HomeMy WebLinkAbout101105434 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: {011o,5434
Pin #: 71fi7
Proiect Address: 3900 S Bristol Sta
Assessor's Parcel: 412-131-22 Lot. NA Block: NA
Unit: B Bldg
Tract: NA
Address Range: 3800-3950
Historic: No
Suite Range.
Zoning: CR
Building Use: Commercial
Job Type: Revision
Nature of Work: Revision
Existing Bldg. & Use: Commercial
Proposed Use:
Occupancy. B, M, S-1
Constr Type: V B, SPK
Code: CBC 2019
Flood Zone' X-0602320259J
# of Stories:
1st FL Area:
2nd FL Area:
Other Areas:
Patio:
T.l.Area:
Yards Req'd:
Garage Area: Valuation:
Total: 0
Oeacription ot Wotk: R€vbion to 10110338'l & 101104854 - revised length of exi.ting firo corridor, rsvi.od door typ.r, door.dd.d, updeted c.sh oflice
c.iling freming, toundatlon, baaement foundation, mezzanine demo, roorframing.
Planning Conditions
Owner:
Address:
Phone:
Tenant:
ArneYoungman,SDC/Pacific/Youn Contractor: HobbyLobbyConstruction
One Corporate, Suite 200 Address: 7707 SW 44th Street
Newport Beach, CA 92660 Oklahoma City, OK 73179
(949) 760-8591 Phone: (405) 745-1s57
Hobby Lobby State Lic #: 948265
Lic Type: B
Bus. Lic #: 371314
Workers' Compensation lnsurance:
Carrier: Ace American lns Co
Policy #: WLRC67814885
Expires: 1213112021
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
Lr1 I 16LlLt2- 536r_rr-r[t[t[t-
11 i cr of i 1m & Documerr t s
r_t 1 1 1 60tr2- i777r-rt_rt-rt_r-
ICL Check L744??4
PBz Architecture & Engineering
P. O. Box 2076
Rogers, AR 72757
(888) 656-3545 ext. 289
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp.
PWA lnsp. Req'd:
Planning Insp. Req'd:
Landscaping lnsp. Req'd:
Fazekas & Assoc.
Fire lnsp. Req'd:
Police lnsp. Req'd:
Ffood Zone Cert. Req'd
75044
Total
07776002 57770 Microfilm Records
07176002 53600 Revision
07776002 57600 General Plan Update
G , Pedro
Amsden, Julie
Date: 01lOGl2O21
Date: 1212212020
Date: 0210812021
Subject to Field:
Misc. Receipt
Misc. Receipt
Misc. Receipt
$48 60
$1 ,675.38
$0 00
No
No
No
No
No
Yes
No
Account#
01116002 53600
01 1 16002 57770Every 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 permit is suspe nded or abandoned for a period of 360 days after
the time the work is commenced.
Fee Total:
Paid to Date.
Balance Due:
$1,723.98
$957 36
$766.62
lnspector MtD#'. 2019-155793
$48.60
BUILDING. INSPECTOR RECORD
SITE-WORK DATE ID/SIG.COMMENTS OWNtsR BUILDER DELCARATION
I hcrcby allirm undcr Fnalty of lErjury that I m cxcmpl liom tlrc CotrlracloF' Liccns kw tbr thc following rca$rn (Scc.?011.5
Rusincss anl Profcssion Culc); Any City or County which rcquircs I lErmit k) construct. alts. improve, demolish or rcpair any
struclurc, prior to ils issuancc, also requircs thc .pplic.nt lbr such [rrmit to lilc a sigrcd statcmnt that he or slE is liccnsd pffiuant
to thc lmrvisklns of tlrc Conlnctor's Liccn$d llw (Chsltcr 9. Commcncing with Scction 7fi)O of Division 3 of lhe Busincss and
Pmlcssions Codc) or thal hc or slrc is cxempt thcrcfrom and thc basis for thc allcgcd cxcrDtion. Any violation of Scttun 701 1.5 by any
applicanl tirr a pcrmil subjets thc applicant to a civil pcnalty of nol morc than fivc hundrcd dollds (S500).
_1, as owncr of thc propcrty, or my employecs wilh wages as thcir vrlc comJrcnsation. will do thc work aflJ thc stru.*turc is not
rntcrxlcd or olfered firr salc (Scr.7M4, Business and hol'essions Crxlc: Thc Contractor's License law does not apply to an owner of
thc pnrJrcrty who buikls or improves thcrcnn, arxl wlxr docs such work himsclf or hcrsclf or thrlugh his or hcr own employccs.
pnrvidcd that such improvcnrcnts arc not intcnded or oll'crcd lirr salc. If, trrwcvcr, thc buikling or improverrpnt is sokl within onc yciu
ol'complction, thc Owner Bui.kler will havc thc burdcn ol'pnlving that hc or shc did not buill or impnrvc the pmpcrty for thc purposc ol'
sah).
__1. as owner of thc property, am exclusivcly contracting with liccnscd contractors to construct thc projcct (Sec. 7(X4, Business
and Prulbssion Crx.lc: Thc Contractor's Liccnsc Law dtrcs not apply to an owncr of proSrcrty who builds or improvcs thcrcon,
and who contracts for such projccts with a Contractor(s) liccnscrl pursuant to thc Contractor's Liccnsc Law).
-IamcxcmptundcrScctitln-'B.&P'C.tilrthisrcastln.
f l.i. ^.
WORKERS' CONIPENSATTON
DECLIIBAIIAN
I hcrcby afiirm undcr Fnalty of pcrjury onc of thc fbllowin8 dcclsrotions:
-lhavcanlwillmintainaCcrtifreatcofcon$nttoSclf-lnsurcforwrrkcrs'crrm;rcnsation,as
FovidcdforbySetion-17U)oflhc
tatxr Oxlc, for thc ;rcrfomfrt of thc work tbr which thc JEmit ir issucd.
OU havc ancl will maitrtain workcrc' comJEnsation insurarec, as ,cquircd by SNlion -1700 of thc kbor Codc, for thc [trtormnc! of
thc work for which this Jrcmit i! is$ql. My works' com;rcnstion insurancc cuicr anl JDlicy number de:
AIE-Arn e,r.t (^^, T/vs. Cnt^n oPn^/\JL-3i-xPolicyLI
_l ccrtily that in thc Jrcrlilrmancc of thc wrlrk tirr which lhis prmit is issuctl, I shall rxrt empkry any pcrson in any manncr
so as lo bcconrc subjcct to the workers' comJrcnsation laws of Calitilrnia, and agrcc thal if I should bccomc subject to thc
workcrs' compcnsation pnlvisions of Scction 3700 of thc Lahlr CrxJc. I shall. lilrthwith comply with thosc provisions.
WARNING: Failurc to sccurc workcrs'comprcnsation covcragc is unlawl'ul, and shall subjcct an cmpklycr to siminal pcnaltics and
civil lincs up to onc hundrcd thousand dollars ($100,Uru), in addition lo thc cost of comlrcnsation, damagcs as provided lilr thc
Scction 3076 of thc Labor CtxJe, intcrcst and attorncy's l'ccs.
o"t.,b8-L\
I hcrcby allirm undcr pcnalty of pcrjury that I arn liccnscd undcr pnrvision of Chaptcr 9 (commcncing with Scction 7000) of Division 3
of thc Busincss and Prot'cssions Codc, and my liccnse is irr lirll firrcc and cft'cct.
l-iccnsc Nunrbcr:
q
B-
W
I hcrchy all'irm undcr pcmlty of pcrjury that th6c is a constructk)n bnilinS rgcncy for thc lsfbmnce of thc vork for vhich lhis JEmit is
issucd (Ss. -1097, Civ. C.).
[lndcr's Nam:
lrndcr's Address:
APPLICANT DECLARATION
I trcrcby aflrm undcr grcnalty of perjury one of thc folklwing dcclarations:
Dcmolition Pcrmits-Asbcstos Notification Federal Rcgulations (Titlc 40, Part6)
_Rcquircd lrttcr ol' Notilication
_l ccrtity that the t'cderal rcgulations rcgarding asbcstos rcmoval arc not applicahlc to this project.
!f ."rtify thar I havc rcarl this application anrl statc that thc ahrvc inlirrmatklr is corrcct. I agrce to comply with all City and Cuunty
ordinanccs and Statc Laws rclating to building c<lnstruction, and hcrchy rcprcscntativcs of this City and County to cntcr uJxrn the
atxrvc nrcnlioncd proJrcrty lirr
Applicant or Agent
Penuilee nanre oLo
$-zl'\^e --l 8-2i
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bf loor/Ve nVl ns u latio n
Roof Sheathing
Shear Wall
Framing
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
lVasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif
///-e
F!NAL ZlLL lzt Jlr gL
Certificate of Occupancy tl
Notes, Remarks, Etc.
Elorr nR-n7-2n 1 q