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APPLICATION AND
<br />ELECTRICAL PERMIT
<br />(TYPEWRITT OF PRINT IN INK)
<br />a a CITY OF SANTA ANA
<br />206 W. 4th Sr.
<br />667 -2738
<br />3 APPLICANT FILL IN AREA BELOW
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<br />(Besidential I I lndustrial commerc ar
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<br />.o"r l rorAL
<br />03 42azLl2+Res. Hotels, Motels, Apt. Sq Ft.
<br />Gar. or Carports Sq. Fl LB1 02 3,7 tr
<br />Beceptacles 50
<br />-ffiie Q-ta.Z*-r"@ aS;id@*-M-*t t.r4q-*W
<br />Switches .50
<br />Fixtures 50
<br />Air Conditioners
<br />Each
<br />20.00 d0, t'a
<br />Approved
<br />List
<br />Faclory Wired Unit buJ, OP-
<br />Vs--d-b 5.00 7o, s'n
<br />Busways, special raceways, under floor
<br />duct, trolley or plug-in busways ea. I10' or
<br />fraction thereof
<br />5.00
<br />Fire Siqnalino Svstem. Minimum lee
<br />Outle[ q!6@or heat sensor /
<br />10.00
<br />.50 ^SnLighting Standards with One Lamp
<br />Each Add'l fixture on same standard
<br />5.00
<br />1.00
<br />L)wner Builder Declaration
<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 meler
<br />/15.00
<br />35.00
<br />75.00
<br />,/e (n
<br />Signs and high potential gas tube lighting 15.00
<br />Swimming pools, lountains, spas 35.00
<br />motor control center ordm-)Swittboard.
<br />Aanels)
<br />Each
<br />r 5.00 /{, o-1)
<br />Temporary construction meter service
<br />pole
<br />Each distribution pole
<br />25.00
<br />5.00
<br />4empr 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: Generalors,
<br />motors, transformers, recliliers, industrial
<br />zheating, cooking, or baking equipment
<br />and other apparatus as follows:
<br />Up to and including 1 HP KW KVA
<br />Over 1 and nolover 10 HP, KW KVA
<br />, Over 10 and not over 50 HP, KW KVA/ 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 />)E lr/1
<br />ADDFESS
<br />-]a+o <. Sfto ',
<br />- Saa Dfiz.* -- lA rzzrr
<br />I he.ebyarlrrm lhat I haveacertrficale ol consent Io sell-rnsure, or a cerlrficale ot Worker's Compen
<br />salron lnsLrrance Certrtted copv rs filed wrlh the Crty burldrnq rnspeclron department
<br />ll, alter making lhrs Ceiliircale of Exemptron. vou should become sublecl lo the Worker's Compen-
<br />satron provrsrons ot the Labor Code, you m!sl lorthwtth co[rply wrlh such provrsrons or thrs permrl
<br />shall be deemed revoked
<br />Expiration
<br />Applicant's Declaration
<br />Contractor Use Only
<br />I sTArE/zrP
<br />Darcexpres111 /lfuve,rred By {s,s I
<br />,"" /1-2 €9 Apprcan, (s,s )
<br />not employ any
<br />dIl*1*, a .A,,r
<br />CONTRACTOR PHONE
<br />CITY
<br />rS
<br />theT'ffi&tr as to become
<br />whrchI ce.trly lhal rn the perlormance ol the
<br />Apphcanl (Srg
<br />Notice To
<br />Workors Componsation
<br />r / , ' I r I r , n r I i ' !, , , , , ) I I I r . , r I ! I t , r , r r I . , r r I I r I I r r I I r
<br />Subtotal /.7e,(to
<br />Penalty Fee (when applicable)
<br />Violation Fee (s0.00)
<br />Plan Check 650/o of sublotal ffi, trO (minimum 20.00)
<br />Receipt No. 6 7/l Pc # b 127 oate
<br />Plan Check (Adiustment)
<br />lssuance Fee 10.00
<br />4otatPERMrrFEE (minimum $35.00)/ye-
<br />oarc // -f, - f,fl PERMIT NO.23s49
<br />ii-i,i:,"*4/6_VERIFIED BY lSq I PERMIT ISSUED BY {Srg.)
<br />a$rY )
<br />tu t& sn
<br />Lt/ww 5:5EPt{ 413 t142.m
<br />VALIT]ATION (OFFICE USE ONLY)
<br />IACCOUNT #t 1.413)
<br />Distribution: 1. lnspector Copy 2. File Copy 3. Finance Copy 4. Applicant Copy (, S 6r I
<br />N.N
<br />\
<br />I herebv alIrm thal I am hcensed rrnder lhe provrsrons ol Chapter g. Drvrsron 3 ol Ihe Busrness and
<br />Proless,or,s Code, and mv lcensr rs rn lull lorce and ellectt?*(S_1{} 9 2- c,",,. e_,/ o c ,v L ceqsc 0/21 |-ff
<br />,",112 8q con,,ac,o,,s,s, Xd*d*+
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