HomeMy WebLinkAbout20165869 - Permit (2)20 Civic Center Plaza (M-19), Santa Ana, CA 92702 ).?
I nspection Requests: (7 1 4) 667 -27 38 lnspector Section: (7 1 4) 647 -5853
Electrical Permit #:20165869
Pin #: G,4,8.24
City of Santa Ana
Permit Counter: (714) 647-5800
Project Address: 403 N Susan St
Assessor'sParcel: 198-261-23 Lot: NA
Unit:
Block: NA
Bldg:G
Tract: NA
AddressRange: Buildings
A.H
Historic: No
Suite Range:
Zoning: R2
Owner:
Address:
Phone:
Tenant Name:
Contractor
Address:
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
John Henry Foundation Care Facility
403 N Susan St
Santa Ana, CA 927033433
(714) 480-0025
John Henry Foundation Care Facility
Owner-Builder
FeeType Amount
01 1 16002 51 603 Light Switches, Occ. Se 1 .52
01 1 16002 51603 Light Fixtures 1 .01
01116002 5'1600 GeneralPlan Update 21.25
01 1 16002 51603 lssuance 52.98
Qty
1.00
1.00
1.00
1.00
Fee
$1.52
$1.01
$21.2s
$s2.98
I'rnnEi
Ili: ni
pL*ttr2264't7ir - 5i 1:,/;lt'19
et'r50r:t ion Tstal
hn Henrs Fourrdcrt iorr (:flr'e
r:nercI PIan Updote
1 I 16002- 516lr00rJr:r-
lectr i caI
1 1 16Lt(r?- i16Lr3rrLr0-.
is0
i :(:+ : r x rr r rlrr **r[t?,Building Use:
Job Type:
Nature of Work:
Other
Alteration
Ext. Fixture
Date:
Date:
Date:
R-3.1
V B, SPK
cEc 2016
Planning Conditions:
Planning Approval By
Plan Checked By:
Permit lssued By:
Subject to Field:
Buildins Permit #; 101 96432
Every permit issued shall become invalid unless fhe work on the site
authorized by such permit is commenced within 1 80 days after its
issuance, or if the work authorized on the site by such permit is suspended
or abandoned for a period of 1 80 days after the time the work is
commenced.
05t15t2018
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total:
Paid to Date:
Balance Due:
\('"'n"ndez,
KathY
01116002 51600
01116002 51603
$21.25
$55.51
$76.76
$0.00
$76.76
lnspector MID#: 2015-125336
I
1[6 t
Occupancy:
Constr Type:
Code:
ELECTRICAL.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DELCARATION
I hcrchy affirm undcr pcnalty of pcrjury lhat I am crcmpt frcm thc Contrnctors' l,iccnsc l;rw for thc folk)wing reason (Scc.70.ll.5
Busincss and Profcssion Codc): Any City or Counly which rcquircs il Jrcrorit lo construcl. alter. irnprovc. dcmlish or rcplir any
struclurc. prio, to ils issuancc. also rcquircs lhc appliconl for such frcrmil b lilc a signcd stnlcmnt lhnl hc or shc is liccnscd pursuant
k) lhc provisions of thc Conlractor's I-iccnscd [nw (Chaptcr 9. Conuncncing wilh Scclion 7(M) oi Division 3 of lhe Busincss antl ,
Prolcs\ions Codc) or thal hc or shc is cxcmpl lhcrcliom and thc hasis for thc allcgcd cxcrnption. Any violati(r ofSccli)n 701 I 5 by any
applictrilt for { pcrmit subjccts lhc applicant to a civil pcnalty of nol nbre than fivc hundrcd dollars (gsfi)).
-1.
as owncr of thc pre[rcfly. or my cmployccs with wtgcs as lhcir solc coDrpcnsali()n. will do the work and thc stMturc is n(il
irilcndcd orofl'credlbrsalc(SL{.7044.Busincssandl'rolcssionsCodc:TheContrackrr'rLiccnscLawdocsnolnpplyloanowncrol
lheprcFny whobuildsoriilrF()vesilEton.aftlwk)d@ssuchwo*himselforhcrsclforthroughhisorhcrowncmphyccs.
providcd that such inlpmvcmnls m nol intendcd oroffcred tbr salc. lf. however. thc building or irprovctmnt is sold within oilc yciu
ofconrplclion. lhc Owncr Buildcr will havc lhc burdcn of proving lhal hc or shc did not build or intprovc thc pmpcny for thc puryns of
salc).
-1.
as ()wncr ol-thc propcrty. im cxclusively contrncting wilh licensc(l conlrnclors lo coDslruct lhc pr()jcct (Scc. 704.1. Busincss
and Pn){bssi)nCodc: lhcConlracmr'sLicenscLawdocsnotapplyk)rnowncrofpropcrtywhobuildsoriillprovcslhcrcon.
and who contmcls li)r such projccts with a Collrack)r(s) liccilscd pursuanl kr lhc Conlracl()r's Liccnsc Law).
I rrrr cxcurrt untlcr B .C. lirr
o,r", 5- lf' / t 0wner:_
I hcrcby alfirnr under pcnalty ol perjury onc ofthe dcclaralknls
-l
havc arrd will ruinlain a Ccrtilicalc of Conscnt k) Sclf-l[surc for workcrs' comJnnsation. as providcd tor by Scclion 37{D of thc
tit()r Code. li)r thc pcrfornlancc oflhc work for which thc pcrrnit is issucd.
-l
huvc and will ntinlain workcrs' compensalion itrrurrncc, us rcquircd by Scction 37U) ol lhe [:hor Codc. for thc ;rcrtbrrruncc of
thc work for which lhis pcrmit is issucrl. My workcrs' compcnsiltion insurancc caricr and policy numhcr re:
Policv Number: Eroircs:
-l
ccnify Ihal in lhe perfornlnncc o[ lhc work for which lhis pcrmit is issucd. I shull not cnrpk)y any person iil any nrflnncr
so as lo hcconr subjccl lo thc workcrs'conrpcnsnlior hws ofCalitornir. and agrcc that il l should hccotrc suhjccl lo lhc
workcrs'contpcnsatt)nprovisionsofScctionlT(noflhcL;ttx)rCodc.lshall.li)nhwithcomplywiththospiovisions..
civil lincs uP lo onc hundrcd thousand dollxrs ($l(X).0U)).
Sccli()n .1076 ol the Latx)r Codc. iilcrcsl and alk)rncy s lccs.
in addilion to damugcs as providcd lbr thc
D"r., F /?l{Applicant:
I hereby affirrn undcr pcnalty ol pcrjury lhat I atn
of thc Busincss and Profcssions Codc. zutd nry I
prcvision ofChaptcr 9 (comrncncing with Scclion 7Un) ofDivision l
Iirll li)rcc nild cllccl.
l,iccnsc
Do(e:
Nunlhcr:
Conlrsclor:_
CONSTRUCTION LFNDINC AGENCY
lhcrcbyrffirnrundcrpcnaltyofperjurylhallhcreisaconstruclionlcndirgagcncyforlhcpcrformanccoftheworkforwhichlhislrermitis
issucd (Scc.3097. Civ. C.).
[*ndcr's Nanrc:
kndcr's Addrcss:
APPLICANT NECI ARATION
I lrcrchy affirrn undcr pcnally of pcrjury onc of thc following dcclarations:
Dcmolilion Pernrits-Ashcslos Notification Fcdcral Rcgulations (Tillc 40. Pan6)
_Rcquircd [.ttcr ()f Notilicrtbn
_l ccnify that thc lcdcral rcgulalions rcgtrding ashcstos rctilovllarc [ol rpplicrblc Io lhis pr(rjccl.
_l ccaify that I havc rcad this applicalioil .md slalc that thc rtx)vc infortruilion is corcct. I agre to comply
ivcs oflhis ('ity
wilh all Cilyand County
orrlinunccs and Slrtc [-rws rclalinS k)ion. and horizc rcprcscntat and Counly lo enlcr upon lhc
atx)vc ilrcillioncd profcrly lbr
Appli(trnt or Agc[t Signslur(:
I'cmritee name (prinl):I 1/-a2 Aarilg *," 5:-tFt(
Site-Work
Underground
Pole Bases
Lioht Standards
Spas, Pool, Fountains
Sions (monument)
Life Safety /Low Voltage
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 (Rouqh)
Ceilings (Hard & Soffit Rouqh
Ceilinqs (T-Bar Rouoh)
Meter Release
Rouqh
Service Meter
FINAL i -7-rB J /<- 3z 7 Srdr.tl
Notes, Remarks, Etc.