HomeMy WebLinkAbout40433025 - PermitCity of Santa Ana 20CivicCenterPlaza(M-19), Santa Ana,CA927O2 Mechanical
PermitCounter: (714)647-5800 lnspection Requests: (714) 667-2738 lnspectorSection: C/14) 647-5853
Permit #:40433025
Pin #: 27749
Project Address: 1638 E Seventeenth St Unit:
Block: NA
Bldg:
Tract NA
Address Range:
Historic: No
Suite Range:
Zoning: C5
l, '.
Assessor's Parcel: 400-251-03 Lot: NA
Owner:
Address:
Trinidad Cisneros
1125 E Seventeenth Street, W-l7
Santa Ana, CA 92701
01 1 16002 s1604
01 1 16002 51604
01 1 16002 5160C
01 1 16002 51604
Fee Type
Heat Pump
Bathroom Fan
General Plan Update
lssuance
Amount
107.85
30.52
22.08
55.04
Qty
2.00
2.00
1.00
1.00
Fee
$215.70
$61.04
$22.08
$55.04
Phone
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
43302
-{4 AH
1?17.?
Building Use:
Job Type:
Nature of Work:
Commercial
Tenant lmprovement
TI-1st floor
Occupancy:
Constr Type:
Code:
B
VB
cMc 2016
1
Notes: C lO
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By: Zuniga, Allissa
Subject to Field:
Buildins Permit #: 10498364
Date:Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
01t04t2019
Account#
Every permitissued shall become invalid unless the work on the site
authorized by such permit is commenced within 180 days after its
issuance, or if the work authorized on the site by such permit rs suspended
or abandoned for a peiod of 180 days after the time the work is
commenced.
01 1 16002 51600
01 1 16002 51604
$22.08
$331 .78
Fee Total
Paid to Date:
Balance Due:
$353.86
$0.00
$353.86
Inspector MID#: 201 8-147302
ffi:
M ECHANICAL.I NSPECTOR R ECOR D
APPROVALS DATE ID/SIG COMMENTS OWNEN, BUTLDER DELCARATION
I hcrcby affum under Jrcnrlty of Jrcrjury thst I m cxempt ftom lhc G,ntrrctoB' Licenrc hw for th€ following rc&sn (Stc.7031.5
Busincss cnd Profcssion Code): Any City or County which rcquircs r pemil to @nsNruct, alts, inprcrc. dcmlish or rcSir aEy
structre. trhr to its issure. 8ls rcquircs thc spplbmt for swh pcmit to filc I sigrcd st&lemnt thst ]E or shc b licmsd puMt
lo thc pmvisbns of tlE Contrclor's Liccosd llw (Chspto 9. Comrcrcing wilh Scction 7000 of Division 3 of thc Business 8nd
Pmfcssions Codc) or thst hc or she is exempt thercftom snd thc besis for thc alleged cxemption. Any viohtion ofscrbn 703 1,5 by sny
applicant for 8 lEmit subjsls thc applicant to 8 civil pcnllty of not mrc the five hundrcd dolles ($500).
I
t{
-1.
as owncr of the propcrly. or my cmployces with wagcs as their soh compensation. will do thc work and the struture is rrcl
intcndcd or offcred for sale (Sec.70l4. Business and Pmfcssions Codc: The Contraclor's License hw does not apply to an owner of
thc prnperty who builds or impmves thercron. and who does such work himself or hcrsclf or through his or her own employees.
provided that such improvenrcnls are not interdcd or offcrcd for sale. lf. however. thc building or inprovenrnt is sold within onc )rar
of completion. thc Owner Buildc'r will have thc burden of proving thal hc or she dkl rnt build or improve the propcrty for thc purynsc of
sah).
-1.
as owner of the proprty. am exclusivcly contracting wilh liccnscd contractors lo construct the projcct (Sec. lOM. Busincss
and Professirn Codc: The Contractor's Liccnsc law does not apply to an owncr of proJrcrty who builds or improves thereon.
and who contracls for such projects with a Contracto(s) licenscd pursuant to thc Contractor's License kw).
-I
B.lirr this rcason.
I hcrchy atllrnr undcr penalty of pcrjury onc of thc tblkrwing
-l
have ard will maintain a Certifrcate of Consent to Self-lnsure for workcrs'compensation, as providcd for by Section 37fi) of the
I-abor Code, for thc pcrformarrcc of the work for which thc pcrmit ls issued.
-l
have and will maintain workers' compcnsation insurancc. as requircd by Section 3700 of thc Labor Code, for the performancc of
the work for which this permit is issued. My workers' compcnsation insurance caricr and policy numhr are:
Policv Number: Exoires:JU
-l
certify thal in the perfornrance of thc work for whhh this permit is issued. I shall not employ any pcrson in any manner
so as lo bccomc subjcct to the workers' compcnsation laws of California. and agree that if I shnuld become subpct to the
workcrs' compcnsation provisions of Section 3700 of thc lahor Code. I shall. forthwith comply with thosc provisions..
WARNING: Failurc lo sccure workers' comyrcnsation and shall subjcct an cmployer to criminal pcnaltlx and
civil fines up to onc hundrcd thousand dollars ($l lo thc cosl of compcnsation. damagcs as providcd for thc
Scction 3076 of and
DECLARATION
I hereby affirm under penalty of perjury that I am licenscd undcr provision of Chapter 9
of the Busincss and Profcssions Codc. and my licensc is in full forcc and cffc"ct.
7000) of Division 3
License Class: Licensc Number:
l)ate:
W
I hcrcby arftrm under Fmlty of perjury thd tlm is 8 onstruction brdinS rycrcy for thc pqfmre of the wtrl for which this pcrnit b
issucd (SE. 3097, Civ. C.).
lcnder's Name:
lrnder's Addrcss:
Aro, ,c NT D"c, ARAT,
I lrrcby affmn undcr pcnnlty of pcrjury onc of thc following dcclarations:
Dcmolition Pcrmits-Asbcstos Notificalion Fcderal Regulations (Titlc 40. Part6)
-Required
lrttcr of Nolificalion
-l
ccrtify that the federalregulations regarding asbestos rcmoval ffe nol applicablc to this projcct.
-l
certify that I have read and state thal thc abovc inforrnation is correct. I agrcc to comply with all City and County
ordinanccs and Statc L:ws
atxlvc rncntioncd property for
Applicant or Agcnt
Pcrrnitcc namc
and hcrcby authorize reprcscntatives of this City and
-\
ufnn thc
Appliances
Metal Fire Place
Evaporative Cooler
Furnace
Compressor
It/isc. Equipment
Duct Work
Pre-lnsulation
Insulation
Smoke Detectors Installed
Rouqh Ductwork
Vents
Toilet Room I Clothes Drver
Residential Ranoe
Other
Hood
Type I Hood
Type Mood
Grease Duct
Fire Damper
Openinqs
Installation
F.D. Drop Test
Above Hard Lid
Above T-Bar
Rouqh Mech.
Final Test
Meter Release t/\
FINAL lA-b"'2 urfl.ru
Notes, Remarks, Etc.\\I
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Dulc: