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Resrdenlial lndustrial Commerctal NO.EACH TOTAL
<br />Res. Hotels, Motels, Apt. Sq fL//f2 03 ,7. 2k
<br />Gar. or Carports Sq. Ft. C/ ql .o2 8,?o
<br />Receptacles 50
<br />,frlnro ^5"'x- +r- -Vr7!-fr*.,eAD{*nfu a*+*.fr2 €fb Jouo
<br />33tS /".;-"':'*' ,€L"'biTu 7:z** d)"'|Ae *l'Switches 50
<br />Fixtures .50
<br />Air Conditioners
<br />Each
<br />Dwry I 20 00 )o.co
<br />Approved Factory Wired Unit
<br />List -7 5.00 35,0o
<br />Busways. special raceways, under floor
<br />duct, trolley or plug-in busways ea. 110' or
<br />lraction thereol
<br />500
<br />Fire Sionalino Svstem. Minimum fee
<br />Outlei 66[dirr heat sensor I
<br />10.00
<br />.50
<br />Lighting Standards with One Lamp
<br />Each Add'l frxture on same standard
<br />5.00
<br />1.00
<br />Ownor-Builder D.chratlon
<br />I hereby allirm lhal I am exempl lrom lhe Conlractor's Lrcense Law lor the lollowrng reason lSec
<br />7031 5, Busrness and Prolessrons Code Any crly or counly whrch requrres a permrl to construct,
<br />alter, rmprove. demohsh, or repair any structure, pror lo rls rssuance, also requrres the applicant ior
<br />such permrl to lile a srgned stalement that he rs Icensed pursuant to the provrslons ol lhe Conlrac-
<br />tor's Llcense Law (Chapter I (commencing wrth Secilon 7000) ol Drvrs,on 3 ol lhe Busrness and
<br />ProlessronsCodelorthatherserempttherefromandlhebasrsforlheallegedexemptron Anyvrola"
<br />lron ot Sectron T03l 5 by any applcant lor 6 pg16l1 5p6lecls the app[cant to a crvrl penaltv ol nol
<br />more than lve hundred dollars I S50Ol
<br />E S""oon 7O44A l, as owner o, lhe property, or my emptoyees wrth wages as ther sole com-
<br />renslron. willdo the work. and lhe structure rs nol rntended or olle.ed lor sale
<br />tr Secton 70448 l, as owner ol the properly, am exclu$vely contraclrng wrth lrcensed con-
<br />lractors to construcl lhe prolecl
<br />DatB--. ,_ Owner lsro )-
<br />-
<br />-- ,_-
<br />Maintenance Permit (annual)50.00
<br />Service Meters
<br />Up to 400 amps, per meter
<br />Over 400 amps, per meter
<br />Over 1200 amps, per meter
<br />I 15.00
<br />35.00
<br />75.00
<br />/5.o
<br />Signs and high potential gas tube lighting 15 00
<br />Swimming pools, fountains, spas 35.00
<br />sffis'"
<br />motor control center qr666-)
<br />I
<br />r 5.00
<br />1,fr ot
<br />Temporary construction meter service
<br />pole
<br />Each distribution pole
<br />25.00
<br />5.00
<br />,tlempor ary construction lighting
<br />500 lamps or less
<br />Over 500 lamps
<br />2.00
<br />4.00
<br />Time clock or photo electric cell 3.00
<br />POWER APPARATUS: Generators,
<br />molors, translormers, rectiliers, industrial
<br />heating. cooking, or baking equipment
<br />and other apparatus as follows:
<br />Up to and including 1 HP KW KVA
<br />Over| and notover 10 HP, KW KVA
<br />Oyer 10 and not over 50 HP KW KVA
<br />OQer 50 and not over 100 HP, KW KVAl}ver 100 and not over 5OO HP, KW KVA
<br />Over 500 HP, KW KVA
<br />2.00
<br />s.00
<br />10.00
<br />20.00
<br />30.00
<br />40.00
<br />Rt*r',lofr'ol ?/^L
<br />I hereby atfrrm that I am hcensd under lhe prousrons of Chapter 9, Drvrsron 3 ol the Busrness and
<br />I her€by allrrm that I have a certrfrcato ol consent to slf-rnsuro, or a certrficate ol Worker's Compen-
<br />glron lnsurance CertrlEd copy rs frled wtrh the Crly burldrng
<br />I certrly that rn the perlormancc ol the work for whrch thrs
<br />ll. alter makrng lhrs Certrficate ol Exemptron. you should become sublect to the Worker's Compen-
<br />$lron provrsrons ol lhe Labor Code, you must lorthwrth conrplv wrlh such provrsrons or lhrs permrl
<br />shall be deemed revoked
<br />Contraclor Uss Only
<br />CONTRACTOB
<br />ADDRESS
<br />& Ttzaf'/nru
<br />6 /)t.f ,{L City
<br />'il$"-#
<br />nI
<br />,s
<br />3l to
<br />lron departmenl
<br />Venfred By lsrg I
<br />Apphcanl lSrg.)
<br />I shall not employ any
<br />Cf""r--€-/oL,No
<br />Conlraclor (Srg )
<br />Notice To
<br />Workers Componsation
<br />ol CaIlotnta
<br />5o.
<br />2r.-*
<br />,fa--J-^rL
<br />,rsrArr.zrP
<br />rrr,'r!f Czrr)
<br />_trO - 3y/3
<br />,^rll
<br />and my kceose rs rn lull to.ceand ellecl
<br />Subtotal l7l.l(.
<br />10.00
<br />/r-z- ?
<br />, ,,,,'" f{L7 0 VERIFIED BY (Srg I PERMIT ISSUED BY (Sis.l VI-IFn
<br />el ,ry)
<br />5:,
<br />I
<br />DATE
<br />a$-
<br />*. I L2, fiappr can, cr Asen, ,s,
<br />It/VtlW Ss5$il +13 t1+1.66
<br />Receipt No.7b Pc#
<br />OIilze represenEUves o, lhrs crty to enler uoon the
<br />Penalty Fee (when applicable)
<br />Violation Fee
<br />Plan Check 650/0 of subtotal
<br />Plan Check (Adjustment)
<br />Fee
<br />PERMIT FEE
<br />(s0.00)
<br />Date
<br />(minimum 20.00)
<br />(minimum $35.00)
<br />PERMIT NO.
<br />Expir:rtion
<br />VALIDATION IOFFICE USE ONLYI
<br />(ACCOUNT #11.413)
<br />Applicant's Oeclaration
<br />APPLTCATTON AND o
<br />ELECTRICAL PERMIT
<br />(I YPEWRITE OR PRINT IN INK}
<br />o CITY OF SANTA ANA
<br />206 W. 4th St.
<br />667-2738 MsAPPLICANT FILL IN AREA BELOW
<br />@g-ozo
<br />o0amaa
<br />\rl{
<br />s
<br />\4
<br />&
<br />$tI
<br />F
<br />Distribution: l. lnspector Copy 2. File Copy 3. Finance Copy 4, Applicant Copy
<br />I
<br />,.so
<br />I
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