HomeMy WebLinkAbout20165868 - PermitCity of Santa Ana
Permit Counter: (714) 647-5800
20 Civic Center Plaza (M-19), Santa Ana, CA 92702 -S Electrical
lnspection Requests: (7 14) 667-2738 lnspector Section: (714) 647-5853
Permit #:20165868
Pin #: 7ll124
Proiect Address: 403 N Susan Sta
-
Unit:
Block: NA
Bldg: E
Tract: NA
Address Range: Buildings
A-H
Historic: No
Suite Range:
Zoning: R2Assessor'sParcel: 198-261-23 Lot: NA
Owner:
Address:
John Henry Foundation Care Facility
403 N Susan St
Santa Ana, CA 927033433
(714) 480-002s
John Henry Foundation Care Facility
Fee Type Amount
01116002 51603 Light Switches, Occ. Se 1.52
0'l 'l '16002 51603 Light Fixtures 'l .01
01 't 16002 51600 General Plan Update 21 .25
0'l 1 16002 51603 lssuance 52.98
Qty
1.00
1.00
1.00
1.00
Fee
$1.52
$1.01
$21.25
$52.98
Phone:
Tenant Name:
Contractor
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires:
e
Building Use:
Job Type:
Nature of Work:
Other
Alteration
Ext. Fixture
Occupancy:
Constr Type
Code:
R-3.1
V B, SPK
cEc 2016 Notes:
Planning Conditions:
Planning Approval By
Plan Checked By:
Permit lssued By:(Nr",n"noez, Kathv
Date:
Date:
Date:05/15/2018
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
TotalSubject to Field:
Buildins Permit #: 10196431 01'116002 51600
01 1 16002 51603
$21.25
$55.51
Fee Total:
Paid to Date:
Balance Due:
$76.76
$0.00
$76.76
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 180 days after its
rssuance, or if the work authorized on the site by such permit ls suspended
or abandoned for a period of 1 80 days after the time the work is
commenced.
lnspector MID#: 2016-126369
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pti:t
OnSO':
ELECTR!CAL.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS
Site-Work
Underqround
Pole Bases
Liqht Standards
Spas, Pool, Fountains
Siqns (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Buildinq
Under Slab / Floor
Bonding / Grounding / UFER
Transformers
Torqueinq
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouoh)
Ceilinqs (Hard & Soffit Rouqh
Ceilinqs (T-Bar Rouqh)
lt/eter Release
Rouqh
Service Meter
FINAL I i- 7 -/g JK -3/zl -f //t.t-
Notes, Remarks, Etc
OWNI]R BUILDI:R DEI,CARATION
I hcrchy allirnr under penalty ofpcrjury thal I am cxcmpl lioD lhc Contractors' Licensc Law for thc following rcay)n (Scc.7031.5
Ilusiness and Prolbssion Codc): Any City or County which rcquircs a FErmit to construcl. alter. inrprovc. demolish or repair any
structurc. prior to ils issuancc- also rcquircs lhc applicatrt tbr such pcnnil to nlc a signed slatcrrenl lhal hc or shc is licctrscd pursuunt
lo the provisions of tlrc Conlraclor's Liccnscd Law (Chaptcr 9, Conlncncing with Seclion 70(D of Division 3 oI thc Busincss and
ProfcssionsCodc)orthdlhcorsheiscxcnrpllhcrcfromatrdlhcbasisforthcilllcgcdcxcmplk)n. AnyviolationofScclionT0ll.5hyany
applicanlforapermitsubjcclslhc applicnnlk)acivilpcnilltyofnotmorcthrnlivchundrcddollars($5(){)).
-1.
as owncr of lhc prolErty. or ilry cilrpk)yccs wilh wagcs xs thcir solc conrpctrs0tion. will do thc work and the slruclw is nol
inlcnded oroffcredforsalc(Scc.7(M4.BusincssandProfcssiotrsCodeiThcContracmr'sl,iccnscLawdocsnolapplytoanownerof
the prcFEny who builds or iilrp(rvcs thcmn. and who (lms such work himsclfor hcrsclfor through his or hcr own cmployces,
providcd lh{l such impro\cmnts m not illcndcd or oflcrcd for slc. ll. howevcr. thc huikling or iDrprovcnrnt is mkl withirr onc ycar
ofcoilrphliur. lhc Owncr Buildcr will ha\c lhe hurdcn of provirg thal h( or shc did not huikl or improvc thc pmlEny for lhe purJfiE of
sale).
_1, rs owner of thc proFrly. am cxclusivcly conlracli,lg with liccnscd coDlractors to construcl thc p()icct (Scc. 7(ll,l. Busincss
and Pn)fcssbn Codc: 'l hc Contractor's Liccnsc Law docs not apply lo an owncr ofpropcrty who huilds or itnprovcs thcrcon.
and who contracls lbr such prl)jccts wilh il Contraclor(s) liccnscd pursunnl lo lhc Conlrack)r's Liccnsc ljw).
_l anr cxcmpt lndcr P.(,*", 5- I f^t t
DI,tCl.AR,\l't0N
I hcrchy aliirnr undcr pcnally ol pcrjury onc ol lhc (lcclrrrti()ns:
I hr\c and will nHiiltrln n ('cililicrtc Scll'lnsurclorworkcrs'cotrpcns{tion.as p.ovidcdli)rhyScctionlT(nofthc
tntx)r Codc. for lhc performncc of thc work for which lhc permil is issued.
_lhavcan(lwillnrilintninw(,rkers compcnsalioninsurancc.ils rcqniredbyScction.lT(X)oflhctJborCodc.lbrthcpcrfornEnceoI
lhc work li)r which this pcrrnit is issual. My workcrs' conrpcnsxlknr insurnncc camicr and fnlicy numbcr [c:
Policy Nurnhcr: Expircs:
-l
ccnily lh{l iD thc Frlbrtrrrncc ol lhc work for which this pcrmit is issucd. I shall nol enrpk)y any pcrson in any manncr
so rs lo becomc suhjccl lo thc workcrs'conrpcnsalion hws ofCalili)rniil. and agrcc thal il l should hccomc suhjcct lo lhe
workcrs'compcnsrtionprovisionsofScclion-lT0OoflhcLrtxrrCodc.lshilll.l'onhwilhcomplywiththoscprovisions..
WARNIN(I: Frilurc k) sccurc workcrs'coillpcnsiltion covcrrgc is unhwful. ond shall suhjcct an cmpkrycr to friilrinal lEnilltics aild
civil lincs up to onc hundrcd thousand dollars lSloO.UD).lo cost of daroges as providcd for thc
Scctiotr .1076 oflhc tntbr Codc. intcrcst and allorrcy s fees.
l)nlr:,Ftf't (
I hcrcby allirnr undcr 1)clxlly ol pcrjury lhnl I anl
of thc Busincss and l'rolessions (ixlc. an<l rty
provi\t)n of Chnllcr 9 (conrnrncing wilh Scction 7(XX)) (,[ t)ivision J
in lirll li)rcc xn(l cllict.
I)alo:Conlmclon_
CONSTRUCTION LENDINC A(;ENCY
I hcrcby afllrm undcr FEnally of pcrjury lhat lhcrc is a conslruclion hnding agcncy for Ihc pcrl'ormarEe of the work for which lhis Frcrmil is
issucd (Scc. 3097. Civ. C.).
Lcndcr's Nrmcl
lrndcr's Addrcss:
APPLICANT DECI ARATION
I hcrcby affimundcr pcnally of perjury onc of the tbllowing dcclarations:
DenDlilion Permils-Asbcstos Notilication Fedcral Regulalions (Title 40. Pdl6)
-Rcquircd
Lrttcr of Nolification
_l ccrlily lhal thc ltderillrcEulalions rcgarding nshc\k)s rcrnovrl urc nol rpplicrhlc lo lhis prejcct
-l
ccnily lhrl I havc rcrd lhis applicalion and slatc lhal lhc xtx'vc infonnrlion is coficcl. I agrs k) coilrply with xll Ciry and (i)uDly
(trdinancc\ aDd Stalc Ijws rclaling lo building rcprcscnlalivcs ol lhis City and County to cntcr uFil lhc
rh()vc trlcflliorrcd |r()l)erlv tin *,"3--/{-rfApplicanl or AgeDt Signature: _
Prnnilee nanre (prinl):
rnd
tle cl5-
Liccnsc Clilss'_Liccrrrc Nunrhcr: