HomeMy WebLinkAbout20170403 - Permitcity of Santa Ana 20 civic center Plaza (M-19), santa Ana, cA927c2
PermitCounter: (714)647-5800 lnspection Requests. (714)667-2738 lnspectorSection. (714)647-5853
Electrical
TJ
Proiect Addressi 2148 S Bristol Sta
-
Assessor's Parcel: 408471-17 Lot: NA
Unit: D
Block: NA
Bldg:
Tract: NA
Address Range: 2104-2160
Historic: No
Suite Range:
Zoning'. C2
Owner:
Address
Phone:
Tenant Name:
Contractor:
Address:
Phone:
Au Zone Santa Ana Llc
5850 CANOGA AVE 650
Woodland Hills, CA 913676573
Thomas lnternational Comp
'l 5030 Goldenwest Cir #1 16'1
Westminster, CA 92685
(6s7) 365-9978
01 't 1 6002 51 603
01't16002 51603
01116002 5'160C
01 1 'l 6002 5'l 603
Fee Type
'125 Volt Receptacle
Min Fee Adj
General Plan Update
lssuance
Qty Fee
1.00 $1.51
1.00 $70.84
1.00 $22.95
1.00 $57.20
1ffi: t:t:t.tt.t.$4191
l'l ? r:l' 4
t'+ I 2r:ll /l-l4tl:]
Lt:r-r -i:49 Pn
t7 7'i .2.1
Amount
151
70.84
22.95
57.20
011 16002 5777C Microfilm Re-c,ords :::;J / 1 I . 193,,2,:t,i
rii i i ce; iTTH Trurrsi i
.. --;:- Rgh,.-Ll,t.i,:pi,i;iri8;i73I+ - L;3/?.ironssci ion TotttI
i hoilss int,ernctL iurrui ilompttirn
State Lic #: 876125
Lic Type: A, C-10
Bus. Lic #: 367085
Workers' Compensation lnsurance:Carrier: Exempt
Policy #:
Expires:
rrenensi Flqn UPdote Fee
r, t.t lOLlLll- :rIOLlLrLrULr-
i:, iecir i csi
i ;l I IOLILII-' ;rl OLl.fULrLt-
ii ir:rof i ir & Documpnts
t rI I.l0LlLll- i/ / /LtLrUU*
rt.L i.hecir t]l189
Notes: lnstall new washer/dryer within existing utility room
$22.91
$ t2? . :i5
13. ?l
$772.?-3
Building Use:
Job Type:
Nature of Work
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Commercial
Miscellaneous
Washer/Dryer lnstallation
Occupancy:
Constr Type:
Code:
B
VB
cEc 2016
W 0'U03t2020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Zuniga, Allissa
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within360 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
01 1 16002 51600
011't6002 51603
01116002 57770
$22.9s
$129.55
$3.91
Fee Total
Paid to Date:
Balance Due:
$156.41
$0.00
$156.41
lnspector MtD#. 2019-154342
Permit #:2O17O4O3
Pin #: 4980{
ELECTRICAL-I NSPECTOR RECORD
APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DEI,CARATION
I hoeby aflim undo poalty of pojury that I m erempt from lhe ContractoB' Licose Law for the following reMn (58.70-11.5
Businas md Profssion Code): Any City or County which require a perrnit lo construct. alts, improve. dmolish or repair any
struclure, Irior lo its isuance. also rcquirs the applicml for such pmnit to file a signed statmmt lhat he or she is licmsed pureuanl
to the provisions oflhe ('ontractor's l-icensed Larv (Chapto 9. Commencing lvith Sfflion 7000 of Division 3 ofthe Busincss md
ProfessionsCode)orthalheorsheiscxcmptthoefromddthebasisfortheallegedexemption. AnyviolationofSetionT03l.5byany
applicant for a pmnit subisls thc applicant to a civil penalty ofnot more than five hun&cd dollars ($500).
_ l. 6 o\\'ns of the proFE ty. or my employec rvith rvage ro their $le compmsalion. will do the work md the slnrctue is not
intoded oroffscd for Mle (Se.7M4. Busins ad Profssions Code: 'fhe Conlraclor's l-icose Larv doe not apply to an oNns of
lhe propoty rvho builds or improve thtron. ild who do6 such work himself or hmelf or through his or her ou'n employcs.
provided that such imlrovqnmls ac dol intdded or offtrcd for sle- If. horvevq. the building or irnJnovonmt is rld within one y6
ofcotnplelion. the (Ivnq Buildo rvill have the burdo ofproling thal he or she did nol build or irnprote the prcpaty for lhe pupoFof
ule).
_ I, o owno of the propsty. m cxclusively contraoing with licmed conlracloB lo coNlruct the prcjsl (S(. 7044. B6ins
md ProfessionCode:'lheContractor'sLiccnscLawdo6nolapplyloeownsofpropertywhobuildsorirnprovesthereon.
md who contracts for such projats wilh a Contrado(s) licmsed pursuanl to the Conlractor's LiceNe Larv).
I m exempt unds s(tiof,--. B. & P.c. for this r6on.
l)nlc:owner,
-
UOSX&BS:CAMIENSAI!9N -
DECLARATION
I hoeby affirm under penalty of pojury one of thc following dalaatiom:
_l have od will maintain a Cenificatc of Commt to Self-lnsure for *'ork6'comp€Mtion. o provided for by Sstion .1700 of thc
Labor Codc. for the pofomilce of the work for which the pennit b i$ucd.
I havc and will maintain workm' cornpemation insurance. 6 required by Setion 3700 of the Llbor Code. for the pcrfomancc of
the rvork for rvhich lhis pmit is issued. My rvorkm'insurance canier md policy numba a'c:
(
Policy Nunrbcr:Irxpiresl
-l
certify that in the perforrnance oflhe work for lhis plmit is issued. I shall not mploy any perrcn in any mmno
o s kr become subjet to thc workqs' cornposalion laws of Califomia. and agre lhal if I should become subj(l to the
u'orkss' cornpensation provisions ofSation 1700 ofthe l-abor ('ode. I shall. fonhrtith cornply rvilh thos provisiofls..
WARNINC: Failure lo recure workers'compmsation covtrage is unlawful. md shall subjet m mployo lo Fiminal penaltiB and
civil lincs up lo one hundrcd lhousand dollars in addition lo thc cost of compenutiou. danags o provided for the
Seclion 1076 oflhr t-alnr Codc. intcrst and fes.
o","' *l-3 -lC
I hqeby amrtn undr p6ahy ofpdjury that I m undcr provision ofChapts g (commencing with Setien 7000) ofDivision -l
of lhe Busincs and Profesions Code. md my license is in full force md effect
8)6 tL'r
D,te, I-\LO
I heeby aflirm undo poalty ofpdjury that lhse is a coEtruction lending
issucd (Se. 3097, Cir. C.).
L€ndq's Nme:
for lhe pq fomance of the work for which this pmnit is
Lenclq s Addres;
APPLICANT DECLARATION
I hoeby affm unds penalty ofperjury onc of the following declaations:
Demoliton Pqmits-Asbstos Notification Fedsal Regulations (Title 40. Part6)
-Required
Letls of Notificatioo
_l c6tiry lhat the Hqal rcgulatioN regdding obctos ronoval are not applicablc to this prcjat.
Il certify ttrat I havc read this application md state that the above infomalion is corect. I ag.e lo comply with all City and County
ordinancs dd State Laws relating lo building coNtrucliof,. md hqcby authorizc retr6mtativ6 of this City md Couoty to otq upoo the
abovc mcnlioncd propeiy ft)r
Applicatrt or Agcrt
Permite nnme (print):
purposcs.
Site-Work
Underqround
Pole Bases
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Building
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 Rouqh
Ceilings (T-Bar Rough)
Meter Release
Rough
Service Meter
F!NAL 4lc{eo q Mt 2D)
Notes, Remarks, Etc.ur
r-i.m"ctc, ^ 4-0ID
Drte:
a a