HomeMy WebLinkAbout20171875 - Permita\.City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Electrical
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: 2o^171875
Pin #: 45612
Proiect Address: 112 N Susan Sta
Assessor's Parcel: 198-251-24 Lot: 39, 40
Unit.
Block: NA
Bldg:
Tract. 540
Address Range: 110-112
Historic: No
Suite Range:
Zoning: R2
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires:
MARINA & MANUEL GALVEZ
2222 W FLORA
Santa Ana, GA 92704
(7141 654-5041
01 1 16002 51603
01 1 16002 51600
01 1 16002 51603
01 1 16002 57770
Fee Type
Serv Meter
General Plan Update
I ssuance
Microfilm Records
Amount
57.40
23.79
59.30
4.05
Qty
1.00
1.00
1.00
1.00
Fee
$57.40
$23.79
$59.30
$4.05
..
a
Building Use:
Job Type.
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field.
Building Permit #:
Single Family Dwelling
Miscellaneous
Service meter
Occupancy:
Constr Type
Code:
Date.
Date.
Date:
R.3, U
VB
cEc 2019
09/1 1t2020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes: Upgrade service meter. Handout given.
Fee Total:
Paid to Date:
Balance Due:
Amsden, Julie
Every permit rssued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
issuance, or if the work authorized on fhe sife by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
01 1 16002 51600
01 1 16002 51603
01 1 16002 57770
$23 79
$1 16.70
$4 05
$144.54
$0.00
$144.54
lnspector MID#: 2020-1 61434
\
ELECTRICAL.I NSPECTOR RECORD
APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DEI,CARATION
I hreby aflim unda pendty of pojury that I m cxcmpt fiom th€ Contncror' Liccre lrw for thc folloying rcnlSc.703l.5
Busin6s urd Profeion Codc): Any City or County which rcquirs a po'mit to @Etruct. altq. improvq rtrnolbh or rqair my
structuc. prior to its issuocc, also rcquirs thc spplicot for such pcrmit to filc a sigrcd $atmot thgt h€ or slrc b licq&d plN4t
to rhc provisioN of tlE Contractor's Licosd taw (C.hapt6 9. Comocing with Setion 7000 of Division 3 of thc Buins ud
Profsions Codc) or that he or shc is cxmpt thscfrom ild thc basis for thc alle?cd cxmption. Any violatiotr of Sstion 7031.5 by ey
applicantforapmitsubjctsthc applicmttoacivilpoaltyofnotmorethmfivchundrcddollus(3500).
,-l+\ u omc of the popaty, or my cmploye with wag6 6 thcir sle compcrEdion. will do thc wort &d thc stnrc1N is mt
intqdcd or ofiqed for slc (Sc.7O44. Buine md Prcfqiom Code Thc Contrrclor's Licre [8w do6 not apply to e oms of
th€ propcrty who builds or imprcrc th@n, dd who do6 such rcrt himsclf or hq*lf or thrcugh his or ho om cmploy€6,
providcd that such improvmts e mt intodcd or offqEd for slc. tf, howea, thc buikling or improvmt is sld within onc )ry
of complaion, thc Owno Buikk will harc the buda of prcving tha he or she did rct build or imprcw lh€ plopdy for thc pupos of
sD.
_1. re oms of thc propqty, m qclsive ly contracting with licased @ntracton to @nstruct thc projet (Se. 7044, B6ins
md Proftssion Code: Thc Contmctor's Liccnsc Law doc not apply to e own6 ofprcpqty who builds or imprcvG ths@n,
and who contncls for such projers with 8 Contmcto(s) licos€d puE@t to thc Contractor's Licffi taw).
-l
am exempt under B. & P.C. for this reason./\ttzn'DtuA 64L/(?-
I hereby alTirm under penalty of po'jury
_l have and will maintain a Certificate of Conse'nt to Self-lnsure for workers' compersation, as provided for by Section 3700 of the
Labor Code. for the performance of the work for which thc pennit is issued.
_l have and will maintain workers' compcnsation insurance. as required by Section 3700 of the Labor Code. for the performancc of
the work for which this permit is issued. My workers' compensation insurance carrier and policy number are:
fu 4, certi$/ that in the performance of the work for which this permit is issued, I shall not ernploy any pcrson in any manner
so .ls to become subject to the workers' compe{sation laws of California. and agree that if I should bocome subject to thc
workers' compensation provisions of Section 3700 of the L:bor Code. I shall. forthwith comply with those provisions..
a
WARNING: Failure to secure workers' compcnsation coverage is unlawful, and shall subject an onployer to criminal paulties and
civil fines up to onc hundred thousand dollars ($100.000). in addition to the cost of compensation, damages as provided for the
Section 3076 of the l-abor Code. interesl and attorney's fees.
oarcz fl '//- 2- O Appricant:
LICEI{
DECI.,ARATTON
I hereby affrm under paralty of perjury that I am liccrsed under provision of Chapter 9 (cornmorcing with Section 7000) of Division 3
of the Business and Professions Code, and my license is in full force and effect.
License Class: License Number:
W
I hcby affum unda pcnalty of pqjury that thqc is 8 coru(ruc{bn hnditrg agacy for thc pafor:rucc of lhc rcrk for which this pqmit b
isued (Se. 3097, Civ. C.).
Lender's Name:
knder's Address:
APPLICANT DECLARATION
I hereby aftirm under penalty of perjury one of the following declarations:
Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6)
_Required Letter of Notification
-l
cdiry thd thc ftdGal rcgulatioro rcgrdiag rbctos moval re mt eplicablc to thi! prcj6l.
, , I cqtiry thar I hrye ud this applicaion and st8tc that thc abovc iofomdion b cor€{. I agr to comply with 8ll city md Couty
ordimcB ud Ststc tts rcldiru to building con$rucriorl ad lEcby fltrhorirc rcpwrtatiE of thi! City ed Couty to atq rpotr thc
abovc mtioncd prcpsty fq ilspclion purpos6.
AppncnrorAsqrst,.*-,rl44RtP A G ALVeZ orr",Q - //- 20
Pemlte mm. (prlol):
Site-Work
Underqround
Pole Bases
Light Standards A
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm I Dampers
Communications Cable
/
Building
Under Slab / Floor ,4
Bondins I Groundins IUFER
Transformers U v
Torqueing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Roush)
Ceilings (Hard & Soffit Rough n
Ceilinqs (T-Bar Rouqh)ln
J\Ieter Release 6'22-fu *Jq-1'6 IY
Rouqh 0.-
Service Meter 6,71 ^7A
FINAL \)
Notes, Remarks, Etc.
h
I
Rev. 08-07-2015
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