HomeMy WebLinkAbout101105614 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Building
Permit Counter: (714) 647-5800 lnspection Requests'. (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: {01105614
Pin #: 79{OO,A
Project Address: 1241 E Dyer Rd
Assessor's Parcel: 411-131-36 Lot: NA Block: NA
Unit: 200 Blds:
Tract: NA
Address Range: 1231-1241
Historic: No
Suite Range:
Zoning: SD63
Building Use:
Job Type:
Nature of Work:
Existing Bldg & Use:
Proposed Use:
Commercial
Tenant lmprovement
Tl - Card Readers
Commercial/Office
Occupancy:
Constr Type:
Code:
Flood Zone'.
# of Stories:
B
VB
cBc 2019
x-0602320278J
1st FL Area
2nd FL Area
Other Areas:
Garage Area:
Totat
Patio:
T.l.Area:
Yards Req'd
Valuation:
:
$20,000.00
Description of Work: lnterior security upgrades - card readers.
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Planning Conditions:
Owner:
Address:
Phone.
Tenant
Greenlaw Partners
1231 E Dyer Rd #240
Santa Ana, CA 92705
(949) 331-1316
Contractor: KPRS Construction Service:
Address: 2850 Saturn St
Brea, CA 92821
Phone: (7141 672-0800
State Lic #: 751130
Lic Type: B, A
Bus. Lic #: 188704
Workers' Compensation I nsurance:
Carrier: Everest Premier lnsurance
Policy #: CA10004028201
Expires: 10/01 12021
Engineer:
Address:
Phone:
License #:
Architect /
Desiqner:
Address:
Phone.
License #.
SAA
Dickson Oi
18600 MacArthur Blvd, Suite 100
lruine, CA 92612
(s4e) 724-8es8
c-32277
:p.lt-t.,
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA Insp. Req'd.
Planning lnsp. Req'd:
Landscaping lnsp. Req'd:
Pezeshkpour, Ali
Ahangian, Kathy
Hernan dez, Kathy
Date: 0310812021
Date: 0310412021
Date: 03/1 812021
Subject to Field:
\s
No
No
No
No
Misc. Receipt
Misc. Receipt
Misc. Receipt
07776002
07776002
07776002
07776002
07776002
07776002
57607
53600
57770
57572
57600
57607
75111
Total
Permit Fee
Plan Check Fee
Microfilm Records
BIdg. Stds. Revolving
General Plan Update
lssuance
$34s.28
$478.68
$4.05
$1.00
$23.79
$se.30Fire !nsp. Req'd:
Police lnsp. Req'd:
Flood Zone Cert. Req'd 01 1 16002 51600
01 1 16002 51601
01 1 16002 51612
01 1 16002 57770
No
Yes
No
Account#
Every permit issued 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.
$23.7e
$404.s8
$1 .00
$4.0s Fee Totat
Paid to Date:
Balance Due:
$912.10
$478.68
$433.42
lnspector MID#: 2020-1 62058
BUILDING. INSPECTOR RECORD
SITE.WORK DATE !D/SIG GOMMENTS OWNER BUILDER DELCARATION
I haeby affm undo pcnalty of perjury that I m cxmpt from thc Conraclos' LiccN tiw for thc following rNn (Se.7031.5
Buines md Profsiotr Code): Any City or Couty which rcquirs a pcmh to constoct, alta, improvc, rhnolish or rcpair uy
struc1ue. prior to its isumcc, also rcquir6 thc applicmt for such pcnnit to filc a signcd stalmmt that hc or drc b licmscd p$uet
to the provisions of thc Contretor's Licmrcd l-aw (Chapter 9, Commencing with Strtion 7000 of Divbion 3 of thc Busincs md
Prcfwions Codc) or that he or she is cx@pt th@from ud thc basis for thc allqgcd cxmption. Any violation of Setion 7031.5 by uy
applicantforaparnitsubj*tsthe applicanttoacivilpemltyofnotmorcthilfivchundrcddollm($500).
-1.
as owner of the property, or my employecs with wages as their solc compensation. will do the work and the snrcture is not
intended or offercd for sale (Se.7044, Business and Professions Code: The Contraclor's License [-aw does not apply to an owncr of
the p,roperty who builds or improves thereon. and who does such work himself or hersclf or through his or her own cmployees.
provided that such improvemcnts are not intcndcd or offerod for sale. I[, howerrcr. the building or improvemcnt is sold wilhin one ]&ar
of complaion, thc Orvner Builder will have the burden of p,roving thd he or she did not build or improve the property for the purposc of
sale).
-1.
as owner of the property, am exclusively contracting with licersed contractors to construct the project (Sec. 7M4, Business
and hof€ssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a Contraclor(s) licenscd pursuant to the Contraclor's License Law).
_l am exempt undcr Scction-, B. & P.C. for this reason.
Date:
WORKERS' COMPENSATION
DECLARATION
I hereby affrrm undcr panalty of perjury one of the following declarations:
-l
have and will maintain a Certifrcate of Consent to Self-lnsure for workcrs' compensirtion, as provided for by Section 3700 of the
Labor Code, for thc performance of the work for which the perrnit is issued.
-l
have and rvill maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of
the work for which this permit is issued. My workers' compensation insurance canier and policy number are:
Ail;r*I l* irt^x.t ) ," icc 5 , lac.
poricy N"^u-' cy'.IOOO 1O ZEZ0I Expires:,0'l-?Dzl
_l certiff that in thc performance of the work for which this permit is issucd. I shall not onploy any person in any manner
so ils to become subjcct to the workers' compensation laws of California, and agree that if I should bccome subject to the
workers' compensation provisions of Secrion 3700 of the Labor Code, I shall, forthwith comply with those provisions.
WARNING: Failure to sccure workers' compcrsation coveragc is unlawful, and shall subjcct an onployer to criminal pcnaltics and
civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compensation. damages at providcd for the
Section 3076 of the Labor Code, interest and attorney's fees.
o*ez 3- 16'?o2l
I hereby affrm undcr penalty of perjury that I am licensod under provision 9 (commencing with Section 7000) of Division 3
of the Busincss and Professions Code, and my license is in full force and effect.
License Nurnber:n30
CONSTRUCTION LENDING AGENCY
I hseby affm unds pcrulty of psjury that thqc is a congruction hnding agocy for thc tsfomcc of thc wort 6r which this pqmit is
issucd (S*. 3097, Civ. C.).
Lender's Name:
Lender's Addrcss:
APPLICAIIT DECLARATION
I hereby affirm under pcnalty of perjury one of the following declarations:
Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6)
-Required
lrttcr of Notification
-l
cgriry that the fcdral regulatiom rcguding abctos moval rc not applicable to this prcjet.
_l cdiry thar I havc rad this application md statc that the abovc infomaion is conet. I agre lo comply wilh all City ild Couty
ordinilc6 ud State laws rclating to building coEtructiorl ard hwby authorizc Ep(Gatarivs of this City md County to otq upor the
abovc mentioned propcrty for
Appticant or Agent
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
S u bfloo r/VenUI n su Iatio n
Roof Sheathins
Shear Wall
Framinq
Insulation/Energy
Dryruall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Engineer Final Report
Flood Zone Certif
,u
FINAL lo lf l-l,t DWV fl
Certificate of Occupancy
Notes, Remarks, Etc.
tu)9Laooficnnt: L/
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