HomeMy WebLinkAbout20170626 - Permit (3)City of Santa Ana 20 Civic Center Plaza (M-'19), Santa Ana, CAg27o2 Electrical
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #: 2lJ17062fi
Pin #: 4e6fj
Assessor'sParcel: 111-1'l.1-1'l Lot. NA
Unit:
Block: NA
Bldg
Tract: NA
Address Range:
Historic: No
Suile Range;
Zoning: Ri
Owner:
Address
Phone
Tenant Name
City Of Santa Ana
.5lec.y,/aloh+r?€ffiqr6te-- 20 cN l'- eElrt={L lir-
r oc ^ngAfcrt Cn 90g3€36ao . *pra .pl, CA 1?zal 01116002 5'1603
01 1 16002 5'1600
01116002 51603
01116002 57770
Amount
107.11
22.95
57 .20
3.91
Fee
$'l 07.1 1
$22.95
$s7.20
$3.91
S R Bray LLC dba Power Plr
'1210 N Red Gum St
Anaheim, CA 92806
(714) 507-1881Phone
State Lic #r 980589
Lic Type: B, C-10, D-31
Bus. Lic #: 344085
Workers' Compensation lnsurancelCarrier: Federal lns Co
Policy #: 54309652
Expires: 0313112020
Building Use:
Job Typel
Nature of Work
Planning Conditions:
Planning Approval By
Plan Checked By:
Permlt lssued By:
Subject to Field:
Building Permit #:
City
Miscellaneous
Temporary Power Pole
N/A
N/A
cEc 2019 Notesr lnstallation of a temporary power pole for a City Sewer
Lift Station.
$191.17
$0.00
$191.17
Chavez.Dave )L _01t2112020
Account#
Every pomit tssued shallbecome invalid unlesslhe wo* on lhe site
authoized by such pemit is commenced wlhin 360 days aftet ils
issuance or if lhe work authorized on the site by such pemtt is suspended
orabandoned for a penod ot 360 days afte( the ume the work is
commenced
lnspector MID#: 2020-157216
01 1 16002 51600
01116002 5'1603
01116002 57770
$ 164.3'1
$3.91
Fee Total:
Paid to Date:
Balance Due
Project Address: 1112 W Segerstrom Ave
Fee Type
TPP
General Plan Update
lssuance
Microfilm Records
Qty
1 .00
'1 00
100
100
Contractor:
Address:P.ntch+:51996 -triii.Pt t:TYll
ticp t+ | 0?969.i;i4
Tronqo,:t ion Tc
l/1.t)1.1 9111
*1?1.
!r F( Er.(le l-L(-: dbcl FoHer' Plu
Occupancy:
Constr Type:
Code.
Date:
Date:
Dale.
Misc. Receipt:
Misc. Receipt:
l\4isc. Receipt:
Total
ELECTRICAL.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS O\vNER BUILDER DALCARATION
I h6eby amnn u.dn p.nrlry ofpdtury lh,l I m erempl 6om th. ContEcloB Licmc Lrw for rh. aollowing r.etr (S.c.7oll 5
Busi.* and Profsion Codc) Afly City oi Couoly which r.qun6 a pdi,n ro co6rdcl. rhd. improve d.molth or re.n uy
srtocl@, pnor lo ns isuec€, also r.quns lhc @plic l lor such poen lo [L a sig.al iatdd thal tE or si. G lic.ns.d puea
to the povtions ot the Conrmcrois Licoscd Lar' (Chaptc 9, Conm..cing enh S€crion 701$ of Divisioo 3 oflh€ Dusin6s md
Pbtcsiofls Code) o! thar hc or shc is cx€h/ $qc6oh dd $. bsk for rh. alL8.d dmption Any violalion olselion 703 I 5 by any
applicdl aor a pmnil subjels thc appliol lo . civil pdahy o I not oor. lhd 6v. hundr.d dollds (1500).
l. ai ownd oarhc propc,1y, o ny onploy€B wnh was* a thcn sob compesation, ll do lh. Norl ad lhc slru.l@ G mt
inradcd or oiIded aor elc (Sa.7044. DGin6s ud Pror*ioB Codq The Com.actoas Lic6. L.w doe nol opply to 4 omq oi
rhcFDrqly Nho hil& or inpro!6 rhdotr .flj who &6 suct wolk hinsclt or h.Rlf or rhm$h his or hs own cmployc,
provid.d thar such improv@b e
"ol
orod.d oi otrad for sL. Ii hovd6, th. hildin3 or inp.olcMl i! $ld *ithin oe ,@
of conpldion lne Own.r Butls will luvc thc bNkn ofpmving thd he or shc did rcl build or in{rcvc $e popdy for d. purloe of
l. 6 osrs oarhc pmrdy, e .xclBively contadins wirh licm.d conlradoE lo corclrud lh. projctl (Sd ?044, a6rB
ud Eol*ion Cod.: Th. Conrra.iofs Li.c.sc Law do6 nor apply lo an own6 orpropeny rvh. brilds o. imProv.s thdon,
and who co;racrs lor such pmj.cls wirh a Co rscto(d liceGol ru sur l lo ihc Contraclois Lic€e L,*).
I m.rmpr unds Sdion-. B. & P.C. for rhi. rae..
uoaBlB,t-coMtDrl rox
!ECl. aAUAr
I hdcby amm uod6 paaly olpsjury onc olthc fouowing ddlaotio$:
I h.E a.d will @intai! a C.nificstc ofco6dr lo S€lf-lBurc for workds .onpdMio.. 6 plovided tor by Sdion 3700 oflh.
ribo. Code am tbc palolrmc. o ath. K* for which thc p6ftil b N!cd,
X n*. ,,0 *u, .",r,",n *olk.6 .onpcGorion iEuranc., s r€quircd by ser ion 37oo of rh. kbor cod., ro' thc Fro,r@c. oa
compdslion insurarcc ffid dd poli.y nunlbcr ac:
CD
P"li.yN".l,", q3O qL.B}r at.9L,3D
I ccdify rhal in rh. p.iforman c ollh. *ork lor which lhis p.rnn is is$.d. I shallnot mploy a.y p6on in any h&nr
e s lo b*one subjdr to rhc w6rk6 @npcBatio. lass ofcalifomia. ed asc thal if I tlould b..omc aubjal lo th.
*0r!6' .oinp€Ntion pmvisioN of Salion 1700 ollhc L€hor C.de, I slull. aonhwnh cosply wnh lhos provitions..
\YARNINGT F.ihr.lo Kuc wort6 co,npqelion covdagc ir nnlawinl, Md $all subj*l u oplors lo dihi.al Fullis dd
civi, n.B up ro oDc hun&.d thoMd dolld ($100,000). i. addniod ro thc cosl otcomFEalion. d@scs e provid.d lor rhc
Sdion 1076olrhe Labor C.de inrcr6l and artomcy s 16.
l)t,( r,,\R.\ r x)\
I h6eby amm und.. p6akyoapdjuryrhar I dn lice$.d undcr provitio. olChaplr 9 (corm.ncing vin Sdion 7000) ofDilition l
oa thc a*ind ed PmfsioB Cod., a.d my lic€e b in lull lorc. &tJ .Itdr
c\o (tr$s. NumLT
q
,"",1.Jr.f,oQ)
cqlsr8lJcro!-LElDllcacrNlI
I h@by ailrm und6 Fehy ol psjury rhal thac ir r @ii(fudioo h.drn8 agdcy for th. Ffomo.. ohhc uo.t 6. whkh lhi. Fmil b
isu.d(se. 3097. Civ. c.).
ATTLICANLDECI.AEAIIO!
I heq 6ftn uodd paaly ofpdj.iy 6n of ttr followirg d(laaliom:
D.solition Pmils-&b6ros Norificdion Fldd.l R.gtrlarnrf,s (Tiil. 40, Pd6)
Rcquir.d l-.lld of Notifi&lion6;d Ihc i.d6al resulnlioB rcsddins 6b6los rflovalac nor ,rpltlbl. to rhis pmjrl
I havc r.ad lhis rmlic.rion md srar€ that thc.bov. infomation is coder I aBr€ ro.orpl, wi$ allCny.nd Cou.ly
&d hdcby aulhorize reprMnariv6 ollhis Ciry dd Cou.ryto dr6 upon th.
trbor€ mfltione! prcp€ny
l.e.(
) .,I.,DJD
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Siqns (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Buildinq
Under Slab / Floor
Bonding / Groundinq / UFER tlzrl"r D+lfloL _+ts"4,
Transformers rl
Torqueing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilings (Hard & Soffit Rough
Ceilings (T-Bar Roush)
Meter Release tp?l2a Pfr{fl6,-4&a
Rough
Service Meter ll14l'k)PWa z# Ej - 'frlvtO Po"t.r-
FINAL t l "-b'114 Dnroc LJLET
Notes, Remarks, Etc
e*
Rev.0B-07-2015
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