HomeMy WebLinkAbout20161920 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Electrical Permit #: 20161920
Permit Counter: (714) 647-5800 Inspection Requests: (714) 667-2738 Inspector Section: (714) 647-5853
Project Address: 3417 S Timber St
Assessor's Parcel:
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
State Lie#:
Lie Type:
Bus. Lie#:
410-161-11
Tracy Tran
3417 S. Timber
Santa Ana, CA 92707
(714) 334-3170
Lot: 23
Master Construction & Deve
1228 Village Way #A
Santa Ana, CA 92706
(714) 568-5444
532153
B
347001
Workers' Compensation Insurance:
Carrier: State Fund
Policy #: 1965180
Expires: 05/31/2017
Building Use:
Job Type :
Nature of Work:
Single Family Dwelling
Addition
Addn-1st/2nd Floor
Occupancy:
Constr Type:
Code:
Planning Conditions: All materials to match existing.
Planning Approval By: , n ,
Plan Checked By: .. \ \ ,,,~//
Date:
Date:
Unit: Bldg: Address Range:
Block: NA Tract: 7002 Historic: No
R-3, U
VB
CEC 2013
Misc. Receipt:
Misc. Receipt:
Fee Type
01116002 51603 Addn /Res
01116002 51603 Low Voltage/Res
01116002 51600 General Plan Update
01116002 51603 Issuance
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,,
Notes:
Permit Issued By: ,t . _t~~w ~~i)eri
Subject to Field: ( '---·
Bui lding Permit#: "t6190132
Date: 11/02/2016
Account#
Misc. Receipt:
Total
Every permit issued shall become invalid unless the w ork 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 is suspended
or abandoned for a period of 180 days after the time the work is
commenced.
Inspector MID#: 2016-130238
01116002 51600
01116002 51603
$20.56
$127.06
Fee Total:
Paid to Date:
Balance Due:
Pin#: 79100
Suite Range :
Amount
0.13
34.2 0
20.56
51 .26
Zon ing: R1
Qty
320.00
1.00
1.00
1.00
Fee
$41 .60
$34 .20
$20.56
$51 .26
$147.62
$0.00
$147.62
APPROVALS
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
Bonding /Grounding/ UFER
Transformers
Torqueinq
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rough)
Ceilings (Hard & Soffit Rouqh
Ceilings (T-Bar Rouqh)
Meter Release
Rough
Service Meter
FINAL
Notes, Remarks, Etc.
DATE ID/SIG.
I I ' v ~/l\
V V
ELECTRICAL-INSPECTOR RECORD
COMMENTS
,.........,,
'
OWNER BUILDER DELCARATION
I h ereby affirm u nde r penally of pe1j my that I run e:,;:e rn pt from t he Contrnctors· License Law for the fo ll owing reaso n (Sec.7031.5 •
Busi11 css and Pro fession Code): Any C ity or County which n:quircs ,1 p<.11nil to constrncl. nlter. im pro\'e, d~1.i10lish or r<.-p.1ir an y ..
s tructure, prior to its issuance. also requires the applicant for such permit to file a sig ned s tateme nt that he or she is licensed pursuant
to the provisions of the Contrn cto r·s Licensed Law (Chnpter 9. Commencing w ith Sectio n 7000 of D iv is ion 3 o f lhe Business and
Pro fessions Code) or that he or she is exempt therefrom and the basis for the a ll eged e xemption . Any violation of Section 703,1 .5 by any
applicant for a pen ni t subjec1s the applicant 10 a civil penalt y of not more than f1,1e hund red doll ars ($500).
~I. as owm:r of the prope1ty. or my employees with wagc-s as th eir sole compensation. will do the work and the structure is not
int ended or offe red for sa le (Sec. 7044. Business and Professions Code: The Co111rnclor 's Li cense Law docs nol apply to an cnvncr o f
the property who builds or im pro\'es thereon. and who does such wOl'k him self or hersel f or th rough his or her own employees.
provided th.it such improvemcnis are no! intended or offered for sale. ff. however. the building or impr0\·cmen 1 is so ld within 011 e year
of complet io n. the Owner Bui lder will have the burden of provi11g that he or she did not buil d or im prove the property for 1hc puq,ose of
sale).
_I. as owner of the prc•pe1ty. am cxd usi,·cly contracting with li censed contractors to construct the project (Sec. 7044. Busirn:ss
and l'mfession Code: The Contrnctor ·s Li cense Law docs not apply lo ;m owner o f propert y who builds or im pro \"es !hereon.
and who contmc1s fo r such projects with a Co111m cto r(s) licensed pursu.rnt to the C'ot11 rac1or"s Li cense Law).
_I Ml e xe m pt under Sec tion ________ . B. & P .C. fo r this reason.
Dn te: __________ Owo c.-: _______________________ _
WORKEllS' C O~ll'ENSATION
UEC LAllATl()N
I hereby affi rm under pc11alty o f pt.-rjury one of the fol lowing d eclaralions:
_I have and wi ll mai ntain a Cc11ilirntc o f Consent to Sel f-Insure for work1...,·s· co mpensation, as prov ided for by ScrtiC'ln .HOO of the
Lalx.lr Code. fo r the pl.1-fonn.ince o f the work for which th e pL'llnit is issued.
_1 h.ivc and w ill ma intain workers· compensation insurance. as requil'ed b y Sect ion 3700 o f the L.ibor Code. for the JX-,·fonnance of
lhe wo rk for which th is penni t is issued. My workers· co m pensatio n insurance carrier and policy nu mber me:
Carrier: __________________________ _
Policy Numbcr: _____________________ Expircs: __________ _
_I cer1 ify that in the per fonnance C'l f the wor k for which th is permi1 is issued. I shall no1 employ any person in :my m:mner
so a.., to become subject to the workers' compcnsa1ion l.lws of Califo rnia. Md .igree th.it if I should become su bject to the
workers' compensation prov isions of Sect ion 3700 of the Labor Code. I shall. for1hwith compl y with those provisions ..
WARNING: f ai lure lo secure workers' compensalion coverage is unlawfu l, and sh.ill subject an emp loyer to c1iminal penalties and
c:iv1\ li nes up to one hund1l.-d thousand doll,,rs (jl 00.000). m add1t1on lo the-cost of compensation. damages as prov1dd for the
Scct1011 3076 o r t?t..: L.il.x:,r Code. mte 1cst nd altrcy's fees _ -7
1 I / , ,, , -/ -i --7 I '"7 ,,-, /
l>ule: ! 1 / 1 /( l icant: / , ., · / ~, ·
LICENSED CQNTll'ACToil I
I -' DllCLARA'I ION '
1 he1eby affirm under pcnaltyc;i)crjury l 1at I am hcc ed unde r pro,11s1on of Chapter 9 (commencmg with Sect ion 7000) of D1v1s1on J
of t he Business and Pro:~<le. and my hccnse 1s m full fo,ce ~~ \ ..---7
L,ccnsc Class _) I LJCCJ!SC N~~---1 ~_:=) / / rt:lor'~---_::-_y -~' . i ; , >/") J',/' O,1tc /I /
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/
TRI ,r·nnN LENDING AGENl'Y
~ hereby affirm undc~ pem1lty of perjury th at there is a ~!ruction le nding agency fo r the 1x1·fonmmcc o f the work for which this permit is
,ssucd (Sec . 3097. C,v. C.).
Lcndcr ·s Na me: _________________________ _
Lcndcr·s Address: _________________________ _
A PPLICANT DEC LARATION
I herebyaffi1m under penalty of perjury one of tht: fol lowing dec larations:
Demolit ion Pe nnit s-Asbestos Notification Federa l Regulations (Title 40. Prut6)
_Required LettcrofNotili calion
_I ccrt ifY,,(h at 11\e federa l regula tions regarding asbcs10s removal are not applicable to 1his project.
I cet1 i that I h~wc read this applicat ion and state th at the abo ve informat ion is com.:ct. I ag ree lo comply with al l City a nd County
or an sand State Laws reklting to bu ild ing constrnction. and hereby authorize represen tatives o f th is City and Co urlly to enter upo n the
above 1tioncd property for inspeclion purposes. ,
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App ic;ml o:zA: nt S ignnture~._-____ _,,~_,-,'--c7,'/'----,_,,_/_,,..._--,-'-,,-'--~--IJ 111c•_._1~/-~,:~··,r'-/~/_; __
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