HomeMy WebLinkAbout20171916 - Permit (2)City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Electrical
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #:2lJ171916
Pin #: 97492
Proiect Address: 5103 W Sixth St
Assessor'sParcel: 100-241-08 Lot: 34
Unit:
Block: NA
Bldg:
Tract:1078
Address Range:
Historic: No
Suite Range: {1
Zoning: Rl
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
Maria Carbajal
5103 W 6th Street
Santa Ana, CA 927032520
1714).718-8296
Freedom Forever
43445 Business Park Dr, #1
Temecula, CA 92590
(951) 445-5645
Fee Type
01'l 16002 5'1600 General Plan Update
01'116002 57770 Microfilm Records
Amount
23.79
4.05
Qty
0.00
0.00
Fee
$0.00
$0.00
State Lic #: 1029644
Lic Type: B, C-10, C-39, C46
Bus. Lic #: 370076
Workers' Compensation I nsurance:Carrier: Redwood Fire and Casualty lnsurance Company
Policy #: FRWC1134Z1
Expires: 0110112021
PAID
SIP 2 D
$
City Ana
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By
Plan Checked By:
Permit lssued By:
Single Family Dwelling
Solar
Solar
\.\
VioleN
Occupancy:
Constr Type
Code:
Date:
Date:
Date:
R.3, U
VB
cEc 2019
09t21t2020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes: lnstall solar panels, fees pd on 101104697
Fee Total:
Paid to Date:
Balance Due:
Verduzco,
Subject to Field:
Buirdins Permit #: 101104697
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
lssuance, or it the work authorized on the site by such permit ls suspended
or abandoned for a period of 360 days after the time the work is
commenced.
$0.00
$0.00
$0.00
lnspector MID#: 2020-161615
ELECTRICAL.INSPECTOR RECORD
Rev.08-07-2015
APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION
I hqeby 8ffirm undtr penalty of psjury that I m exempt from lhe ContractoE' Licme law for lhe following r@n (Src.7031.5 1
Busincs ad Profsion Codc): Any City or County which requira a pcnnit to comtrucl. alla. improve dmolish or rcpair my
structuc, prior lo its isuoce. also requirGlhe applicel for such p€rmil to file a signed statmot lhat h€ or she is licmed pmuilt
to the provisioN of lhe Contractor's Licensed Law (Chaptq 9, Commcncing with Setion 7000 of Division 3 of thc BsinN a{d
ProfcsionsCode)orthatheorsheisexcmptthoefromddthebasisforthcallcgedexmption. AnyviolationofsslionT03l.5byany
applicant for a pmit subjsts the applicant to a civil penalty of not morc lhu ,ivc hundred dollus ($500).
I, o owno of the prc[Erty, or my crnployffi with wag6 6 their sole composation, will do the work dd the structue is not
intqdqi oroffqcdforsale(Sc.T044,BusinessmdProfmionsCode: TheContractor'sLicmseLawdocsnolapplytomown6o[
thepopoty whobuildsorirnprovethd@n,ildwhodo6suchworkhimsclforhoselforthroughhisorheownemployec.
provided that such improvonols ae nol intoded or offqed for sle. If. howcvq. the building or imgovment is sld within one y@
ofcomplction, the Osrm Builda will have the htrdo ofproving thal hc or shc did not build or tnprovc lhe propqty for the purpo* of
gle).
_1. roma of the prcpsty, m exclNively contracting with licGd contractoG to coNtruct the froj€t (Se. 7044, B6ins
od Ptoftssion Code: The Contractor's Licmsc Law do6 not apply lo e owns ofpropqty who builds or improvB th6sn.
and who contmds for such prcjets with a Contmcto(s) licmed puE@t to the Contractor's Lic6e L{w).
I an exenlpt under S{tion-, B. & P.C. for lhis redon.
DECI.ARATTON
I hoeby alfim unda pmalty of pojury ooe of thc following dclilatioN:
_l havc ud will mintain a Cenificatc of CoMt to Selflsure for workc' compcnsalion, c provided for by Setion 3700 of thc
tabor C6dc, for the psfot]@ce of the work for which the p6mit is issucd.
{ havc and will maintain workm' compcnsation iruudcc, a requircd by Setion 3700 of the Labor Code, for the psfommce of
lhc perrnit is issual. My insurance carier md policy number oc:L
Policy Nunrbe:(- t z(
_l cefliry that in thc psformance of thc work for which this pemit is issued, I shall not mploy any pmon in ay mmner
s 6 to b€come subjet to thc work6' comp€nsation laws of Califomia. ild agre thd if I should beome subjct to the
workm'comp€nsationprovisiomofSection3T00oftheLaborCode,lshall,fonhwithcomplywilhthosprovisiorc..
WARNING: l.-ailure to scure workcrs'conrpcnsation coverage is unlawful. and shall subjcct an qnploycr to siminal penaltiB and
civil fines up to one hundred thouwd dollus ($100.000), in addition to the cost of compemation,u provided for the
Section ]076 oflhe [-]bor CoJe.
,,,",1/z// z o
intersl md attomey's fe6.
T t
DE('LARA I'I()N
I h6eby amrm und6 penalty of p€rjury that I an licensed undo provision of Chaplo 9 (comocing with Scction 7000) olDivision -1
of the Busins md Profesiore Code, ud my licme is in full force ad effect.
l-iccnsc -c(c Nrunlxr:rozqc( c(
ZU ('onlreclor:
W
I hrcby alfirm undr penalty of psjury lhat lhqc is a coctruclion ldding agocy for the pofomece of thc work lor which this pqmit is
issucd (Se. 3097, Civ. C.).
Lender's Nanle:
l-ender's Addr6s:
APPLICANT DECLARATION
I hotbyaffim undq psralty ofperjury onc ofthe following deldations:
Demolition Pqmits-Asb6tos Notification Fcdoal Regulations (Titlc 40, Part6)
Requircd Lcntr of Notifi cation
_l cqtify lhat the fedsal re8ulations regilding cbctos rmoval are not applicable to this prcjet.
-l
ccrtify lhat I have rad this application with all City and County
ed Couty to ot6 upon theordinancG md Slale laws relating to
above molioned property for
Applicant or Agmt
Permile nanre C (cro,0 i?-,
z/-@
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 A
Bondins/Crffin-q/UFER bq;rc l/-{--o I
Transformelr- -Torqueinq
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilings (Hard & Soffit Rough
Ceilinqs (T-Bar Rouqh)
lt/eter Release
Rouqh lt hi 44
Service [t/eter ID.YIF W ti,-/u,lrL
FINAL to - n.?h -l?c-tq ilc69 v?:)
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