HomeMy WebLinkAbout20165954 - Permit (3)City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Electrical
Permit Counter: (714)647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #:20165954
Pin #: 74lJ92
unit: 136
Block: NA
Btdg:
Tract: MAYBURY
Address Range: 1901-1903
Historic: No
Suite Range:
Zoning: C5
EProiect Address: 1901 E First Sta
-
Assessor'sParcel: 400-081-08 Lot: POR 15
Owner:
Address:
Phone:
Tenant Name:
Contractor
Address:
Phone:
Lyon Realty Advisors lnc
4901 Birch St.
Newport Beach, CA 92660
(949) 838-1239
Por-ovita Juice Bar
MITCHELL GENERAL CONT
52 TESLA
lrvine, CA 92618
(94913874477
Fee Type
01 1 16002 51603 Serv Meter
01116002 51600 GeneralPlan Update
01 1 16002 51603 lssuance
Amount
139.86
21.25
52.98
Qty
100
1.00
1.00
Fee
$139.86
$21.25
$52.98
State Lic #: 831334
Lic Type: B
Bus. Lic #: 352269
Workers' Compensation I nsurance:Carrier: lnsurance Co of the West
Policy #: WSD504010800
Expires: 03/08/2019
Building Use:
Job Type:
Nature of Work:
Planning Approval By
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Mixed-Use
Tenant lmprovement
Service meter
Occupancy:
Constr Type
Code:
B, R-2
iltA
cEc 2016
Planning Conditions:
Amsden, Julie
Date:
Date:
Date:
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 180 days after its
issuance, or it the work authorized on the site by such permit,s suspended
or abandoned for a period of 180 days after the time the work is
commenced.
05t24t2018
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes: lnside location. Underground feed.
Fee Total:
Paid to Date:
Balance Due:
01'116002 51600
01 1 16002 51603
$21.25
$192.84
$214.09
$0.00
$214.09
Permitee MID#: 2017-139449
ELECTRICAL.INSPECTOR RECOR D
APPROVALS DATE ID/SIG.COMMENTS OWNER BUII-DER DELCARATI0N
I hcrcby alfirm undcr pcmlty of pcrjury that I am cxcmpt fmm lhc ('onlrflclon' Liccnsc [-aw for lhc li)llowirg rcasn (.Scc.?0:]1.5
Busincss und Profcssion Codc): Any Cily or Counly which rcqui,cs a pcrnlil k) construcl. alter. improvc. dcnrolish or rcpair any
slruclure.priork)ils issuancc.alsorcquircslheapplicrnllbrsuchFrmiltolileasigncdslatctrcnl IhatlEorshcisliccDscd pursuant
to lhc pmvisions of thc Contractor's l"iccnscd bw (Chaplcr 9. Conrmcncing wilh Scction 7fin o[ Division ] of thc Busincss and
PmlcssioosCodc)orlhalhcorshciscxcmptlhcrcfronrandlhchasisforlhcallc8cdcxcrnftion. Anyvk)lationofScctionT0-ll.5byany
applicailllbr0fcrrlitsuhjcctsthc applicanttoacivilpcnaltyofnotnx)rcthanfivchundrcddollars(S5(D).
_1. rs owncr of thc propeny. or my cmpk)yces wilh s'ages as thcir solc conlpcnsrli(m. willdo thc work and lhc strulurc is not
inlcrrdcd or oflcrcd for salc (5(.70.14. Busincss and Profcssions C(xlc: Thc G)nlrack,r's Liccnsc Law docs nol alply b an owncr of
thcpmFny whobuildsorimprovesthcrdnr.mdwhodocssuchworkhirnscl[orhcrsclforthroughhisorhcrowncmpbyccs.
providcd that such imp()vctrrnts m nol inleftlcd or olLrc{ for salc. lf. howcvcr. thc buildirrg or impro\cnEnt is sold within one ycar
ofconrplctkrn. thc Owncr Buiklcr will havc thc burdcn ol proving thal hc or shc did nol huiH or inprovc lhc pmFrly tbr thc pur[nsc of
ulc).
-1.
rs owncr of lhc profcrly. am cxclusivcly conlraclin8 with Iiccnscd collrock)rs lo conslnrcl Ihc projccl (Scc. 71)4i1. Busrncss
ilril Pmlcssi[Codc:ThcContrack)r's[,iccnsct-{wdocsnolapplyloatrowncrofpropcrtywhohuildsorimprovcslhcrcon.
and who conlrrcls li)r such pr(riacls wilh u Cor{rrclor(s) liccnscd pursuanl k) lhe ('onlrrckrr's l,iccnsc l;rw).
-IamcxemplunderSccti()n-.B,&P.C,lbrlhisrcason,
I)ale:0wner:
lV()RKER.S' COlltPDNSA'IION
DI'CLARA'I'ION
I hcrcby alfirnr undcr pcnalty ol pcrjury onc ofthc folkrwing rlcchrations:
-lhavcandwill
mainlainrCcflilicatcofConscnl bSclflnstrcfrrrworkcrs'compcnsrtion.as providcdforbyScctir)il37tX)ofthc
l,ak)r Codc. for I he pcrformilncc of thc work for wh ich I hc rcrmit is is\ucd.
-l
havc and will maiilflin workcrs' conlpcDlalion insurrncc. us rcquircd hy Scction J7(X) ol thc lrhor Codc. for thc pcrfornmncc ol'
thc work for which lhis pcrnril is issucd- My workcrs' compcnsaliu insuralcc crricr ilil(l fmlicy rrumbcr iuc:
F.-xnircs:Policy NumtEr:
-l
ccrlily lhat ir thc pert)rnlancc of lhc work for which lhis pcrmil is issucd. I shall not cnrploy any pcrsoil in any ilranncr
s ar b hcconr subjccl k) lhe workcrs' compensati()n laws ol Caliti)rnia. and sgrcc thnt if I should bccotrrc subjccl to thc
workcrs' conrpcnsalion provisions ofScclion 37(x)ol lhc l-atnr CGlc. I \hnll. Ii)nhB,ilh conrply with thos provisions..
WARNINGT Failurc lo securc workcrs'conrFnsalion covcragc is ullaulul. und shilll suhjcct {n cnlploycr k) criminill frcndliies and
civil lincsupbonehundrcdthousanddollars($l(n.U)0).inadditioniolhcco\lofconrJrcnsalion.damagesaspr(,vidcdforthe
Scclion J076 of thc htx)r Codc. ttcrcst and iltbrncy's tccs.
D8l€r_,\pplicnnl:
I ICENSEN CONTRACTOR
DFCLARATION
I hercby al'lirnr undcr pcnahy of Frjury that I am licclsd !ndcr p()vision of Chaplcr 9 (connrcncing with Scction 7(XX)) of Division 3
of lhc Busincss and Profcssions Codc. dnd my liccnsc is in full fore and effcct.
Liccnse Class: Liensc Number:
Dsle: Cotrtnc'lor:
CONSTRUCTION I ENDINC AGENCY
I hcrcby affirm undcr pnalty ofperjury lhat thcre is a conslruction lcndin8 agency for lhc pcrfornuncc of thc work for which lhis Jrcrmit is
issued (Scc. 3097. Civ. C.).
lrndcr's Nrrnc:
Lcndcr-s Addrcs\:
APPLICANT DECLARATION
I hcrchy allirrn undcr penulty of pcrjury one of lhc folhwing dcclaralionsi
lXnxrlition Pcrntits-Asbcslos Notiticati(m Fcdcral Rcgulalions (Tillc 40. Pan6)
_Rcquircd lJncr ot Noliticalbn
_l ccaily lhrl lhc fcdcralrcSulations rcgnrdinB ashcsbs rcrnovrltrrc nol rpplicthlc to this pro.iccl.
-l
ccf,ily lhat I havc rcad this application od slatc that thc nk)vc informalion is corR-t. I agre to cotnply with all City and County
ordinilmcs and State Lrws rclating to building construclion- and hcrchy authorize reprcscnlativcs oflhis City and County to cnler upon thc
alDvc nrcnlbncd propcny for inspcclbn purF)scs.
ApplicaDl i)r Agcnl Signalure.Dale:
Pcrntiler namc (prinl):
Site-Work
Underground
Pole Bases
Liqht Standards
Spas, Pool, Fountains
Siqns (monument)
Life Safetv /Low Voltaqe
Fire Alarm / Dampers
Communications Cable
Buildinq
Under Slab / Floor
Bonding / Grounding / UFER
Transformers
Torqueino
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouoh)
Ceilinqs (Hard & Soffit Rouqh
Ceilinqs (T-Bar Rouqh)
l/leter Release
Rouqh
Service lvleter t
FINAL 7 /zz/ 14 Lfa
INotes, Remarks, Etc