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NO.EACH TOTAL{"'ou^u^'lndustrial Commercral
<br />Res. Hotels, Motels, Apt. Sq. Ft.03
<br />Gar. or Carports Sq. Ft.02
<br />Re.eplacles 50
<br />3loo S4vfn fr Jr
<br />**r. i/la1) rcN
<br />()otTft tuctA
<br />JOB ADDRESS
<br />MAILING ADDSESS
<br />N'[-t
<br />4(Saclapg_
<br />tti be A.rL.
<br />I pHorrrL
<br />rzb
<br />UI
<br />.*#il., i: cowck
<br />ts*ncney'L 50 t-.vtffis 50
<br />Air Conditioners
<br />Each
<br />20.00
<br />Approved Factory Wired Unil
<br />List 5.00
<br />Busways, special raceways, under floor
<br />duct. trolley or plug-in busways ea. 110' or
<br />fraction thereof
<br />500
<br />Fire Signaling System. Minimum fee
<br />Oullet, smoke or heat sensor
<br />10.00
<br />.50
<br />Lighting Standards with One Lamp
<br />Each Add'l trxture on same standard
<br />5.00
<br />1.00
<br />owner-tldcr Occlaratlon
<br />I hcreby afffim thal I am exempl from lhe Conlractor's Lrcense Law lor the followrng reason lSec
<br />7031 5, Busrness and Proressrons Code Any crly or counly whrch requres a permrl lo conslruct,
<br />aller, rmprove. demolrsh, or repatr any structure, pnor lo rls rssuance, also requres lhe applcanl lor
<br />such permrt to irle a srgned statement lhat he is lrcensed pursuant lo the provrsions ol the Conlrac-
<br />lor's Lrcense Iaw lChapter 9 (commenc.ng wrlh Sectron 7OO0) ol Drvrs,on 3 ol lhe Busrness and
<br />ProfessronsCode)orlhalhersexempttherelromandthebasrslorlheallegedexemplron Anyvrola-
<br />lron ol Sectron 7031 5 by any applrcant tor a permrt sublecls the applicanl to a crvil penaltV ol not
<br />more lhan five hundred dollars lS5OOl
<br />E S"",,on7044A l,asowneroftheproperty,ormyemployeeswrthwagesasthelrsolecom-
<br />pensatron. wll do lhe work, and the structure rs nol rnlended or otlered lor sale
<br />tr Secton 70448 l. as owner ol the propertv, am exclusrvely conlractrng wrth lrcensed con'
<br />tractors lo conslrucl the prolecl
<br />Date-
<br />-
<br />Ownsr (Srg )---.--
<br />Mainlenance Permit (annual)50.00
<br />Service Meters
<br />Up to 400 amps. per meter
<br />Over 400 amps, per meler
<br />Over 1200 amps, per meter
<br />15.00
<br />35.00
<br />75.00
<br />Signs and high potential gas tube lighting 15.00
<br />Swimming pools. fountains, spas 35.00
<br />Switchboard, motor control center or sub-
<br />panels
<br />Each
<br />15.00
<br />Temporary construction meter service
<br />pole
<br />Each distribution pole
<br />25.00
<br />5.00
<br />Contractor Use Only
<br />Co^tt1to t J *d',
<br />Co[Loufrl,o #e '
<br />iin*",a U
<br />I hereby atlrrrn that I a9lhcenseri rrnrler lhe p.ovrsrons ol Chaple. I
<br />Prolessror,s Code, and my hcense rs rn lull lorce and elleul
<br />,,"un""tff/fDk ,,r", QID c,tvrfenseoa )33
<br />o",4-6/ qt, 1o,uu",o,,s,"Fl {Hlfh94, -
<br />CONTEACTOR
<br />kac4sS
<br />AODBESS
<br />31 p tz.
<br />qb
<br />o- bt >o.
<br />lhe Busrness and"':i:!,
<br />27_
<br />Temporary constructron lighting
<br />500 lamps or less
<br />Over 500 lamps
<br />2.00
<br />4.00
<br />Time clock or photo electric cell 3.00
<br />POWER APPARATUS: Generators,
<br />transformers, recliJiers, industrial
<br />Over 10 and not over 50 HP, KW KVA
<br />Over 50 and not over 100 HP, KW KVA
<br />Over 100 and not over 500 HP, KW, KVA
<br />Over 500 HP, KW KVA
<br />cooking, or equipment
<br />L 2.00
<br />s.00
<br />10.00
<br />20.00
<br />30.00
<br />40.00
<br />//> lruo. t *E
<br />,_\
<br />OloEQnTDn
<br />, i.;
<br />Notice To Applicant:
<br />' 'r ir trr i ,r; ,r ' 1r, ,r ..i. i rii, r,f,,r L i
<br />'I
<br />I hereby atfrrm that I hav€ a certificate of consenl to s€lf
<br />l,,r.r, , ,r , r,r,r. .r I 1,, n, l. 1l ll'
<br />co ^pens arfig) cr a,(!!)n
<br />,S
<br />:?too,, , (flrt I
<br />'::l:!?
<br />Venied By {Srg
<br />Dl Applcant t
<br />perlormance of the wo.k lor
<br />or a certtrcat€ ol Worker's Compen-
<br />Worksrs
<br />I shall not employ any
<br />Laws of Calrlornra
<br />stron lnsurance Certrl'gd copy rs ilod wrlh the Cily
<br />nvt--Subtotal
<br />Penalty Fee (when applicable)
<br />Violation Fee (50.00)
<br />Plan Check 65% ol subtotal (minimum 20.00)
<br />Receipt No.Pc#Date
<br />Plan Check (Adjustment)
<br />lssuance Fee 10.00
<br />TOTAL PERMIT FEE (minimum $35.00)55-
<br />E x pirat ion
<br />Appllcant's Doclaration
<br />I certrlv that I have read thrs a,rphcatron and state lhal the above rntor
<br />comply wrlh allcrtv ordrnances and slale laws relatrna to buLldrng
<br />"*ftfr
<br />rs correct I aqrselo
<br />lron. and hcreby aulho-
<br />rnspeclon purposesrEe,epresnlalrvesol thrsqty losnter upon the a
<br />DAr+ -;.b-rc PERMrrNo. 2497 8
<br />,-r4 bs7
<br />0BY (Stgl
<br />0y26/90 l:slPf{ ofo(
<br />BUILDING
<br />PERN,IIT NO
<br />VALIDATION IOFFICE USE ONtY)
<br />TACCOUNT lll'413r
<br />APPLICATION AND
<br />ELECTRICAL PERMIT
<br />(TYPEWFITE OF PRINT IN INK)
<br />I o CITY OF SANTA ANA
<br />206 W. 4th Sr.
<br />667-2738 W
<br />APPLICANT FILL IN A BELOW
<br />@groz
<br />6)
<br />oa
<br />o
<br />0
<br />\
<br />Distribution: 1. lnspectorCopy 2. FileCopy 3. FinanceCopy 4. ApplicantCopy
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