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APPLICATION AND
<br />ELECTRICAL PERMIT
<br />(TYPFWRITE OR PRINT lN INK)
<br />a t CITY OF SANTA ANA
<br />206 W. 4th St.
<br />667 -2738 'ffid3APPLICANT FILL IN AREA BELOW
<br />@Crozo
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<br />rndustriar commerc.ar
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<br />}rResidential EACH TOTAL
<br />Res. Hotels, Motels, Apt. Sq. n. I 73b 03 3 7.09
<br />Gar. or Carports Sq. Ft.14{02 f,n7o
<br />Beceptacles 50
<br />?i ru;4zz<Jurkol-'"'C*h, /n-n-a-a-
<br />{4dtt/o
<br />AILING ESS
<br />C+ ?zozt
<br />k-c-FI
<br />J08 ADDRESS
<br />3706
<br />Switches 50
<br />Fixtures 50
<br />Air Conditioners
<br />Each
<br />20 00 2o. rYo
<br />Approved Factory Wired Unit
<br />List 7 5.00
<br />Busways, special raceways, under floor
<br />duct, trolley or plug-in busways ea. 1 10' or
<br />lraction thereot
<br />rylrngSlstem. Minimum fee
<br />Gmotrelor heat sensor
<br />Fire Sigr
<br />Outlet./10.00
<br />.50 .s0
<br />Lighting Standards with One Lamp
<br />Each Add'l frxture on same standard
<br />5.00
<br />1.00
<br />Owner-Eullder Declaratlon
<br />I hereby aflrm lhat I am exempl lrom the Contraclor's Lrcense Law for the lollowrng reason {Sec
<br />7031 5. Busrness and Prolessrons Code Any crly or county whrch requrres a permrl to construcl,
<br />alter. rmprove, demolsh, or repaI any slruclure, paror to rls rssuance, also requrres lhe appllcant lor
<br />such permrt lo trle a srgned statement that he rs lrcensed pursuanl lo the provrsrons ol the Conlrac-
<br />tor's Lrcense Law lChapter I lcommencrng wrlh Seclron 7000) ol Drvrs,on 3 of the Eusrness and
<br />ProlessronsCode)orthathersexempilheralromandthebasrslorlheallegedexemptron Anyvlola,
<br />lron ol Seclron 7031 5 by any applcanl lor a permrt sublects lhe appllcanl to a crvrl penally ol not
<br />more lhan lve hundred dollars t55O0)
<br />E Su",,on 7044A l, as owner ot the property, or my employees wrth wages as therr sole com.
<br />pensatron, wrll do the work, and the structure rs not rntended or olrered for sale
<br />tr Secrron 70448 I, as owner o, lhe properly, am exclusrvaly contractrng wrth lrcensec, con-
<br />lractors to construcl the pro|ecl
<br />Owner (Srg.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
<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, fountains, spas 35.00
<br />motor conlrol center o@Switchboard,
<br />,6'ne-l6)-=e66
<br />/15.00 /{,n
<br />Temporary construction meter service
<br />pole
<br />Each distribution pole
<br />25.00
<br />500
<br />tuae@-iSDREas --- ^_zzL{e_I.-I-h*d-arLM
<br />I hereby allrrm rhat I am |censed ilnder the provrsrons ol Chapler I, Drvrsron 3 o, the Busrness and
<br />Prolessrot'sCodp and mv lrcensers,ntull lorcearrdelluct
<br />k7,,*("E
<br />=
<br />t 4? r'"," --C- : 1. Q -.- c,,v t,""n"n Q /21 gd
<br />,",11481 con,,ac,or (s s, lltUu4
<br />Contr6ctor Uso Only
<br />CON]EACTOR f{6- 7r/3
<br />4q_?
<br />STATE]ZIP
<br />Temporary conslruction 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 APPABATUS: Generators.
<br />motors, transformers, rectif iers, 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 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 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 />workers compensarion De{/rario n U
<br />I hereby alfrrm lhat I trave a certrfrcate ol consenl lo self-rnsure, or a certricate ol Worker's Compen
<br />satron lnsrrrance Certrfredcopy rsfiled wrth lhcCrly buildrng rnspeclron depailment
<br />It, aller mak.ng thrs Certrfrcate ot Exemplron, you should bscome sub|ecl lo the Worker's Compen
<br />gtron provrsrons ol lhe Labor Code, you must ,orthwrlh comply wnh such provrsrons or lhrs permrt
<br />shall be deemed revoked
<br />ortu E,pon" 142-e\nif red By ISiq. )-
<br />,""/f -e€3 Appr,canr(ss )
<br />lor whrch rl rs rssued
<br />t,,,,,
<br />14
<br />Nolics To
<br />nol employ any
<br />ol Callornta
<br />I certrly that rn lh€ porformance of lhe
<br />Subtotal /<t.1*
<br />Penalty Fee (when applicable)
<br />Violation Fee (50.00)
<br />Plan Check 650/0 of subtotal ,C. (( @inimum21.O}l
<br />ReceiptNo. lZCl ec* f,y';J oate
<br />Plan Check (Adiustment)
<br />lssuance Fee 10.00
<br />TOIAL PERMIT FEE (minimum $35.00)/4t.y9
<br />Expiratlon
<br />Thrs permrt shall expfe by limrtalron and become null and void rf the work authonzed by this permit rs
<br />nol commenced wrthrn 180 days lrom the date ol thrs permrl or rl work aulhonzed by lhrs permrl rs
<br />susp€nded or abandcned at anv lrmeafler the work rs commenced lor a penod ol l80 davs A new
<br />permrl shall be obtarned irsl belore such work can be recommenced
<br />Applicant's Declaration
<br />,","))4'$1 ApplEsnt or Agsnt lS
<br />DATE l)-z-81 PERMIT NO.235s0
<br />| ,,**,, SSL.J.DByrSrl t Z.A-Sn
<br />d- I al I u/w./s s:ispr{ 41r r14r.+g
<br />VALIDATION (OFFICE USE ONtY)
<br />tACCOUNT *|.4r31
<br />BUITDING
<br />PERlrillT No
<br />g(At 7 vr*rrrroevrs,gr 4-7-n-
<br />Distribution: 1. lnspector Copy 2. File Copy 3. Finance Copy 4. Applicant Copy c s.613
<br />5.00
<br />3f, o'o
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