HomeMy WebLinkAbout20164535 - PermitCify of Santa Ana
Permit Counter: (714) 647-5800
20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Electrical
lnspection Requests: (7 1 4) 667 -27 38 I nspector Section: (7 1 4) 647 -5853
Permit #:20164535
Pin #: 15414
Proiect Address: 1100 W Warner Avea
-
Assessor'sParcel: 410431-06 Lot: NA
Unit:
Block: NA
Btdg:
Tract: NA
Address Range:
Historic: No
Suite Range:
Zoning: C2
Owner:
Address
Phone
Tenant Name:
Contractor:
Address:
Phone
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Orange County Convalescent Hospital,
1030 W Warner Ave
Santa Ana, CA 927073147
(714) 546-6450
South Coast Post Acute
Owner-Builder
Fee Type
01 1 16002 51603 Light Fixtures
01 I 16002 51603 Min Fee Adj
01 1 16002 51600 General Plan Update
01 I 16002 51603 lssuance
Amount
1.01
69.63
21.25
52.98
Qty
1.00
1.00
1.00
1.00
Fee
$1.01
$69.63
$21.2s
$52.98
llbY
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lrc(n50r::f, lofi
Genernl P10n Upilut
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Electr i':ctI
t:rL l 1,5rllrz- 516r:rSLrLrLl
V isn
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Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
,,,,M
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Other
Signs
Monument Sign
Zuniga, Al
Occupancy:
Constr Type
Code:
Date:
Date:
Date:
N/A
N/A
cEc 20't6 Notes: Relocate monument sign, "SCPA South Coast Post
Acute". Bond posted on M-70232. Auth on file.
11t02120',t7
Account#
Building Permit #: 10191609
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 180 days after its
lssuance, or if the work authorized on the site by such permit is suspended
or abandoned for a period of 1 80 days after the time the work is
commenced.
01 1 16002 51600
01't16002 51603
$21.25
$123.62
Fee Total:
Paid to Date:
Balance Due:
$144.87
$0.00
$144.87
lnspector MID#: 2016-133462
L
ELECTRICAL.INSPECTOR RECORD
APPROVALS DATE ID/SIG COMMENTS
Site-Work
Underground
Pole Bases
Liqht Standards
Spas, Pool, Fountains
Siqns (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Buildinq
Under Slab / Floor
Bonding / Grounding / UFER
Transformers
Torqueinq
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilinss (Hard & Soffit Rouqh
Ceilings (T-Bar Rough)
lr/eter Release
Rough
Service Meter
FINAL q-/g -/g ,J/e{a*(h
Notes, Remarks, Etc.
OWN'R BUILDER DEI,CARATION
I hereby aflim undr pcnalty ofpdjury lhat I m exempl from lhe Conlraclo6 l-icmse hw for the following rc6on (Sec.70.ll 5 '
Businss md Profsion Codc): Any Cily or County s,hich require a pmrit to conslrud. alta. irnprovc. dmolish or repair my.
slructure. prior to its issumce, also requires the applicant for such permit to file a signed statemmt that hc or she is licensed pursuant
to the provisiom of the Contractor's Licensed law (Chaplo 9. Commencing with Section 7000 of Division .l of thc Businss anrl r
ProfessionsCodelorthatheorsheisexemptthereliomandlhebasisfotlheallegcdcxemption. AnyviolationofsectionT03l.5byany
applicantforapermitsubj(tsthe applicanttoacivilpenaltyofnotmorethmfivehundreddollars($500).
I. o owncr of thc propeny, or my employe with wags o their rclc comprcation, will do the work ild the stnrctue is nol
intodel or of[ged for slc (S6.7M4. Busins md Profsiom Code: The Contraclor's Licose Lrw do6 not apply to m o$ner of
the preperly rvho tuilds or improvs thqon. md who doe such rvotk himself or hmelf or through his or ho orvn employc.
proridcd lhat such irnprovqnmts N not intmdel oroffsed for slc. l[ howws. the building or improvmot is wld rvithin one yrr
ofcornplaion. the Orrntr Buildg will have the burdm ofprcving tha he or she did not build or improve the pmpqty for lhc purfns of
sle).
l. o orvner ofthc ;ropdy. an erclusivcly contracting wilh lic6sed contraclors to construct lhc projet (S(. 7044. tJusin*s
and PrchsionCode:TheContractor'sLicenscl-awdo6notapplytoanorvnoofpropertywhobuildsorimproves(herNn.
and who conlracls for such projccts rvith a Contmclo(s) liceNcd pursudl lo the Contraclor's Licffse L!w).
I an cxempt undq Srclion-
r,,," - 'll -2.a7
I hreby affirm under pmalty of pojury onc of the following
I havc dd N'ill maiilain a ('ertificate ofConsenl lo Self-lnsure rvorkm'cornproation, as provided for by Sslion .1700 of the
Labor Code. for the psfonnilcc ofthe work for which the permit is i$ued.
I have and will maintain workm' compemation insurmce. o required by Sction 3700 of thc Labor Code. for thc pcfomrmcc of
thc work for which this pemit is issued. My workm' compmation insurmcc cmiq ild policy numb6 ile:
( an ier:
Policy Nurnber:-Expircs: _
I cef,iry that in lhc pqfonnance of the work for rvhich this pomit is issued. I shall not mphy any pe6on in any mannc
s 6 to becom. subjel to the $!rk6s'comp€nsation larvs ofCalifomia. md agre that ifl should become subject to the
worktrs' composalion provisions ofSection -1700 ofthe Lahrr Code. I shall. forthwith comply rvith thow provisions..
WARNING: l;ailure to sccure workcB'cornpensation covcrage is unlawful. and shall subject an unployo kr oiminal penaltis and
civil fines up lo one hundred thousand dollare ($l ). in lo the of comperoation. darnages as providecl for the
Sslion 1076 ofthe l-ak)r Code. intq6t and Ies.
I hreby affirrn undcr poralty of perjury that I m licosed undq
of the Businss and Profsions Code. ud my liceroe is in full
9 Scction 7000) of Division -l
effst.
License Class:-- Licerec Nurnber:
lh(e:Contrsctor:__ _
CONSTRUCTION LENDING ACONCY
I heeby affnn undo pen.lty of pgjury that thac is a consruction lending agocy for the Jn'fomoce of thc work for u'hich this pmnil is
issued (Sec. .1097. Civ. C.).
Lendq's Name:
Lfldq's Ad&s:
-APPLICANT DECLARATION
I hottry affinn undo psralty ofpcrjury one ofthe following dsldalions:
Demolition Pstnits-Asb6los Nolification Fedsal Regulations ('l ille 40. Pa16)
_.-Required Letter of Nolifi cation
I colify that thc fedcral rcgulations rcgtuding 6bcslos rcrnovnl are trot a|plicablc to lhis projecl.
I colily lhat I hare rcorl lhis applicalion i!il slalc that the ahrrc inforrnalion is conccl. I agre to cornply with all Cily and (\runty
f this City and County kr ml{ ufrn the
o,u,1ll-Z-tZ
ordinancG and State laws relating
abo\c nreillionc(l l)ropcllv for
Aplllicaill 0r Agcnt
l'ernrit$ trsnrc (print):
to building md hrcby reprsenlative o
D^r", /ll'z - 17