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NO. EACH TOTALlndustrial Commercral(Resiaentiat
<br />Res. Hotels, Motels, Apt. Sq. Ft. / / / O 03 73.70
<br />Gar. or Carports Sq. Ft.B7 02 9,7 y
<br />Receptacles 50
<br />JOB ADDRESg
<br />- i-"zee Jr,.ezeW4iad'. f -Hi**:'-r-ffi4//o-
<br />-77/YM-"'bEy/** -il'T;rir
<br />Switches 50
<br />Fixtures 50
<br />IAir Conditioners
<br />Each
<br />/20.00 lo.Oa)
<br />Approved Factory Wired Unil f,t tU. !P.List l/.nl 7 5.00 3f,ao
<br />Busways, special raceways, under floor
<br />duct, trolley or plug-in busways ea. 110' or
<br />fraction thereot
<br />5.00
<br />Fire Signalilg-System. Minrmum tee
<br />Outlet zsrtr-okaor heal sensor
<br />10.00
<br />.50 ,54
<br />Lighting Standards with One Lamp
<br />Each Add'l trxture on same slandard
<br />5.00
<br />1.00
<br />Owner-Bullder Declaratlon
<br />I hereby allrrm lhar I am erempl lrom lhe Contractor's Lrcense Law lor lhe followrng reason {Sec
<br />7031 5, Busrness and Prolessrons Code: Any crty or county whrch requrres a permrt lo construct,
<br />alter, rmprove. demo[sh, or repatr any struclure, pnor lo rls rssuance. also requfes lhe applcant lor
<br />such permrt to ile a srgned statement thal he rs lcensed pursuant lo lhe provrsrons o, lhe Contrac-
<br />tor's License Law lChapter I lcommencing wrth Sectron 7000) ol Drvrsion 3 ol the Busrness and
<br />ProlessronsCodelorlhathersexempltherelromandlhebasrsforlheallegedexemptron Anyvrola-
<br />tron of Seclron 703'1 5 by any applcant for a p€rmrl subtecls lhe applicanl to a crvil penalty ol nol
<br />more than lrve hundred dollars I S500)
<br />E S""uon 7044A l, as owner ol the prope.ry. or my employees wrth wages as therr sole com-
<br />pensalron, wrll do the work, and lhe slructure rs not rntended or ollered for sale
<br />n Seclron 70448 l, as owner o, the property, am exclusrvely contractng wrth ltcensed con-
<br />traclors lo conslrucl lhs prolscl
<br />Dale Owner lSig.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, cO
<br />Signs and high potential gas tube lighting 15 00
<br />Swimming pools, fountains, spas 35.00
<br />motor control center or@W"o'tach
<br />/15.00 /f.d-O
<br />Temporary custruction meter service
<br />pole
<br />Each distribution pole
<br />25.00
<br />5.00
<br />I hereby afrrm lhal I am |censed rlnder the provrsrons ol Chapler g, Drvrsron 3 ol the Buslness and
<br />Cont?actor Uss Only
<br />CONTFACTOF 'prror.rt
<br />Ls4:244
<br />-? , r-a*o
<br />/ JYrb
<br />I sTATt rzrP
<br />lc+ ?rz<r
<br />7z'/a
<br />lorce and effact
<br />Citv Lrcen
<br />-fmporary 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 />/notors, transformers, reclifiers, industrial/ 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)4 and not over 50 HP, KW KVA--MftO and not over 100 HP, KW, KVA
<br />Over 100 and not ovrar 500 HR 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 cerlrfy that rn the perlormance ol lhe work for whrch
<br />Workers Compensation Df,.lratto n /
<br />I hereby alfrrm thal I have a certitrcaie ol consenl to sell'rnsure, or a cerlrlrcate ol Worker's Compeo.
<br />salron lnsrrrarrce Cerlrtred copy rs frled wrlh lhe Crty burldrng rnspeclron deparlmenl
<br />ll, alter making this Cerlricate of Exemplion, you should
<br />slron provrsrons of lhe Labor Code, Vou musl lorthwith comply wrth such provrsrons or lhrs permrt
<br />shall be deemed revoked
<br />Notice To
<br />subjocl to lhe Worker's Compon-
<br />Date Erpnes /-/SAventred By lsrg
<br />o"," /l -28:
<br />X,Appr,can, (s s )
<br />Subtotal /27st
<br />Penalty Fee (when applicable)
<br />Violation Fee (50.00)
<br />Plan Check 65% of subtotal f J, 7L (minimum 20.00)
<br />Receipt f.lo/ 76 7 Pc # A3 23 Dare
<br />Plan Check (Adiuslment)
<br />lssuancg,Fee 10.00
<br />-ldTALpERMtr FEE (minimum S35.00)I 37c!
<br />Explrstlon
<br />Thrs permrt shall exprr€ by hmrlalron and become null and vord rl the work authorzed bv lhrs permrt rs
<br />not commenced wrthrn lB0 days lrom the dale ol thrs permrl or rl work authonzed by thrs pe.mrt rs
<br />suspended or abandcned at any trme aller the work ls commenced lor a perrod ol 180 days A new
<br />permrl shall be obtarned frrst belore such work can be recomm€nced
<br />Applicant's Declaration
<br />'tt,l
<br />,,",,,1 I 2-g1 o,,u,,u.,,, o,u,,,
<br />fize representatrves ol lhrs ctty lo enler upon the
<br />D^rE lt-Z-f1 | eenurrno. 23553
<br />Tl* sjf;4ry PEBlvltT ISSUED BY {Srq )
<br />M/0ettfr rfffiiil +gld, f)Y
<br />VERIFIED BY lSrg )
<br />BUILDINC
<br />PEBMIT No
<br />VALIDATION (OFFICE USE ONLY}
<br />(ACCOUNT f,l 1-413)
<br />APPLTCATTON AND a
<br />ELECTRICAL PERMIT
<br />(TYPEWRITE OR PBINT IN INK)
<br />o CITY OF SANTA ANA
<br />206 W. 4rh Sr.
<br />667-2738 W3APPLICANT FILL IN AREA BELOW
<br />@g-0zo
<br />Ioa
<br />N
<br />N
<br />\
<br />Distribution: 1. lnspector Copy 2. File Copy 3. Finance Copy 4. Applicant Copy
<br />N
<br />n
<br />&+^-
<br />nol anyrs
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