of Jrcrjury that therc
issucd (Scc. .1097. Civ. C.).
a constructi()n agcncy firr thc Jrcrlornrancc of thc work lilr which this pcrmit is
I-cndcr's Addrcss'
APPLICANT DECLARATION
I lrcrcby atl'rrn unr.lcr pcnalty of prjury onc of thc folkrwing rlcclarations:
Demolition Pcrmits-Asbcstos Notil'ication Fcrlcral Rcgulations (Titlc 40, Pafl6)
_Rcquircd lrttcr of Notification
-l
ccnily tlut lhc fcdcralrcCulali(rns rcgatrdiDg asbesk)s rcnxlvalec ml applicablc b lhis ps)jel.
_l certify thal I havc rcad this application anl statc that thc atDvc informlion is corccl. I a8rc lo comlly sith all Cily and County
ordinanccs and Statc Laws rclating to building construction, drt hcrcby aulhorizc rcJrcrcntalivcs ofthis City and Coutrly to cnlcr uIx)n the
atxlvc mcntionctl proprty lilr inspcction
Applicant or Agtnt
Pennitee nanlc (prinl):T**- D,+"f. oe c ,
o^r", 2't- (DZl
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/Ve nV! ns u latio n
Roof Sheathing
Shear Wall I I I l-
Framing 1t,Dl+#6 t
Insu !ation/Energy
Drywall L '?/rfLt D\qoffif 4
Ext./lnt. Lath \[ I
Brown Coat
J\Iasonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif
A-t
F!NAL lo t617 DWF6 7
Certificate of Occupancy
Notes, Remarks, Etc.
Elav n9,-n7 9n 1 6
lrndcr's Namc:
(o -A
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