HomeMy WebLinkAbout101105998 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: 1O{ {05998
{F,
Project Address: 104 E Fourth St
Assessor's Parcel: 398-501-02 Lot: POR 7 & POR 10 Block: 10
Bldg: Address Range:
Tract: TOWN OF SANTA ANA
Pin #:
Suite Range:
Zoning: SD84
Unit:
Historic: Yes
Building Use:
Job Type:
Nature of Work:
Existing BIdg. & Use:
Proposed Use.
Commercial
Tenant lmprovement
TI
Com m erc i a l/Resta u rant
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories.
A-2, B
V B, SPK
cBc 2019
x-0602320276J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Totat
Patio:
T.l.Area:
Yards Req'd
Valuation: $e,500.00
0
DGcrlption of Wo.k Tl-lnst.ll serylce lrar on 2nd floor-no giease lnterceptoa roq'd ..
Planning Conditiona:
Engineer: Langaton & Arlociatea
Owner: Noften Foigl.m.n Contracior: D J Z Con3tructlon Jim L Lan$ton
Addrsss: 86 H.rtorRldge Dr Addrsss: 23806 Elyce Court Addrcss: 603 N Partc.nter Drlve, Sulte r0S
l{ewpdrt Be.ch, cA 92660 t oreno V.lley, cA 92553 santr anal cA 9rr05
Phone: (949) 230{988 Phone; (e,le} s36-2631 ll-", gl1}jf+tJi , . .
Ten.nt Er Rincon Msxicano state Lic#: 1029251 Liceme #: c29373
Lic Typ€: B Architect / daal {Dr.itingiorA i
Bus. Lic *: 37a364 Desiqner: Jalme U.jil, ,, ,
Workers' Compensation lnsurance: Addrsss: '18455 Yucca 6!,Canier: St te Fund H$peri.icA92345
Policy #: 9266253
Expires: 1212112021
Phone: (909) 534-33t0
License #: I :'i
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
Guevara, Jerry
Lee, Wayne
Amsden, Julie
Date: O7lO1l2O21
Date: 0312512021
Date: 0710G12021
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
No
,NO
No
No
Account#
75282
Total
077760 02
07776002
07776002
08907007
07776002
07776002
077750 0 2
57607
53600
s7770
24000
57672
5760 0
57607
Permit Fee
Plan Check Fee
Microfilm Records
SMIP - Category 2
BIdg. Stds. Revolving
General Plan Update
I ssuance
$345 28
$478.68
$48 60
$1 82
$1 00
$23.79
$59 30
a6fire lnsp. Req'd: Yes
Police Insp. 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.
01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01116002 57770
08901 001 24000
$23.79
$404 58
$1 00
$48 60
$1 82
Fee Totat
Paid to Date:
Balance Due:
$958 47
$478.68
$479.79
lnspector MrD#' 2021-164238
BUILDING- INSPECTOR RECORD
SITE.WORK DAT.E .lD/slG.COMMENTS
Set Backs a
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bf !oor/Ve nt/l n s u I atio n
Roof Sheathing
Shear Wall
Framing R18Z,l 0.<*24
lnsulation/Energy A
Drywall v(gat l?-dz rl
Ext./lnt. Lath
Brown Coat
lVlasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif .
/'
FINAL 7-294 /L hrn ',€46 ?zv
Certificate of Occupancy
Notes, Remarks, Etc.
OWNER BUILDER DELCARATION
I hcreby affirm undcr pcnahy of pcrjury that I am cxcmpt frcm thc Contractors' Liccnsc Law for thc following rcasn (Src.?031.5. .
Busincss and Profcssion Codc): Any City or County which rcquircs a pcrmit to construcl, altcl improve, dcmlish or rcpair any
structuc. prk r to its issuarcc, alm rcquircs the opplicont for such pcrmit to tih a signed statcrcnt that he or shc is liccosd pusuolt
to lhc pmvisions of thc Contractor's Liccnrcd law (Chapter 9, Commcncing wilh Setion 70fi) of Division 3 of the Business md
ProlbssioosCodc)orthathcorshciscxcmptthercfromandthebasisforlhcallegcdexemption. Anyviolationofs6tion?O3l.5byotry
applicant for a pcrmit subjects thc applicant to a civil pcmlty of not mrc than fivc hundrcd dollars ($500).
_1. as owncr of thc propcrty, or my cmployccs with wages as thcir sole compcnsation, will do thc work and thc structurc is not
intcndcd or ofl'crcd firr salc (Sec.7M4, Busincss and Prolbssions Codc: Thc Contractor's License Law docs not apply to an owner of
thc propcrty who builds or improvcs thcrctrr, and who docs such work himsclf or hcrsclf or through his or her own employees,
providcd that such irnprovenrcnts are not intended or offered for salc. If, howcver. the building or improvenrcnt is sold within onc ycar
of cornplction. thc Owner Builder will havc the burden of proving that hc or she did not build or improvc thc property for thc purposc of
sale).
-1.
as owner of thc propcrt), am cxclusivcly contracting with liccnscd contraclors to construct thc projcct (Scc. 7M4, Busincss
and Profcssion Code: Thc Contraclor's Liccnse Law docs not apply to arl owner of property who builds or improves thereon,
and who contracts for such projccts with a Contractor(s) licensed pursuant to thc Contractor's Licensc Law).
_l arn excmpt undcr Scction_. B. & P.C. fbr this rcason.
I)ate:
WABTEESSOMSENTAIIAN
DECIABAIION
I hcrcby affirm undcr pcnalty ofpcrjury onc ofthe following declmtions:
SfAmvcarawitlmintainaCertificatcofconsnttoself-lnsurcforworkqs'ompcnsolion,as prcvidcdforbySetion3?0Oofthc
tabor Codq for thc Frformncc of thc work for which the lEmit is issued,
Jlftave and will minlain workcn' comlrcnsation insurancc, as rcquircd by Scclion 3700 of thc Labor Codc. for thc pcrforrc of
thc work for which this pcrmit is issucd. My workss' compensation insumce cmier atrd policy number re:
.-*,^.. <1 n4. Fr )rt nJ
lL-LCtPolicy
-l
ccrtity that in the perf<rrrnancc of thc work for which this pcrmit is issucd. I shall not enrploy any pcrson in any nranncr
so as lo bccomc subjcct to the workcrs' compensation laws of California. and agrcc that if I should bccomc subject to thc
workcrs' conrpensation provisions of Section 3700 of thc Labor Code, I shall, forthwith cornply with those provisions.
WARNING: Failurc lo secure workers' contpensation covcrage is unlawful, and shall subject an crnployer to criminal pcnaltics and
civil fines up to onc hundrcd thousand dollars ($100.0m). in addition to thc cost of compensation, damagcs as provided fbr the
Scction 3076 of the Labor Code, intcrcst and attorncy's fccs.
o
"^,", 07 /0 6f I (Annricanr: 5or&c A - kA rrl ) 0
LICENSBIT(IN'Tf,.AC'I'(}R I
DECLARATION
I hercby affirrn undcr pcnalty of pcrjury that I am liccnscd undcr provision of Chaptcr 9 (cornmencing with Scction 7000) of Division 3
of the Busincss and Professions Codc. and rny liccnsc is in full force and cffcct.
Liccnse
Date:
Nunrbcr:
/ 06 / 1 t
I I
W
I hercby affirrn undcr pcnahy of pcrjury thlt thcrc is a onstruction lcnding agcrcy for thc pcrformns of thc work for which this lrcrmit is
issued (Sec. 3097, Civ. C.).
hndcr's Namc:
Lcndcr's Acldrcss:
APPLICANT DECLARATION
I hercby affinn undcr pcnalty of pcrjury onc o[ thc tbllowing declarations:
Dcrnolition Permits-Asbestos Notification Fcderal Rcgulations (Title 40. Part6)
_Required Lettcr of Notification
_l cc(ify thdt thc fcdersl regulations regsding $bcstos rcmval drc not applicablc to this prcjcct,
f(l ccnify tnat I havc read this application and stotc thut thc abovc infbrmrion is corcct. I agre to comply with ull Cityand County
ordinances and Statc Laws rclating to building construction, ed hcrcby authoria rcprcsntativcs ofahis Cily and County to cntq ulren thc
abovc rrtcrttioncd propcrty for purposcs.
Applicanl or Agent
Pernritee nilnre
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