HomeMy WebLinkAbout30440458 - Permitt
.:
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Plumbing
Permit Counter: (714) 647-5800 Inspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit#:3O44lO458
Pin #: 5OO25
Project Address: 1638 E Seventeenth St Unit:
Block: NA
Bldg:
Tract NA
Address Range:
Historic: No
Suite Range:
Zoning: C5Assessor's Parce!: 400-251-03 Lot: NA
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Trinidad Cisneros
1125 E Seventeenth Street, W-17
Santa Ana, CA 92701
Owner-Builder
01 1 16002 51602
01 1 16002 51602
01 1 16002 51602
01 1 16002 51602
01 1 16002 5160C
01 1 16002 51602
Fee Type Amount
Water Closet 14.22
Sink 12.70
Gas Line repair/replace 44.51
Wtr Htr (Comm up to 50 22.25
General Plan Update 22.08
lssuance 55.04
Qty
2.00
2.00
1.00
1.00
1.00
1.00
Fee
$28.44
$25.40
$44.s1
$22.25
$22.08
$55.04
Building Use:
Job Type:
Nature of Work:
Commercial
Tenant lmprovement
TI-1st floor
Zuniga, Allissa
10498364
Occupancy:
Constr Type:
Code:
B
VB
cPc 2016
Planning Conditions:
Planning Approval By
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Every permit issued shall become invalid unless the work on the site
authoized by such permit is commenced within 180 days after its
issuance, or if the work authorized on fhe site by such permitis suspended
or abandoned for a period of 180 days after the time the work is
commenced.
Date:\(\ ,/\VDate:
$ Date:01t04t2019
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total
Paid to Date.
Balance Due:
01 1 16002 51600
01 1 16002 51602
$22.08
$17s.64
$197.72
$0.00
$197.72
lnspector MID#: 201 8-147302
PLUM BING.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS
UNDER GROUND I
Waste & Vent 7/lzzz/4
Water-Under floor I (v -v
Gas-Underfloor
Building Sewer
Area/Storm Drain
I nterceptor/ Cla rifier
TOP OUT
Waste & Vent
Water Piping
Gas Piping
Roof Drain
Tub/Shower Test
Rough Water Heater
POOUSPA
P-trap/Drain Line
Main Drain/Pool Pipinq
Fill Line/Back Flow
Pool Heater/Gas Line
Miscellaneous
Gas Service
Water Service
Lawn Sprinkler
Sanitary SewerlCap
Back Flow Device
Rough Plumbing
Final Gas Test
Meter Release
xfl#(FINAL 1,0*q'-A \
Remarks Etc.
Io
I hcrcby allirm undcr pmlty of pajury thrt I m qcmpt frcm thc Coilr.ctoE' LicGre Law for thc followinS Een (SG.7031.5
Busincss and Pmfcssion Code): Any City or Couny which rcluircs r Fmit to @ndruct. slt6, impmrc, &mlbh or quL sy
stnrcluc. Irbr to il3 issreq sho EquiG thc applicmt for sch Jrmit to filc 8 signEd statclmt that h. or shc h lictrsd puMot
to thc prcvisioB of th. Coilretc'3 Licn3cd Lrw (Chsptr 9, Comrcing wilh Sation 7fi)0 of Divhion I of thc Burincs and
PmfcsionsCodc)orthathcorrhchcxcmptthtrcfrom8rdthcb6qisforthccllc8f,dcxctrrption. Anyvioloiionofs6{ion703l.5by8ny
applicant for a pcmit sbjcts thc .pplient to I civil peEltyof mt mE thao fivc hudrr{ rlollm ($5(x)).
-1,
rs owner of the propeny, or my emplolrces with wages as their sole compensation, willdo the work and the structure lq rnt
intended oroffered for sale (Sec.7(X4, Business and Pmfessions Code: 'l'he Contractor's License Law does not apply to an owner of
the progrerty who builds or improves thermn, and wtrl does ruch work himself or herself or through his or her own employees,
provided that such impmvements are not intended oroffered for sale. l[, tnwever, the building or inprovement is sold within one ]€ar
of completion, the Owner Builder will have the burden of proving that he or she did ncrt build or improrr the property for the purynse of
sale).
-1,
as owner of the property, am exclusively contracting with licensed contraclors to construct the pmject (Sec. 7M4, Business
and Professbn Code: 'l'he Contractor's License Law does not apply to an owner of property who builds or imprnves thereron,
and who crntracts for such pmjects with a pursuant to lhe Contractor's License Law).
_l am exempt under .C. for this reason.
s s\-
I hereby affirm under penalty of perjury one of the following
-l
have and will maintain a Certificate of Consent to Self-lnsure for workers' conrpensation, as
Labor Code, for the performance of the work for which the permit ls issued.
Scctiorr .17(X) o l' tlre
-l
have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the perfornrance of
the work for which this permit is issued. My workers' compensation insurance canier and plicy number are:
Policy Number: Expires:
-l
certi& that in the performance of the work for which this Jrcrmit is issued, I shall not employ any penion in any manner
so as to become subject to the workers'compensation laws of California, and agree that if I should become subject to the
workers' compensation pmvisions of Section 37fi) of the Latnr Code, I shall, forthwith comply with ttnse pmvisions..
WARNIN(I: l;ailure lo secure workers'
civil fines up to one hundred thousand
and shall subject an to criminal Jrenalties and
to the cost of as provided the
Section 3076 of the Labor Code, interest and
,",_ -r+_\\
I hereby aflirm under penalty of perjury that I am licensed under of Chapter 9 (commencing with of Division 3
of the Business and Profcssions Code, and my license is in full force and effect.
Liccnse Clasc: Licenqe Number:
('ontractor:
CONSTRUCT!(IN LENDING AGENCY
I hcrcby allirm undcr pcnahy of pcrjury that therc is a omtruction lcnding agffy for lhc pcfomarce of the work ftrr which this pcmit is
issued (Sec. 1097, Civ. C.).
Lender's Name:
Lender's Address:
NTPL|CANT nrct ARATTON
I hcrebyaffnnrunder penalty of perjury one of the following declarations:
Demolition Permits-Asbestos Notification Federal Regulations ('l'itle 40, Part6)
-Required
Letter of Notification
-l
certify that the Heral regulations regarding asbestos removal are not applicable to this project.
-l
certi$ that I have read this and state that the atnve inftlnnation is correct. I agree to comply with all City and County
representatives of this City and Counly to enter uJrrn theordinances and State Laws
above mentioned property for
Applicarrt or Agerrt
Pernritee nanle
constructior\ ald hereby
,
JJ
IA
Date:
-=,6Fq.,{el