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Resrdentral lndustnal{Commercrat l* lEA.Hl
<br />rorAL
<br />.03Res. Hotels, Motels, Apt. Sq. Fl.
<br />Gar. or Carporls Sq. Ft.02
<br />Receptacles ?50 ,/.oo
<br />3+€A Snarrn Fe V,ute,:
<br />Fnrc u;d r?ond
<br />OWNER
<br />.J1,4;tbeen 546'otloAssxnres
<br />,',.Q,'aG?L
<br />'Hi;'5'
<br />"'&to r77qn Switches 50
<br />Fixtures .aq .50 4-t o<)a1 /.
<br />Air Conditioners
<br />Each
<br />20.00
<br />Approved Factory Wired Unit
<br />LiSt 500
<br />Busways, special raceways, under floor
<br />duct, lrolley or plug-in busways ea. 110' or
<br />traction thereof
<br />500
<br />Fire Signaling System. Minimum fee
<br />Outlet. smoke or heat sensor
<br />10.00
<br />.50
<br />Lighting Standards with One Lamp
<br />Each Add'l fixture on same standard
<br />5.00
<br />1.00
<br />Owrrer Brrilder Declaration
<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 /15.00
<br />35.00
<br />75.00
<br />-o6/b
<br />Signs and high potential gas tube lighting 15.00
<br />Swimming pools, fountains, spas 35 00
<br />Switchboard, motor control center
<br />panels
<br />Each
<br />/15.00 /f
<br />Temporary construction meter service
<br />pole
<br />Each distribulion pole
<br />25.00
<br />5.00
<br />/ 7 o tl BEncH BLvb.
<br />Huunryro.o tm.a
<br />"'Q)6
<br />y7
<br />Use Only
<br />CONTBACTOR
<br />ADDRESS
<br />"'""8')',;,'i";;?
<br />,. ol*ffi6" C ",;"(?,
<br />I hereby rnder the o,Chap
<br />rs Ilrl
<br />No lass-
<br />Date-
<br />tfl,- 3 SE
<br />t'lilrl"L?w,md-
<br />lr2.
<br />Conraclor (Srg I Temporary construction lighting
<br />500 lamps or less
<br />Over 500 lamps
<br />Z.00
<br />4.00
<br />Time clock or photo electric cell /3.00 300
<br />POWER APPARATUS: Generators.
<br />motors, transtormers, rectifiers, industrial
<br />heating, cooking, or baking equipment
<br />and other apparatus as follows:
<br />Up to and including 1 HP, KW, KVA
<br />Over 1 and nol over 10 Hq 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 HR KW KVA
<br />2.O0
<br />5.00
<br />10.00
<br />20.00
<br />30.00
<br />40.00
<br />Workers Compen ."tion dl"hr"tion L
<br />I hereby allrrrir lhal I trave a cc{lrlrcal{J ot consenl lo sclf.rnsure, or a certrlrcale ot Worker's Comper'.
<br />salron lnsrlrance. Cerlrfied copy is filed with the Crty burlding
<br />Dare !xp,rcs FAO vor,t,pd By is,a r
<br />*" l1-ffiAp, canris's )
<br />I cerlrly thal rn the perlormar)cc ol the work
<br />person rn any manner so as to become sublect to the Worker's Compansalron Laws of CaLlornra
<br />Date----.- ,-- - Apphcanl (Srg.)
<br />I{otico To AppllcEnt:
<br />ll, alter makrng thrs Cerlrlrcate ol Exemptron, you should become sublect to the Worker's Compen
<br />salron provrgons of lhe Labor Code. you must forlhw,th comply wrth such provrsrons or thrs permrl
<br />shall be deemed revoked
<br />tor
<br />deparlment
<br />shall nor employ anypermrt rs
<br />Subtotal 6y. b
<br />Penalty Fee (when applicable)
<br />Violation Fee (s0.00)
<br />Plan Check 650/o of subtolal O (minimum 20 00)
<br />Receipt No.Pc#32}.o^r"
<br />Plan Check (Adjustment)
<br />lssuance Fee 10.00
<br />TOTAL PERMIT FEE (minimum $35.00)7q,02
<br />Expl[tion
<br />Thrs permrl shall exprre by hmrtalron and become null and vord rl lhe work authonzed by thrs permrl rs
<br />nol commenced wrlhrn 180 days lrom the dale ol lhrs permrl or rl B,ork aulhoftzed by thrs permil rs
<br />suspended or abandcned at any lrme arler the work rs commenced tor a perod of lSO days A new
<br />permrt shall be oblarned frrsl belore such work can be recommenced
<br />Applicant's Declaralion
<br />Ior rnspecton purposesflze representaliveS ot lhrs ctly lo enter upon lhe
<br />Applcant orAgent {,"lLbfi
<br />DATE tl-L-y?NO.
<br />VERIFIED BY (S,g I PERMIT ISSUED 8Y (Sig r_
<br />d,S,lY )tl/wlw 3:55p; 415 ,?4.
<br />?iti|ii&b0
<br />VAI,IDATION IOFFICE USE ONLYI
<br />(ACCOUNT f1 1.413r
<br />APPLICATION AND
<br />ELECTRICAL PERMIT
<br />(TYPT\/VRITF OR PF]INT IN INK)
<br />3+
<br />a 1bass PruE-. t
<br />Btx'e-
<br />APPLICANT FILL IN AREA BELOW
<br />CITY OF SANTA ANA
<br />206 W. 4th Sr.
<br />667 -2738
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<br />NDistribution: l. lnspector Copy 2. File Copy 3. Finance Copy 4. Applicant Copy c s.6t3
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