HomeMy WebLinkAbout104100343 - PermitProject Address: 1638 E Seventeenth St
Assessor's Parcel: 400-251-03 Lot: NA
Unit:Bldg: Address Range:Suite Range:
Zoning: C5Block: NA Tract: NA Historic: No
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA92702 Building
PermitCounter: (714) 647-5800 lnspection Requests: (714)667-2738 lnspector Section: (7141647-5853
Permit #: 1O41OO343
Pin #: MA89
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Building Use
Job Type:
Nature of Work:
Existing Bldg & Use:
Proposed Use:
Commercial
Revision
Revision
Commercial office bldg
Chiropractic office
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories:
B
VB
cBc 2016
x-0602320163J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Total
Patio:
T l.Area:
Yards Req'd
Valuation:
Description of Work: revision to 10498364. Revision to move interiior walls
Planning Conditions:
'\ Owner:
Address:
J
Phone:
Tenant
Trinidad Cisneros
1125 E Seventeenth Street, W-l7
Santa Ana, CA 92701
Contractor:
Address:
Owner-Builder
Phone.
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Engineer.
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
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
Carvajal, Verny
Zuniga, Allissa
Flood Zone Cert. Req'd: No 01 116002 53600 $222.16
07776002 53600 Revision
07776002 57600 General Plan Update
Fee Totat
Paid to Date:
Balance Due:
Date: 06/06/2019
Date:
Date: 06/06/2019
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
G. Moran
$222 16
$0 00
No
No
No
No
Fire !nsp. Req'd:
Police lnsp. Req'd
No
No Account#Total
Every permit lssued 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 MtD#'. 2018-143061
$222.16
$0 00
$222.16
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUII,DER DELCARATION
I hcrhy allirnr undcr lrcnalty ol Frjury that I am c\cmpt lh)m thc Contrnckns Liccnsc hw lirr thc following rcasn (Scc.?O.ll.5
Busincss ail P(rtcssion Codc): Any City or Courty which rcquircs a Jrrnit k, (r)nstruct. allcr, imp(rvc. dcmrlish or rcprir any
slructurc. pri)r k) its issu{trcc. also rcquircs thc applicant li}r such lEnnil k) lilc n signcd statem'trt lhal lrc or shc is liccnscd pursuanl
to lhc [m)visi()ns of lhc Contrackrr's Liccnscd llw (Chnplcr 9. Conrmefting with Scction ?Un of Division 3 (]f lhc Busincss and
Prolbssions Codc) or that lrc or shc is cxcmpt thcrcliom and thc hasis ti)r thc rllcgcd cxcnlption. Any violation of Sccttrn 70-l I .5 by {ny
rpplicanlforalrcrmitsuhjcclslhc applicanltoacivilpcnaltyo[n(]tmorcthunlivchundrcddollrs(3500).
_1. as owncr ol'lhc pn)lrcrty. ()r tny cmployccs wilh wagcs as thcir solc conrpcnsrlion. will do thc wrlrk ard thc structure is lx)t
intcrrdcd or oll'crcd lirr salc ( Scc.7044. Business anrl Proll'ssions Crxlc-: 'l'hc Cirntractor's I -iccnse l.aw docs not apply lo an ttwncr ot'
thc pnrpcrly wlxr buikls rlr impnlvcs thcrcon. aml who tkrcs such wrxt hinrscll'or hc'rscll'or lhrough his or hcr own entpl()yccs.
provitlcd that such inrprlvcrncnls arc n<lt inlcndcd or ollbrcrl lilr salc. I[. lrtlwcvc-r, thc huikling or improvenrcnl is sokl within ()nc yr'iu'
of con4rlction. tlrc Owncr Buildcr will havc lhc burdcn ol'pnrvirrg lhal lrc or slrc did not buihl or inrprrtvc thc prrt;u1y lilr lhc purposcol'
sah).
and lhrlbssirnCrdc: 'l'hcConlraclor's[-iccnscLawrlocsrrolapplvlo:rnowrr('rol'pro1^*rtywhohuilds<lrimproveslhc'rr'ttn.
anrl wlrrl conlracts lirr such projccts with a Contrirctor(s) liccnscd pursuanl lo lltc Crxttritclrlr's l.iccltsc l.aw).
-IamexenlplundcrScclion-.B.&P.C.tilrlhisrcasrtn.
lVORKERS' COt\I PENSA'TION
DECLARATION
I hcrc:hy all'irnr undcr pcnalty ol'pc{ury onc ol'thc lirlkrwirrg rlccl:rrations:
_lhavcarxlwill nrainlainaCcrlilicatcol'ConscrrtloSclt-lrrsurclirrworkcrs'contpcnsali()n.as providcdlirrbyScctiolt-]7fi)ofthc
Lalxrr Codc, tirrthc lrcrlirrmancc o[the work lilr which thc pc'rrnit is issucd.
_l havc and will maintain workcrs'conl[rcnsation irrsurancc. as rcquirc'd hySr-ction -17(X)ol'thc l.ahor(iilc. fitrthc lrcrlilrntanccol'
thc work tirr which lhis permit is issucd. My wrlrkcrs' c()mlrclrsaliorr insuritncc carricr antl ;xrlicy rtunrhcr arc:
Policy Numbcr: Expirc's: Ab-
_l ccrtitythat in thc;rcrlirrmancc o[thc work lirr which lhis pcrnrit is issuctl. I shall not cmpkry ilny pcrson in any nrdnncr
so as lo hcconrc subjccl lo thc workcrs'conr;rcnsatiotr laws ol Califtlrnia. and agtcc that il'l shoultl hcome sulljcct ft) llrc
workcrs' conrlrcnsation pr)visiorrs of Sccl ion .l7U) ot'thc l-alxrr Crxlc. I shall. lirrthwith contply wrlh thosc provisi.9,s.
WARNING: Failurc to sccurc workers' comJrcnsati()n covcrilgc is unlawhrl. anrl shall suhject an cmpktycr t() critninal pcnaltics and
Scclion -1076 ot'lhc [.ahrr Crxlc. inlcresl iurd attorncy's l-ccs.
Dale:
LICENSED CONTRACTOR
DET]LARATION
ol' llrc Busincss and Prol'cssiorrs Clodc, and my liccttsc is irt lirll lirrct- :uttl cl'tcct.
Licensc Class: l-iccnsc Number:
l)ale :
W
I hcrchy altirm undcr Jrnillly ol pcrjury that lhcrc is r conslrction lcndi[g agcncy li)r thc pcrli)nnancc of lhc work lirr which lhis lrnnit is
issucd (Scc. l(rr7. Civ. C.).
I.cntlcr's Nanrc:
lrndcr's Addrcss:
APPLICANT DF]CLARATION
I l**rc-by allinn unrlcr J^-nalty ol'p-rjury orrc ol'thc lirlkrwing tlcclarations:
Dclnolilion Pcrnrits-Asbcstos Nolil'ication l;crlcral Rcgulations lTitlc 40. Pun6)
_Rcquirctl Irltcr ol' Nriliticaliorr
_l ccrlily lhal thc ll'dt:ralrcguhtions rcgiuding ashcstos rcnxrvalarc n()l applicahlc lo lhis projccl.
_l ccrtily lhal I havc rcatl this applicatiorr with all City and County
arrd Counly to eltlcr uprn lltcorrlilr:urccs antl .Stalc I-aws
atxrvc' nrclrt iorrctl proJxrly lirr
Applicarrl or Agent
I'enrrilt t nAnrc
sl:rlc llurl
J -/
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bf loor/Vent/l ns u lat io n
Roof Sheathing
Shear Wall
Framing
Insulatio nlEnerqy
Drywall
Ext./lnt. Lath
Brown Coat
l\/asonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
,r^,
FINAL lo-5-?l Dn r/l [ )t
Certificate of Occupancy
\Notes, Remarks, Etc
Annlicrrnl:
arrtl lrcrc'tly ittt I lx rrizr'