HomeMy WebLinkAbout20170990 - PermitCity 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 #:2O17O99O
Pin #: 45612a-\c\
Proiect Address: 2000 E Seventeenth St
Assessor'sParcel: 400-121-06 Lot: 1
Unit:
Block: NA
Bldg:
Tract: MAYBURY
Address Range: 2000-2278
Historic: No
Suite Range:
Zoning: Cl
Owner:
Address:
Phone:
Tenant Name:
Safeway
5918 Stoneridge Mall Road
Pleasanton, CA 94588
(877t-723-3979
Albertson's
01 1 16002 51603
01 1 16002 51603
01 1 16002 51600
01 I 16002 51603
01116002 57770
Fee Type
125 Volt Receptacle
Min Fee Adj
General Plan Update
lssuance
Microfilm Records
Amount
1.51
70.84
22.95
57.20
3.91
Qty
't.00
1.00
1.00
1.00
1.00
Fee
$1.51
$70.84
$22.95
$s7.20
$3.91
Contractor: R4 Electrical Construction, I
Address: 30141 Antelope Road Unit D
Menifee, CA 92584Phone: (951) 925-0429
State Lic #: 782019
Lic Type: A, C-10
Bus. Lic #: 348504
Workers' Compensation lnsurance:Carrier: Hartford lnsurance Company of the Midwest
Policy #: T2WECAA9KGV
Expires: O1lO1l2O21
afitoing use:
l{o rype:
r.Jetrre of Work.
Planning Conditions:
Planning Approval By
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Occupancy:
Constr Type
Code:
Date:
Date:
Date:
B,M
IIIB, SPK
cEc 2019
Chavez. Davev3'03111t2020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes: lnstallation of (1)outlet.
Fee Total:
Paid to Date:
Balance Due
01 1 16002 51600
01 1 16002 51603
01116002 57770
$22.95
$129.55
$3.91
$'t56.41
$0.00
$156.41
Every permit issued shall become invalid unless lhe 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.
lnspector MID#: 2020-158359
f tce:
pti:t-tl
ctn snc t
Ilect
Commercial
Miscellaneous
Outlet
ELECTRICAL.INSPECTOR RECORD
08-07-201 5
APPROVALS DATE ID/SIG COMMENTS
Site-Work
Underground
Pole Bases
Liqht Standards
Spas, Pool, Fountains
Siqns (monument)
Life Safetv /Low Voltaqe
Fire Alarm / Dampers
Communications Cable
Building
Under Slab / Floor
Bondinq / Groundinq / UFER
Transformers
Torqueino
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilinos (Hard & Soffit Rouqh
Ceilinqs (T-Bar Rouqh)
Meter Release
Rouqh
t'l tService lvleter t,^ I5tr/lw &tz1/ t /1011 tI1\FINAL ttNotes, Remarks, Etc.
J,
oWNI]R BUII,DI'R DI;I,CARATION
I hereby affrnr under penulty of perjury drilt I atrr cxenrpl fronl lhc CbntractoB' License liw for tha following rcasn (Sec.70Jl.5
Busincss and Prol'cssion Codc): Any City or County which requires a fErmit to construct, altcr, irnprovc. dcrnolish or rcpair any
structurc, prior () its issuance. dso requires lhe allplicaill tbr such p€nrit b fih a siBDed slatercnt tlEl lE or shc is licensd pursuanl
to thc previsions of tlE Conlraclor's l,iccnscd law (Chapter 9, Commcncing wilh Scction 7000 of Division 3 ol thc Business and
Professions Code) or thlt lE or she is cxcmpt tl)erclionr and llE b&sis fo, llE alle8ed €xemplion. Any violatiol ofSeclion 7031.5 by any
applicanlforrpnnitsubjcclrthe nppticontlorci!ilpenillyofnotrmrethanfivchundrcddollars($5ui).
_1. as owncr o,'lh. prolL..nv. or my ernployccs with wagcs as their Fle cornpcnsation, will do the work and (hc stM@ is mt
iilerrled or offercd for ule (S6.7tX4. Busincss and Pn)fcssions Cq.le: The Conlractor's Licensc [:w rloes not spply to an owncr of
the prcFny wk) builds ()r inwoves llErdnr and wlx) do4 such work himself or lErself or tfuough his or her own enrployees,
providcd that such improvcrrcnts arc ffx inrcndcd or olltrcd for Mlc. ll. howcvcr. thc building or irprevcrrcnt is sld within onc ,til
ofconrphliur. tlE owrcr Builder will lurve tlre burdcn of proviilg lhat lE or shc did ftn build or imprcvc tllc prupeny for the puqrcw of
sle).
_1. as owner of thc p()per1y, am exclusively contructing with liceNd conlracloB to construcl tha projcct (Scc. 7(N4, Busines
ard PrDfe$ixl Code: The Contractor's LiceDse La* dcs not apply lo il ownet of proltny who builds or improves lhereon.
and who conuacts for such projccls wilh a Contftb(s) licensd pursumt to thc Conuaclor's LiccN kw).
-l
&rexenrpt under Sectiur-, B. & P.C. fbr tlis reason.
l)alc:_
WORKE RS' COMPI.:NSATION
pEslABAUgN
I hcrcby aflirm undcr pcnalty ofperjuryonc ol lhc ti'lh)win8 dccleations:
_lhareandwillnBinlsinaCenificaleofconscnltoSclf-l[surcf(rrworkers'eumFnsalion,as pmvidcdforbyScction3T0OoftlE
hbor Codc, for thc tqforltffic of thc work for which lhc pqmit is issued.
)11 lu"e aud wrll rnarntxln workers cotrrFErlsrtkD insurance. as rcqutre,l by s.ctx,n' thc work tirr whch this lErnrit rs issuc4. My srrrkcrs' cunrpcNalion i[3ulilrcc cuicr
c,-ie., r H,ln6,-o1
3700 of the hbor Code, for lhc pcrfom€ of
{xi [blicy numbcr dc:
Policy
_l cenify rhat ir rlE Frlbrnuncc of tlt work for which this pcrnil is issucd, I shall not employ my pcrson in any mmner
s as to becotre subjcct to thc worlers' conrpcnsation laws of Califomia, and agrcc thst if I slhuld becorrc subjcct lo lhe
worliers'conrpcnsationprovisionsofSectionl?00oflhctiborC'ode,lstull,fonhwithconplywilhlho*prcvisioro..
WARNING: Failure lo *cure workcrs'mrnpensation covcmge is unlawful, and shall subject an cmploycr to Fiminrl pcnaltics and
civil tinesuDtoulchundredthousanddollars($100.{D0).inadditiootothecostofcompcrsalion,danHgesasprovidcdfortlrc
Scction 3076 of Codc. intcrcst and ilk)ancy s ltcs.
Z
a 2
, (-,-lo
a
DECLARATION
I hcrcby affrm undcr pcnalry of pcrjury thar I am liccnsl undcr prcvision of Chrptd 9 (conmE-b8 whh SBlbn 7000) of
of thc Busircss and Prcfcssions Codc, and my lkcnsc is in full fo.c iud cffccl.ro""
Licelsc Nunrber:.'Tgzaii
s"n","rn",Gur;,/aerA, -.-o/ ?e2^/cy'. r,,/. -oa,-
CONSTRUCTION LENDING AGENCY
I hcrcby altiln undcr pcnalty o[ pcrjury thd thcrc is a construction lcnding a8crcy for thc pcrfoflnarcc of thc *ork lt]r which this permit is
issucrl (Scc. 1097. Cir. C.).
kndcr's Nanrc:
-
[.nder's Address:
APPI,ICANT DECI,ARATION
I hrcby rfrirnr undcr pnalty of perjury onc of thc fi)llowing d@lilalions:
Dcnrclition Pcrnrits-Ashcsbs Notification Fcdcral RcSulalions (Tillc 40, Pd(,
-Rcquircd
trltcr of Ndification
-l
ceaily thal thc lcdcral regulations rc8ilding ashcskrs rcrmval dc nol applicablc to this pmirt.
-2-tQllfln\ lhdt I luv( rcil(l (tns apph(ntir'[ ilkl stiltc tlul tlrc rhrvc inli,rtrL[ir,tr .
4lini6rnccs rmi Statc l,rqs rcl.ilinp I'r huildrnt c,,n\truclx,n. und hcrchy aulhdriz('
is corrcct. I agrcc to conrply with all City and Coutrty
rcprcscntatives ofthis City and County to cnts
a Zd
abovc rnentioncd prrpeny for
Applicant or Agcnt
Pcmlitcc nanrc