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NO.EACH TOTAL
<br />03
<br />02
<br />Res. Hotels, Motels, Apt. Sq. Ft.
<br />Gar. or Carports Sq. Ft
<br />Residential' llndustrial dCommercral
<br />Receptacles lLl 50 7./
<br />5a-^Ta- v-- /i./bz_*P6,,)
<br />a--a--a+<te.E ,qL - o t/ o
<br />Varr''-^"-'^:
<br />Y<.e---a--a--
<br />JOBADDRESS'3zoa.
<br />MAILING
<br />2,: I (v-'-J
<br />ESS
<br />STATE/ZIP
<br />/*.-
<br />A-n-k- ??Leb Switches /D 50 fr
<br />Fixtures )7 50
<br />Air Conditioners
<br />Each I
<br />20.00 /o./
<br />Aooroved Factorv Wired Unit
<br />Liist t1 /1,-.,i lZuAt*/U.*. /rn^r t7 500 Lq/
<br />Busways, sftcial raceways, under floor
<br />duct, trolley or plug-in busways ea. 110' or
<br />lraction thereol
<br />5.00
<br />Fire Signali4qSystem. Mrnrmum fee
<br />Outlet, gtrokA or heat sensor I
<br />10.00
<br />.50 .50
<br />Lighting Standards with One Lamp
<br />Each Add'l trxture on same standard
<br />5.00
<br />1.00
<br />Owncr tsrrilder Declar.rtior)
<br />';',
<br />l
<br />Maintenance Permit (annual)50.00
<br />Service Meters
<br />Up to 400 amps, per meter
<br />Over 400 amps, per meter
<br />Over 1200 amps, per meter
<br />I
<br />15.00
<br />35.00
<br />75.00 lSoo
<br />Signs and high potential gas tube lighting 15.00
<br />Swimming pools, tountains, spas 35.00
<br />^Q@Each
<br />Switchboard, motor control cenler or slE
<br />(
<br />15.00
<br />3oEI- o ct
<br />Temporary construclion meter service
<br />pole
<br />Each distribution pole
<br />25.00
<br />5.00
<br />Contractor Use Onlyt.4- 824-F*i> pr-rnr':r (zrt)
<br />CA)
<br />I
<br />o.
<br />ffi
<br />t,aDDRESq3 a {a
<br />CIT ,&^fi.- cLA-trr/*,7lZOd
<br />of lhe Busrness and
<br />./ ?z.tAb,
<br />Temporary clnstruclion lighting
<br />500 lamps or less
<br />Over 500 lamps
<br />2.OO
<br />4.00
<br />Time clock or photo electric cell )3.00 L. oo
<br />POWER APPARATUS: Generators,
<br />motors, transtormers, rectitiers, industrial
<br />heating, cooking, or baking equipment
<br />and other apparatus as follows:
<br />Up to and including 1 HP, KW KVA
<br />Over 'l and not over 10 HP, KW KVA
<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 />2.00
<br />5.00
<br />10.00
<br />20.00
<br />30.00
<br />40.00
<br />workerscompenr"tion//"1"r:rtlon /
<br />I herebv atfrrftr lhat I lrave n certrlrcate ol consenl lo self-rnsure, or a cerlrlLcate ol Worker's Compcn-
<br />salron lnsrlraflce Cerlrled copy rs Irled wrth lhe Crly bu ldrng rnspeclron departmenl
<br />Dr:,.r.q,,.\ AdqA,,.48!,\,r Zi,{""- -:':!!:>fr;'::';^fu?ru*
<br />p4rsorr Irdrryrnanrr{rrs().islObc(roftlIsrrt)tr.ll{)llr{)Worker'\(lonrtrrnsatrorrL,rws()lCalloilra
<br />llotlce To Applicanr:
<br />ll, after making thrs Cerlrlrcale 01 Exemptron, you shoulcl become subtecl to lhe Worker's Compen
<br />salron provrsrons ol the Labor Code, you must Iorlhwrth comply wrth such provrsrons or th s permrl
<br />shall be deemed revoked
<br />Oate.Apphcant lSrg.l
<br />Subtotal /ff.ro
<br />Penalty Fee (when applicable)
<br />Violation Fee (50 00)
<br />Plan Check 650/o of sublotal / 0r. L / (minimum 20.00)
<br />ReceiptNo. L7 L-7 Pc# l-g j\ Dpte
<br />Plan Check (Adiustment)fA-- qL)r/
<br />Y/- l'Lln 10.00
<br />rorAL penirurr #e /(minimJm dsslodl'q{,J-"
<br />ExpiI.tion
<br />Thrs permit shall exprre by lmrlalron and become null and vord rf the work authoilred by thls permrt rs
<br />not commenced wrlhrn 180 days lrom the date of thrs permrl or r, work authonzed by lhrs permrt rs
<br />suspend€d or abandcned al any lrme altor the work rs commenced for a penod ol lS0 days A new
<br />permrl shall be oblarned trrsr belore such work can be recommenced
<br />Applicanl's Doclaration
<br />I corlrlV lhal I have read lhrs applrcaton and stale thal the abovo rnlormat on rs correcl I agree to
<br />comoly wrlh all crly ordrnances and slate laws relalrng to burldrng construclron, and hereby aulho-
<br />rre represenlalrves of lhrs ctlv io enler upon the
<br />,"il' )-61 App,.anr cr Asen, {S,g
<br />lor inspectro-n purposes
<br />DArE /l-2-31 PERMIT NO.
<br />PERMIT TSSUED BY lSrg I Ylbra
<br />il l,zyj )98.9lyv,/g? ],zffiit *17:
<br />BUILDING
<br />PERMIT No
<br />VAIIDATION IOFFICE USE ONTYI
<br />(ACCOUNT #11-413)
<br />APPLTCATTON AND a
<br />ELECTRICAL PERMIT
<br />(TYPEWRITE OR PRINT IN INK)
<br />o CITY OF SANTA ANA
<br />206 W. 4th Sr.
<br />667-2738
<br />)
<br />@C-0zo
<br />oIamaa
<br />$.)? APPLICANT FILL lN AREA BELOW
<br />W
<br />\\
<br />F
<br />p
<br />r
<br />r
<br />\
<br />N.
<br />\tf
<br />F
<br />Distribution: l.lnspectorCopy -ZTileCopy 3. FinanceCopy 4.ApplicantCopy c s '613
<br />I hereby al,'rm
<br />my lrc6n* rs rn
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