HomeMy WebLinkAbout101107259 - PermitProject Address: 2210 3/4 N Grand Ave
Assessor's Parcel: 396-191-01 Lot: POR G.L. RUSSEBIOCK: A
Unit: WCC01 Bldg: Address Range:
Tract: A.B. CHAPMAN Historic. No
Suite Range:
Zoning: C5
City 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 #: {O1107259
Pin #: 4OO83
Building Use:
Job Type:
Nature of Work:
Existing Bldg & Use.
Proposed Use:
Other
Revision
Change of Contractor/Cell Site
Occupancy.
Constr Type:
Code:
Flood Zone'.
# of Stories:
N/A
N/A
cBc 2019
x-06023201 63J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Totat
Patio.
T.l Area:
Yards Req'd
Valuation:
Description of Work: Replaces 10110590zletter on file
Cell site modification, replace 3 exisitng antenna with 3 new antenna.
Planning Conditions:
Owner:
Address:
Phone.
Tenant
SCE
1 lnnovation Way
Pomona, CA 91768
(eoe) 274-1e24
Contractor: Solex Contracting lnc
Address: 42146 Remington Ave
Temecula, CA 92590
Phone: (951) 795-5714
State Lic #: 842101
Lic Type: B, A, C-10
Bus. Lic #: 322021
Workers' Compensation lnsurance:
Carrier. Federal lnsurance Co
Policy #: 54310302
Expires'. 10/01 12021
Engineer:
Address.
Phone:
License #:
Architect /
Designer:
Address:
Phone:
License #:
Crown Castle
Richard Boelter
200 Spectrum Center Drive Suite 1700 &
lruine, CA 92618
c-60291
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning !nsp. Req'd:
Landscaping lnsp. Req'd
Hernan dez, Kathy
Date:
Date:
Date: 0711612021
Subject to Field:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
07716002 57607 Change Owner/Contr
07776002 57770 Microfilm Records
07776002 57600 General Plan Update
Fee Total
Paid to Date:
Balance Due:
$71.22
$0 00
$0.00$
No
No
No
No
Fire lnsp. Req'd:
Police lnsp. Req'd Account#
No
No Total
Flood Zone Cert. Req'd: No 01 1 16002 51601 $71 22
Every 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.
Inspector MID#: 2021-164083
$71 22
$0 00
$zt .22
I
BUILDING. INSPECTOR RECORD
SITE-WORK DATE !D/SIG.COMMENTS OWNER BUILDER DELCARATION . LI rcLrcby affirm under pnalty of prjury that I am cxcmpt from thc Contractors' License [:w for the following reason (Scc.7031.5
Busincss and Profcssion Codc): Any City or County which rcquires a pcrmit to constnrct. altcr. improvc, demolish or rcpair any
slructurc, prior to its issuance, also rcquircs the applicant for such permit to file a signcd statcmcnt that hc or she is licensed pursuant
to thc provision.s of thc Contractor's Licensed l-aw (Chaptcr 9, Comrncncing with Section 7000 of Division 3 of thc Business and
Profcssions Codc) or that hc or shc is excmpt thcrcfrom arxl thc basis for thc alhgcd cxemption. Any violation of Scction 7031.5 by any
applicant for a pcrmit subjcrts the applicant to a civil penalty of not more than fivc hundred dollars ($5OOl.
-1.
as ownL*r of the propcrly. or nly cmpltryces with wages as thcir solc compensation. willdo lhc work and the stnrcturc is ncrt
rntcndcd or ofl'crcd for sale (Scrc.7044. Business and Profcssions Codc: Thc Contractor's Liccnsc [:w docs not apply lo an owncr of
thc propcrty who builds or intproves thcrmn, and who does such work hinnclf or hersclf or through his or hcr own employees.
providcd that such improvcnrcnts arc not intendcd or offercd for sale. If. however, thc buikling or inrprovemcnt is sold within onc ycur
of conrphtion. ttrc Owncr Buildcr will havc thc burden of proving that hc or shc did not buikl or improvc tlrc propcrty for thc purynsc of
salc).
-1.
as owncr of the propcrty. am exclusively contracting with licensed contractors to construct thc projcct (Scc. 7W, Business
and Profcssion Cr:dc: Thc Contraclor's Licensc Law does nol apply to an owner of progrcrty who builds or improvcs thcreon,
and who contracts for such projects with a Grnlracto(s) liccnsed pursuant to thc Contractor's Licensc l-aw).
_l am excrnpl undcr B. & P.C. for this rcason.
i )irl t' ( )rr rrcl'
WORKI'RS' CONT PI'NSATION
DI'CLARA'I'ION
I hcrcby affirrn undcr pcnalty of pcrjury one of thc following dcclarations:
-l
have and will maintain a Ccrtificate of Conscnt to Self-lnsurc for workcrs' compcnsation. as ;novidcd for by Section 3700 of thc
[:bor Codc. for thc pcrformance of thc work for which thc pcrrnit is issucd.
x havc and will maintain workcrs' compcnsation insurarrcc. as requircd by Scction 3700 of thc L:bor Codc. for thc performance of
work for which this pcrrnit is issucd. My workcrs' compcnsation insurance carricr and policy nunrber arc:
(fi|WftL I h/*lPtt't-€ urtYd{
Ptrlicy ltln, luz;t-
_l cerrify that in the pcrf<rrmance of the work for which this perrnit is issucd. I shall not employ any pcrson in any nunncr
so as lo bccomc subicct to thc workcrs' compcnsation laws of California. and agrcc that if I should bcconrc subict to thc
workcrs' compcnsation provisions of Scction 3700 of the L:bor Code, I shall. forthwith comply with thosc provisions.
WARNING: Failurc to lrcurc workers'compcnsation covcrage is unlawful. and shall subjcct an employcr to criminal pcnalties and
civil fincs up to one hundrcd thousand dollars ($100.000), in addition to the cost of comgrcnsalion. damages as provided for thc
.Scction 3076 of the l-:bor Codc. intercst and attorncy's
ox",-4la{zrrn
I hercby affurn undcr pcnalty of Jrcrjury that I am licensed undcr provisbn of Chaptcr 9 (comnrcncing with Scction 7Un) of Division 3
of thc Busincss and hofessions Code. and my licensc is in full force arxl cffcrct.
Liccnsc B ctD Nurnbcr:0t
orr", ?.lt u
I hcrcDy affm urdcr pemlty of perjury thal tlw is I @nslruction letrditrg sgcrcy for thc pcrfomcc of the work for which thir [Emil is
issc{ (Se. 3G)7, Civ. C.).
hndcr's Narc:
Lcndcr's Addrcss:
APPI ICANT NECLARATION
I My affinn under pcnalty of perjury one of thc following dcclarations:
Dcmolition Pcrnrits-Asbcstos Notification Fedcral Rcgulations (Title 40. Part6)
-Requircd
lrttcr of Notification
-l
ccrtiry thar thc fcdcml regulations rcgedin8 a$cstos rcrmval rc ffn applicable to this pmj6t.
_l ccnify that I havc rcad lhis application and stalc lhal thc atnve informtion is corccl. I agrc to cotrply vith all City and County
ordinamcsardStatc[2wsrclatirgtobuiHingconslfftion andhcrcbyauthoriarcprcsntaliwsofthisCilyandCountytocnlc]ulnnthc
abovc rrrcntioncd property for
Applicant or Agent
Pernritee nanle
ox", tltuluu
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Su bf Ioor/VenYI nsu Iatio n
Roof Sheathing
Shear Wall
Framing
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
l\ilasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
It r [,I n
FINAL 0 r(L(WVJIA SffnD
Certificate of Occupancy ll
Notes, Remarks, Etc.
Rev. 08-07-201 5
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