HomeMy WebLinkAbout20167448 - Permit/-)
20 Civic Center Plaza (M-19), Santa Ana, C492702
lnspection Requests: (714\ 667-2738 lnspector Section: (714\ 647-5853
Electrical Permit #: 20167444
Pin #: 77382
City of Santa Ana
Permit Counter: (714) 647-5800
Proiect Address: 814 112 N Pacific Ave Unit;
Block: NA
Bldg:
Tract NA
Address Range:
Historic: No
Suite Range:
Zoning: R'lAssessor'sParcel: 405-131-30 Lot: NA
Phone:
Tenant Name:
Contractor:
Address:
Amount
o.14
53.28
22.08
55.04
Qoe
ESTANISLAO VEGA
814 N PACIFIC AVE
Santa Ana, CA 927032946
(7141675-2410
Owner-Builder
Fee Type
01116002 5160: New Res
01 116002 5160: Serv l\.4eler
01 116002 5160C General Plan Update
0'1 116002 5160: lssuance
Qty
588.00
1.00
1.00
1.00
Fee
$82.32
$53.28
$22.08
$55.04
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carrier:
Policy #:
Expires:,-
Building Use:
Job Type:
Nature of Work:
R-3
VB
cEc 2016
Accessory Dwelling Unit-A Occupancy:
New Conslr TYPe:
ADU Code:Notes:
Planning Conditions: All materials to match exisling.
Planning Approval By:
Plan Checked By:
Permit lssued By: Zuniga, Allissa
Subject to Field:
Buildins Permit #: 1 01 9831 0
Date:
Dale:
Dale: 1112712018
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
01116002 51600 $212.72
$0.00
$z',t2.72
Every permit issued shall become invalid unless the wofu on the site
authotized by such pemit is commenced withinl80 days afler its
issuance, or if the wo* authoized on the site by such pefinit is suspended
or abandoned lot a peiod o1180 days afler the time the wo* is
connenced.
01 116002 51603
$22.08
$190.64
Fee Total
Paid to Date:
Balance Due:
Owner:
Address:
Phone:
lnspector MID#: 2018-147353
APPROVALS ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I h.rcby rfltrr undcr pcnllry or lclury rh l im cxcmfl fi,d rhc conlr&kni Liccnlc lrw for rlr n]l!'winP rc.$n (Scu?oll5
auurc$ .ntj Plrt*tr)n C(iic): ny Ciry or Counry *hich rcquircs . IEmir k, consrnr.r. .lrci imrr,!c. Jcnnnh r tuFn riv
nru.furc. prrn io iB $uancc, lho ,.quiEs rhc appli.dr n, such llcmir t, lil. a ngncd nd.tunr rhar lt or she ir lt.nsd lllislanl
b rhc ptuvsions oi rh. Coordcttr's Lcnsqi Low (Ch2pier 9 commn in3 wirh S..rion ?0Oo or DivNon I ofrhc nusitus &d
Pn,tlsbn\ Co'lc) or rhd hcorshc il c\chor rturlidm and lhc$ash li)trhc rlldgcd cxcnrPlion Anyvn dbnolsccrioiT0ll5hvanv
appli.anr ror a p.rmir subjcch ltu attlicantioaciviltcnahyofo.rmrclhMlivcntn'trt{ldollds(5500
l. rs owtrc! ol rhd l,n)trdy. or nry cmlhF.\ ,nh *ag8 Ls rhcr. snc dnnncn\d Dn. wil nd rlE work d,rJ lh. (Brh \ ndr
txcntcd oroll.r.d tur srle (Scc7(14,1. Blrftss.nd PRntsions Co.l. lh.Citnrracktr\l,ir.n\cLawlocsnorrtplybatroqncrol
rh. BJtf,dy who hlrldr$ in{'otr rhcr.!n, d! who dEs $ch w,* himscll ot hcrellor rhi(nr3h his or hcr own cmFlovcc\.
povidcd rhd nrh innn)vcm.6 r. Rn i,r.ndcd .r.tlN.l lat eh ll. lokv.i rhc huil'ltrr! or mllrtuvcntni s $l'l wihm onc ){:ar
.l uomp|rtr)n. rh. Own.r B!tucr will hlt rhc hrrdd dfpruvm! th.l hc or \h. Jd n.r ttrilj or Fpn)rt rhc lnrFrlv li)r rlr PuqDs'f
L isowncroirhc ll)p.dy, !Nciclunvclyconkacriry wi(h ltcn\c!.ontrr,s kJ.on(r!cr rlE pol.d (sLt. ,7O{4, Buinclt
a Pnnar\rr C\dc: l hc Contr.fu \ l-iccnse Ldw d,Es .or rplly b rn.*ncr oi lropc yDh(ihurl'.ls.rin{rov.srhcr'on.
lnd Bio ronkacc for ruch pmrcct wirh a Conkn bn O lrccnscd pu^urr (' rhc O[rrtttr s l-irn\c Law)
I !'!.\c'n!r unJcr S.cr a & PC n)rrhsrci$n.
Ila85E8[COlItENlArlON
DECLAR-ATION
I hcrcby alftfr und.r pcnalry oI pcrj!ry onc oi$c lollowins dccleaiions:
thalc{,villm' rin r Ccniliqrc orco.snl lo Scl[lnslrc lor soi*cs' ompens ifi.as provid.d lor $v S(rrn :l?{x) or rh'
tibor Co{c, nr lhe p.rfo@c oi lhc worl lor whnh rhc p€mit is Gsue'i
-l
hale ed wiu ntintrin wotlc^' .oml.marion rsummc, .s ,cquircJ bv Selirn J'700 ol th. bhot Codc for rh' P'rlirm'n@ ot
rhc *ork tur whrh thG pcmir is Bsdl. M, workcs dmpe nsation iBurlM sier aol Plicy .umb$ rc:
Poli.y Nunhcr:-ExPncs:
-I ecditu rhai in rh. lEI lnrmn . ol rh. work nt which rht pcrmi '\ i\{'cd. I {ulln.r Mrlndv anv ix.vrn in rnv nrnNr
i, N n) h..uN utjcd t,lhc sotkcs.ompensarn,n Lwsofcdlilnnrin. an,l x!tuc th iil \houll L.onr Nrbicd n'r^(
*orkctr conrp.nqtonlnrvnions oiScrrion:lTlDol rhc Dbor Cixlc.lndl nnlheirh.onrlly wirhrhok Pr)viri.ns.
IVARNING trihrc b {curc wo*cn ormp.ntrbn covcixge s unlawtul. dd shall s'h,ccr rn.lnln,vcr lo cnninal lEroltis M'l
cNn ires up ro onc hundmd lhousand lollan (Sl{x),(x)o), r addil'on 6 rh. co( ot comp.nsr n am!8es ar pr]vntd tnr rh'
sc.tion]016 ol rhc lltrrcode, tnlcrc( ao'l ody sLcs
loDlimnl:-
LICENSED CONARACTORpEqldBlllloN
I h.Eby a,lom undcr JEnlllyotpcrjury rhal I am licensd unJfi prevnion olChaflo9 (4mmcroins wnh S.dirn 70@) otDiviion l
of rhc Bxsifts and Pmhssn,trs C.d., and my lsense n in fiill t)td ,il c,lt.l.
-LNnrc
Numhcr:
$I}IEIEqCUONTENpEIiICENCr
I htrhy dftnn undcr lEnall, or !.rjury rhal rh.a h a @nddcrion Ic lir8 4cmy tur lhc lErtanmn.c or rhc mrk lor whth rhc Isnir Ll
issuen iS.r. .1097, Civ. C.)
ATPLI('ANT I'E('LARATION
I lERrry rltim u ndcr aanalry olr.riury dnc olihc 61!,sin8 dcclrarns:
llcm)lion PcinneAshc(os Noriir ion Fcdclal Re3ulations lTnlc 40, P!n6)
Rcqun.d hllcrol Notiidrtr t
-l
c.niti rhd rhc l.{.ral tcrubl ions c8ddi.s rcb.nos rcnDvrlm not a$licnhlc nr rlrt tniel
l ocnili rhar I hav. r..d rhn apolicll n,n d {.rc lh.l rhc .h'v. inromEron s comd I r8N lo .omllv wirh ,ll Cilv lnd Coun(v
ordinands xrd Sr,r.l2ws Eblins ro building constnr.rbn. ad i.rby authorizc Errcrntariv.s dlthn Ci!v lnn counrvlo cnrcr ulon lh'
$ovc nrcnriorcd ptur.dy ror i.sp.dnr tx{rxcr.
,\ppli.anl or,\renlSiflnrlu
Site-Work
Underqround
Pole Bases
Light Standards
Spas, Pool, Fountains
Siqns (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Buildinq
Under Slab / Floor
Bondinq / Groundinq / UFER
Transformers
Torqueinq
Sub-Panels
Air Conditioners
Rool Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rough)
Ceilinqs (Hard & Sollit Rouqh
Ceilinqs (T-Bar Rouqh)
Meter Release
/,^\
Rouqh ,-21.10t *"Wnd
Service Meter t-(
FINAL L'lS-},|V.A
Notes Remarks EtC
ELECTRICAL-INSPECTOB RECORD
DATE
LctrJ1 . A'lJr*
=