HomeMy WebLinkAbout30143321 - PermitCity of Santa Ana 20 Civic Center Plaza (M-'t9), Santa Ana, CAS27O2 Plumbing
Permit Counter: (7'14) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 3O143321
Pin #: 72745
lrt-tt
Proiect Address: 104 E Fourth St-a
Assessor's Parcel: 398-501-02 Lot: POR 7 & POR 10
Unit:
Block: 10
Bldg: Address Range:
Tract TOWN OF SANTA Allistoric: Yes
Suite Range:
Zoning: SD84
Owner.
Address:
Phone.
Tenant Name:
Contractor.
Address:
Phone:
Norbert Foigleman
86 Harbor Ridge Dr
Newport Beach, CA 92660
(e4s) 230-8e88
EI Rincon Mexicano
D J Z Construction
23806 Elyce Court
Moreno Valley, CA 92553
(e4s) 836-2631
01 1 16002 s1602
01 1 16002 51602
01 1 16002 51602
01 1 16002 5160C
01 1 16002 51602
01 1 16002 5777C
Fee Type Amount Qty Fee
Sink 13.68 1 .00 $13.68
Floor Sink 17.39 1.00 $17.39
Water Piping (Each 100 47 .95 1 .00 $47.95
General Plan Update 23.79 1.00 $23.79
lssuance 59.30 1 .00 $59.30
Microfilm Records 4.05 1.00 $4.05
'',(i (, , lli . l"r /i'ir-ii;, ., .,' i.: ./ .,, .: ,. . r., ,..i t' . :t'
. .l r I t ,l .. . , I t-, I | ; L
r I I t,
,,.-,1 r i. il ', i ..: ,r , ,i , .i; . l.lr,
'' : ,..'(.'f :'. l..:.)Jy il .-" i' '\ | .' l.: : I .. t r ', :
,,..ill:lr,,-,,'.|ll1.,..l...l..:'.:..\l
D J Z Construction
State Lic #: 1029251
Lic Type: B
Bus. Lic #: 378364
Workers' Compensation I nsurance:Carrier: State Fund
Policy #: 9266253
Expires: '12l,2112021
Generol FIon Updote Fee
01116002- 516tt00[t0-
ll i crof i lr & Docurent s
01116002- 3777A00(t-
F lurb i ns
0l 1t6tru2- 516u2000-
(:ash
Chonse
SZJ . {Y
$4. [r5
$139,3?
$ 7(ttt , [tLt
( $33,5t-t)Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #.
Commercia!
Tenant lmprovement
TI
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
A-2, B
V B, SPK
cPc 2019
Amsden, Julie
1 01 1 05998
Every permit issued 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.
07 t06t2021
Account#
Misc. Receipt:
Mrsc. Receipt:
Misc. Receipt:
Total
Notes: Plumbing for Tl
Fee Total
Paid to Date:
Balance Due:
01 1 16002 51600
01 1 16002 s1602
01 1 16002 57770
$23.7e
$1 38 32
$4.05
$166 16
$0.00
$166.16
lnspector MtD#'. 2021-164238
r
r
PLUM BING.INSPECTOR REGORD
APPROVALS DATE ID/SIG.COMMENTS
UNDER GROUND
Waste & Vent
Water-Under floor
Gas-Underfloor
Building Sewer
Area/Storm Drain
I nterceptor/ Clarifier
TOP OUT lr^
Waste & Vent ql,r-ZL fu{J4
Water Piping
Gas Piping
Roof Drain ./
Tub/Shower Test ./
Rouqh Water Heater
POOL/SPA
P-trap/Drain Line
Main Drain/Pool Piping
Fill Line/Back FIow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler \
Sanitary Sewer/Cap 4,
Back FIow Device
Rough Plumbing
Final Gas Test
Meter Release a,,1-LeFINAL7-24 2/42/@ -7V
Notes, Remarks, Etc.
\
7
I hqdry aIfirm uods poalty of pqjury thd I m qmp 8om rhc Codrtm' Licre try for thc folbwiog re[ (Soc.703l5
Buine and Prcfebn Codc): Atry City or Cout y which rsquirs a pmn to ordru(t altc, inprcrc holbh or rcpah uy'
sruclur,Fbrtoits isuucc,dsorrquiEthceplixtforshpmit!oflrasigocd$dmt thatcorshcblissod pman
to thc Fovbioru of thc Cotrtac'ttr's Limscd hw (Chrpta 9. Commiag wilh Setiol 7000 of Divisioo 3 of thc Buim md
Profeiom Co&) m rtut hc fi shc is qcryt thsc&om ad thc bsb for thc s[Ggod qoprion. Aoy vblatbn of SBrbr 703 I .5 by uy
applimt for I pqmit sbjcBthc applicrd to s civil pfl[yof mt mGtt$ fivc hu!&rd dollJ! (t500).
-1.
I om6 of thc popctn u my mplolc with wsg6 s lhcir sh compasaion, will do th. work md thc rfudrc b mt
iltqd.d or oftrcd fq slc (Sc.7044, BBin6 md Profc*rioro Codc: Thc Cortrrclor'! Lic@ l.rw do6 mt @ly to m ow of
thc prcpsty who tuil& tr inptoG tllmo, ad who do6 erch w!* hirelf or hqetf or thrcugh hir or ha om snploycca,
providcd that sucb imtrowErt! m mt idodcd or oftrod for sh, l(, how, ttr buildiog or imFovarcd is $ld wilhin olc )ar
of ompl*iln, thc Ownr Builda wilt hm thc hrd6 of poving tha hc or drc dil mt tuild or inprcvc thc popaty for thc prrpos of
elc).
-1.
a ow of thc pmpqty. u qclGircly @otrting with li@Gd correloa to onnnrct thc pojcd (Sc. 7044, hlirB
ad Proftriim Co&: Thc Contnctor'i Licce l:w doB rct lpply to m omq of prcpaly who buitls or inprcs thqatr
ud who 6rtuB for swh Foirts with a Cofiaclo(s) lilmcd pnuaot to thc Cortrrttr'! LLlre ts).
-I
m qmDr utrd6 Sction , B. & P.C. for thb @!.
I hereby alTirm under penalty of pojury
Owner:
WORKERS' COMPENSA
DECLARATION
one ofthe following declarations:
have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the
Code. for the perfonnance of the work for which the permit is issued.
have and will maintain workers'insurance.as by Section 3700 of thc Labor Codc, for the pcrformance of
rcarrier and policy number are:the work for which this permit is
Policy 12- 7O2 t
certiS that in thc pcrformance of the work for which this permit is issued. I shall onploy any pcrson in any manner
so .ls to become subject to the workers'compensation lau's of California" and agree that if I should become subject to the
workers' compensation provisions of Section 3700 of the t^abor Code. I shall. forthwith comply with thosc provisions..
WARNING: Failurc to sccure workers' comporsation coveragc is unlawful, and shall subject an onployer to oiminal pcnalties and
civil fincs up to one hundrcd thousand dollars ($100.000), in addition to the cost of cornpensation, damages as provided for the
3076 of the Labor Code, interest and attorney's fees.
DF'.rLIII.ATTON
I hereby aflirm under paralty of perjury tha I am licensod under provision of Chapter 9 (commancing with Secrion 7000) of Division 3
of the Busincss and Professioru Codc, and my licsrse is in full forcc and cffect.
Number:
Dpl/c t/'I
I hereby affrm under penalty of perjury that
issued (Sec. 3097, Civ. C.).
knder's Name:
CONSTRUCTION LENDING AGENCY
there is a construction lending agency for the pcrformance of the work for which this pennit is
Lender's Address:
APPLICANT DEC II\RATION
I hcr*yaffirrnundcr poralty of pcrjury one of the following dcclarations:
Dernolition Pcrmits-Asbcstos Notilication Fedcral Regulations (Title 40, Part6)
-Required
Lcttcr of Notification
_l certifu that the federal regulations regarding asbestos rcmoval are not applicable to this project.
with all City and County
and County to enter upon the
above mcntioned property for inspeaion
0
or Agent
a
Appricanr:,Ok(f h 0rAU? O
LICENSEDTONTRACTOR I
Class:E
and
LA I^