HomeMy WebLinkAbout101108219 - 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 #: {O11O821 I
Pin #: 59367
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Project Address: 3503 S Harbor Blvd-
-Assessor's Parcel: 414-262-03 Lot: POR 3 Block: NA
Bldg.
Tract: WILLIAMS
Unit:Address Range: 3501 -3521
Historic: No
Suite Range:
Zoning: P
Building Use: Commorclal Occupancy: A-2,8 1st FL Area Patio:
Job Type: tliscoll.noous Constr Type: lll B, v B, SPK 2nd FL Area T.l.Area:
Nature ofwork: OrT lnspoction Code: cBc 2org Other Areas yards Reqd
Existing Bldg & Use: commeric.t Flood Zone: x-0602320258J calage Area vatuaton: to.Ol
Propoaed Use: # of Stori$:
Totat
D.loription ot Work Off lnapoctlon for aft.r houE on Frid.y lolEf2o2l (Building.nd Electric.l) with inlpoctor Robert Cbnero. 71+36&2890
Contact Jeffroy 48+557-2'126
Bat,,:l'r,llolt-tlit-t lt-t/&/2i-r?l ID: ttriPlanning Conditions:
Phone:
Tenant
Meltdown Management, LLC
PO Box 1267
Sunset Beach, CA 90742
(562) 685-3430
Observatory
Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
Rcpt i : tt34324'tZ
TrnnBor-t, i ori'[aLcrI
i_t/g/21121
Owner:
Address:
Contractor: JJ Ross Electric
Address: 2201 N Lakewood Blvd D14!
Long Beach, CA 90815
Phone: (310) 503-7775
State Lic #. 838229
Lic Type. C-10
Bus. Lic #. 351849
Workers' Compensation I nsurance:
Carrier: Exempt
Policy #:
Expires:
P.Ids i;t;ds irE\,rl1v i rrs
r-r I I I 6r-nl? -- 51 ,5 I 2tjUtJ -
ltu i ld irrg
0l I l6rJ02- 516rJ1'J[rJ-
I'ici st er i:nr d
C(:* : ****f ****x**5928
r- t.-
tCl
Planning Approval By.
Plan Checked By.
Permit lssued By:
NPDES !nsp. Req'd: No
PWA lnsp. Req'd: No
Planning !nsp. Req'd: No
Landscaping !nsp. Req'd: No
Fire Insp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No
Zuniga,Allissa
Date:
Date:
Date: 1010812021
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Recerpt:N
07776002 57770 Microfilm Records
07776002 57607 O/T lnspection
07775002 s7672 Bldg. Stds. Revolving
07776002 57600 General Plan Update
Fee Totat
Paid to Date:
Balance Due:
$0.00
$690 56
$1 .00
$0.00
$6e1 56
$0.00
$691 .56
Account#Total
01 1 16002 51601
01 1 16002 51612
$690 56
$1.00Every permitissued shall become invalid unless the work on the site authorized by
such permit is commenced within360 days afterifs issuance,or if the work authorized
on the site by such permitis suspended or abandoned for a period of 360 days after
the time the work is commenced.
lnspector MID#: 2021-168808
I t-l
rluL 5; : ti
BUILDING. INSPECTOR RECORD
SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hercby atfm under penalty of psjury that I m exempt from the Contrscton' Licw law for the following rron (Se.7031.5
Buincs md Profcion Codc): Any City or Couty which require a pemit to snstruct, alts, improvq dmolish or rcpair uy
strucluc. prior to its isumcq also rcquirs the applicut for such pcnnit to file a sign€d ststmmt that he or she b licq$d pmuilt
to thc povisiom of the Contractor's Licenscd taw (Chapts 9, Commencing with Setion 7000 of Division 3 of the Buins ad
Prefe$ioN Codc) or that hc or shc is qempt thrcfrom ad the basis for thc alleged exmption. Any violation of S*{ion 7031.5 by uy
applicantforapemitsubjetsthe applicanttoacivilpmltyofnotmorethdfivehundreddollm($500).
__1, o owns of the property. or my employu with wags o thcir $le compensation, will do rhe work ud thc stnrcluc b rct
intqdcd or offqed for slc (Se.7044, Busins ed Prcf6sioN Codc: Thc ContBctq's LiccN law do6 not apply to u oma of
the propgty who buil6 or imprcvc thq@n, ud who do6 schwrk hirelf or hffilf or thrcugh his or ho om mployc,
providcd that such imprccmts rc not inladcd oroffqcd for slc. If, howq. the buildiry or improvmt is rld whhin one )q
ofcompletioo, the Osos BuiHq will haw the hrdo ofproving that he or she did not build or inprovc the prcpaty for thc puposof
ulc).
-1.
u omr of thc prcpoty. m cxcluively contracring with licqts€d cotrtnctoE to coctoct thc Fojet (56. 7044, Busitrs
md Profesbn Codc: Thc Contractor's Licmsc Law do6 not epply to m own6 ofpropcay who builds or improvs ths@n,
and who contracts for such prcjets with a Conrmcto(s) lic@scd pNud[ to thc Contractor's Lic@ taw).
-l
m cxcmpt undq Sction-, B. & P.C. forthis rcen.
}VORKERS' COMPENSATION
DECLAR/TTION
I hereby alTirm under penalty of perjury one of the follorving declarations:
_l have and will maintain a Certil'rcate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the
Labor Code. for the performance of the work for which the perrnit is issued.
_l have and rvill maintain workers' compensation insurance, as required by Section 3700 of the Labor Codc, for the pcrformancc of
the work for which this permit is issued. My workers' compersation insurance carrier and policy numh are:
Policy Nurnber: Expires:
_l certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner
so ils to become subject to the workers'compers:ltion laws of California. and agree that if I should become subject to the
workers' compcnsation provisions of Seclion 3700 of the l-abor Code, I shall. forthwith comply wilh those provisions.
WARNING: Failure to secure workers'compensation coverage is unlawful. and shall subject an anployer to crimind poralties and
civil fincs up to one hundred thousand dollan ($100,000), in addition to the cost of compensation. damages as provided for the
Section 3076 of the Labor Code. interest and attorney's fees.
Applicant:
LICW
DECLARATION
I hereby allirm under penalty of perjury that I am licensed under provision of Chapter 9 (commencing with Scction 7000) of Division 3
of the Business and Professions Code. and my license is in full force and effect.
License Class: License Numbcr:
CONSTRUCTION LENDING AGENCY
I hrcby affum undo pei8lty of pcrjury thal th@ is 8 construction lcoding ag@cy for thc po forc of thc wrk for which this portrit b
issucd (Se. 3097, Civ. C.).
Lcndq's Nme:
Lcnder's Ad&ess:
APPLICANT DECLARATION
I hetEby alfrrm under penalty of perjury one of the following declarations:
Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Pan6)
_Required Letter of Notification
_l certify that the federalregulations regarding ashtos removal are not applicable to this project.
_l ceni& that I have read this application and stat€ that the above infonnation is correct. I agrec to comply with all City and County
ordinances and State Larvs and hereby authorize representatives of this City and County to etter upon the
above rnentioned property for
Applicrnt or Agent
Pcrlni(ee nflnrc
to
r0-8-?l
Set Backs
Forms/Steel/Holdowns )
Erection Pads
UFER Ground
SLAB Floor
S u bfloor/Ve nUI n s u lation
Roof Sheathinq
Shear Wall
Framinq
lnsulation/Enerqy
Drynruall
Ext./!nt. Lath
Brown Coat
Masonrv
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
Flood Zone Certif.
FINAL /0'a ,z I fr (!/a n/r ru9 a,r/
Certificate of Occupancy
Notes, Remarks, Etc.
f\^.^.
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