HomeMy WebLinkAbout20170662 - Permitcity of Santa Ana 20 civic center Plaza (M-'19), santa Ana, cA 92702
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Electrical Permit #:2lJ170662
Pin #: 838836
Proiect Address: 4006 W Roberts Dra
-
Assessor'sParcel: 108-602-26 Lot:18
Unit:
Block: NA
Btdg:
Tract: 4548
Address Range:
Historic: No
Suite Range:
Zoning: Rl
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
Lily Ngo
4006 W ROBERTS DR
Santa Ana, CA 927042131
(714) 496-0685
Tesla Energy Operations
2102 Alton Parkway
lrvine, CA 92606
(702) 785-2998
01116002 51603
01 1 16002 51600
0't'!16002 51603
01116002 57770
Fee Type
Serv Meter
General Plan Update
lssuance
Microfilm Records
Amount
55.37
22.95
57.20
3.91
Qty
1.00
'1.00
1.00
'1.00
Fee
$55.37
$22.95
$57.20
$3.91
State Lic #: 888104
Lic Type: B, A, C-10, C-20, C-46
Bus. Lic #: 324801
Workers' Compensation I nsurance:Carrier: American Zurich
Policy #: WC107458302
Expires: 1013112020
Batch*:54632 - 3/Z/?tt?i I0: qnonqleslS
Office: CTYH Trons*: 64 ? of' ?Acct*: Ref *: 21117U,562
Rcpbi:02906445 - 3/2/2fi211 10:l:19 Al1
Tronsoct i on Totol t611.26
TesIs Enerss 0perations
Genernl PIsn Updnte Fee $'12.'.t'il
tll 1 161:102- 516t-'tlll0t-t-Electricql 111?.1:;7
Lrl I 160tr2- 516t13(tlil_r..llicrolilm & Docurents $i.)'1
Lrl 1 161102- 5777(rtrtru-
lnstall lftir $6otkrountetl-S&61 PV system. ALL Stff4AR:rS
FEES PAID ON 101102915. Service meter handout
given.
$139.43
$0.00
$139.43
Building Use:
Job Type:
Nature of Work:
Single Family Dwelling
Solar
Solar/Service meter
Date:
Date:
Date:
R-3, U
VB
cEc 2019
Planning Conditions:
Planning Approval By:
Plan Checked By: Smith, Mark
Amsden, Julie
1102915
02t04t2020
03t0212020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total:
Paid to Date:
Balance Due:
Permit lssued
Subject to Field:
Building Permit #:
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 rs suspended
or abandoned for a period of 360 days after the time the work is
commenced.
10 01 't '1 6002 51 600
01116002 5't603
01116002 57770
$22.95
$112.57
$3.91
lnspector MID#: 2020-157301
Occupancy:
Constr Type:
Code:
ELECTRICAL.INSPECTOR RECORD
Rev.08-07-2015
APPROVALS DATE ID/SIG.COMMENTS OWNI.]R BUILDER DI]LCARATION
I hcrcby affrnl undcr pcnalty of p€rjury that I dil excmpt from the Cbntraclon Licensc liw for thc following Een (Se.7031.5
Busincss and Prolcssion Codc): Any City or Couily which rcquircs a pcnnil lo cons(ruct, sltq. ihprovc, demlish or repair any
strucluE, prior b its issuancc. also rcquiEs the applicail foa such frcmil ro fih a sigrcd slatcmnt thst lE or shc is licctl*d pur$ant
lo thc pmvisions ol thc Contractor's l,iccnscd Law (Chapter 9, Cornrnencing wilh Scction 7000 ol Division 3 o[thc Business und
Professions Code) or that hc or she is exerDl therefrom and tlB basis for tlF allcged eien{,tiotr. Any violarion ofSection 703L5 by sny
applicantforalEnnilsubjststhc appliciDttoacivilpcnaltyofnolrrcrclhanfivchundrcddollars($500).
_1. as owncr ol'thc propcny. or rny crnployccs with wagcs as thcir $lc compcnsathn, will do thc work and the structuc is not
intcrxled or offered for slc (Sc.7(N4. Business md Profcssions Codc: Thc Conlraclor's Liccnsc Law des not apply lo m owncr of
theprcFny wlphoildsorhprowstherqnliodwlEd6suchwoIkhimselforlEr*lforthrcuthhisorherownentployes,
providcd that such imprevurcnts @ mt intcrxlcd or ollcrcd for elc. Il, howcrcr, OE boiUing or irprovcmil is eld within one )rd
ofconulctfur! thc owrer Builler will havc the burden ofpNving lhd lE or she did Nt buill or imprcvc tlrc pnrpaty for th. purpo* of
Mle).
_1. as owner of thc prupeny. am cxclusi!cly contractins with liccnsd contrelos m con(rud th. prcjcd (Scc. 7Ol4, Busihcs
and E$tlsiDCode:TheContractor'sLicenseLawdoesnotapplyloanownerofpropcnywhobuildsorinrprovesthereon.
and who conlracls for such prejccts wilh a Contrack)(s) liccnscd pursutut to thc Contr&lor's Licensc [jw).
-lanlexempt!DdeIsecli(ll-'B.&P.c,,oflhisreason-I)at(:
UIISEES:SAMIJNSAIIAN
DECLANATION
I hcrcby aflirnr undcr penalty of pcrjury ooc ofthc t'ollowing decltrationi:
_lhaveudwillnEinlahaCenificalcofconsenttoSelf-Insureforworkcrs'conrpe[sation,as prcvidedforbyScctionST00ofthc
tatnr Codc, for thc pcrforolec of lhc work lbr which tlE pcruit is issued-
151 have and will rDaintah workeB'conrpcNation insursncc, as rcquircd by Sccliur 3700 of lhc tibor Codc, for lhc lErfonBrcc o[
thc work for which lhis pcrnit i3 issucd. My workcrs' compcnsation insurdce c6ier and Frlicy numbcr uc:
Policy r-)c-\c'l 2 1'1-/3t I LC)
_l ccnify that in tlt lrrlornurcc of tlrc work for which this pcrmil is issucd, I shall not employ aoy person in my IMrcr
e aslobcmrcsubjccttolhcworkcrs'compcngionlawsofcalifomia.andagccthatiflslnuHbecorrcsubjecttothc
workcrs'compcnsationprcvisiosofScction3T00ofthctaborCodc,ldull,fonhwithcomplyailhlho*prcvisioN..
WARNING: Frailurc to sccurc worlerr'compensation coveragc is unlawful, and shall subjcct an employcr to oiminul pcnahics md
civil fmes up b onc hundrcd thousand dollars ($lOJ.lX)o). in additiul to tlE cost of comFcretion, dmugcs as providcd for rh.
Scction 3076 ofthc Lahor Co(lc. intcrcst md altorrcy's lccs.
D^1", blLlLo nppt*t, *-/ -
LrcEli[Lp_eQNI&LCTOR _./-
I her.by afltrm undcr p€n{lty ofpcrjury that I an, li".r*,I iiliJiiiiiii?chapt{ 9 (connrncing with Scction 7000) ofDivision 3
of the Business and Prcfessions Code. and rny license is in full forc aRl affcct.
Liuensc Nunlber:8E6 l0 r-l
,*-, a)? lza aesVtC0ntract0r:
CONSTRUCTION LENDING AGENCY
I hcreby alliiln undcr pcnalty ol pcrjury that thcrc is a construction lendihg agercy for thc pcrlbrmarce oflhc work lor which lhis pcrmit is
issu.d (Scc. 3097. Civ. C.).
[rndcr'r Noilrc.
[ander's Addrcss:
4llJNI.p!,c!&Eq
I luehy affim undcr pnalty of pc{ury onc ofthc folkrwing dccluationsr
Dennlition Pcrnrits-Asbcsk)s Notification Fcdcral RcSulalioos (Titlc 40, Pm6)
_Rcquircd trxcr of N(niri6lion
_l cc(ily that thc tcdcralrcgulations rc8ilding asbcstos remvaluc not applicablc to this pmjcct.
29f,J cenify rlur I havc read ltus applicalion {d statc tlut ilrc dbove inforrotiotr i5 conm. I agre to conrply with all City snd County
ordinanccs ud State l-aws rclatinS to building consmction, and hercby autlnrize rcprcsntativcs oflhis City md County to cnter upon rlrc
ubovc rnantioned pft)peny for inspeclion plrposes.
Applicant or Agot
Itcrnrilcc [smc
^.", 3lz/zo
Site-Work
Underqround
Pole Bases
Liqht Standards
Spas. Pool, Fountains
Signs (monument)
Life Safety /Low Voltaqe
Fire Alarm / Dampers
Communications Cable
Buildinq
Under Slab / Floor /-\
Bondinq / Groundinq / UFER 4.^Z-z
Transformers
Torqueino
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouoh)
Ceilings (Hard & Soffit Rough
Ceilinqs (T-Bar Rough)
Ivleter Release tzlu -trx7
Exh L/'o+.fi- P l*rOL I Y4WK
Rouqh
Service Meter ).-,r4itr
FINAL
Remarks Etc
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