HomeMy WebLinkAbout20162298 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Electrical Permit#:2O16.2294
a
Pin #: 6475$\
Project Address: 2603 S Main St
Assessor'sParcel: 016-052-08 Lot: 5-12, PORS 4 & 1
Unit:
Block: NA
Bldg:
Tract: 159
Address Range: 2601-2607
Historic: No
Suite Range:
Zoning: C2
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone;
Gardena Group Holdings LLC
10240 Geary Ave
Santa Fe Springs, CA 90670
(562) 699-861 1
T L M Petro Labor Force lnc
909 N Alameda St
Compton, CA 90220
(3101 639-2227
01 1 16002 51603
01116002 53601
01 1 16002 51603
01116002 51600
01116002 51603
Fee Type
Light Fixtures
PIC - 650/0
Min Fee Adj
General Plan Update
lssuance
Amount
1.01
0.65
58.52
21.25
52.98
Qty
12.00
11.76
1.00
1.00
1.00
Fee
$12.12
$7.64
$58.52
$21.25
$52.98
State Lic #: 761755
Lic Type: B, A, HAZ, C-10
Bus. Lic #: 364698
Workers' Compensation lnsurance:Carrier: State Fund
Policy #: 1 541 150
Expires: O1lO1l2O18
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Commercial
New
Canopy
Occupancy:
Constr Type
Code:
Date:
Date:
Date:
M
IB
cEc 2013 Notes: fee pd on M-70226
$
Fee Total:
Paid to Date:
Balance Due:
No\/ 0 1 Z01l
PAID
Davis. Scott
$,r",n*0",,
05t1412017
't1to'U2017
Account#
Misc. Receipt: 69014
Misc. Receipt:
Misc. Receipt:
Total
City of Santa nna
Kathy
Buildins Permit #: 10191772
Every permit issued shall become invalid unless lhe work on the site
authorized by such permit is commenced within 180 days after its
issuance, or if the work authorized on the site by such permit ls suspended
or abandoned for a period of 1 80 days after the time the work is
commenced.
$152.51
$152.51
$0.00
lnspector MID#: 2015-119845
N/A - No Balance
@
ELECTRICAL.INSPECTOR RECORD
APPROVALS DATE lD/stG.COMMENTS OWNER BUILDER DELCARATION
I hscby afllril undq pmalty o[ pojury lh.l I m exeilpt from the Conlracto6 Licosc liw for thc following remn (Sec.?03 1.5
Businas and Profxion Code): Any City or Counly which rcquira a pcnnit to construcl. all6. improve. doalisl or rerl.l any
sltuclurc. prior to its isumcc. also rcquirB the applicant for such pmnit to file a signed stalolol thal he or she is licosed pursuanl
ro the provisions oflhe Conlraclor's Liccnsed larv (Chapls 9. Commcncing with Section 7000 ofDivision J ofthe Busirress and
ProfesionsCode)orthath€orshciseiempttherefiomandthebasisforthcallegedexmplion. Anyviolationofs(tion?0-1l.5byan!
applicantforapemitsubjatsthe applicanttoacivilpenaltyofnotmorclhmfivehundreddollus($500).
_1. as owno ofthe prop€rty, or rny cmployeB with wag6 d lheir sle conpmsation. will do the work ald the structuc is nol
intodql oroflsedlorsle(Ss.T044.BusinesandProGssionsCodc:'l'heConlractor'sLicmse[-awdoesnotapplytoanouncrof
the prepgty rvho builds or improve thson. md who do6 such wo* hirnself or hmelf or through his or her own employeB.
provitled lhat such improvsnenls de nol intmded oroflqed for sle. lf. howw6. lhe buildinS or improvemmt is mld within one 1m
ofcomplaion. the Orvns Builde rvill have the burdo ofproring thal hc or she did not build or irnprove the prepqty for lhe purlx)s of
sle).
- l. o orvns ofthe prcperty. dn e\clusively conlracling with licm€al contractoE to conslruct lhe prejd (Sa. 7044. tsusins
ard ProfasionCode:TheConlractor'sLicenseLawdo6notapplyloanownsofpropmywhobuildsorirnproveslhseon.
and who contracts for such prejets rvith a Contracto(s) licosed pursuilt to lhe Contractor's l-icmse law).
-l
tun cxenlpt under Sectt)n U. & P.C. for lhis re6on
Dalr:()rrncr:
\\ oI{Kl)ts' ( ()lIPl,.Ns,\'l loN
Dl:( t.,\lt,\ l loN
I hocby aflinn undcr poalty of ;rjury one of the follorving delrations:
I havc md will maintain a Cmillcate of Comot to Self-lnsure for workqs' compmsation, o povided for by Setion 3700 of lhe
Labor Code. for the pqfommce of thc wotk for which the pmnit is issued.
I have anrl rvill maintain workeN' compensalion insurance. as required by Setion 3700 ofthc t.ahor Code. for the psfonnance of
the rvork for rvhich this pennit is issued. My rvorkos' conrpensation ins[rance can'ier md policy numbet uc:
Canicr:
Policy Numbs:-_Expires:
I cmify lhat in the poforrnance ofthe rvork ftrr rvhich this pennit is issued, I shall not ernploy any p6son if, any manntr
s stobscorne subjcttotheNorks'compensationlarvsofCalifomia.andaSrethatiflshouldbecornesubjecttothe
wo*ss'compnsationprovisionsofSstienlT00ofthetaborCode,lshall,forthwithconplywiththosprovisions..
WARNIN(;: I,ailure (o secure workcrs'cornpensation coveragc is unlarvful. and shall subjecl an crnpkryer Io oirniiral pLlrahics nnd
civil fincs up lo one hundred thousand dollars ($100.000). in addition lo the of conrpnsation. damages as providecl for the
Section lhc Code. ints6t and atlomsy's
I)atc:
DECLARATION
I hqeby amril undq penahy of psjury lhal I an licens€d undq Frovision ofchaptc 9 (commmcing wilh Scction 7000) of Division -1
of the Business and Profcssiom Code. md rny licase is in full force md eff(t.
l.iccnsc ( lass:Nunr[rl
rrll)rl r:llit contrsctor:+
CONSTRUCTION LENDING AGENCY
I hrcby allirm undo penally of pejury lhal lh6e is a comlruc(ion l€nding agmcy for the pcfonnmce of the rvork for lvhich lhis fEflnit is
issued (S(. 3097. Civ. C.).
Lends's Name:
l-endcr's Addras:
APPLICANT DECLARATION
I hotby affinn unds penalty ofpojury one ofthe following delaations:
Demolition Psmils-Asbetos Notilication Fcdsal Regulations (Tillc 40. Pa(6)
Required Late of Notification
I corify that the federal regulalions rcgading obckrs remlval are nd applicable to this preject.
I colily that I have read this applicaliof, and stale that the at{vc infomralion is corecl. I a8r@ lo comply with all City and (hunly
ordinancs and Stalc lnrvs relating to building conslruclion.hqeby authorize reprsenlativ$ oflhis City and Counly to enlo u[x)n lhc
above mmtioned property for inspection
Applicrnt or Agcrt Sigtrsture:
Permile name (print):
l)rlc lt bln
Site-Work z(\
Underground 6'2r-v V.#AL I
Pole Bases
Liqht Standards
Spas, Pool, Fountains
Siqns (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Buildins
Under Slab / Floor
Bonding / Grounding / UFER
Transformers
Torqueinq
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rough)
Ceilinqs (Hard & Soffit Rouqh
Ceilinqs (T-Bar Rouqh)
Meter Release
Rough
Service Meter
FINAL -7J -Zlt \.NI,lL\
Notes, Remarks, Etc.\V
IA