HomeMy WebLinkAbout20166144 - PermitCity of Santa Ana
Permit Counter: 1714) 647-5800
20 Civic Center Plaza (M-19), Santa Ana, CA92702
lnspection Requests: (714\ 667-2738 lnspector Sectionr (714) 647-5853
Electrical Permit #: 20166144
Pin #: 44583
Project Address: 100 S Main St
Assessor'sParcel: 398-278-04 Lot: 1,2
Unit:
Block: 1
Bldg: Address Range: 1OO-i lO
TTact: PALMER.S ADD HistoTic: Yes
Suite Range:
Zoning: SD72
E
Ownerl
Address
Phone:
Tenant Name:
Contractor
Address:
Santa Ana H.S. Cross Country
Owner-Builder
Fee Type
011 't6002 51603 FWU
01116002 51600 General Plan Update
011 16002 51603 lssuance
Amount
23.87
21 .25
52.9A
Fee
$23.87
$21 .25
$s2.98
Phone
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
Building Use:
Job Type:
Nature ot Work
Planning Conditions:
Planning Approval By
Plan Checked By:
Permit lssued Byl
Subject to Field:
Building Permit #:
Other
Miscellaneous
Fireworks Stand
N/A
N/A
cEc 2016
Occupancy;
Constr Type
Code:Notesr Handout given/fees pd in full on M-71110
Date
Date
Date
Misc. Receipt: 71110
Misc. Receipt:
Misc. Receipt:
Total
Link, Patricia
Every pefinil issuod sha bacomo invalid unless the wo* on the sile
authorized by such pemil is commenced wilhin180 days after its
issuance, or if the work authonzed on the site by such permit is suspended
or abancloned tor a perlod of 180 days after the time the wotu is
commenced.
06t13120't8
Account#
$98.10
$98.10
$0.00
lnspector MID#: 20'18-'143953
N/A - No Balance Fee Total:
Paid to Date:
Balance Due:
\4,(
100 South Main Street Llc
1200 N MA|N ST 900
Santa Ana, CA 927013627
Qty
1 .00
1 .00
1 .00
ELECTRICAL-INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS
Site-Work
Unde round
Pole Bases
Fountains
monumentSiNS
Life Safe /Low Volta
Fire Alarm / Dam rS
Communications Cable
Buildin
Bondin / Groundin / UFER
Transformers
To uern
Sub-Panels
Air Conditioners
Roof T UI enlE
Facto Wired Unit
Ceilin Hard & Soffit Rous h
Ceilin S
Meter Release
Rou h
Service Meter
FINAL
Notes, Flemarks
OWNER BUILDER DELCARATIONI ncrcby amrm un&r pcmlry or pcrjnry thar I m crcm fmn rhc co.ra.r66 Liccns tjw tor rh. folowins rcamn (S(.7o] I t
sorincss rnd Pmrcsion Codc): Ary Ciry or County whih rcquircs o Fjmn b hndtucr. alr.( inl,mv., d.mliii or Epair lny
sru.rrrc. lrhr to n! isiu,rcc. aho rcquiEs rh. lppticanl ror s$h Fnnit to itc a siSmd satctunr ttor tE or sh. a ti.cnscd pu^annlt' thc pmvhionr ofltf, Conka..or's Lienscd L{w (Cha/cr 9. Commncine sirh Ssrion TOur of oiahi.n I of rhe Burinc* n.d
Por.sioN Codc) o. lh ne or shc t crcnll rh.rctom and rhc bask tu rhc atlcscd cxcmprion An, viohtion otsccr,on ?Oll tnyatryanlh. ntr ! |.,nrit{br.d\rr. sFrticanr to Jc'v.t[Icnokyotnor mn,e rhrn n!e Fundrcodo e\ ls5tur)
ffirr,r:lr,*r,Jil,l::l'J"".:;r',;"f:#irHllf,r'rfirlr'#;r',r#tl'h*:HffH,.I'r,.,
rhc lr(lllny whd huilds or inrprews irEftn, ad wlb d6 shh w* hinsctror h.rctror rhmuslr his or h*o*;;dpby.s.
Iirclidcd rhsi such inlroEmnb ft mr inrcndd oroficnd fo.sh Il. k *chi rhc tlildins or inphhmnr G std uirhin nnc rroronpkrioo. rh. Os,rer auirlq wi!, nls llE hrd.n nfrovinS rh,r lx.r sh. did mt t{ild or irlhh rh€ pmFny aor llE l)Urrs{ or
l. r!.wncrolrhc nror.ny. ! crch'\ivcty.otrkrcrins wih tNrscd.nnrrNru\ lo cotrslrucr rh. pmlc.r lScc.704,t. Busin.sl
fhfcssiJn Codc lhcConracrtr s l,iccnsc Lra dllc\ hor apntylo nnosmrofrorcdywho huit s.rnnd sho conlmck ror su.h ltrojdF wirn a Gnrmcro(9 ticctrsd pursued |o ric Coorrodof\ Lic.nrc L!
I h.rcby arfirn undcr lcn,htorI€rjuryonc orrh. rdkrsins
I h!!€ andsill hEimain a C.nificorc of Consor ro S€lt-lnsuB for *ortcm compcns.rion, os pmvided fo!bySeion3T0ooftheblnr Codc, aor fie poiomne of thc wor* for *hich lnc p.mt h nsucd.
_l horc and will maintai, worrcB c.fipensarion iosuratuc, as rcquicd by s..lion 3?OO oflhc Labor Codc. ro, rhc rj.rformncc of
rhc work ro. whth rhn tsnil is isskd. My vortcB onip.osarion inslErc. cei.r ajld Flicy rumbs ml
I'D r ! fr'!n: i" itry n,rnai
worlc^ compctrsurion pmvisi,,ns ofSc.tn,tr 37m.frh.Iitnr Codc.I\hrtt. ionhwith conrty wirh rths prnvhions
rii'allc'
coalP.ns nnr ..!crxgc i. I w{nl, Md \hall rubicr !n cnl,',orrr ro 6in nal rculras rnd
ion. daruCus as providcd lor rh.dolhr (SloO.{XX)r. in ld
I hctuhy rllt'! undcr pcn{lryofp.rjuy thd I nti.cnscduoderpmvistunorChDrrer9(connmrcinSwirhs
ol rh. Busirc$ !M Profc$ions Codc. nxl nry ticdn{ G in lull tirN od dffccr
CONSTRUCT(IN I I'NDII\(; A(:FNCV
I lrEby ulilflnundcr p.nalryofFrjury thot rh.ic h a.onnrucli.tr hnding {cocy i'or lhe pcrtorna..c orrhc work ior which lhh p.rni n(sred (Se. 3097, Civ C ).
APPI,(:ANT DFCI AR,{TIoN
I llatby nfllm onner pcnnhyorF.rjury onc oirhc lottowing dcclir0rions:
I)cmnIion Pcrmirs-Asbcar.s Norificotiotr Fcdcrat Regllations (Tirtc 4t], pfi 6)
-Rcqutcd
Lcxs of Nolificxrion
I cniryrhrr ihc riicrolrclutal(rn\ rsstin8 !\bcio\.cmvltarc ml{fti.,blc kr rhis pmjccr
rhd Ih !c rcldlih amtic.r tnr d nrrr lhnr rhc dtbvc ini{nnDli,rr i(c.rc.r I rlrccr,cor
rnd Srar. IjRs retarins ro bui rizc rcprcsctrhllcr.rrhh C
atn,vc nEtrrbmd pnrEny for i.sn .rn,n
ApDlic{nr o. AXent Signatuft:
dt con{ru.rioD. itrd hcr.6r-
ply sirh nllCtyrM C.trfrv'"^;lilitr^*
Liqht Standards
Spas, Pool,
Under Slab i Floor
Walls (Conduit)
Walls (Rouqh)
(T-Bar Rouoh)
t tl
Etc.
rJdcfs Addrcs: _