HomeMy WebLinkAbout20171664 - PermitCitV of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Electrical
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #:2O17166'4
Pin #: 38662
Proiect Address:1217 N Cabrillo Park Dr
Assessor's Parcel: 400-172-35 Lot: 35
Unit:
Block: NA
Bldg:
Tract: 9207
Address Range:
Historic: No
Suite Range N
Zoning: R4
Owner:
Address:
Phone:
Tenant Name:
Contractor
Address:
Phone:
HENRY H WILSON
1217 CABRILLO PARK DR
Santa Ana, CA 927013180
(71419s3-1942
Greenstar Home Services ln
1951 N Main Street
Orange, CA 92865
(949) 885-0102
Fee Type Amount Qty
01116002 51603 FWU 26.71 1.00
01116002 51600 General Plan Update 23.79 1.00
01 1 16002 51603 lssuance 59.30 1.00
01 1 16002 57770 Microfilm Records 4.05 1 .00
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0ff ice: CTYH Trnns*: /A.--! r. Flr:f +:HLLt,?.
Rcpt* : rJ3t-t?92i6 - g/ L1/ ?i-t?ll
Trunsoct i on Totnl
6reenstor Hone Servi,:es Inc
Generol F'Inn Updsbe Fee
r:t1 1 16[Lr?- 5l 60lJi[JI:l-
EIectr i coI
u11 16(trr?- :l6Lr3urrlr-
11 icrof i Itt & DocumentE
r:rl 1. 1601t2- t7770LrL[:r-
I(:L Chertr u3641i
Fee
$26.71
$23.79
$59.30
$4.05
(:i:uEi.l-AFi
i LII t
Afi
State Lic #: 795556
Lic Type: C-36, C-20
Bus. Lic #. 344246
Workers' Compensation lnsurance:Carrier: Liberty lnsurance Corp
Policy #: WA763D508631019
Expires: 1Ol01l2O2O
$23.79
$86. r-rt
$4. r-r5
s635. 96
Building Use:
Job Type:
Nature of Work:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Single Family Dwelling
Alteration
HVAC
Occupancy:
Constr Type
Code:
R.3, U
VB
cEC 2019
Planning Conditions:
Planning Approval By:Date:
Date:
Date:Amsden, Julie
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
lssuance, or if the work authorized on the site by such permit is suspended
or abandoned for a period of 360 days after the time the work is
commenced.
08t14t2020
Account#
l\tlisc. Receipt:
Misc. Receipt:
l\4isc. Receipt:
Total
Notes: Direct change out of furnace & a/c
Fee Total:
Paid to Date:
Balance Due:
01 1 16002 51600
01 1 16002 51603
01116002 57770
$23.79
$86.01
$4.0s
$1 13.85
$0.00
$113.8s
lnspector lVlD#: 2020-160760
,l
ry
DATE ID/SIG.COMMENTSAPPROVALS
Site-Work
Underqround
Pole Bases
Liqht Standards
Spas, Pool, Fountains
Sions (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Buildinq
Under Slab / Floor
Bondinq / Groundinq / UFER
Transformers
Torqueing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilinqs (Hard & Soffit Rough
Ceilings (T-Bar Rough)
Itrleter Release
Rouqh
Service lvleter I/14MtFINAL/0/z ?/ 2d I
LNotes, Remarks, Etc. /
oWNER BIJII,I)ER DT.]I,CA RATION
I hereby afrirnr ufider penalty of perjury that I aDr exeDrpt from th. Contraclos Licensc law for the following rcasn (Scc.703 1.5
Busincss and Prolssion Codc): Any Cily or Counly which rcquires a fEnnil lo construcl, altq, improvc. dcmlish or Rpair My
slructurc, prior k, ils issuarrc. also rcquins lhc app[cet for such Frcmil lo fih a sigkd slatcmf,t that hc or shc k liccred pur$il1
to thc prcvisions of (hc Contractor's Liccnscd lrw (Chaptcr 9. Cornmcncing wilh Section 7000 of Division 3 of the Busincss and
ProfessiotrsCode)orthatheorsheisexempttherefiomandthebasisforthealle8edcxenlplioil. ADyviolalionofSectionT03l.5byany
opplicanl for a permit subjccts th. applicant to u civil pemlty of not more than five hundrcd dollars ($500).
_1. as osncr ol'llr prol--ny. or rny crnpbyecs with wages as thci, $le comltnstion, will do thc wtrk ard thc stMm is mt
intcrxlad oroffcrcdforulc(Sec.7(}l,l.BlsincssendProfcssionsCode:ThcContracrcr'sLiccnrLawdcsnotapplytomowncrof
the pmFny wlxr huilds or inproves llMdilL atxl wlD does such work himself or lEr*lf or throuSh his or her own enlployees,
provided lhat such improvcrrcnts trc not intcnded or olfcrcd for snlc. ll, howcvca, lhc building or improvemnt is sold within one yc4
ofconrpleli)n, thc OwrEr Builler will lrave the burden ofpNvio8 th{t he or shc did Nt build or imptuvc th€ prcpqly for lhc purlx)s o[
sk).
_1. as owncr of thc propeny, dm cxclusi!cly contracting wilh liccnsd contretoA to consNct th. prcjcct (Scc. 7014, Busincs
arx, hollsqiflCode:TheContracbr'sLicenseLawdoesDotapplytoanownerofpropcnywhobuildsoriDprovcsthereon.
and who con(racls for such prdccts with a Glnlmcto(s) liccnsed pursuml to lhc Conractor's Liccnse hw).
-IaneIemptundelSecti(nl-.B.&P'C'lbrtIrisrcayln,Datc:-
WORKERS' COMPI]NSATION
DECLARATION
I hcrcby aflirm undcr peralty ofpcrjuryom ofthc following decldatioN:
_[ have ard will nEintain a Cenil-rcalc of Conscn( to Sclf-lnsurc for workm' om1rcroation, as prcvidcd for by Setion 3700 of the
l2bor Code, tor thc psforlmc of the work lbr which the pelmit is issued.
[flur. "na
*ltt n)arntain wurk.rs conlpcnsation insuranc., as rcquircd by s.clion 3700 of lhc kbor Codc, for lhc pcrfomurc of
the_work for wlich lhis frcrnil i3 issucd. My sorkqs' @mpcMion imurmcc wicr ud policy numher re:
n
Policy
_l certify lhat iD thc lErli,rnuncc of lhc work for which this pcrmil is issucd, I shall not cmploy my Jrcrson in any mnncr
s as lo bccorrc subjcct to lhc workcrs' cornpcnsation laws of California, and aSrcc that if I should bccom subjcct to the
workels' conrpensation pruvisions of Section 1700 of the Labor Code, I slnll, fonhwith cornply with thos provisions..
WARNING: Failurc to scur. workcrs'compcnsation covcnSc is unlawful, md shall subjcct an cmploycr lo oiminal p.mhics and
civil fircs up to orc hundrcd thousand dollars ($100.000). ir addition lo lhc co$ of cotrqrretion, deug.s u providcd for thc
atrorrcy s
I hercby affrnr undcr pnalty of pcrjury thal I an lic.nsd undct pmvision of Chsptcr 9 (comminS with Setion 7000) of Division 3
of thc Busincss and Prcfessions Codc. arxl my liccnsc is in full fore and cffcct.
Liccnse Nunrb€r:
CONSTRUCTION LENDING AGENCY
I hcreby allirm undcr pcmhy of pcrjury thd thcrc is a construction hnding a8crcy for the pcrformarcc ofthc worl lor which this t6mit is
issucd (Scc. 3097, Civ. C.).
Lcrder's NanE.
[.ndcr's Addrcss:
APPI,ICAN'T DECLARATION
I hrcby dllrnrundcr ltnalty of prrjury ooc ofthe folk)wing dcclurtions;
DcnDlition Pcrn)its-Asbcstos N({ificati(xr Fcdcral RcSulati()ns ('l itlc 40, Pm(,
_Rcquircd [rttcr of Noti6calion
_l ccnily thd thc fcdcralrcgulations rcgdding asbcstos rcmlal dc not applicablc to rhis project.
,fi,{t .cnlty rt,nr I luvc rcad tlus applcation drd statc lhal thc atxrve informlion is co[cct. I agrcc to conrply qith all City od County
'oldinances ild Slatc l2ws rclating to building constructio[ anl hcrcby aulhorire rcprcrcntativcs of this City ild County to enter upon thc
ah)vc rrenlioncd pmpcny for purposs.
Applicant or Agrnt
I'crnrilcc nflnrc
^*,[$lJ4!L2-
ELECTRICAL.INSPECTOR RECOR D
\,
08-07-201 5
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