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Project Address: 1417 S Main St Unit: <br />Block: NA <br />Address Range: <br />Historic: No <br />Suite Range: <br />Zoning: CSM <br />q <br />Assessor'sParcel: 0'14-032-35 <br />Owner: <br />Address <br />Medhat Rafael <br />17150 Euclid St. #322 <br />Fountain Valley, CA 92708 <br />17141337-0747 <br />South Main Dental Group <br />Fee Type <br />01116002 5'160: Serv Meter <br />01116002 5160: Min Fee Adj <br />01116002 5160C General Plan Update <br />01 1'16002 5'160: lssuance <br />Amount <br />5'1.29 <br />'r 9.35 <br />21 .25 <br />52.98 <br />Qty <br />1.00 <br />1.00 <br />1.00 <br />1 .00 <br />Fee <br />$51.29 <br />$19.35 <br />$21.25 <br />$s2.98 <br />Phone: <br />Tenant Name <br />Conlractor <br />Address: <br />Owner-Builder <br />Phone <br />State Lic #: <br />Lic Type: <br />Bus. Lic #: <br />Workers' Compensation lnsurance: <br />Carrier: <br />Policy #: <br />Expires: <br />Building Use: <br />Job Type: <br />Nature o, Work <br />Commercial <br />Miscellaneous <br />Serv Meter <br />Occupancy: <br />Constr Type: <br />Code: <br />B <br />VB <br />cEc 2016 <br />Planning Conditions: <br />Planning Approval By: <br />Plan Checked By: <br />Permit lssued By: <br />Subject to Field: <br />Building Permit #: <br />Pezeshkpour, Ali <br />Zrnioa,nffis\ <br />Date <br />Date <br />Date <br />06/0s/2018 Misc. Receipt: <br />Misc. Receipt: <br />Misc. Receipt: <br />Total <br />06/05/2018 <br />Account# <br />Every pennil issued shall become invalid unless the work o, the site <br />authotizod by such pemit is commenced within180 days after its <br />issuance, ot if the work authoized on the site by such peftnit is suspended <br />ot abandoned for a period ofl80 days after lhe time tho wotk is <br />commenced. <br />$144.87 <br />$0.00 <br />$144.87 <br />lnspector MID#: 2017-139483 <br />$21.25 <br />$123.62 <br />Cify of Santa Ana 20 Civic center Plaza (M-19), santa Ana, cAgzloz Electrical <br />Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Sectaon: (714) 647-5853 <br />Permit #: 20{65786 <br />Pin #: a2463 <br />Lot: 9 <br />Btdg: <br />T.acl:245 <br />Botch+:44111 - 6/5/2111 <br />tlf{ ire: (I YH Tr(tns+;ArcL+l R <br />ttrp ti : 02?89(t84 - 6/5/ <br />Tronsq,:t ion TotalRAFAEL NEDHAT <br />Generol P10n Updote <br />rl1 1 I 6t:rit2- 51 60ot:[:ttt- <br />F:l Ectr i ,:o I <br />fll 1 160r-12- 51603tfir:r- <br />U iso <br />(:(:* i *r ilrtt*rrr* 1 ? <br />Fee <br />ft <br />Notes: Per Notice To Correct Work Service meter <br />replacement like for like. "*No UUw required"*' <br />Fee Total <br />Paid to Date: <br />Balance Due: <br />01116002 51600 <br />011 16002 51603