HomeMy WebLinkAbout20124160 - PermitCity of Santa Ana
20 Civic Center Plaza (M-19), Santa Ana, CA 92702
Electrical Permit #: 2lJ12416O
Permit Counter: (714) 647-5800 lnspection Requests: (714)667-2738
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Project Address: 1925 E Kemper Ave
Assessor's Parcel: 390-542-14 Lot: 33
Suite:
Block:NA
Bldg:
Tract: 6530
Address Range:
Historic: No
Suite Range:
Zoning: Rl
Owner:
Address:
Phone:
Tenant Name
Contractor:
Address:
Phone:
Jim & Dixie Bosley
1925 E KemperAve
Santa Ana, CA 927056831
(714) 633-6256
Aqua Scapes Pools & Spas
321 Calle Felicidad
San Clemente, CA 92672
(e4e) 4e2-7664
Fee Type
Receptacle
lssuance
Notes:
Fee Total:
Paid to Date:
Balance Due:
Amount
0.75
23.50
Qty
2.00
1.00
Fee
$1.50
$23.50
$25.00
$0.00
$25.00
State Lic #: 754729
Lic Type: C-53, HIC
Bus. Lic #: 0003689
Workers' Compensation lnsurance:Carrier: Exempt
Policy #:
Expires:
Building Use:
Type of Work:
Nature of Work
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Single Family Dwelling - De Constr Type:
Alteration Occupancy:
Exterior BBe Code:
Date
Date
Date
VN
R3/U1
cEc 2001
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:Morales, Janet 06/03/2003
Building Permit IC bZL
This permit shall expire by limitation and become null and void if the work authorized by this permit
is not commenced within 180 days from the date of this permit, or if the work authorized by this
permit is suspended or abandoned at any time after the work is commenced for a period of 180 days.
Before such work can be recommenced, a new permit shall be first obtained to do so.
Account #: 01 1 -01 -591 3 lnspector
ELECTRICAL.I NSPEGTOR RECORD
APPROVALS DATE ID/SIG GOMMENTS Owncr-Builder Dcclsation :
I hereby affirm undcr penalty ofperjury that I m cxempt fom thc Contractors' Liccnse Law for thc following rcuon (scc.70};5 Dcs'incss
od Profession Code): Any City or County which rcquires a pcmit to construct, alter, improve, dcmolish or rcpair my structurc. prior to iE
issuance, also requires thc applicmt for such pemit to filc a signcd statement that he or she is liccnscd pursuut to thc provisions ofthc
Contractor's Licensed Law (Chaptcr 9, Commcncing with Section 7000 ofDivision 3 ofthc Busincss ild Profcssions Codc) or that hc or
shcisexempttherefromudtheb6isfortheallegedcxemption AnyviolationofSectionT03l.5byanyapplicutforapcmitsubjcctsthe
applicant to a civil pcnalty ofnot morc than fivc hundred dollars ($500).
_1, m owner of thc propcrty, or my cmployces with wagcs s their solc compcnsation, will do the work and thc structurc is not intcnded
or offercd for salc ( Scc.7044, Busin6s md Profcssions Codc The Contractor's Liccnsc Law docs not apply to m owncr ofthe propcny
who builds or improvcs thercon. ild who do6 such work himsclfor hemclfor through his or her own cmployces, provided that such
improvementsarcnotintcndcdoroffercdforsale If,howevor,thcbuildingorimprovcmcntissoldwithinoneycdofcompletion,the
Owner-Builder will have the burdcn ofproving that hc or shc not build or improvc for thc purposc of salc)
_1, c owncr of thc propcrty, m cxclusivcly contreting with Iicensed contractors to construct thc projcct ( Scc. 7044, Busincss ild
Profssion Code: Thc Contrrctor's Licensc Law does not apply to an owncr ofproperty who builds or improvcs thscon , md who
conracts for such projects with a Conractor(s) liccnsed pursumt to thc Contractor's Liccnsc Law.).
_l am exempt under Section _,B & P C for this reroon
Datcr
-owncr,
-
WORKERS COMPENSATION DECLARATION
I hereby affim under pcnalty ofperjury one ofthc following dcclarations:
_lhavemdwillmaintainaCertificateofConsenttoSelf-lnsurcforworkers'compcnsation,6 providcdforbySection3T00ofthe
Labor Codc, for the pcrfomace of thc work for which thc pmit is issucd.
_l have od will maintain workers' compcnsation insurmcc, c rcquircd by Scction 3700 ofthc Labor Codc, for the pcrformancc ofthe
work for which this pmit is issued. My workcrs' compcnsation insurilcc cmier od policy numbcr ac:
Policy Numbcr: Expiru:
4d;::not bc complcted if thc pmit is for Onc hundrcd dollas {$ 100} or lcss)
thc pofomancc of thc work for which this is issucd. I shall not cmploy any pmon
agrcc that ifl should bccomc subject to
in manncr so 6 to
bccmc subjcct to thc workcrs ' compcnsation laws of
compcnSation 3700 ofthe Labor Code,with thosc provisions.
WARNING,to sccurc worke6' compcnsation coveragc is unlawful, ud shall an cmploycr to riminal pcnaltics and civil
fincs up to onc hundrcd thousmd dollm ($100,000),in addition to thc cost of
thc Labor Codc. intcrcst md attomcy's fccs.
damagcs r provided for the Section 3076 of
LICENSED CONTRACTORS DECLARATION
I hereby affirm undcr pcnalty ofperjut] that I m licenscd undcr provision ofChapter 9 (commencing
thc Busincss md Profcssions Code, ud my liccnsc is in full forcc ud cffcct
with Section 7000) of Division 3 of
Date
I hcrcby affim under penalty ofpcrjury rhat thcrc is a construction lcnding agcncy for thc pcrfomoce ofthc work for which this pcmit is
issucd (Scc. 3097, Civ. C.)
Lcndcr's Nmc:
Lendcr's Addlcss:
APPLICANT'S DECLARATION
Dcmolition Pcmit$-Asbcstos Notification Fcderal Rcgulations (Titlc 40, Pat 6)
_ Rcquircd Letter ofNotification
_l ccnify that the federal regulations rcgarding Gbcstos removal ae not applicable ro this projcct
-Zdry lr"r.tn^vc rcad this ild statc that thc abovc infomation is corcct. I agrce to comply with all City dd County
ordinanccs md Statc Laws to building construction, and hereby
abovc mcntioncd propcny
^:::ry,,
purPoses.
rcprocntativcs of this City to cntcr upon the
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains )4f<5 L l>-'
Signs (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Building
Under Slab / Floor
Bonding / Grounding / UFER
Transformers
Torquing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rough)
Ceilings (Hard & Soffit Rough
Ceilings (T-Bar Rough)
Meter Release
Rough
Service Meter
FINAL l.l'b-zo w( lo,
Notes, Remarks, Etc
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