HomeMy WebLinkAbout20165954 - Permit (4)City of Santa Ana
Permit Counter: (7 1 41 647 -5800
20 Civic Center Plaza (M-19), Santa Ana, CA 92702
lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Electrical Permit #: 20{65954
Pin #: 74ll92
Project Address: 1901 E First St
Assessor'sParcel: 400-081-08 Lot: POR '15
unit: 136
Block: NA
Btdg:
Tract: MAYBURY
Address Range: 190'l-'1903
Historic: No
Suite Range:
Zoning: C5
Owner:
Address:
Phone:
Tenant Name
Contractor
Address:
Lyon Realty Advisors lnc
4901 Birch St.
Newport Beach, CA 92660
(949) 838-1239
Por-ovita Juice Bar
MITCHELL GENERAL CONT
52 TESLA
lrvine, CA 92618
(949) 387{477
Fee Type
01116002 51603 Serv Meter
01116002 51600 General Plan Update
011'16002 5'1603 lssuance
Amount
139.86
21 .25
52 98
Fee
$139 86
$21 .25
$52 98
Qty
1.00
1.00
1.00
Phone
State Lic #: 831334
Lic Type: B
Bus. Lic #: 352269
Workers' Compensation lnsurance:Carrier: lnsurance Co of the West
Policy #: WSD504010800
Expires: 03/08/2019
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planninq Approval By
Plan Checked By
Permit lssued By:
Mixed-Use
Tenant lmprovement
Service meter
Occupancy:
Constr Type
Code:
B, R-2
t A
cEc 2016 Notes: lnside location. Underground feed
Datel
Date:
Date:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Amsden, Julie
Subject to Field:
Building Permit #:
Every permit issuod sha become invalid unless the work on lhe site
authoized by such permit is commenced within 180 days after its
issuance, ot if the wo* authoized on the site by such permit is suspended
or dbandoned fot a peiod of 180 days after tha time the wotk is
commenced.
o't24t2018
Account#
$21.25
$192.84
lnspector MID#: 2017-139449
01 1 16002 51600
01 116002 51603
Fee Total:
Paid to Date:
Balance Due:
$214.0e
$0.00
$214.09
APPROVALS DATE ID/SIG.COMMENTS
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Sions (monument)
Life Safety /Low Voltaqe
Fire Alarm / Dampers
Communications Cable
Building
Under Slab / Floor
Bonding / Grounding / UFER
Transformers
Torqueinq
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilings (Hard & Soflit Rouqh
Ceilings (T-Bar Rouqh)
lVleter Release
Rouqh
Service I\/eter A
FINAL \)thaltJ ^,HultNotes, Remarks, Etc.,l--11 tr "- -:J::7
OWNER BU!LDER DEI-CARATtON
I hcrchy oifirm under rEnahy.f pcrjury rhat I n ex.ntr rrom (hc Co rador'LiNnse liw tor rhc rolloNin8 rc.sn lscc 7O3l5
Busirlcss rd Prt,r.scn G)dc) Any City or Counly which rcquncs a pchrir ro .on$fl.t. 0lir. inl[trovc. dcnnish or rcI)an ,ny
{tu.ruo. pri.rro ns issurncc. also rcquiresthc lpplicMl lbr such rc'nir t, filc, sign.d sl.lcnrctrt lh.r hcorshe is lic..scd pu udnr
b rh. prcvhion\ oftlr C.nra.rols Lic.nscd tiw (Ch0/cr 9. ComDcncing with S..rnrn 70d) uf Dilkion 3 ot rh. Buri'ts rnd
Pmlcsions Codc) or thil hcorshc iscreqrr rhercfrofilnd rhc bNh lnrrh. dlc8cdcrenDlion Anylidario.ofScdionTllSl.5byuny
applicanrforapcrnislhjccarhcJlpli.nnrlor.ivillrnhyornormorcthMr'ivchrndrcddollatr($500).
!.xso*rcrorrhcDopcny-ormycnrploycdswilhwn8csr\rhcnk,h.olp.rsdion.willdorheworkandrh.nru.rmnmr
inrcndcn oro0ercd lor salc (Se.7014, Busirrs a.d Profcssions C.dc l hc G)ilrlcrois l,iccnt L2w doN trol .pply lo u owncr o{
rhc tml.ny wh. huilds or nn orcs lhcB)r. and who docs such so]t hiDselr or h$slr o. lh ou8h hh or hq o*n .mlk,y.cs.
pmvidcdrnar such inrprokftn* c nor iricrxLd oiDrcntrl for sdlc.ll hwcvcr. lhc hU iltiry .r imi,otmfi hsldwirhinonc )tr
ofomptb,. ttE Owncr Builds will hrr rhc ltrdcn or pmling rhd rt or shc dt tror huild o! impow lhe pDFiy for ll[ PUIIN ol
-1,
$oqrNrolthc flopcny. d.xclusivcly.oita.rirg wirh iiccnscd coffadoN ro consrru.r rtc pmjc.r (SL\. 7044- 8u5ir'css
Md A.fcssi.n Codd: Thc Contrdofs Liccnsc Lnw docs n.l0prly ro an o(ncr olnopcny who builds or nnptr,tcs rh.t.n.
rtrd qho o mcls for such lm]cck sirh r Contacrrl\) liccn\cd rur\ld ro rhc Co rcl(r'r l -iccn* Iiw )
I Jn'crctrrDr undcr SNIrn . B & PC n1 rhi. rcJ..n
UATtrESS-I;UIIIENSAIION
DES'NAIIA!
I hcrcbyrtlimundcrncnilry.In.rjury.n .f rhclalbwnrgdc.lrraliotrs
I hrv. flnlvill mrinhin !CcnificorcoiConEntro Sclllnsu.e for tr!&c6 .unrrnsalion..s pmlidcd ftn hy S.crion l?00 ofrhc
uhtr Co&. ror rhc p.rroflnaRc ofrhc sork for whlch ltc pcrmil h tsucd.
, ha\r dtrd vill nrrirr{ir sorkcs compctr
rhc sork ror *hi.[ rhh |Ennir h hn'cd My
sarion insuranc€. 's reqoncd bySc.liotr l?0Oofthc LoborCodd, nJr rhc lrcrlomrtrcc oi
workcrs compcnssri.n i'ruran.. caricr md policy nunbcr ue:
lvgr-t{ kN "&U ,F rW w6r
iogao
-l
.cniiy rhar i| lhc pcraormrnce.frhc work fu whih rhis F'nir C nsuca- I shall nor cnDk,y any |.6on ir.try nmnncr
$ rs b b.co r. suUc.r kr rhc workcn co,nFnsdion l.w$fcllitnnia, rtul iltc rhar if l shotrld hccom subjccr io rh.
workcA.olPcns ionpovisiotrsofSdioD3?u)oirheLrhorC.Jc.lrhtrlr.tun[wirhcomtlywithrlntPn!tn,n\
WAIININ(;: liilurc 1o ssurc workcr( conll)cnsdioo cortug. ir uninwful. md shrli subJ..l m cn,pk,ycr h Lri'n$.lN* ic\ un
.ivil fircs np lo orc hn.drcd lhouslnd dollar\ ($lo0,o(lo). in addi ro thc cost ol compensqrion. da [gcs as prorided r'or rhc
s..r'nn 1r,76 ofrh.l ahor Codc rrercrr
V,.," . f-r[,*
DECIAEAIIO!
I hcrchy nfiit! undo pcmlryofpcrjury lnrl I an liansd under lrovision orCh,I.r 9 (omnrcrcins with Secrion 7(n0) oioivtion 3
oi lhc BusnEss ond ttolissionr Cod., and my lhcnsc h in till lbra dd cl'isl
0ro* I j<Ln-(e:l
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T]ONSTRI](]TIoN I-ENDIN(; AGINCY
IhcrchyrffinnunJ..pcrlr!olt)crjuryrhdIhcr.isrcon{rudbnb i'rgxScncy nrrhc PcnonMtrcc ollhcsork i{r{hi.hrhi\ Ifnnit is
tsucd (scc 1097, Civ. C.)
titrd.asNa.r:-
AITLICANLDESAAAT9N
I lBrby llltmundcr pcnalry ofpcrury orc ollhc i.ll.win! dcclarariors:
Dc'nolnion P.irnils-Asbc{osNorificrionfcdelal RegnE i{rns(Tirld40.Pd16)
Rcquncd L.ncr oi Norifi coliotr
l.crilydid lhc icddrlrcsuhlnnx r.Erdina rsbeio\ ru'noul rrc or Uflic$lc kr Ihis F)jccr
lc.dilirharlhrvcrcrtlrhisrtfli..rionrtrd{dlclhdthcahi!crtrhnMi,)niscorccrIa!a.!r,.orl,yqirhallCir}xtrd(,ndy
rucrio.. Dd h$cby iulhorizc rcpr.scnr ivc\ oflhsC
ihov. nrori,,tr.d Dn,tIrt lin N /'7----It41x+k
' P€mritee Dnre (prinl){rL t"€z-
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ELECTRICAL.INSPECTOR RECORD
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