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,)Resrdentiat lnduslrial Commercral NO.EACH
<br />Res. Hotels, Motels, Apt. Sq Ft I ln I
<br />I
<br />.03
<br />TOTAL
<br />Gar. or Carports Sq Ft U"02 ?22
<br />Receptacles .50Titr ft.^4^-n ZZ''b44- k4t*-, e.. ? zl 4 Switches .50
<br />Fixlures 50
<br />Air Conditioners
<br />Each I 20 00 ib.oo
<br />Approved Factory Wired Unit
<br />List 7 5.00
<br />Busways, special raceways, under floor
<br />duct, trolley or plug-in busways ea. 110' or
<br />fraction thereof
<br />5.00
<br />3.5, o o
<br />Fire Sionalino Svstem. Minimum fee I
<br />Outte[ s66[6ir heal sensor I I
<br />10.00
<br />.50 -5.?D
<br />Lighting Standards with One Lamp
<br />Each Add'l frxture on same standard
<br />5.00
<br />1.00
<br />Owner-Bullder Declaration
<br />I hereby alfitrr thal I am exempt Jrom the Contraclof's Lrcense Law for lhe lollowrng reason {Sec
<br />7031 5. Busrness and Prolessrons Code Any crly or county whrch requrres a permrl to conslrucl,
<br />alter, rmprove, demolsh, or repaI any struclure, pfior lo rls rssuance, also requrres lhe app|canl lor
<br />such permrl lo lile a srgned stalement lhat he rs lrcensed pursuanl lo lhe provlslons ol the Conlrac-
<br />lor's Lrcense Law (Chapter I lcommenc,ng wrth Seclron 7000) of Orvrs,on 3 of the Eusrness and
<br />ProlessronsCodelorthathersexempltherelromandlhebasrslorlheallegedexemptron Anyvrola-
<br />lron ol Secnon 7031 5 by any applrcant lor a permrl sublecls lhe applrcant to a crvrl penally ol not
<br />more lhan ftve hundred dollars I S5O0)
<br />n s"auon 7044A l. as owner ol lhe property, or my employees wrth wages as thcrr sole com-
<br />pensal@n, wrll do the work. and the slruclure rs nol rnlanded or oifered lor sale
<br />tr Sect'on 70448 l, as owner ol the property, am exclusrvely contractng wrth lcensed con.
<br />raclors lo construct lhe prolecl
<br />oate--- Owner lsrg.l
<br />Maintenance 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 meler
<br />/15.00
<br />35.00
<br />75.00
<br />/f,-oo
<br />Signs and high potential gas tube lighting 15.00
<br />Swimming pools, lountains, spas 35.00
<br />motor control center o6iDSwitchboardffi /
<br />15.00 /foo
<br />Temporary construction meter service
<br />pole
<br />Each diglribution pole
<br />25.00
<br />5.00
<br />ffiary construction lighting
<br />500 lamps or less
<br />Over 500 lamps
<br />.00
<br />.00
<br />2
<br />4
<br />Time clock or photo electric cell 3.00
<br />POWER APPARATUS: Generators.
<br />molors, transformers, rectifiers, industrial
<br />lxting. 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 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 nol 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 />I hereby affirm that I am lacensd Under the provrsrons of Chapter 9, Drugon 3 of the Busness aod
<br />p€rson in any manner so as lo become sub|ect lo the Wo.ker'aCompensatron Laws of
<br />I hereby atfirm thal I have a cerlrhcale o, consenl lo sell-rnsure, or a cerlrtrcale ot Worker's Compen-
<br />satron lnsurance Certrfred copv rs filed wrth the CltV burlding rnspectron deparlment
<br />Notice To Applicant:
<br />':.
<br />Workers Compensation
<br />.L,
<br />-)
<br />cr
<br />4o
<br />Dc-t
<br />Cr
<br />rs rssued, I nol
<br />Date Applrcant lSrg.)
<br />A.-
<br />Al*l .rt{ffite
<br />for whrch lhrs employ anv
<br />Cailornra
<br />Subtotal 177,51
<br />Penalty Fee (when applicable)
<br />Violation Fee (50.00)
<br />Plan Check 65o/o of subtotal ? 7, rj (minimum 20.00)
<br />ReceiptNo. (oZ (l Pc# L3?t Date
<br />Plan Check (Adjustmenl)
<br />10.00lssuance Fee
<br />(minimum $35.00)FEE /r75a
<br />Exphation
<br />This permrl shall expir€ by lrmrlatron and become null and vord rt lhe work authoilzed by thrs permit rs
<br />not qommenced wrthrn 180 davs lrom lhe date ol rhrs p€rmrl or rl work authonzed by thrs permrl rs
<br />suspended or abandcned at any lrmealter lhe work rscomm€nced for a penod ol lS0days A new
<br />permrl shall be obtarned ,rrsl belore such work can be recommenced
<br />Applicant's Declaration
<br />' i I i I i i, )
<br />,^"1 l' ) L? App, canl.r Asen, (s r74-orrrrl // -2-f 1 PERMIT NO.DATE
<br />VERIFIED BY lSrg.)PEBMIT ISSUED BY lSrg.)x0- sa
<br />or( 5"tY )
<br />{4,L I
<br />ll/WW S:SFfi +tS lt3.l.n
<br />t,''li"r'
<br />ii,l';:, ft?e / L
<br />VALIDATION {OFFICE USE ONTYI
<br />tACCoUNT fr r-4r3)
<br />APPLICATION AND
<br />ELECTRICAL PERMIT
<br />(TYPEWRITE OR PRINT IN INK)
<br />o t CITY OF SANTA ANA
<br />206 W. 4th Sr.
<br />667 -2738 llr"
<br />APPLICANT FILL IN AREA BELOW
<br />u,Crozo
<br />ooamaa
<br />I
<br />Distribution: 1 . lnspector Copy 2. File Copy 3. Finance Copy 4. Applicant Copy C S-613
<br />"Wyiry eb -3tt3
<br />Oate Exprros Venfied By lSrg. l
<br />ont f I
<br />I cerlrlv lhal rn the
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