HomeMy WebLinkAbout20172201 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Electrical
PermitCounteh: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #:2O1722O{
Pin #: 50475
Project Address:Unit:Bldg: Address Range:
Tract: BUCKINGHAM Historic. No
Suite Range:
Zoning. R2Assessor's Parcel. 008-21 2-34 Lot: POR 11, POR 12 Block: A
Owner:
Address:
Michael B Mattlingly
1021 W Chestnut Avenue
Santa Ana, CA 92703
(7141 325-6230
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
$s7 40
$23.79
$5e.30
$4.05
Phone.
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires:
Building Use:
Job Type:
Nature of Work:
Single Family Dwelling
Alteration
Service Meter
Occupancy.
Constr Type:
Code:
R-3, U
VB
cEc 2019 Notes: upgrade/handouts given
Planning Conditions:
Planning Approva! By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Verduzco, Vio,"r{tl
Date:
Date:
Date:10t29t2020
Account#
Misc. Receipt.
Misc. Receipt:
Misc. Receipt:
Total
Every permitissued 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 permit rs suspended
or abandoned for a period of 360 days after the time the work is
commenced.
tnspector MtD# : zo2o-,u*I{
01 1 16002 51600
01 1 16002 s1603
01 1 16002 57770
$23.7e
$1 16.70
$4.05
Fee Total:
Paid to Date:
Balance Due:
$144.54
$0 00
$144.54
ELECTRICAL.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNI'R BUILDI'R DI'I,CARATION
I hereby affrnr under penalty of perjury that I arn exempt from the Contractors' License l-aw for the following reason (Scc.7031.5
llusincss and Protbssion Codc): Any City or County which requircs a pcrmit to construct, altcr, improvc, dcmolish or rcpair any
structurc, prior to its issuance. also rcquires tlle applicant for such penuit to filc a sigrrcd slaternent that lp or she is licerrsed pursuant
to thc pmvisions of thc Contraclor's l,icenscd law (Chapter 9. Commencing with Scction 7000 of Division 3 of the Busincss and
Professions Code) or that lrc or she is exempt therefrom and tlre basis for tlre alleged exenrption. Any violation of Section 7031.5 by any
appticant for a pennit subjects the applicant to o civilpenaltyof not rnorc than five hundred dollars ($500).
_1. as owncr ol'the propcrty. or my clnployecs with wagcs as thcir solc compcnsation, willdo thc wnrk and the stnrcturc is not
intcrxled or offeretl for sale (Sec.7M4, Busincss and Professions Cotle: Thc Contractor's Liccnsc [-aw does not aPPly to an owncr of
the pmperty wlro builds or inrproves thereon, and wlxr does srch work himself or lrerself or ttuough his or her own employees,
provided that such improvcmcnts arc not intended or offcrcd for sale. Il. howcver, trc building or funprovcnrcnt is sold within one )aar
of completion, tlre Owncr Buil&r will have thc burden of proving thd hc or she tlid mt buill or inpmve tlrc propaty for thc purposc of
llale).
_1. as owner of the propcrly, am exclusively contracting with liccnscd conlractoni to conslrucl thc projcct (Sec. 7(Xa, Business
and hrolbssi.m Code: The Contractor's License Law does not apply to an owner of proSrcrty who builds or improves thereon.
and who contracts for such pro_iects with a Contractor(s) liccnscd pursuant to thc Conuactor's Liccnse Law).
B. & P.C.
I hercby affirnr unclcr pcnalty of pcrjury onc of tlte tbllowing
_l have and will nuintah a Certil-rcate of Consent to Self-lnsure for workers' contpensation, as pnrvided for by Scction 3700 of the
labor Code, for the ;rcrforrnance of thc work for which thc Srcrrnit is issucd.
_l lrave arrd will nuintain workers' conrpensation insurarrce. as required by Section 3700 of the Labor Code, for the perfonrunce of
the work for which this pcrmit is issucd. My workers' compcnsation insurance carricr and gxrlicy number are:
Policy Number: Expires:
_l ccrrify that in tlrc lxrfornrancc of thc work for which this pcrmit is issucd, I shall not cmploy any person in any m:rnner
so as to becorne subjcct to thc workers' compensation laws of California. and agree that if I slnuld bccorrc subject to the
workers' conpensation provisions of Section 3700 of the Labor C'ode, I slrall, forthwith conrply with those provisions..
WARNING: Failure to secure workers' compensation coverugc is unlawful, and shall subjcct an employcr to criminal penahics and
civil fines up to one hundred tlnrusand dollars ($100.000). in addition to tlrc cost of comSrctsalion. danrages as provided for the
.Section 3076 Codc, intercst and lecs.
0 4
DI'CI,ARATTON
I hereby affirm under pnalty of pcrjury that I anr licenscd untler provision of Chapter 9 (conurrcncing with Sccrion 7000) of Division 3
of the Business and Professions Codc. arxl my licensc is in full forcc and effect.
Licensc Class: Licensc Number:
CONSTRUCTION LENDING AGENCY
I hcrcby aflirm undcr pcnalty of pcrjury that thcrc is a construction lending agency for the pcrformance of thc work ltrr which this permit is
issued (Sec. 3097. Civ. C.).
Lender's Nanre:
APPLICANT DECLARATTON
I ffiy affrmunder penalty of pcrjury one of the following declarations:
Denrclition Pcrmits-Asbcstos Notification Fedcral Rcgulations (Title 40. Part6)
_Rcquircd l-etter of Notification
_l certily thal the fcdcral regulations regarding &sbestos removal arc nol applicable to this project.
_l certify that I luve rcad this application and state tlut thc above infornration is correct. I agrec to conrply with all City and County
ordinances and State Laws rclating to building constructiorl and hereby authorize representatives of this City and County to entc{ upon the
above rnentioned property for
Alllllicant or r\gent
Pcrnritcc nanlc
purposes.r dl>n\zo
Date:-
Site-Work
Underqround
Pole Bases
Lisht Standards
Spas, Poo!, Fountains
Siqns (monument)
Life Safety /Low Voltaqe
Fire Alarm / Dampers
Communications Cable
Building
Under SIab / Floor I I 1l
Bonding I Groundinq / UFER /a2v/b OZ"r'H ,ff
Transformers /
Torqueinq
Sub-Panels
Air Conditioners
Roof Top Equipment
Factorv Wired Unit
Walls (Conduit)
Walls (Roush)
Ceilinqs (Hard & Soffit Rouoh
Ceilinqs (T-Bar Rouqh)I /
N/eter Release ttlzta 0lktM,K
Rough
Service Meter I .t I ,l/
FINAL '//rtl'-v Vf-/rvr7v - v ce
Notes, Remarks, Etc.
Rev. 08-07-201 5
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