HomeMy WebLinkAbout20146574 - Permitcity of santa Ana 20 civic center Plaza (M-19), santa Ana, cA 92702
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738
Electrical permit #: 2Ol 4G574
! nspector's Section : (7 1 4) 647-5853
Project Address: 3610 S Bristol St
Assessor's Parcel: 412-131-12 Lot: NA
Unit:
Block: NA
Bldg:
Tract: NA
Address Range: 3000-3798
Historic: No
Suite Range:
Zoning: C2
Owner:
Address:
Phone:
Tenant Name:Pumpkin City
Owner-BuilderContractor:
Address:
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Fellowship of Christian Athletes
3610 S Bristo! St
Santa Ana, CA 927040000
Fee Type
01 1 16002 51603 Special Event
01 1 16002 51600 Genera! Plan Update
01 1 16002 51603 lssuance
Amount
149.50
18.25
45.50
Qty
1.00
1.00
1.00
Fee
$149.50
$18.25
$45.50
P'n t
Ltf f
t_r?/15/11 ID: ,::t_
Trnns*: lll? I nf
Ref *: zll1 46?-,74
4 9 / L5l?CI11 3:29 F,Hstol $?13.2:i
FeIl.nuship of (:hristinn AthIet
Plan tjpdgte Fee
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5l6tt3rlt-rtr
? 135
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Other
Miscellaneous
Pumpkin Patch
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
N/A
N/A
cEc 2010
09/1 5t2011
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes: LUC 2011-81/handout given.
Fee Total:
Paid to Date:
Balance Due:
Amsden, Julie
Every permitissued shall become invalid unless fhe work
on the sife authoized by such permit is commenced within
180 clays afterifs issuance, or if the work authorized on the
sife by such permif is suspen ded or abandoned for a period
d 1 80 days after the time the work is commenced.
01 1 16002 51600
01 1 16002 51603
$18.25
$195.00
$213.25
$0.00
$21 3.25
lnspector MID#: 2011-99258
a
L
ELECTRICAL-INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS Omcr-Builds Dcluation
I hqcby affirm undcr pcnslty of p€riury thtl I m cxcmpr fom thc Contrrctors' Lienrc Law for thc following rcen (w.?03 t.5 Bu{itrcss
ud Profssion Codc): Any City or County which rcquircs a pcrmit to @nsrucl, dtcr, improve, demolish or rcpair uy sructuc, prior to its
issuancc, rlso requircs thc appli@t for such pmit to filc r signcd ststcmcnt thrt hc or shc is liccn*d pursuet to thc prcvisions of thc
Contnctor's LiGtrscd Lrw (Ch8pt6 9, Commcncing with Setion 7000 ofDivirion 3 ofthc Busincss ud Profcssions Codc) or that hc or
shc is acmpt thercfrom and thc bris for thc allcged cxcmption .Any violation of Swrion 7031.5 by oy applient for r pemit subjcas thc
applicut to a civil pcoalty ofnot morc rhe livc hmdrcd dollus (S500).
-_1, u omq of thc prcpcrty, or my cmploys with wag6 s their rclc ompensrtioq will do thc work ud thc struclue is not intcndcd
or offacd for salc ( 58.7044, Busincas md Profcssions Codc: Thc Conrebr's Liccns Lsw docs trot rpply to u ow ofthc prcpcny
who buildr or improvcs thcr6r! ed who dq such work him*lfor hcrslfor tkough his or hcr om cmployes, provided that such
improvemcnts uc not intrndcd or olfcrcd for salc. If, howwcr, thc building or improvcment is rcld within onc yw ofomplaioq thc
Owner-Buildcr will hEvG thc burdcn ofproving lhat he or shc not build or improvc for thc purpos ofsalc).
__1, ss oMcr of thc propcny, am cxclusivcly conirscling with liccnscd @ntrsctors to @nstrud thc prcjcct ( S@. 7044, Busines! ed
Profcssion Codc: Thc Conraaor's Liccnrc hw docs not spply to m omcr of propaty who builds or improvcs thcron , md who
@nracE for ruch prcjetE with ! Contractor(s) liccnsd pursuant to thc Cotrtr.clor's Licnsc Law.).
_l arn exempt under Section & P.C. for this reason.
Date: Owner:
WORK ERS COM PENSA'I'ION DECLA RATION
I hereby a(Tirm under penalty of perjury one of the following declarations:
_t hsvc ud will maintlin s Ccrtifi@rc of Consnt to Sclf-In$rc for workcs' compcmrtion, rs providcd for by Setion 3700 of rhc
trbor Codc, for thc pcrfomue of thc work for which thc psmit is isucd.
__l havc md will maintain workcrs' ompcmtion insurance, s rcquircd by Section l70O of lhc Llbor Codc, for thc prfome of thc
work for which rhis pcrmit is isucd. My workcrs' compcnsation insurme wicr md policy number uc:
Carrier:
Policy
(This section need not be One hundred dollars {$100} or less)
__l certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to
became subject to the workers' compensation laws of Californiq and agree that if I should become subject to the workers'
compensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with those provisions..
WARNING: Failurc to wurc workcrs' compcnsation ovcrrge is unhwful, sd !h&ll sbj6t u cmploycr b siminrl pcmltiG md civil
fitrca up to onc hundrrd thouud dollrs (t 100,000),in sddhiotr to thc os of compcnstioq dmagcs a providcd for thc Scrion 1076 of
thc Lrbor Codc, intsGt ud rttomcy's fes.
LICENSED CONTRACTORS DECT.ARATION
I hcrcby e,Iirm undo pcmlty ofpdjury that I m lienscd undcr prcvision ofChaptcr 9 (ommencing with Setion 7000) ofDivision 3 of
thc Busincss snd Profcssions Codc, md my liccnsc is in full fore md cffwt.
License Class: License Number _
Date: Contractor:
CONSTRUCIION LENDING AGENCY
I hacby rllim undcr pcDdry of psjury thrt th6c i! r 6Etruc1ion lcnding agcncy for thc psfomue of thc wdk for which this psmir is
issucd (Sc. 3097, Civ. C.).
Lcnder's Namc:
Lender's Address:
A PPLICANT'S DECLARAT'ION
Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part 6)
__ Required Letter of Notification
*--l certify that the federal regulations rega.rding asbestos removal are not applicable to this project.
_ I ceniry thar I havc rcsd this applicition ud state that thc above informrtion is @rcci. I agre to comply with all City and County
ordinances and State Laws relating to building hereby authorize representatives of this City and
above mentioned property for inspection
Applicant or agent
Permittee name (print)2 q
to enter upon the
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm I Dampers
Communications Cable
Building
Under Slab I 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 E\,Errr )En
-r
-! !!
Rough rFc tl.I ?ffn
Service Meter .)A
FINAL ,,.tM\., V{+Or 4l |% uDtt, w7
Notes, Remarks, Etc.\,/V \L/
Date:_
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