HomeMy WebLinkAbout20470769 - Permit (2)City of Santa Ana 20 Civic Center Plaza (M-'19), Santa Ana, CA 92702 Electrical Permit #:2o,47O769
Pin #: 22364Permit Counter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section. (714)647-5853
Project Address: 1614 S Standard Ave
Assessor's Parcel: 014-241-26 Lot: NA
Unit:
Block: NA
Bldg:
Tract: NA
Address Range:
Historic: No
Suite Range:
Zoning: Cl
Tenant Name: Mathew Paleteria
Nguyen & Pham
10012 E Garvey, #4
El Monte, CA 91731
(714) 470-6068
USA Builders & Constructio
791 W. Brookhurst Street
Anaheim, CA 92804
(714) 448-9633
Owner:
Address:
Phone
Contractor:
Address:
Phone:
01116002 5'1603
01 1 16002 51603
0'l 't 1 6002 51 603
01 1 16002 51600
01 1 16002 5'1603
01116002 57770
Fee Type
'l 25 Volt Receptacle
Low Voltage/Comm
Penalty
General Plan Update
lssuance
Microfilm Records
Amount
1.51
35.21
252.69
22.95
57.20
3.91
Qty
10.00
100
1.00
1.00
100
100
Fee
$1 5.1 0
$35.21
$252.69
$22.95
$57 20
$3.91
State Lic #: 1043259
Lic Type: B
Bus. Lic #: 375069
Workers' Compensation lnsurance:Carrier: State Compensation lnsurance Fund
Policy #: 9236070
Expires: 0810412020
6sgshi:543Llt -'2/lu/21-t2u I0: qiloroieElii
Office: CTYH Trons*: 18ii 2 of 4
Ac,:ti: Ret'*: ?tl47i-t/5'i
Rcpt;: (12991,1?6 - 2/lL/?fi2tt 3: ?2 F !'l
Tronsot:t i on Totql tl 168S. ??
IJSA Builders & Constructionr I
t
Building Use:
Job rype:
Nalure of Work:
Commercial
Tenant lmprovement
Tl/Walk-ln Coolers
B
VB
cEc 2019 Electrical for T.l.
t22.?E
$360. 2rl
s3.?t
ttr/ril8.'19
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By: Chavez, Dave
Subject to Field: 99 '
Buirding Permit #: 104101 533
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes
Fee Total:
Paid to Date:
Balance Due:
02t10t2020
Account#
Every permit issued shall become invalid unless lhe work on the site
authorized by such permit is commenced wtthin 360 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.
0'11'16002 51600
01 1 16002 51603
01116002 57770
$22.95
$360.20
$3.91
$387.06
$0.00
$387.06
lnspector MID#: 2019-154524
t-
ELECTRICAL.I NSPECTOR RECORD
Rev.08-07-2015
APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION
I hereby aflim undo penalty of perjury that I an exmpt fiom the Contrado6' Licffi ljw for the following rwn (Sc.7031.5
Busin6s dd Profsion Codc): Any City or County which rcquire a po'mit to coBtruct, aho, improve, dmolish or repair oy
stru(1ue. prior to its issumcc, also requirG thc applicant for such pemit to file a signed statcmflt that hc or she is licffcd pmuant
to the prcvisioN of the Contractor's Licensed Law (Chapttr 9, Comnencing with Sstion 7000 of Divfuion 3 of the Business @d
ProfcssionsCode)orthathcorsheisexemptthqefiommdtheb6isfortheallegedexmption. AnyviolationofScaionT03l.5byari
applicant for a pmit subjsts the applicant to a civil penalty of not more the five hundrcd dollus ($500).
_1, c ownq of the prop€aty. or my employees with wage o their rcle compensation, will do the work md the slruclue is not
intoded oroffcredforsle(Se.T044,BusinssmdhofGsionsCoderTheConlraclor'sLicenscLawdo6notapplytoilowntrof
thepmperly whoboildsorimprovGtha@[mdwhodo6suchworthirnselforhwlfortkoughhisorhaowncmployec,
providcd that such improvmfits @ not intflded or offqtd for sle. If. howwd. the building or im[rcvemmt is eld within one ]q
ofcomplaion. thc Owns Buildq will have the burdm ofproving thd he or she did not build or irnprove the prcpoty for the purpos of
sle).
_1. 6 owner of the p(opmy. m excluively contracting with licrued contracton lo construcl the projet (Se. 7044. B6ins
and ProfsionCodetThcContractor'sLiccnseLawdo6notapplyloeownsofpropertywhobuildsorimproveslhsmn,
and who conlracts for such projects wilh a Conlncto(s) licmed puEum( lo the Contractor's Licme taw).
I m excmpt undq Setion-, B. & P.C. for this reson.
WORI(ERS' COM PENSATION
DECLARA'TION
I hcreby affirm undo peralty ofpejury one ofthc following dwlaratiom:
_l havc ud will maintain a Cealificate of Consot to Self-lNurc for workqs compwlion. 6 provided for by S{tion 3700 of the
labor Codc, for thc psfomilce of lhe work for which the p6mit is i$ued.
I have and will maintain workers'Section 3700 oflhe Labor Code, for the pofcrnnuce of
the work for which pcnrit is cmio ad policy numbo ue:
Policy Numbq: Expires:
_l ceniry that in the psfomancc of the work for which this pmit is issucd, I shall not mploy my person in my mmno
s 6 to becomc subjet to the wort6' compsMtion laws of Califomia ed agr that if I should becomc subjct to the
workm' compmation provisiom of Scction 3700 of the t bor Code I slull. fonhwith comply with tho$ prcvisiom..
WARNINC: Failure to sue workem' compmation covqage
civil fue up to one hundred thouwd dollffi ($100.000), in r
S€tion 3076 of rhe Labor Codc inlqGl ad 8llorcy's fe6.
is unlawful. and shall subjct an mploys to oiminal psaltiG md
addition to the cost of compensation. dmagcs c provided for the
o^n 2 -lo -2-2-I
DECI.ABAIION
I hoeby affrm undc poahy of ptrjury that I m licens€d unds provision of Chaptc 9 (commcinS with Scclion 7000) of Division 3
of the Busins md Prcfsiom Code, ad my licre is in full force md cffct.
l-i"*"ct*, t E LiccnseNumbq:'1o9741
CONSTRUCTION LENDTNG ACENCY
I hmby affim undo penalty of psjury thd th6c is a conslrudion lendhg agmcy for thc pcfomilce of thc work for which this pqmit is
issued (Sc. 3097. Civ. C.).
[,mds's Nme:
Lqda's Addre:
APPLICANT DECI-ARATION
I hoeby affim unda paalty ofpcrjury one ofthc following dslaations:
Demolition Pemits-Asbestos Notification Fedsal Regulations (Title 40, Pat6)
_Required Lata of Notification
with all City and County
md County to mts upon the
above mstioncd prcperty for inspcoion puposa.
Applicant or Agcnt
l'crnrilcc nailrc
o"",2-1o'Z"-Zp
Site-Work
Underqround
Pole Bases
Liqht Standards
Spas, Pool, Fountains
Siqns (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Building
Under Slab / Floor
Bondinq / Groundinq / UFER
Transformers
Torqueing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilinqs (Hard & Soffit Rough
Ceilings (T-Bar Rough)
Meter Release
I
Rough 4,lo 7t)i-Xkr ?*)tP'1 lbot<,rl rt
Service Meter rl
ll \,I
FINAL L vll/>,6Ly57
Notes, Rpmarks, Etc I I
l{
D'H
All n rtN o Dr gb/-6-Zr