HomeMy WebLinkAbout10498364 - Permit\l
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City of Santa Ana 20CivicCenterPlaza(M-19), Santa Ana,CA927O2 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #= 10498364
Pin #: ,r:rfl
Project Address: 1638 E Seventeenth St Unit:Bldg: Address Range:Suite Range:
Zoning: C5Assessor's Parcel: 400-251-03 Lot: NA Block: NA Tract: NA Historic: No
Building Use Commerclal Occupanry: B 1$t FL Aree Patio:
JobType Tonant lmprovomont Constr Typs VB 2nd FL Aree T.l.Area: 29OO
Nature ofwork rl-l3tfioor code: cBc 2016 other A,"as yards Req.d
Existing Bldg. & use commerclel ofnco bldg Flood zone: x{602320163J
Garage Area vatuation: glo4,llo.oo
Proposed Use: Chiropr.clic ofiice # of Stories:
Totat
Deacrlpdon ot Work Naw yrrll3 & cellinga to crsato (2) rsstrooms, ofrlcsa, thoEpy rcom, massaga rcom, rgcoption aroa, & oxah room! for a chiropractia
office. Applic.nt a.ld lhero wlll be roof mtd squlp but not lncludod ln th.6o plana. Auth on lile.
Planning Conditions:
Owner:
Address:
Phone:
Tenant
Trinidad Cisneros
1125 E Seventeenth Street, W-17
Santa Ana, CA 92701
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires:
Engineer:
Address:
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
Danny Rodriguez
Danny Rodriguez
1317 N Custer Street
Santa Ana, CA 92701
(7141 926438e
Planning Approval By:Gomez,
Plan Checked By: So, Anson
Permit lssued By: Zuniga, Allissa
NPDES lnsp. Req'd: No
PWA lnsp. Req'd: No
Planning lnsp. Req'd: No
Date: 0110312019 Misc. Receipt:
Date: 1211312018 Misc. ReceiPt:
Date: O1lO4l2O19 Misc. Receipt:
Subject to Field:
No
No Account#
01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 57770
71801
Total
07776002
07776002
07776002
01776002
07776002
07776002
s7607
53600
57770
51672
s7600
57601
Permit Fee
Plan Check Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
$725.00
$1 ,015.00
$33.84
$5.00
$22.08
$s5.04Fire Insp. Req'd:
Police !nsp. Req'd:
Landscaping lnsp. 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 180 days after ifs issua nce,or if the work authorized
on the site by such permit rs suspended or abandoned for a period of 180 days after
the time the work is commenced.
$22.08
$780.04
$5.00
$33.84 Fee Totat
Paid to Date:
Balance Due:
$1,855.96
$1 ,015.00
$840.96
lnspector MID#: 2018-147302
BUILDING. INSPECTOR RECORD
SITE.WORK DATE ID/SIG.COMMENTS
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf loor/VenVl nsu lation
Roof Sheathing
Shear Wall
Framinq
Insu lation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
h\
FINAL l0-9-a)h.lt[),fy
Certificate of Occu
Notes, Remarks, Etc.
OWNER BUILDER DELCARATION
I hcrchy allirm urrdcr Jrcnalty ol pcrjury that I m cxempt Irum thc Contraclos' Liccnsc kw lbr thc lirllowing rcavrn (Scc.70.11.5
Busincss nnd Prolc$skrn Cq.lc): Any City or C(lutrty which rcquircs a lEmit to construct, altcr, impNvc, dem)lish or Elair rdy
structurc. pri(rr to its irsuancc, alv) rcquircs thc applicanl li)r such lrrmil lo file a signcd stalcmcnt that hc or shc is liccnscd pursuant
b thc prtvisions of lhc G)ntracbr's l.iccnrd [:w (Chaptcr 9, Commcncing wilh Sslt]n 7000 of frivisi(]n J of lhc Busincss md
Pr)lcssionsCodc)orth{tlEorshciscxemplthcrctiomandlhcbasislbrthcallegcdcxcmption. AnyviolalionofsetionT0-ll.5hyany
applicant lor a Jf,rnit suhjccts thc applicnut to a civil pcnalty of not m)rc the tive hundrcrl dollus (3500).
1
1
_1, as ()wncr of the proJrcrty, or my cmpklyees with wages as their solc comlrcnsation, will do tlrc work and thc structurc Ls nrtt
intcndcd rlr olll.rcd lirr salc (Scc.7(X4, Busincss and Prol'cssions Crxlc: The Contractor's Licensc [aw docs nol apply to an tlwncr ol'
thc pn)pcrty who builds or impnrvcs thcrcon. and who drrcs such work himsclf or hcrsclf or through his rlr hcr own cntpkryccs.
prcvidr.d that such inrpnlvcrncnts a.rc nol uttcndcd or ollbrcd frrr salc. If , howcver, thc buikling or intpr<tvcmcnt is stlkl within onc ycar
ol'comphtion. tlrc Owncr Buiklcr will havc tlrc burden ol'proving lhat hc or she did not buikl or impruvc the prupcrty fbr thc puryls,c ot'
sah).
_1, asowncrol'thc pr()pcrty, amcxclusivclycontracting with licenscd contraclorstoconslruct thc pnljcct (Sec. 7M4, Busincss
aml Pnrtbssion Cotlc: 'l'hc Contraclor's l-iccnsc Law does not apply to an owner of propcrty who huilds or improves thcrcon,
antl who contracts frlr such pnljccts with a pursuant to thc Contractor's Liccnsc Law).
_l am lirr this
I hcrchy al'l'irnr undcr Jrcnalty ot'Jrcrjury onc of thc tblklwing dcclarations:
_l havc and will nraintain a Ccrtilicatc ol'Conscnt to Sell-lnsurc frrr workcrs'comlrcnsation. as pnlvidctl lilr
l:txrr Crxlc, lirr thc Jrcrlilrmancc of thc work tirr which the Jrcrmit is issucd.
.17fi) ol'thc
_l havc and will nraintain workcrs'contJrcnsation insurance, as rcquircd byScction 37fi)of thc LahorCode, lilrthc lrcrlirrntancctll'
thc work lirr which this Jrcrmit is issued. My workers' comlrcnsation insurancc carricr anl Jxrlicy numbcr arc:
Carrier:
Policy Nunrber: Expircs:
_l t:crltly tlrat in thc pcrlirrnrancc ol'thc work lilr which this pcrrnit is issucd. I shall not cmploy any pcrson ilt any mannL'r
so as to hccomc- suhjcct to thc workcrs' cornpcrrsal ion laws ol'Calilirrrria, and agrce that if I should hccomc subjcct ttl thc
wrlrkcrs' conrpcnsalion pnlvisions ol'Scclion l.akrr Codc, I shall, tbrthwith comply with thosc provisions.
IVARNIN(i: ljailurc l() sccurc workcrs'is unlawl'ul, and shall subjcct an cntpklycr ttl crintinal J-._ltaltics and
civil I'incs up lo onc hurrrlrcd thousand dollars addition to thc cost of damagcs as providcd ftlr thc
Scction ol'thc
-i
and
I lrc'rchy al'lirnr undcr Jrcnalty ol'pcrjury tltat I ant licenscd undcr of Chaplcr 9 (commcncing with Scclion .l
ol' thc Busincss and Prot'cssions Codc. anrl my liccnsc is in tirll lirrcc and cffbct.
Liccnsc Class: Liccnse Numhcr:
CONSTRUCTION LENDING AGENCY
I hcrchy allirm undcr Fnalty of Frjury that thcrc is a conslructbn hnding agcncy for lhe Jrrfotmrec of lhc work lirr which this JEmil is
issucd (Scc. .1097. Civ. C.).
lrndcr's Name:
[rndcr's Addrcss:
APPLTCANT DECLARATTON
I lrcrehy atlirm undcr Jrcnalty of pcrjury onc of the lirllowing tlcclarations:
Dcmolition Pcrmits-Ashcstos Notificalion Fcdcral Regulations (Title 40, Part6)
_Rcqu irctl [rttcr ol' Notilication
_l ccrlily that thc l'cdcralrcgulations rcgarding asbcslos rcmoval are not applicablc to this pnljcct.
_l ccrtity that I havc rcad this arxJ slate that thc ahlvc inlilrmation is corrcct. I agrcc to with allCity and County
rlrdinanccs antl Statc [-aws rclating and County to cnlcr
ahrve nrcntioncd prol^-rty lirr
Applicnnt or Agent
Pentritee nanre
constnrction, and hcrcby uprn llrc
B.&