HomeMy WebLinkAbout20170628 - Permit (2)7062City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Electrical
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Proiect Address 1622 3/4 N Main Sta
-
unit:WCC02 Blds:
Block: NA Tract: NA
Address Range:
Historic: No
Permit #:
Pin #:
Suite Range:
Zoning: SP3Assessor'sParcel: 005-153-20 Lot: NA
Owner:
Address:
Phone
Tenant Name:
Contractor:
Address.
Phone:
Santa Ana Arts Collective LP
1640 S Sepulveda t1425
Los Angeles, CA 90025
(310) 575-3s43
R L Clotworthy Constructior
26079 Jefferson Avenue
Murrieta, CA 92562
(9s1) 693-5130
01 1 16002 51603
01 1 16002 51603
01 t 16002 51603
011't6002 5160C
01 1 16002 51603
01116002 5777C
Fee Type
125 Volt Receptacle
Subpanel
Min Fee Adj
General Plan Update
lssuance
Microfilm Records
Amount
.t.5.1
55.37
9.43
22.95
57.20
3.91
Qty
5.00
1.00
1.00
1.00
1.00
1.00
Fee
$7.5s
$55.37
$9.43
$22.95
$s7.20
$3.91
State Lic #: 803626
Lic Type: B
Bus. Lic #: 197398
Workers' Compensation lnsurance:Carrier: Old Republic Genera lnsurance Corp
Policy #: A1CW11441803
Expires: 1010112020
E,ntch
Building Use:
Job Type:
Nature of Work
easnrer-_
/NsPCI-oA
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
N/A
N/A
cEc 2019
I 1 16ttLt2-'ri16tll:ltlull-
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By: Hernandez, Kathy
Subject to Field:
Building Permit #: 10196863
01t21t2020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Fee Total
Paid to Date
Balance Due:
01 1 16002 s1600
01 1 16002 51603
0't116002 57770
$22.95
$129.55
$3 91
$156.41
$0.00
$1s6.41
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within360 days after its
issuance, or if the work authorized on the site by such permit is suspended
or abandoned for a period of 360 days after the time the work is
commenced.
MID#: 2O15-124429
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Commercial
Miscellaneous
CellSite
ELECTRICAL.I NSPECTOR RECORD
Rev.0B-07-2015
APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARA ION
I hoeby afflrm undq poalty of ptrjury that I an cxempt from lhe Contractos Licrue tiw for thc followinS reen (Sa.7031.5
Business md Profession Code): Any City or County which requira a pomit lo coNtrucl, a.lts. improvq dmolish or rqnir uy
structue, prior to its issuoce, also requir6 the applicilt for such pefinit to file a signed stammt that hc or she is lic$cd pmumt
to lhe provisions of the Contractor's Licensed taw (Chapttr 9, Commencing with Srction 7000 of Division 3 of the Bsincss md
ProfNions Code) or that he or she is excmpt thqefiom md the basis for the all€ged exmption. Any violalion of Section 70-11 .5 by any
applicantforapmnitsubjectsthe applicanttoacivilpenaltyofnotmorethafivehundrcddollas($500).
_1. s osn6 of the propeny. or my employe wilh wa86 6 their sle compcmation, will do the work md the struduc is nol
intfldql or ollered for ele (56.7044. Busins md hofsions Codc: Thc Contractor's Liccnse liw do6 not apply to il owns of
thc prepsty who builds or improve th6on. md who do6 such work himself or hwlf or thrcugh his or ho om employes.
providcd that such improvmls tre mt intmded or offsed for slc. I[ horvryq. the building or improvement is rcld within one ]s
ofcompletion. the O*ner Buildq will have the budo ofproving thd he or she did not build or improve the prcpaty for the purpo* of
sle).
_1, s owns of lhe propdy. an exclusively contracting with licfficd contractoE to coNlruct the prcjst (Sec. 7044. Bwins
md PrcfcssionCode:TheContractor'sLicenseLawdoesnotapplytoilown6ofpropertywhobuildsorimproveslhs@rL
and who contracts for such projGts with a Contrado(s) licmsed pumumt to the Contraclor's Licmsc Law).
I an exemDt unds Sslion-. B. & P.C. for this re6on.
O*ner
YABtrEBSIAMEENIAIIAN
DECLARATION
I h6cby amm undq pmalty of pojury one of thc following dslealioru:
_l have md will rnaintain a Cqtificatc of Coront to SelflNurc for workos' compmation. 6 pmvided for by Sction 3700 of the
Labor Codq for the pqfomucc of thc work for which thc permit is i$ued.
(have and will maintain work6' comp€roation imurece. a required by Setion 3700 of th€ Labor Codc, for thc fsfomancc of
the work for which this permit is issued. My imurmce cmie ad policy numbo ac:
D
l\rlicy Lo7 o La
I cefriry lhat in the psformance ofthe work for which this pornit is issucd, I shall not qnploy any poson in any manna
rc olobccomesutrjectlotheworktrs'compemationlawsofCalifomia,andagrcethatiflshouldbecomesubjtrttothe
work6' composation prcvisiore of Saion -1700 of the Labor Code, I stEll. fonhwith comply with thos prcvisioro..
WARNING: Failure to suc worktrs'compeNation covcrage is unlawful. md shall subjet m onployer to qiminal pruhiq md
civil fines up to one hundred lhoused dollds ($100,000), in addition to thc co$ of compensation, danagcs o providcd for thc
Scrclron 3076 of the l,abor Codc, intercsl ild atomey's fe.-1-G-{-ytrrtz t
,n", l-Zl- Lo
DECT,ARATION
I hocby affmn undo penalty ofpsjury that I m licensed undo provision ofChapta 9 (comrnocing with Section 7000) of Division 3
of the Bsins md Prcfqiom Code. md rny liceroe is in full force md effct.
License o3L2h
CONSTRUCTION LENDING ACENCY
I hqeby affrm unds penalty of ptrjury that th6e is a coNtruction lmding agmcy for the pqfonnmce of the work for which this pemit is
issucd (Sa. 3097, Civ. C.).
[,cnds's Name:
Ladq'sAd&B:
APPLICANT DECLARATION
I horby affinn unds paalty ofpqjury one ofthe following dclaations:
D€molition Pnnirs-Asb6tos Nolification Fcdsal Regulalions (Title 40. Pat6)
-Required
Lett6 of Notification
_l certify that the fedqal regulations regdding abetos rcmoval d c not applicable to this projecl.
4 "afi lratl have rcad thrs application od statc that thc with all City ud County
ed County to entq upon theordinance md State Laws relating to building ron.
abovc mfltioncd propcny for imp€rtion
Applicant or Ageilt
l'ortrrilcc name (print)l
Site-Work
Underqround
Pole Bases
Liqht Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Building
Under Slab / Floor
Bondinq / Grounding / UFER
Transformers
Torqueinq
Sub-Panels
Air Conditioners
Roof Top Equipment Utq,/za ,fL< zl
Factory Wired Unit
Walls (Conduit)
Walls (Roush)
Ceilings (Hard & Soffit Rough
Ceilinqs (T-Bar Rouqh)
Meter Release
Rouqh z?/zd 2/ 2,
Service Meter '1^7-ZA tZczT
FINAL q)-7a fl- e isru eA^ I Lrl
Notes, Remarks, Etc
B
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