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20 Civic Center Plaza (M-19), Santa Ana, CA 92702 <br />lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853 <br />Electrical Permit #: 2O165899 <br />Pin #: 1324A <br />City of Santa Ana <br />Permit Counler: (714) 647-5800 S") <br />Project Address: 3401 S Harbor Blvd <br />Assessor'sParcel 414-262-0A Lotr POR 3 <br />Unit: <br />Block: NA <br />Bldg. <br />Tract: WILLIAMS <br />Address Range: <br />Historic: No <br />Suite Range: <br />Zoning: P <br />Owner: <br />Address: <br />Phone <br />Stale Lic #: 370871 <br />Lic Type: B <br />Bus. Lic #: 2108 <br />Workers' Compensation lnsurance:Carrier: Dcpt ot lndustrlal Relatlon3 <br />Policy f: 1053 <br />Expires: 0l/01/2019 <br />01116002 51603 <br />01116002 s1603 <br />01116002 s1603 <br />01116002 51603 <br />01116002 53601 <br />01'116002 51600 <br />01116002 51603 <br />Fee <br />$47 74 <br />$71.61 <br />$46.59 <br />$44.48 <br />$106 91 <br />$21.25 <br />$52.98 <br />Fee Type Amount <br />Dedicated Circuit 23.87 <br />Spec. R/W Per 100' 23.87 <br />Control Panel 15.53 <br />Over 10-50 HP, KW or I 44.48 <br />P/C - 65% 0.65 <br />General Plan Update 2'1.25 <br />lssuance 52.98 <br />Qry <br />2.OO <br />3.00 <br />3.00 <br />1 .00 <br />164.48 <br />100 <br />100 <br />Phone <br />Tenant Name: Kaiser Foundation Health Plan <br />Kaisar Foundation Health Pl <br />1707 Barcelona Circle <br />Placentia, CA 92870 <br />(909) /r274700 <br />Contractor <br />Address. <br />Other <br />Alteration <br />Equipt <br />B <br />II B, SPK <br />cEc 2016 Notes <br />Planning Condations: <br />Planning Approval By <br />Plan Checked By: <br />Permit lssued By: <br />Subject to Field. <br />Buldins Permit #: 10196085 <br />Evory pefinl issued shall bocofie invahd unlass lhe wotk on the site <br />authonzed by such peinit ts commenced within 180 days aftet ts <br />issuance- ot if the wo* authorized on tho site by such pemil is suspsnded <br />or abendoned lgt a peiod ol 1 E0 days alter the tine the wo* is <br />comfion@d <br />lnspector MID#: 2018-142598 <br />\tr <br />o5t22t2018 <br />05/31t2018 <br />Account# <br />01116002 s1600 <br />01116002 51603 <br />01116002 53601 <br />$21 25 <br />$263.40 <br />$48 62 <br />Fee Total: <br />Paid to Date: <br />Balance Due: <br />Misc. Receipt: 70995 <br />Misc. Receipt: <br />Misc. Receipt: <br />Total <br />$391 56 <br />$58.29 <br />$333.27 <br />KaiBer Foundation Health Plan lnc <br />1707 Barcelona circle <br />Placentia, CA 92870 <br />Botchi344065 - 5/31/2018olf ice: CIYH Tnans+: 2UAcct+: Ref+ 3 <br />Rcpt+;02284875 - 5/31/2t)lt <br />Tronsoct ion Totol <br />201651 <br />10!5J <br />t567.5r <br />Authi: I <br />K( iger Foundot,on Heollh I <br />Building Use: <br />Job Type: <br />Nalure of Work: <br />Smith. Mark <br />Hernandez, Kathy <br />Occupancy: <br />Constr Type: <br />Code: <br />Date: <br />Date: <br />Date: <br />lnstall Rad/Fluoro equipt.