HomeMy WebLinkAbout20166282 - Permit (2)City of Santa Ana
Permit Counter: (714) 647-5800
20 Civic Center Plaza (M-19), Santa Ana, CA 92702
l nspection Requests: (7 1 4) 667 -27 38 l nspector Section: (7 1 41 647 -5853
Electrical Permit #: 2lJ16628.2
Pin #: 4475IJ
Project Address: 2424 N Tustin Ave
Assessor'sParcel: 396-261-55 Lot: 8
Unit:
Block: A
Suite Range: Unit A-12
Zoning: R4
Owner:
Address
Contractorl
Address:
Tenant Name
The Bascom Group
26 Corporate Park Drive, Suite 200
lrvine, CA 92606
(866) 695-5s91
Katerra Renovations, LLC
3200 Earhart Drive
Carrollton, TX 75006
(972) 818r065
01116002
01 1 16002
01 1 16002
01 I 16002
01't'16002
51603
51603
51603
51600
51603
Qty
5.00
12.OO
4.00
1.00
1.00
Fee
$7.00
$18.24
$4.04
$21.25
$52.98
Fee Type Amount
125 Volt Receptacle 1.4O
Light Switches, Occ. Se 1.52
Light Fi)dures 1.01
General Plan Update 21.25
lssuance 52.98
Phone
State Lic #: 1009989
Lic Type: B
Bus. Lic #: 366547
Workers' Compensation lnsurance:Carrier: Midrvest Employe/s Casualty Company
Policy #: BNUWCo139070
Expires: 0110112019
iH
7 /2 / ]1118
Irnns* !
LEOSALI
s-1 of
1362.c:i
.: Ffl
t7?,211
It, r
',,,rr Ifii'pti:r:r?;J17i9;7 -
Ironsq,:t ion Totol
Notes: Fixture change outs (unit 12)
$4rt/,7"iltBuilding Use:
Job Type:
Nature of Work
Planning Conditions:
Planning Approval By
Plan Checked By:
Permil lssued By:
Subject to Field:
Building Permit #:
Chavez, Dave
R-2
VB
cEc 2016
06/2sl20't8
Account#
Multi-Family (5 or more uni Occupancy:
Miscellaneous Constr Type
Fixture change outs (unit 12Code:
Datel
Date:
Date:
Misc. Receipl;
Misc. Receipt:
Misc. Receipt:
Total
$21 .25
$82.26
$103.51
$0.00
$103.51
lnspector MID#: 2018-144266
011 16002 51600
01116002 51603
Fee Total:
Paid to Date:
Balance Due:
Bldg: 24.4 Address Range:
Tract: A.B. CHAPMAN Historic: No
Phone;
iirterr{l f(rnD!,nt ions . l-1.,1
Every pemit issued shall becorne invalid unless th€ work on the site
authoized by such permit is conmenced within 180 days after ils
tssuance, ot if the work authoized on the site by such permit is suspended
ot abandoned for a period of 180 days aftet the time lhe wo* is
conmenced.
ELECTRICAL.INSPECTOR RECORD
COMMENTSAPPROVALSDATEID/SIG.
Site-Work
Under round
Pole Bases
Li ht Standards
S S Pool Fountains
monumentSiNS
Lile Safet /Low Volta e
Fire Alarm / Dam ers
Communications Cable
Under Slab / Floor
/ Groundin / UFERBondin
Transformers
To uein
Sub-Panels
Air Conditioners
Rool To E UI ment
Faclor Wired Unit
Walls Rou h
Ceili S Hard & Soflit Rou h
-Bar Rou hCeilins
ltileter Release
?
Service It/eter
FINAL
Notes, Remarks Etc.
OWNER BUILDER DELCARATION
I hcrcby llli,m under p.nahy ol ltijury rhar I a cxc.rl'r from rhc Contracros Ltcn\c Ir* ror lh. followins du (Ss 70ll'5
l,lsincs\ lnd PNrcsio. CoJc): Any Ciry or Counry whict rcquits I p.mrir ro consflcr. .lltr imlrovc. dcmlish nr mn'n 'nt
srdcrurc. Ein b ils , issromc- !h. rcquircs rhc aPplica lor such lcmil to file r sigftd sttlcmnt rhor h. dr shc is liccikd pursurni
tu rhc ,rurisn)ns olrhc C.nlruclols Lice.s.d riw (chaPr.r 9. Conr@trin8 silh Sccrt,n 7000 ol Division I 'l thc Bnsi'r€* trnd
Pmlc$n,n\ C.dd) or lh{i heorshc is.xcmB dcrcfronond rhcbrsis forlhcallcscd cxcnuiotr AnvvioldrionofSsrionT0ll'5bva'v
rppli.rnr lor apcrmir suhjcc(rh. atPliconrloa.ivilPcn0xyornolmrcthrilvchundrcddollus($500)
l- trs own.r ol rhc Doncn v. .r nry cnrdoler uili N!8.s a\ rh- ir $h comFi\rn I. Eill do rh€ *ork ud f, srErtr' h mr
imdidrd orolLrcd for elc (sd 7l)4,1. Btrsines !.d l!rDr.sn,n\ Codc:'Ih. Contn rois Lien\c lf,s docs norllPpl!
'o
an osrcror
rh. propcny (ho l ilds or illllrok\ rhcE)n. ,id who lk\s n'ch x,I hnnscll ot hrFclf or rhiirSh hn or hcr own cnDlovccs
lrovidcd rh0l such impmvcnEns !.c nor inrcndLrt .r ofliRl for eh li tFsct$. rh. huifling or iqftvcnr.r is sU *irhin orc )ttn
;rcon{,lcri(r rh. Own;r Buiklcr willh.rc thc l,ltdcn orp$virre rhdl hc or shc Jid tror huiklot impnrt thc lnilEnv i{r rhc lury$e ol
I. a\ .*Nr of thc fiopcny, n.r cxclusiEly conrDcring wirh licctrsd conrra.ion ro onsldcr rhc t ojNl (Sc. 7l]'t4 auqne$
t ftlrsshnCodcThcConrrucrorst-iccnscL,wdocsn.lryPlyroanowocrolllropciivwhobuildsornnprolcsrhcr€o''
lnd whn conrmch tor stch poixts wnh a Curracn)n rr lictr$d lununr b !h. conlruclois Li..ns tiw)
-l
n drcnrpt undcr SB_li.n-, B. & PC lorrhisr.*on
Dat€ own.r:
wontPxs' r-oitPnlsl nol
NECI {IIATIiJN
, hcrcty rfft r.d.r pcnollyofp.rjuryonc ofthc followiu dc.larariotrs
l havc mdwill Ein(,in sCcnificlrcofconsc ro Sclf lnsuE tnt sukcF comPc.\arion.s rovidcd ror bv Sarion:l?otl or rhc
tihn Cri.. for I hc perfolfumc of Ih. woA roi which thc tE.rnir t i\sncd
-l
h{vc sid willmintoio workcr' .om!.nsolion insuranc..,i i.quircd bv sdrion l70o ofrk Labor Codc. for lhc p'rfonntrme oI
ihc s.rk lbr which this pcmir is L1sd. Myworksi conPctrstlion insurancc.!riq ond rnicy nun$ct tc:
,r,.,_ ^,.*, Otl\)U\^C0 l.3t o-7 "
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.cniry rhrl i. thc n rfo!tu,f,c ofrhc work for whi.h rh( ptirnil h issu.d. I sharl.or enDlov anv p.rcon in 3nvrmnmi
v) !s b b!<,m sbjftt lo lhc workcrs comp.ns.o.n law( olCaliromia. rnd osrcc rhnr irl should t conk \xbiar ro lhc
qorkc6' confcnsdion pmvi\ion\ or s.lriotr 17(x) ol'lhc lirtr Codc. I shlll. rffrhsiih co.rdv *ir h rh.* ,rrovhions
c,vil linc\ up t, oN hund..d rhouu d
::-*"?ili''6']-.
rrsc n u hwtul. ud \hall suhjcct nn cnrPk,$r h aimitra! Pciilrics ind
i', rdditi, ti rl,. .o{ of nrgcs es trovidcd for rhe
Ihcrcbytrlrtnr!tuldrpcnalryoltrcrjlryrhdldnliccn$dundctPmvisionotChuPlcrgl..mrmNinswirhsd6'?O(x))nrr'ivhidl:l
of rh. Busircss ond PrntcsionsCodc. and nry li.eis is in tull lorcc and cffc.r
fs tooa ?zl .
l1.t.t'o YAtv^-
CONSTRTI(]TIoN I FNDIN(: A(;ENCY
I h.rhy trfiirm undcr p.r,lryolpcliuryrhar rhdc is d.otr(nNrion knding.Scncv lor rhc ptrlunmcc 'lrhc v'rk for whichihi! tfnnir n
i\sucd iS... 1097. Ci! C )
lrn,l.r\ Nrtrr:
APPLICANT IIFCLARAfION
I hcNhy dllnr uniLr rcmlry ol p{rjury oic olrhc nnhwin-q dtcl rrridr:
ocnnnion Pcnnik Asb.(.s NolincBiion Fdd.hlRcguhlioN (lnh () Prn6)
Rcqxircd LctrcrotNo!fi. ion
-l
ed if, rhd thc fcdcrsl Esnlnrions Eg0rdins r\trslos dnr,vtl tr. .ot atPltahl. to rhis lnjcc'
ZO (d,ryrh l h$c rcod rhr\ tllllrornn sd $!rdh, Lhc,tnv. inlbrnuri.n i! comcr' I lcd rocomPl, wilfi {llCirvtnd Cou'lv
iJmanc',na Sr:rc u*. rcbrini io buiLdins (ohrdr'oi. nd hcrlbv alrhorizc rertcrcntdilcs orlhh Cilvond Countv ra 'nlq ulx)o rlt
$ovc.Enlioncd potcdy lor ilrspcdt,n puDoscs.
Applidrt nr Agenl SiAnalurc a.?-o
Buildinq
Walls (Conduit)
>a?aRouqh
II
lfre
If,nJc.s AJtIc.'
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