HomeMy WebLinkAbout20165786 - Permit (2)Project Address: 1417 S Main St Unit:
Block: NA
Address Range:
Historic: No
Suite Range:
Zoning: CSM
q
Assessor'sParcel: 0'14-032-35
Owner:
Address
Medhat Rafael
17150 Euclid St. #322
Fountain Valley, CA 92708
17141337-0747
South Main Dental Group
Fee Type
01116002 5'160: Serv Meter
01116002 5160: Min Fee Adj
01116002 5160C General Plan Update
01 1'16002 5'160: lssuance
Amount
5'1.29
'r 9.35
21 .25
52.98
Qty
1.00
1.00
1.00
1 .00
Fee
$51.29
$19.35
$21.25
$s2.98
Phone:
Tenant Name
Conlractor
Address:
Owner-Builder
Phone
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Building Use:
Job Type:
Nature o, Work
Commercial
Miscellaneous
Serv Meter
Occupancy:
Constr Type:
Code:
B
VB
cEc 2016
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Pezeshkpour, Ali
Zrnioa,nffis\
Date
Date
Date
06/0s/2018 Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
06/05/2018
Account#
Every pennil issued shall become invalid unless the work o, the site
authotizod by such pemit is commenced within180 days after its
issuance, ot if the work authoized on the site by such peftnit is suspended
ot abandoned for a period ofl80 days after lhe time tho wotk is
commenced.
$144.87
$0.00
$144.87
lnspector MID#: 2017-139483
$21.25
$123.62
Cify of Santa Ana 20 Civic center Plaza (M-19), santa Ana, cAgzloz Electrical
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Sectaon: (714) 647-5853
Permit #: 20{65786
Pin #: a2463
Lot: 9
Btdg:
T.acl:245
Botch+:44111 - 6/5/2111
tlf{ ire: (I YH Tr(tns+;ArcL+l R
ttrp ti : 02?89(t84 - 6/5/
Tronsq,:t ion TotalRAFAEL NEDHAT
Generol P10n Updote
rl1 1 I 6t:rit2- 51 60ot:[:ttt-
F:l Ectr i ,:o I
fll 1 160r-12- 51603tfir:r-
U iso
(:(:* i *r ilrtt*rrr* 1 ?
Fee
ft
Notes: Per Notice To Correct Work Service meter
replacement like for like. "*No UUw required"*'
Fee Total
Paid to Date:
Balance Due:
01116002 51600
011 16002 51603
DATE IDiSIG.COMMENTS
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Salety /Low Voltaqe
Fire Alarm / Dampers
Communications Cable
Building
Under Slab / Floor
Bondinq / Groundinq / UFER
Transformers
To uerng
Sub-Panels
Rool Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rough)
Ceilings (Hard & Soffit Rouoh
Ceilings (T-Bar Rouoh)
lvleter Release
Rough
I --_\
FINAL 7 ls/|il )
Notes, Remarks Etc
OWNEX BUTLDtrR DELCARATTON
I hercby 0finm undcr pcnalty of pcljuly rhar I m crcmF fmrh rh. Conlr..ros Li.cnk trw lor
'hc
rollowine m.$n (Se.7oll 5
ausinc{\ rnd Plofc$ion Co<lc): An, Ciry or Counry trhich rcqntes ! rrmir to consrrud, ol!s. improvc. dcmolkh or mFt any
rlru.lurc. Frior ro irs hru,ne. ul$ rqutcr lhc +pltdr for su.h pc.mir ro filc ! sirrcd sulemnr rhd hc or sh€ is li.cn*d ,uriuul
tu rhc lnwision\ oI tlE A,nrrrctois Licensd L.w (Cnll'!s 9, Comnrmin8 wirh Sccrion ?00o of Divtion 3 ofrlr 8usi.c$ and
Pmtcrsionr Codc) or rhat hcorrhc ircicmpr rhcrcfromsnd rhe b&\is forrh€alkscd cxc,r{rion. Anyvbl.tionofsstionT0ll J hy y
opplicor iin e Frmir suhirh rh. aptlic,nr r. d.i!il r,c.alrrolnor nrc rhao fivc hlndrcd dollars (t500)
Lnrowncr.llhepropcny.u.m,emplortcs*lrhwo8esrsrhcnsolconrFnsulion-willdoltEw( ondIhc slutN n nor
i.ldtcd or ofcrcd fd eL (S1r.70,14. ausirc$ rnd Pmfcrsiois Codc Thc Co.krcrois ljcens Lrw d{rs frn aprly r, i6ow.cr oi
rhj lmpcny who h ds or i'qx,B rhcEr. and sho Jms och wor* hinsclfor hcr*lfor rhmu8i hi\ or hs own carploFcs.
pn,vidcd rhd such inlroKnrnt aE nor inrcuLi o, offsc{ ior elc lt howcE th. huitiiru .r nr{rorcrBd n sld *irhr orc }rr
ofcoryrtl i,nr. ltE O*ncr Buikh will haE thc hdnlcn ol pn,vins thd lr or sh. did m huiki or inpnnt th. ln,Fny f.r rh puqxM of
_1, !\ ownsol'the pm!.ny. ancxclusivclyco raclnrS wnh li..nsd conri.rors ro onntud rtr pr+.t (Sc..7044. Auiinc\r
Md Pn,tusbn C(ic:Ihc Conrracttr \ Liccosc Law does not !Ipr, h anowncr of poacny qho builds or improvcr thcrl$n.rnd qho co.t,.rs ror such pmjck wir h u Conrhck (s) lienscd ,rBUUr b rhc G)ntactn r lncnsc ljs)
-l
aDeicnu udcr Sc.r.tr*4.4.19
I2li(rrt !t!1
I hcr.by.fllrn und.r p(nrlrrof Frjuryonc of rhc f(,lbwing d.clnr{nrn\:
-lhavcud
Rillnui nirrC.nilicat..lCrtr{nroSclflnsurcra,sorkc^'.unrtrnsnri(,h.r\ r$v'dcdlnbySccrn'nlr7(nofrhc
Lab.rc(xlo.nrrh.rcrfornlm.colrh.s.rklushi.hrhcpcnnir i\i\sucd
I hrvc and $illmaintrin $orkcri compcnsarion insuranc.. trs rcqutcd byScdlon l?(xrolrhc Laln Codc. for rhc rrr.rrorcc oi
rhc trdk nr shich rhis pctrrir is irski My sorltcr' .nmren$l iotr in\ur!rcc .lricr lxl plicy .u nthcr m:
l..n,fy rhir i. rhc l'rrf{r'ek. ofrh. Nork lbr sti.h rhi! lcnnir is i\sucd.I shrll nol rmploy y pc^o. in any nrMftr
$ ash h.Lux subj.rt to
'hc
sorlcs'.onwnslrion lnws ofcrliromid. Md aCec !h,! il I should k*onE subjd lo ll'c
*ortss.olnpcnetionpmvisionsolS(lionlT0oolihchbncodc,lshnll.lbnhanh.oq)lywirh$osFrovisions
W RNIN(;. Iirlltrc (i srtrrc trr'kc^ ..rrtf, \iro r.r.'r8r i\ tr lntraul. nil.lrllnrh.J..r ri.nrpl,yo n,
ciril lincs up to onc hund..d thous0nd dollars (S nrr ro rh. co{ ofcompn<lrnnr. datr
L^4:(
"a
I hcrby rlllnn rnd$ pcmlry ot Frjury thrr I a lirnsd undcr pn,li\nrn ol Chrtrd 9 (
or rhc Du\in.s and Pn,rcsi,'n\ Codc- nl m,liccns. is in lirllturNa etltcr
-Liccnsc
Nu$cr
g)N$rallgu0lrrNDllc-acErcr
I hcrby rit'n trndcr lcnnlry. t pcrju.y lhar rhsc n ! con\rdcrion lcndins,c€.cy ftx rhc ptrf{,tun.c orrlc work ror whi.h rhii Frmir i\
itsucd (Scc :1097. Civ C ).
I ccnity rM I luvc tuM rhis i{u 'kl inrrrl,nilr ah,v. inlnrn ri,n, nro,rrrr r. c. lflly wirh all Ciryrtrd Counry
onli,rn.cs lnd Srrr. Lrw\ eldin8 huiUirigcoi{ .ri{,n. mJ hrrrhrrdhorir.ofrhi! C[, rnd Counry r' ctrrd uF rhc
lrrc trf,nrtrmrl fn,p.ny,,tr 6-AppliGtrt or /\Actrl Siamlu )r
DT C)
r.u7
ELECTRICAL.INSPECTOR RECORD
APPROVALS
Air Conditioners
Service Meter
AIfLTANLDECI.ABA]]O!
t Ercny ailimr undcr pctrolly of pcrjury one olltu hllowiS dNlsrlions:
Dcnnlilion Pcrmih-AslE(os Nolilicalion !-cdc.r I R.Bu L! io.s (Tir tc (). Prn6)
-RcquiFd
L.rrcr ol ,ldiff,.rion
_l ccnify that the fcdqal E8llari.ns Esadin8 ostEsros ,cmval arc nor arplicublc ro rhis pnj.d.
f --f------