HomeMy WebLinkAbout20171267 - Permitt '.),'
,Aw City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Electrical
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (7141647-5853
Permit #:20171267
Pin #: 63403a
Proiect Address: 200 W Santa Ana Blvd-a-
Assessor's Parcel: 398-253-06 Lot. 1-10
Unit 100
Block: 20
Bldg: Address Range:
Tract: TOWN OF SANTA Allistoric. No
Suite Range:
Zoning: SD84
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone.
Santa Ana CA Ii Sgf LLC
1 N Wacker Dr #4025
Chicago, lL 60606
(800) e144887
HCA
H L Miller lnc
2201 E Winston Road
Anaheim, CA 92806
(7141 se8-86ee
01 1 16002 51603
01 1 16002 51603
01 1 16002 51603
01 1 16002 5160C
01 1 16002 51603
01 1 16002 5777C
Fee Type Amount
125 Volt Receptacle 1 .57
Light Switches, Occ. Se 1.70
Min Fee Adj 52.38
General Plan Update 23.79
lssuance 59.30
Microfilm Records 4.05
Qty
9.00
5.00
1.00
1.00
1.00
1.00
Fee
$1 4.1 3
$8 50
$52.38
$23.79
$5e 30
$4 05
State Lic #: 385912
Lic Type: B, C-33, C-6, C-39
Bus. Lic #: 2631
Workers' Compensation I nsurance:Carrier: Falls Lake Fire & Casualty Company
Policy #: FLA00898B
Expires: 0410112021
Planning Conditions: lnterior Tl only. No exterior alterations/modifications.
Building Use:
Job Type.
Nature of Work:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
High-Rise Commercial
Tenant lmprovement
Tl - Partion Walls
Occupancy.
Constr Type.
Code:
Date.
Date:
Date:
B
I A, SPK
cEc 2019
10t07 t2020
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes: electrical for Tl
Fee Total
Paid to Date:
Balance Due:
Zuniga,A[*M
Buirding Permit#,tQ\ \ozr1 sL
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
issuance, or if the work authorized on the site by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
lnspector MID#:2020-1 59 112
01 1 16002 51600
01 1 16002 51603
01 1 16002 57770
$23.79
$134.31
$4 0s
$1 62.1 5
$0 00
$162.15
ELECTRICAL.! NSPEGTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS
Site-Work
Underground
Pole Bases
Lisht Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Ala rm I Dampers
Communications Cable
Buildins
Under SIab / Floor
Bondinq I Groundinq / UFER
Transformers
Torqueing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilinqs (Hard & Soffit Rouqh
Ceilinss (T-Bar Roush)
Meter Release
Rough
Service Meter l, I f - t)
FINAL nt(0t(u /)/r?rw
Notes, Remarks, Etc.I
I hmby affm undo pcnalty of pcjury that I fln cxcmpt fiom thc Comractoa' Licw law for the following r€er (&c.70]1.5
Busines md Profsion Codc): Any City or County which requirs a pannit to corutruct, alte, improve. <hnofh odlir uf
structuq pdor to its isumcc. also rcquim the applicat for such pcmit to filc a signcd stamot thd hc or slrciAcrocd-lNant
to the provisioro of rh€ Contractor's Liccnsed taw (Chaptq 9. Commcncing with Setion ?000 of Division 3 ?i thc Bsin;s ild
Prcf6sionsCodc)orthatheorshciscxmptih@fromodthcbasisforthcallcgc{cxemption. AnyviolationofsElionT03l.5bymy
applicant for a pcrmit subjets thc applicet to a civil pcmlty ofnot morc thil five hundrcd dotlus ($500).
_1, c oms of the prcpcny. or my employc with wag6 6 their slc compqsation. will do th€ rc* ild thc stnrclrc is not
int@ded or offdcd for slc (Se.7044. Bsirs od Prcfsioc Codc: The Contractor's Licce kw doq trot spply to e omq of
th€ prcpqry who tuilds or tnprovs th@n. ed who do6 such w* hiroclf or hemlf or thrcugh his or ha om mployc.
providcd that such imprcvmts se mt intsded or offqcd for salc, If. how6. thc building or imprcwt is wld within onc )ar
of compliiorl the Ovn6 Buiklq will havc thc hqlen of prcvirg tha he or shc did mt build or imtrorc thc popa'ty for thc purposc of
slc).
_1. r ownc of thc prop<rty, m cxclusively contrac{ing with licenscd contrrctoF lo oNlrucl thc projel (56. 7044. BBins
ud Profsion Code: Thc Cootractor's Licmsc Law do6 not apply to m owns of prcp€rty who builds or improvs thq@n,
and who contncis for such prcjets wilh a ContBcto(s) licoscd pm@t to thc Contmc{or's Licw trw).
I
-l
am exempt under B. & P.C, for this reiuon.
WORKERS' CONT PENSATION
DECLAR,{TION
I hereby aflirm under penalty of pojury one of the following dcclarations:
_l have and will maintain a Certificate of Consent to Self-lnsure for workers' cornpensation, as provided for by Section 3700 of the
Labor Code. for the performance of the work for which the perrnit is issued.
_l have and
the work for
rvill 3700 of the labor Code, for the performancc of
are:and policy number
Policy
.(,ccrti$ that in the perforrnance of the work for which this perrnit is issued. I shall not employ any person in any manncr
to become subject to the workers' cornpensation laws of Califonria. and agree that if I should become subject to the
workos' cornpensation provisions of Section -i700 of the labor Code. I shall. forrhwith comply with those provisions..
WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an and
civil lines up to one hundred thousand dollars 100,000), in cost of the
Section 3076 of the interest and fees.
I hereby affirm under penalty of pcrjury that I am p,rovision of Chapter 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code. and rny liccnse is in full force and effect.
o
CONSTRUCTION LENDING AGENCY
I h@by affm undd pcnalty of pqjury thst thqc is I omtruc{ion l@ding ag@cy for thc pqfomilc€ of thc rcrk for which this pqmh b
issucd (56. 3097. Civ. C.).
Lcnder's Name:
Lender's Address:
APPLICANT DECLARATTON
I hereby alfum under penalty of perjury one of thc following declarations:
Demolition Perrnits-Asbcstos Notification Federal Regulations (Title 40, Part6)
-Required
Letter of Notification
_l certify that the federal regulations regarding asbcstos rernoval are not applicable to this project.
-I
ccrlify that have read this application and state that the above with all City and County
and County to enter u5r,on theordinanccsandStateLawsrelating
above mentioned property for
Applicnnt or Agent
Permitee name
to construction.and \
Rev. 08-07-2015
Section
Exoires:
to
,L
infonnation is conect. I
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