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,uo l.o"rl roro,-ial , lndustrial Commercaal
<br />Res. Hotels, Motels, Apt. Sq. Fl 1729
<br />l/f.es,oent
<br />2).?7
<br />Gar. or Carports Sq. Ft.) t.?
<br />.03
<br />02
<br />Receptacles 50
<br />_g-3J_
<br />)):", /b/* Z.- /L%r" 4 -.G
<br />iefu /aa.:-i4 " y, f !' !,,0
<br />39 /, 7.---y.^St 4,,
<br />k-Z* 7tu-z* &., 7?c2/e Switches 50
<br />Fixtures 50
<br />(20 00 ?o,ooAir Conditioners
<br />Each
<br />Approved Factory Wired Unit
<br />List 500
<br />Busways, special raceways, under floor
<br />duct, trolley or plug-in busways ea. I10' or
<br />fraction thereof
<br />(500 j)o. oo
<br />Frre Signaling System. Minrmum fee
<br />Outlet. (66n'aor heat sensor I 10.00
<br />.50 ,f,D
<br />Lighting Standards with One Lamp
<br />Each Add'l fixture on same standard
<br />Ownsr-Bullder Doch?atlon
<br />I hereby allrrm thar I am exempt lrom the Contractor's Lrcenso Law lor the followrng reason (Sec
<br />7031 5, Bus,ness and Prolessrons Code Any crty or county whrch requrres a permrl to conslruct
<br />aller. rmprove, demoish, or repaf any slructure, pilor to rts rssuance, also requtres lhe apphcanl Ior
<br />such permrt to file a srgned slalemenl thal he rs hcen$d pursuanl io the provrsrons o! lhe Contrac
<br />lor's Lrcense Law lChapter I lcommencing wrlh Sectron 70001 ol Drvrs,on 3 ol the Buslness and
<br />Prolessrons Code) or thal he rs exempt therefrom and the basrs tor the alleged exemptron Any v ola
<br />lon ol Seclron 7031 5 by any appllcanl lor a permfi sublects the applcant lo a crvrl penalty of not
<br />more lhan lrve hundred dollars I S50O)
<br />E Su",,on7O44A l,asowneroltheproperty,ormyemployeeswrthwagesastherrsolecom
<br />pensatron, wrll do lhe work. and lhe struclu.e rs nol rntended or ollered tor sale
<br />n Secnon 70448 l, as owner ol the property, am exclusrvely contraclrng wrth hcensed con
<br />lractors lo construct the prolect
<br />Dale---
<br />--
<br />Owner {Srg )-
<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 15.00
<br />35.00
<br />75.00
<br />tU, oo
<br />Signs and high potential gas tube lighting 15.00
<br />Swimming pools. fountains. spas 35.00
<br />ffiSwitchboard. molor control center @
<br />I
<br />15.00
<br />/f,'o o
<br />Temporary construction meler service
<br />pole
<br />Ea/' distribution pole
<br />25.00
<br />5.00
<br />XmWt ary construction 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 />motors, transformers, rectif iers, industnal
<br />\Aaling, cooking. or baking equipment/and other apparatus as follows:
<br />Up to and including 1 HP KW KVA
<br />Over 1 and not over 10 HP, KW KVA
<br />Over 10 and not over 50 HP, KW KVA
<br />Aver 50 and nol over 100 HP. KW KVA
<br />Over 100 and nol over 500 HP, KW. KVA
<br />OVer 5OO HP, KW KVA
<br />2.00
<br />5.00
<br />10.00
<br />20.00
<br />30.00
<br />40.00
<br />lrcensed under the prousrons of Chapter 9, Drvrsron 3 of lhe Busness and
<br />I hereby alhrm lhal I have a cerlrlcate ot consent lo sel|rnsurc, or a cerlrfrcale ol Worker's Compen-
<br />salron lnsurarrce Certrlred copy rS Iled wrlh the City burldrng rnspectron departmBnt
<br />lr. alter makrng thrs Cerl,lrcate ol Exemptron. you should becom6 sublect to lhe Worker's Compen
<br />salron provrsrons of the Labor Code, you must lorlhwrth coftrply wrlh such provrsrons or thrs permrl
<br />shall be deemed revoked
<br />ADDRE
<br />/,,2a t I
<br />I hereby allrrm thal
<br />Crty Lrcens-
<br />Workers Compensation
<br />5c. $7*'44--L2- 1o
<br />9I2tandlu ll andhcenselorce e
<br />71bI
<br />I cerlrly lhal rn the perlornance o, the work I
<br />I smrrrzre 72+
<br />_ Contractor lSig. )
<br />rt rs employ anv
<br />as to become L nratl,,.
<br />Apphcanl (Sr0
<br />Notic6 To
<br />5TL '3 el3
<br />'rr,Nr (ZrO
<br />t#
<br />cj.
<br />Verrfred By (Srg l
<br />Applrcanl (Srg I
<br />Orr,,trp,,,,,rtF
<br />,r,,,"//'r:!tq
<br />I 1,,( Iclo
<br />hTtr
<br />tn"""'fiffi
<br />Subtotal / 07. to
<br />Penalty Fee (when applicable)
<br />Violalion Fee (s0.00)
<br />Plan Check 650/o ol subtolal 7 O. o-, (minimum 20.00)
<br />Receipt No.I ec*
<br />^
<br />Date7
<br />Plan Check (Adiustmenl)
<br />lssuance Fee 10.00
<br />PERMIT FEE (minimum $35.00)
<br />Explrrtlon
<br />Thrs permrl shall exprre by lim'talion and become null and vord rf the work authorrzed by thrs permil rs
<br />nol commenced wrthrn 180 davs lrom the dale ol lhrs permrl or r1 s,ork aulhonzed by lhrs permrt rs
<br />suspended or abandcnedal anv lrme alt€r lhe work rscommenced lor a peflod ol lSO davs A new
<br />permrl shall be obtarned trrsl berors such worl can be recommenced
<br />Applicanl's Declaration
<br />,l
<br />'rl .'., lrj, r'l l.rl,,i- r, j' li I irt r :, l,' rrl,i,l,rl
<br />*-l l->8{ appr,",nr o, ns"nr rs,s ,
<br />PERMIT NO.
<br />I
<br />re
<br />"/. tJY
<br />PERMIT ISSUED BY (Sig )^y''!v 5a
<br />rv{Et8P SsSPtt tls lll?.m
<br />VALIDATION {OFFICE USE ONLYI
<br />iACCOUNT
<br />'t1-413)
<br />!o aAPPUCATION AND
<br />ELECTRICAL PERMIT
<br />(TYPEWBITE OR PRINT IN INK)#>
<br />CITY OF SANTA ANA
<br />206 W. 4th Sr.
<br />667 -2738 W
<br />APPLICANT FILL IN AREA BELOW
<br />@grIzo
<br />o0t)maa
<br />s
<br />[^)Ns
<br />f.
<br />N
<br />I
<br />N
<br />lt
<br />D
<br />Distribution: L lnspector Copy 2. File Copy 3. Finance Copy 4. Applicant Copy c s .613
<br />5.00
<br />1.00
<br />o^rE // -2 -41
<br />':',,),'i,),i"'1 5/ ( /f ,,,,,,i .,
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