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NO.EACH TOTAL!{'Residential -tlnduslnal Commercial
<br />Res. Hotels, Motels, Apt. Sq.n. f 6*03 2).?L
<br />Gar. or Carports Sq. Ft.2/q 02 +,3 f
<br />Receptacles 50
<br />JOB ADDRESS
<br />-i1iu s".,*7+ t/44L
<br />--
<br />-i;";?'tuu4!-*-d4.-*'b-+yrp*STATE/ZIPb ts-c zz
<br />d4. rt
<br />#/d-otto
<br />Switches 50
<br />Fixtures 50
<br />Air Conditioners
<br />Each /20 00 20n)
<br />(UApproved Factory Wired Unit
<br />List L 5.00 J o.oo
<br />Busways, special raceways. under floor
<br />ducl, trolley or plug-in busways ea. 110' or
<br />fraction thereof
<br />5.00
<br />Fire Siqnalinq Svstem. Minimum lee
<br />outte[ @pr heat sensor
<br />10.00
<br />50 ,.fr
<br />Lighting Standards with One Lamp
<br />Each Add'l hxture on same standard
<br />5.00
<br />100
<br />Owrrer Builder Decla,olion
<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 />15.00
<br />35.00
<br />75.00
<br />/t, o-)
<br />Signs and high potential gas tube lighting 15.00
<br />Swimming pools, lountains, spas 35 00
<br />molor control center o(@S@hload.
<br />@elP
<br />Each
<br />15.00 /ft ttz)
<br />Temporary construction meter service
<br />pole
<br />Eqph distribution pole
<br />25.00
<br />s00
<br />I hereby alfrrm lhat I am lrcenscd under lhe provrsrons ol Chapler 9, Drvrsron 3 o{ lhe Busrness and
<br />Prolessror,s Code, and my lrcense rs rn tull Iorce and etlect
<br />[|2!,1!=z+ z L L r,",, c -D t crut,ce,,," -e1e1 g.{':'^':ijY:i4;:,""'",,,!,'$fu 6;"t;;;;*
<br />Contractor Uso Only
<br />PH(lN ICONIRACTOF
<br />n_l_@'!E/s
<br />r'r
<br />ESS
<br />3 Z
<br />lktzz-crrv STATE/ZIPSa-tAA,^<
<br />-#mpr ary construction lighting
<br />500 lamps or less
<br />Over 500 lamps
<br />2.00
<br />4.00
<br />Time clock or photo electric cell 3.00
<br />POWER APPARATUS : Generators,
<br />motors, transformers, rectifiers, industrial
<br />heating, cooking, or baking equipment
<br />and other apparatus as follows:
<br />Up to and including 1 HP, KW KVA
<br />Over 1 and not oGr 10 HP, KW KVA
<br />Qver 10 and not over 50 HP. KW KVAzOver 5O and not over 100 HP KW KVA
<br />Over 100 and not over 500 HP KW KVA
<br />Over 500 HP, KW KVA
<br />2.00
<br />5.00
<br />10.00
<br />20.00
<br />30.00
<br />40.00
<br />I hereby att'rm that I have a cerlricale ol consent to sell{nsure, or a certfrcal€ ol Worker'5 Compen-
<br />satron lnsurance Cerlrfied copv 's I'led wrlh the Crty bualdrng rnspeclron deparlment
<br />ll, after makrng thrs Certrlrcate o, Exemption, you should become sublect 1o lhe Work6r's Compen-
<br />sanon provrsrons ol lhe Labor Code. you musl lorthwrlh comply wrlh such provrsons or lhrs permrl
<br />shall be deemed revoked
<br />rg. I
<br />'s
<br />oecta$/on U
<br />whrch thrs permrl is
<br />Workers Compensation
<br />I cenrfy thal rn the performance of the I shall nol employ any
<br />ol Calrlornra
<br />Notico To
<br />oare t,pr esl/ -1- ?O ve|t'ea av $,c t
<br />,"," / /- 9'{1^pp, ca,,, {s s,
<br />:::tru;frqH",:;
<br />Subtotal /o7.to
<br />Penalty Fee (when applicable)
<br />Violation Fee (50.00)
<br />Plan Check 650/o of subtotal 7 O, O 7 (minimum 20.@)
<br />ReceiptNo6 7a '7 Pc # 6'5 23 Date
<br />Plan Check (Adjustment)
<br />lssuance Fee 10 00
<br />-{ol,pltPERMrr FEE (minimum $35.00)/l7.ea
<br />ExDir.rtion
<br />Applicant's Declaratioo
<br />,","1l'UffiApp can,,r, o,,,,,,r,fuL{rk4
<br />PERMIT NO.235 48oArE r/ -z.fl
<br />VERIFIED BY lSrg )PERMIT ISSUED BY (Sig l Vl, glfuz^-
<br />lr^E/8P S:Spt{ +13 t117.m
<br />BYI',l,iff" &4rr
<br />VALIDATION IOFFICE USE ONLY}
<br />TACCOUNT fr r.413r
<br />afpucATloN AND
<br />ELECTRICAL PERMIT
<br />(TYPEWRITE OR PRINT IN INK)
<br />I o CITY OF SANTA ANA
<br />206 W. 4th Sr.
<br />667-2738
<br />/1 5 wf
<br />APPLICANT FILL IN AREA BELOW
<br />@crozo
<br />o0amaa
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<br />{st'\
<br />LN
<br />N'
<br />+
<br />s*.
<br />\\{
<br />Distribution: l.lnspectorCopy 2.FileCopy 3.FinanceCopy 4.ApplicantCopy
<br />)
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<br />JSJY)
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