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Resrdentral lndustnalftomm"rc,rt NO.EACH TOTAL
<br />Res. Hotels, Motels, Apt. Sq. Ft.03
<br />Gar. or Carports Sq. Ft.02
<br />Receptacles 7 50 q-
<br />fu Srq,um Fc y'r"rtGa
<br />S/"urn@ez ' ssosnras 5Y6-o/ lo
<br />33r t F,+kvieut
<br />Cosrn fiesn Qte>e Switches 50
<br />Fixtures A1 .50 e7-
<br />Air Conditioners
<br />Each
<br />20.00
<br />Approved Factory Wired Unit
<br />List 5.00
<br />500
<br />Busways, special raceways, under floor
<br />duct, trolley or plug-in busways ea. 1 1 0' or
<br />fraction thereof
<br />Fire Signaling System. Minimum fee
<br />Outlet, smoke or heat sensor
<br />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-Builder Declaration
<br />I hereby afrrrm thar I am exempl lrom the Contraclor's Lrcenso Law for lhe lollowrng reason lSec
<br />7031 5, Eusrness and Professrons Code Any qty or counly whrch requrres a permrt lo construct,
<br />aller, rmprove, demolsh, or repaI aoy struclure, pfior lo rls rssuance, also requrres lhe appicant lor
<br />such permrl lo lile a srgned stalement that he is lcensed pursuant lo the provisrons of lhe Conlrac-
<br />lor's Lrcense Law lChapter I lcommanc,ng wrlh Secton 7000, of Drvrs,on 3 of the Busrness and
<br />Prolessrons Cod€l or lhat he rs exempt therelrom and Ihe basrs lor the alleqed exemplron Anv vrola-
<br />non ol Seclron 7031 5 by any applcant lor a permrl subiects lhe apphcanl lo a crvrl penalty ol not
<br />more lhan,rve hLndred dollars lS500t
<br />I Sua,,on 7044A l, as owner ol lhe property, or my emptoyees wilh wages as therr sote com-
<br />pensalron, wrll do the work, and lhe slruciure rs ool rnlended or oflered lor sale
<br />t] Sect'on 70448 l, as owner ol the properly, am exclusrvelv contraclrng wrlh lrcensed con-
<br />lraclors lo conslrucl lhe Prolecl
<br />Date
<br />----
<br />Owner lsrq )------
<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 />3s.00
<br />75.00
<br />/f '
<br />Signs and high potenlial gas tube lighting 15.00
<br />Swimming pools, founlains, spas 35.00@Switchboard, motor control center
<br />panels
<br />Each /15.00 t{-
<br />Iemporary construction meter service
<br />pole
<br />Each distribution pole
<br />25.00
<br />5.00
<br />FAs to e ul h t- Efr4con, r"tor u se onrv
<br />/zorr Baca 84ua'"hbrrrgToD Bm-tt l"Q'| arp
<br />a ::1*-##: r
<br />jr ;5 r i: i a, )
<br />" ",,' )"' ;,ffw
<br />,
<br />", " i?_j)_*a ?.k,,,,,,, d)fi!1_., (.Nt l t *-y._)
<br />CON IBACT
<br />ADD SS
<br />f€ (-3't3
<br />tfut'aeo+
<br />Temporary construction lighting
<br />500 lamps or less
<br />Over 500 lamps
<br />2.00
<br />4.00
<br />Time clock or photo electric cell /300 3.oo
<br />POWER APPARATUS: Generators,
<br />motors, transrormers, rectiliers, 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 notover 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.O0
<br />5.00
<br />10.00
<br />20.00
<br />30.00
<br />40.00
<br />Workers Compensation Dec#atio n U
<br />I cortrly thal rn the perlormance ol lhe work fo. whrch
<br />person rn any manner so as to become sublect to lhe Worker's Compenstion Laws ol Cahlornra.
<br />Dals---- Applicanl(Srg.l-
<br />Notice To Applicant:
<br />C rly
<br />Apphcanr lSrg )
<br />a ce(rlrcate ot Worker's Compen
<br />departmenl
<br />certrlcate ol consent to sell-rnsure
<br />is rssued,I nol employ any
<br />I hereby atlrrm thal I have a
<br />salron lnsuratce Certrf€d
<br />oar.r,o,.d-t
<br />,",.1p{ffi
<br />copy rs filod wrth lhe
<br />rveilfred By (S'g )
<br />Subtotal Gy. *
<br />Penalty Fee (when applicable)
<br />Violation Fee (s0.00)
<br />Plan Check 65'/" ol subloEil ql /. f O 1minimum2o.0o)
<br />Receipt No.Pc# (e Date
<br />Plan Check (Adjustmenl)
<br />,lssuance Fee 10.00
<br />TOTAL PERMIT FEE (minimum $35.00)ry4Df,
<br />Expiration
<br />Applit:ant's Declaratiorr
<br />ri
<br />,",, lltLffiApplcailr,,'A,rcnl s, flurN,,//-2{7DATE NO.
<br />Lk**rr,
<br />'r,0,PERMIT TSSUED BY (S'g )
<br />t?4.m)Y)
<br />JrtYt*tC..'
<br />tl/M,/w lrs/5Pll +13
<br />BUIL DING
<br />PERMIT
<br />VALIDATION IOFFICE USE ONLY)
<br />(accouNT #1 r.41 3)
<br />APPLICATION AND
<br />ELECTRICAL PERMIT
<br />ITYPTWBITE OR PRINT IN INK)
<br />c+o
<br />a HOusr Zn-st_
<br />Broe- 4
<br />CITY OF SANTA ANA
<br />206 W. 4th St.
<br />667 -2738
<br />o
<br />\$'/
<br />APPLICANT FILL IN AREA BELOW
<br />@g-0zo
<br />ooamaa
<br />\r..)
<br />\,s
<br />"c
<br />s
<br />N
<br />$
<br />)l
<br />$
<br />\
<br />Distribution: l.lnspectorCopy 2. FileCopy 3. FinanceCopy 4. ApplicantCopy
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