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APPLICATION AND
<br />ELECTRICAL PERMIT
<br />ITYPEWRITE OR PRINT IN INK)
<br />I o CITY OF SANTA ANA
<br />206 W. 4th Sr.
<br />667-2738
<br />4 tu
<br />APPLICANT FILL IN AREA BELOW
<br />@g-ozo
<br />oa,m
<br />X
<br />XResidentral lndustnal Commeroal NO.EACH TOTAL
<br />Res. Hotels, Motels, Apt. Sq. Ft. I I I l0 .03 33, Vo
<br />Gar. or Carports Sq. Ft +77 .02 I'7t
<br />Receptacles .50STATE/ZlPc* ?zlzeCD-'fr-W,z--n-
<br />7ag7
<br />t H
<br />JOB ADDBESS
<br />73tr
<br />CIT Y
<br />Swilches .50
<br />Fixtures .50
<br />Air Conditioners
<br />Each /20 00 al.0-a
<br />Factory Wired Unit fi,ltApproved
<br />LiSt 4 5.00 Vo,n
<br />Busways, special raceways. under floor
<br />duct, trolley or plug-in busways ea. 110' or
<br />fraction thereot
<br />500
<br />Fire Sionalino Svstem. Minimum fee
<br />Outle[ 66taor heat sensor /10.00
<br />.50 ,9 IH
<br />Lighting Standards with One Lamp
<br />Each Add'l fixture on same standard
<br />s.00
<br />1.00
<br />Owner-Bulldcr D.cle?ctlon
<br />I hereby allrrm thar I am ex€mpt from the Contractor's Lrcensc Law lor lhe lollowrng reason (Sec
<br />7O3l 5, Business and Prolessrons Code Any crty or county whrch requtres a permrt lo construct,
<br />aller, rmprove, demolish, or repaI any structure. plor to rls rssuance, also requrres lhe appIcanl tor
<br />such permrt lo file a srgned stalemenl that he rs hcensed pursuanl to the provrsrons ol the Conrac-
<br />tor's Lrcense Law lChapler I (commenc,ng wrth Soctron 7000) ol Drvrs,on 3 of the Busrness and
<br />ProlessronsCodelorlhalhersexempilherelromandthebasrslorlheallegedexemptron Anyvrola-
<br />ton o, Secton 7O3l 5 by any apphcanl lor a permrt sublects the apphcant lo a ovil penally o, nol
<br />more lhan frve hundred dollars I S 50Ol
<br />n S"",,on7O44A l,asowneroflhepropertv,ormyemployeeswrlhwagesaslhe[solecom'
<br />pen$lron, wll do the work, and lhe structure rs nol rntended or ollered lor sale
<br />D Secrron 70448 l, as owner ol the properly, am exctusrvely contractrng wrth lrcensed con-
<br />l€clors lo conSlruct lhe paolecl
<br />Dale - Owner (Srg l--
<br />-
<br />Marntenance 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 />I 15.00
<br />35.00
<br />75.00
<br />/f,d
<br />Signs and high potential gas tube lighting 15.00
<br />Swimming pools, lountains, spas 35.00
<br />motor control center o@)Switchboard.@Eacn
<br />(15.00 /fifr
<br />Temporary construction meter service
<br />pole
<br />Eqph distribution pole
<br />25.00
<br />5.00
<br />-/mpoary construclion lighting
<br />500 lamps or less
<br />Over 500 lamps
<br />2.00
<br />400
<br />Time clock or photo electric cell 3.00
<br />POWER APPARATUS: Generalors,
<br />motgrs. transtormers, rectifiers. industrral
<br />lyzting, cooking, or baking equipmenttnd other apparatus as follows:
<br />Up to and including 1 HP, KW KVA
<br />Over 1 and not over 10 HP, KW KVA
<br />y'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.OO
<br />5.00
<br />10.00
<br />20.00
<br />30.00
<br />40.00
<br />€/L&L 6t6'3t'/3
<br />I hereby affrrm thal I am lcenscd uhder the provrsrons ol Chapter 9, Drvrsron 3 of the Buyness and
<br />I herebv atllrm thal I have a cerlrficale of consenl lo sell-rnsure, or a ceilrlcale ol Worker's Compen
<br />satron lnsurance Cert(red copy rs lrled wrlh the City burldrng rnspectron department.
<br />lf, alter makrng lhis Certrficale ot Exemptron, you should become subjecl lo the Worker's Compen
<br />satron provrsrons ol the Labo. Code, you must lorthwrth compiy wrth such provrsrons or lhrs permrt
<br />shall be d@med revoked
<br />Contractor Use Only
<br />rlrsr
<br />PHON E
<br />/
<br />44/r'L-
<br />lhe
<br />E
<br />0/z/
<br />eftec rf,fLrcsnseCrly
<br />By lSrg
<br />Applicant (Srg )
<br />CONTRACIOR
<br />lhrs
<br />ker's
<br />nol employ any
<br />Laws of Cal
<br />Workors Componsation
<br />Notice To
<br />I ce.lifv lhal rn lhe psrlormance ol the work
<br />'&" )r7dr
<br />Date
<br />Dat€.
<br />:"",a%ryn:,,"":";
<br />Subtotal
<br />/2.?,54Penally Fee (when applicable)
<br />(50.00)Violation Fee
<br />Plan Check 650/o of subtolal 726f (minimum 20.00)
<br />ReceiptNo e.7L7 ec*(o7)3 Date
<br />Plan Check (Adjustmenl)
<br />lssuany' Fee 10.OO -, )
<br />;W6t PERMIT FEE (minimum $35.00)t12 2J
<br />Expiration
<br />Applicant's Declaration
<br />r' '. , I r,i. i i I rl, 'r rl ', rl,'!'rr"r:,i r rl,'r':
<br />(ze represenlatrves ol lhrs 0ty lo enler upon lhe above.menlroned properly for
<br />" ",. *l l+ fff,,,,,,.,,,.,. oo,,.,,, fihrufl
<br />purposes
<br />D^rE ,//-2 - ?7 PERMIT NO.
<br />{(da-3 VEFIFIED BY {Srg )PERMIT ISSUED BY {Srg I
<br />fzY)
<br />71b-4*ay
<br />llllJ2.lw S:sPll +t3 llsa.Sl
<br />LllllL r l,
<br />.,ir'..".
<br />VALIDATION (OFFICE USE ONLYI
<br />(ACCOUIIT flt'4131
<br />Distribution: 1 . lnspector Copy 2. File Copy 3. Finance Copy 4. Applicant Copy cs.5r3
<br />,
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