HomeMy WebLinkAbout20168158 - PermitCity of Santa Ana
Permit Counter: (714) 647-5800
20 Civic Center Plaza (M-19), Santa Ana, CA92702 Electrical Permit #: 20{68{58 l}
Pin #: 76047lnspection Requests: (714) 667-2738 lnspector Section: (714\ 647-5853
ProjectAddress: 2003 N Bush St Unit:
Block: NA
Bldg: Address Range:
Tract: MAIN STREET Hisloric: No
Suite Range:
Zoning: R3Assessor'sParcel 003-111-14 Lot: 35
Owner:
Address:
Eric Guzik
2003 N Bush St
Santa Ana, CA 92706
(7',t41222-1860
Fee Type
01 116002 5160: 125 Volt Receptacle
01116002 5160C General Plan Update
01116002 5160: lssuance
Amount
1 .45
22.08
55.04
Qty
1.00
1.00
1.00
Fee
$1.4s
$22.08
$55.04Phone
Contractor
Address:
Owner-Builder
Stale Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:
Building Use:
Job Type:
Nature of Work
Single Family owelling
Miscellaneous
Electrical
Occupancy:
Constr Type:
Code:Notes: Electrical
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
web vuser \
Date:
Date:
Date:o3to712019
Account#
Every pemit issued shall become invalid unless lhe wo* on the site
authoized by such pernit is cofimenced within 180 days aflet its
issuance, or il the work authoized on lhe site by such pennit is suspended
ot abandoned fot a pe od o1180days aftet the lime the work is
commenced.
$78.57
$78.57
$0.00
lnspector MID#: 20'19-149925
N/A - No Balance Fee Total
Paid to Date:
Balance Due:
Tenant Name:
Phone:
R-3
VB
cEc 2013
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
ELECTRICAL.INSPECTOR RECORD
APPROVALS ID/SIG.COMMENTS OWNERBUILD€R DELCATlA ION
I hdcbt amr unds poaltyof pdjury lhal I an.xcnDl fior rh. cont0crou' Li..m Lr* forlh. follo{in! rcen (Se70115
nusinBs lnd Prol6sio, cod.) A., Ciry or counry *hich r.qun6 a psnn to construcl. ah6. inprorc. d.ftol*h or .cp.ir sy
srtu.t@, prior to its issumc.. als r.qun6 lh€ appli.anl for srh Fmil rD nl. a sign.d na(m.nl thd h. or 3h. ir licd*d lld3@I
lo rhc provisions ofth. Contr(lois Licos.d La$ ((haptr 9. Commocins snh Sction 7000 ol Division I ofthc Busi.6s and
ProLsiom Cod.) orrhar h. or sh. n crdpl lhacnom md lh. tosis aor ihc oll.g.d.rmpnrn Ant violario.ofsdionr0ll t bran,'
applica aor a Forn srbjris lh. ar9li.anr ro acivilpolllyolnol mo..th fi\. hundrcd dollds 11500)
I,6 ow6 oflhc proF.ny. or my.mployG wilh s.86a rh.n el. conpdsarion. \rilldo (h. \ort rnd rh. en'crm b mr
inl6d.d or olIdcd a6r salc (56 7()44. Burin* dd l\oi6sioE Codc Th. Contrictors l-ica* tiw do6 nol q,ply ro own6 ol
rh.FFly $ho hilds or imFov6lhdon. od vh. dc au.h M,t hins.lfor h.6.llorrhr.ugh hi! or hd osn.mployd,
Ftrovid€d llut such imlrormats e not iniai.l or oftd.d aor sk Ir, h.wad. rh. buildnB or trrymrc,Mr G $ld $ irhm .ft ltr
of co,nrrkio.. rh. oten6 Buildo will hart rh. hrd.n orpr.lins thd h. or shc dil not build or inrprov. lh. tirFty tor ih. purpoF oa
l. a osnd o f th. l'opaly, @ .\clB'v.ly .onradins r'llh licdscd conriacloE ro mnsrru.1 ttE p.ojcct (Sc ?0{t. A6md
and Pr.tusion Codc I hc Conn elors l,iccns. h* do6 nor amly r. an o\!nd o f tr.pmy rh. huil& or introv.s rhdon,
ind qho contmds aor su.h pbjmls \nh a Conrmclo(s) lrds.n puuunr lolhc Conlracrors ljcsc liw).
I m.r.bpl und6 sdlion
]t0B(DBl-(aUPTlSAltOr
DECI.AEAIIQN
I h6.by.fimr und6 p€.ah, oaFjurloncoathc aollo$ing d(lr io s:
I hav. ed vill min16i. a C.nifical. ol coBdr ro S.ll,l6urc for *.rk6 c.mr..etion. as previdcd for by Sclion 3 700 ol thc
tib.r Cod., lor lh. ldaomec. o t th. krt for whict lhc p6mil is isucd
I harc ond sill mrint.i. Norkds compdalion insuran ., ar r.qun.d bls<rion 1700ofthc lrbor Codc. for rhc p-fomancc of
rh. \rork lor rvhich this pmil is isecd. My worl6 conpo&r ion insurd.. cnir dd Ix icy numbs a€.
I cdily rna( ih ih. pdfarntnc. ofth. {ork lor $hi.h lhis !.imil is issu.d. I shallnol6ploy any psson io any n!nn6
s slo b.con. subjer ro
'hc
*ol(qs comp.r6ation lass orcahromi.. dd asre rh.' ifI should tE om. s'hj(l ro rh.
$ork6 compcnsalionprclisionsofScdion 1?01)oarh. Labor cod..I sh8ll. lonhwnh .omply sirh rho* polisioB
WA|INING: r{ilurc ro sure sor[6 .onpoEtion co\qasc is unlasful. and shall sub]d Enplo)s lo ooiMl poaltE lnd
civrl lin.s up to on. hundr.d
'housnd
doud (5100.000)- in addilion to lhc cox of comp.Ntion. dmascs 6 rrovidcd for thc
Sdion 1076 olrh. tlbor ( od., imcd dd diomiy\ t6
LICINSED-(()NTAACTOA
l)Egdaallo!
I hd.b, amm undn posxy oa pdju.y lhin I e lrcq!.d undq provision of Chaprd I (corndcins with Sed ion 70(()) oi Dn ision l
oa lh. Bsins ud Prcfsions Code. ed my licos. is in aull aor.. md .iIfrr
I 'c.cc Numbc'
-
COIiIAIJqTAII.ETDIIG-AG
I h*by a,Im undd Fn lty oa pdjury lhal the i! r consrtu.16. Lndi.s ,cfty ao. rh. p6fo1l@cc of rh. *orl 6. *hth dis Fnn ir
ilsu.d (Sa 1097. Civ C).
APPLICAN'I' I'fCL IATION
I ho*y alln, n.dd Fmlty ofpdjury one oflhc ao,lowinE dclratio.s
D.molilion Pmils-Asbdos Norificrtio. F.ddrl R.€uldio.s (TnE 40. Pan6)
Rcquir.d Lcll6 ot Nolificalion
I cenilyrhat rhc Gdsnl r.! ular io ns Essdin8 isb€stos rmoralu. nor opplicibl. ro rhie rmld
l cdriry thar I ha c r.ad lhG lppli.ar ion ..d aar. rh.[hc ahlr inlomat ion Lr .orc.l l asrc lo comtly with all Cny and Cou.ty
ordinancG 0.d St.r. LaM El,ri.g to boildidg .onsrucion. dd tmby aurlF iz. r.p.Mtalir6 otlhis Cny d Coulty to mlG uBr. tlE
abo!. matio.at popoly for inp<rion rnrposG
.\pplicntrl or Afc l SiA .ln'o
Site-Work
Underground
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
Torqueing
Sub-Panels
Air Conditioners
Roof To p Equipment
Facto ry Wired Unit
Walls (Conduit)
Walls (Rough)
Ceilings (Hard & Soffit Rouqh
Ceili ngs (T-Bar Rough)
Meter Release
Rough
Service Meler
FINAL c/4/1? A ,/Afe- /6 /
Notes, Remarks, Elc
DATE
l.iceNeClas