HomeMy WebLinkAbout20169581 - Permit (2)a City of Santa Ana 20 civic center Plaza (M-19), santa Ana, cAg27o2 Electrical Permit #:2Ol 69581
Pin #: 6o^787PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Proiect Address: 1129 112 S Van Ness Avea
Assessor's Parcel: 013-094-08 Lot: 66
Unit:
Block: NA
Bldg:
Tract: 648
Address Range:
Historic: No
Suite Range:
Zoning: Rl
Owner:
Address:
Phone
Robefta Rogers
1129 S Van Ness Ave
Santa Ana, CA 92707'1135
(714I. 41 5-e8s8
Fee Type
01 1 1 6002 51 603 Serv Meter
01116002 5160C General Plan Update
01 1 16002 51603 lssuance
Amount
55. 37
22.95
57 20
Qty
1 .00
1 .00
100
Fee
$55 37
$22 95
$s7 20
Tenant Name:
Contractor.
Address:
Owner-Builder
Phone.
State Lic #.
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #.
Expires:
Botch*:5175rJ 8/3tii?t-t1? ID: nPINEDAOffice:(.TYH Trnns*:65 7 Lri-')
Acct*: Ref*: ZrJl6?:Ii3l
Rcpti:tr2739?Lr6 s/30/2[r1? 3:?3 F'ri
Transoct i on Totn1 t549.7.j
Rob er t n Rog er' g
Genernl F lon Updcrte Fee
0t I 16u02- 51s[t[tt-tt-tt-t"
Electr i cnI
Ltl t l6ltu2- 51,5t-t3t-tt-tt1-
llcr st er Cor d
CC+ : *rlr***r***x[r4SI
A'?t4 i'lr,*-l.ol .'l
$11?"1:,
AE tt\ -)p.-tt 7 . I
Autht:?+ri,4:tl,
Building Use:
Job Type:
Nature of Work
Planning Conditions:
Planning Approval By:
Plan Checked By.
Permit lssued By: Hernandez, Kathy
Subject to Field:
Buildins Permit #: 10199067
Accessory Dwelling Unit-C Occupancy:
Miscellaneous Constr Type:
Service Meter Code:
Date:
Date:
Date:
R-3
VB
cEc 2016
08t30t2019
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes: handout given
Fee Total
Paid to Date
Balance Due:
01 1 16002 51600
01 1 16002 51603
$22 9s
$112 s7
$1 35 52
$0 00
$135.52
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
lssuance, or if the work authorized on the sife by such permit,s suspended
or abandoned for a period of 360 days after the time the work is
commenced.
lnspector MtD# 2019-154094
ELECTRICAL-INSPECTOR RECORD
n0 rl7 1n -i r
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEI,CARATION
I hcreby alfirnr undcr pcnrlty of Frjury lhar I mr excmpt fmm lhc Contraclo6' Liccnsc l-nw lbr thrfolhwing rosryr (Scc.70.11.5
Busincss and Profcssion Codc): Atry Cily or County which rcquircs a 1rcnnit to construct. altcr. improvc. domlirh or rcpair any
slruclurc, prior to its issuarcc. also sluircs thc applhant for such Jrcrmit to file u signcd stalemtrl that hc or shc is liccnsd pu-,suttl
lo the pmvisions of tlrc Conlrsclor's Licenscd llw (Chaptcr 9. Commcncing with Setion 7()0O of Division 3 of lhc Busircss and
Prcfcssk)nsCodc)orthathcorshciscxcmptthcrcfromandlhcbasisforlhcallcgcdcrcmplion. AnyviolalionofSccthnT0-il.5byany
aIrplicanl for a pcrmil subjccls thc applicant to u civil pcnalty of not morc thiln fivc hundrcd dollars ($5(x)).
_1. as owncr of the proprty. or nly cntployccs with wagcs as thcir solc conrpensalion. willdo thc work and the slructure is not
irrlcntlcd or offcred f<rr salc (Scc.70.14. Busincss and hol'cssiotrs Coclc: 'l'hc Contractor's Liccnsc Law d<lcs not aPply to an owncr of
thc propcrly who builds or itnprovcs thcrmn. and who tloes such work hirnsclf or hcrsclf or through his or hcr own enlployccs.
providc(l that such inrprovcnrcnts are not intcndcd orotTercd ttrr salc. lt. howcvcr. thc building or improverrnt is sold withinonc year
of cotnpletion. thc Owncr Buildcr will havc thc burdcn o[pnrving lhat hc or shc did not huikl or itttprove the propcrry for thc purprsc of
salc).
_1. as owncr of the propcrty. ant exclusivcly contracting with licenscd contractors to conslruct thc pntjcct (Sec. 7M4. Busincss
and Pnrfession Codc: Thc Contraclor's Liccnsc Law does not apply to an owncr of propcrty who builds or improves thcreon.
and who contracts firr such projccts with a Conlractor(s) liccnscd pursuant to thc Contractor's License kw).
-l
anr cxcmpt under Scction-. B. & P.C. for this rcason.
Dale: _owner:- * -WORKERS' COI\I PENSATION
DECLARATION
I hercby affirm undcr Jrcnalty of perjury one of the following dcclarations:
_l have and will maintain a Certificatc of Conscrrl lo Sell'-lnsure for workers' cornpcnsalion. as providcd for by Scction 3700 of the
l-ahor Code. for lhe pcrformance of the work for which thc pcrnrit is issucd.
_t havc and will maintain workers' compensation insurancc. as rcquircd by .Section 3700 of thc Lrbor Codc. for thc pcrformance of
lhe work for which this permit is issucd. My workers' compensation insurancc carricr and plicy nuntber are:
Policy Number: ExPircs:
_l certify that in the performancc of thc work for which this Jrcrrnit is issued. I shall nol cnrploy any person in any manncr
so as to bcconr subject to the workers' compcnsation laws of California. and agrcc thal if I should become subjcct to lhe
workcrs' compensation provisions of Section 3700 of thc Latnr Codc. I shall. forthwith cornply with those provisions..
WARNIN(i: Failurc to sccure workcrs' conlpensation covcragc is unlaw{'ul. and shall suhjcct an crnployer to crinrinal Jrcnaltics and
civil lincs up to olc hundrccl thousand dollars (Slm.(Xn). in addition to thc cost of conrpcnsalion. damages as provided for lhe
Sectiort 3076 of thc l.atxlr Codc. intcrcsl and attorrcy's l'ces.
Appliurnt:
DECLARATION
I herchy afifirm undcr penalty of perjury that I anr ticenscd under provision of Chapter 9 (comrrcncing with Section 7fiD) of Division 3
of thc Business and Prol'cssiorrs Codc. and my license is in full forcc and cffecl.
Liccnsc Nunrhcr:
l )nle : ( 'ottt r:tclttr
C( )N.S'l'Rtl("1'lON LI-N I)ING r\( J liN('t'
I hcrchy affirrn undcr JrcnaltyofFrjury thnl thcrc is il cotrstructioil lendirg ogcocy for lhc pcrformancc ofthc work for which lhis frcrDil is
issucd (Scc. 3097. Civ. C.).
Lrnder's Namc:
APPLICANT DECLARATION
I hcrcby affinn undcr penalty of pcrjury oltc of thc following declarations:
Dcrnolition Pcrrnits-Asbestos Notification Fcdcral Rcgulations (Titlc 40, Part6)
-Rcquired
Letlcr of Notification
_l ccrlity that the fcdcral rcgulalions rcgartling arsbcstos rcnrot'al arc nol applicablc' to this projcct.
_l ccnify thnl I hlve read this applicnlkrn and stiltc lhat thc atmvc i[li)rtrulion is coftcct. I agre to conu)ly wilh all City and County
ordiranccs and Stiltc liws rclnting lo huilding conslruclion. arxl hcrcby aulhoriz. rcprescot{tivcs of this Cily ond Counly lo cnlcl ulnn thc
above rrrcntioncd properly for
r\pplicirnt or Agenl
Pernritee nfl nle (print ):
purp()scs.
Date:_
Site-Work
Underqround
Pole Bases
Light Standards
Spas, Pool, Fountains
Siqns (monument)
Life Safety /Low Voltaqe
Fire Alarm / Dampers
Communications Cable
Buildins
Under Slab / Floor A
Bondinq / Groundinq / UFER I
U \J$ftnl)
Transformers \\_/
Torqueinq
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilinqs (Hard & Soffit Rouqh
Ceilings (T-Bar Roush)
N/eter Release
Rouqh A t A
Service N/eter l0-I *dr*n
FINAL o )h0 ft hu +W
Notes, Remarks, Etc lr l\l
L