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apFlrcATroN AND
<br />ELECTRICAL PERMIT
<br />(TYPIWRITE OR PRIN T IN INK)q-
<br />o o CITY OF SANTA ANA
<br />206 W. 4th Sr.
<br />667 -2738 WAPPLICANT FILL IN AREA BELOW
<br />(!g-ozo
<br />ooamaa
<br />MResidential lndustrial Commerctal NO.EACH TOTAL
<br />Res. Hotels, Motels, Apt. Sq. ft'7 5f 03 22.7L
<br />Gar. or Carports Sq. Ft fu4 .02 +3tr
<br />Receptacles .50
<br />'ZL
<br />STAl lZIP
<br /># )ue
<br />.&. 4
<br />PHONE
<br />Switches .50
<br />Fixtures .50
<br />Air Condilioners
<br />Each
<br />20.00 2o.a'o
<br />TB["*o Facrory wired v^ttp*Lfl L 5.00 70.w
<br />Busways, special raceways, under floor
<br />duct, kolley or plug-in busways ea. 110' or
<br />lraclion thereof
<br />5.00
<br />Fire Sionalino Svstem. Mrnimum fee
<br />Outle[ 6ffi&ior heat sensor /10.00
<br />.50 ,@
<br />Lighting Standards with One Lamp
<br />Each Add'l ftxture on same standard
<br />5.00
<br />1.00
<br />Owner Brril<ier Deciaration
<br />Maintenance Permit (annual)s0.00
<br />Service Meters
<br />Up to 400 amps. per meter
<br />Over 400 amps, per meter
<br />Over 1200 amps, per meter
<br />/@
<br />35.00
<br />75.00
<br />/f, rtzs
<br />Signs and high potential gas tube lighting 15.00
<br />Swimming pools, fountains, spas 35.00
<br />motor control center @Swrlctboard
<br />1Pglelt^Eacn
<br />'r5.00 K.@
<br />Temporary construction meter service
<br />pole
<br />Each distribution pole
<br />25.00
<br />5.00
<br />frazrY *-rO *,
<br />ADDRESS3'ar. So,-5frh't
<br />CITYSarrtrA-,-
<br />I hereby alrrrm thal I am hcenspd llnder the provrsrons ol Chapler 9, Drvrsron 3 of lhe Busrness and
<br />Proless,q,S Code, anc, mv Lcense rs rn Iull lorce and ellect
<br />L:,7:,1! 37{raz .,",, o 4 o c,yl,cens.e o/R/ s-trr
<br />,^"lf-?ffi ,onuu",o,*',fuol,/1L/l JfuAM-
<br />STATE ZIP
<br />Contractor Use Only
<br />CONTRACTOR
<br />5&_q!7
<br />Tzzar
<br />PHONE
<br />W
<br />Jbmpor 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, rectiliers, 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 oGr 10 HP KW, KVA
<br />Qver 10 and not over 50 HP, KW KVA
<br />-ziver 50 and not over 100 HP KW KVA
<br />Over 100 and nol over 500 HR KW KVA
<br />Over 500 HP, KW, KVA
<br />2.00
<br />500
<br />10.00
<br />20.00
<br />30.00
<br />40.00
<br />workers Compensation oJr{ratio " U
<br />I hereby aflrrm lhat I have a certrlicale ol consent to selt-rnsure, or a certrficate of Worker's Compen-
<br />$ton lnsurance Certrfred copy rs lrled wrlh the Crty burldrng lnspacno6 department
<br />It, atter making thrs Certrficate ol Exemptron. you should become sublect to lhe Worker's Compen-
<br />salron provrsrons ol the Labor Code, you musl lorlhwrth comply wrth such provrsrons or thrs permI
<br />shall be deemed revoked
<br />as to become ,s:w;en
<br />o"r" t*pn", /-:-lf4vert,ed By
<br />on"fl'2ffio,,,"",,s,g
<br />o,
<br />nol
<br />{Srg. }
<br />I cerlrly lhal rn the perlormance ol the work rch lhrs
<br />Apphcanl (
<br />Notico To
<br />smploy any
<br />Subtotal /o7, ?D
<br />10 00
<br />//7,","11-2-87 Applrcant c.r Agenl
<br />PERMIT ISSUED BY lSrg l-
<br />"1, tY )
<br />>.r!- ff22 urr,r,,or r,r,o, E{L?
<br />lL/W,/g 3:55P1{ +13 lll?.ql
<br />EUILD
<br />ITPEBM
<br />VALIOATION FICE USE ONTYI
<br />iACCOUNT
<br />'1
<br />.413t
<br />Plan Check 650/0 of subtotal 0rl)(minimum 20.00)
<br />Receipt No.Zb7 pc* /,3)s
<br />nze represnlatvesof thrscily loenler upon the rnspeclron purposes
<br />Penalty Fee (when applicable)
<br />Date
<br />Plan Check (Adjustment)
<br />lssuance Fee
<br />PERMIT FEE (minimum $35.00)
<br />PERMIT NO.
<br />Violation Fee (s0.00)
<br />Expariltion
<br />Applicant's Declaration
<br />j l i'l )l
<br />o^rE /t-> - F7
<br />Distribution: 1. lnspector Copy 2. File Copy 3, Finance Copy 4. Applicant Copy
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<br />'t7t*
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