HomeMy WebLinkAbout20169103 - Permitllfu, City of Santa Ana 20 Civic Center Plaza (M-1e), Santa Ana, CA s2702 Electrical
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Permit #: 2o^{69{03
Pin #: 65121
Proiect Address: 1129 112 S Van Ness Avea
Assessor's Parcel: 013-094-08 Lot: 66
Unit:
Block: NA
Bldg
Tract: 648
Address Range:
Historrc: No
Suite Range:
Zoning: Rl
Owner:
Address:
Phone:
Roberta Rogers
1129 S Van Ness Ave
Santa Ana, CA 927071135
(7141 415-e898
01 1 16002 51603
01 1 16002 51603
01 1 16002 51603
01 1 16002 51600
01 1 16002 51603
Fee Type
New Res
FWU
Low Voltage/Res
General Plan Update
!ssuance
Amount
015
25.76
38 16
22 95
57 20
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Qty
329 00
200
100
1 .00
1.00
Fee
$4e 35
$51 52
$38. 1 6
$22.e5
$57.20Tenant Name:
Contractor:
Address:
Owner-Builder
Phone
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carriei:
Policy #:
Expires:
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Building Use:
Job Type:
Nature of Work:
Accessory Dwelling Unit-C Occupancy:
Conversion Constr Type:
ADU Code:
Julie
Date:
Date:
Date:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Buildins Permit # 1 01 990 67
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 sife by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
07 t05t2019
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total:
Paid to Date:
Balance Due:
01 1 16002 51600
01116002 51603
$22 95
$1 96 23
$2t918
$0 00
$219.18
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lnspector MID#: 2019-149037
-.r.."
ELECTR!CAL.I NSPECTOR RECORD
I hereby aflirrn under penalty of perjury that I am exempt frorn the Contractors' License [.au' for the follorving reason
Business and Profession Code): Any City or County rvhich requires a pennit lo construct. alter. improve. dernolish or
structure. prior to its issuancc. also requires the applicant for such pennit to hle a signed statement that he or she is licensed
to the provisions of the Contractor's Licensed [,au' (Chapter 9. Conunencing rvith Section 7000 of Division 3 of the Business
Profe$ionsCodelorthathcorshcisexcmptthscfromandthebasisforthcallcgedcrmpiof,. AnyviolalionofSctionT0-1l.5byany
applicant for s pemit subjets the applicant to I civil pru[y of not morc than five hundrcd dolles ($500).
_1. as owner of the property. or my employees rvith rvages as their sole cornpensation. s'ill do the rvork and the structure is not
intendetl or offered for sale (Sec.7044. Business and Professions Code: I'he Contraclor's License Larv does not apply to an orvner of
the property rvho truilds or improves thereon. and rvho does such rvort himself or herself or through his or her orvn employees.
provided that such improvonents are not intended or offered for sah. l[, hos'ever. the building or improvement is sold rvithin one year
of cornplaion. the Ou'ner Builder rvill have the burden of proving that he or she did not build or irnprove the property for the purpose of
sale).
as owner of the propeay. arn exclusively contracting rvith licensed conlractors lo conslruct the project (Sec. 7M4. Business
and Code: 'l'he Contractor's [,icense Larv does not apply lo an orvner of property rvho builds or improves thereon.
Contractor's l,icense Law).and rvho contracts ftrr such projects rvith a Contractor(s) licensed pursuanl to the
_l zun exempt under Section_t]. & P.C. ftrr this
so as
WORKERS' (]Oi\I PENSA'TION
DT:(:LARA'I'ION
I hereby alTirm under pcnalty of perjury one of the follou'ing declarations:
_l have and will maintain a Certificate of Consent to Self-lnsure for u'orkers' compensation. as provided for by Section 3700 of the
Labor Code. for the perfonnance of the work for u,hich the pennit is issued.
_l have and rvill maintain workers' compensation insurance. as required by Section -1700 of the Labor Code, for the performance of
the rvork for which this permit is issued. My rvorkers' compensation insurance carrier and policy number are:
Carrier:_\
Policy Number:l:xpircs:
certify that in the perforrnance of the w'ork for s'hich this pcrmit is issued. I shall not etnploy any person in any manner
to become subject to the rvorkers'cornpensation larvs of California. and agree that if I should become subject to the
workers' compensation provisions of Section 3700 of the labor Code. I shall. forthwith comply wilh thosc provisions..
WARNING: Failure to secure rvorkers' cornpensation coverage is unlarvful. and shall subject an employer to criminal penalties and
civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. darnages as provided for the
Section 3076 of the Labor Code. interest and attorney's fees.
?-5- (1
l.t('ENst,.D ('oN'tRA(' I OR
DECI"ARATION
I hereby affirrn under penalty of perjury that I arn licensed under provision of Chapter 9 (commencing rvith Section 7000) of Division 3
of the Business and Professions Code. and my license is in full force and cffect.
[.icense Class:_
- -License
Number:
('ortlr:rclor:
CONSTRUCTION LENDING ACENCY
I hcrcby aflirm undo pcnahy of pqjury rhat th6c is a construdion lf,din8 agscy for the pqfomilcc of the work for \r'hich lhis pcnrit b
issued (Se. 3097. Civ. C.).
[.ender's Narne:
Lendcr's Address:
APPLICANT DEC LARA"T'ION
I h€rdry afErm under penalty of perjury one of the follorving declarations:
Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6)
-Required
Letter of Notification
__l certify that the federal regulations regarding asbestos rernoval are not applicable to this proiect.
rvith all City and County
and County to ent€r upon lhe
above rnentioned property for
W e2 *-I reason.av,*
aYApplicnnt or Agent
APPROVALS DATE ID/SIG,COMMENTS
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm lDampers
Communications Cable
Buildinq
Under Slab / Floor
Bonding I Grounding / UFER
Transformers
Torqueing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rough)
Ceilinqs (Hard & Soffit Rouqh
Ceilings (T-Bar Roush)
Meter Release
Rough l0'-IJ Y'l't-{5i)
Service Meter I \J
_l A
,ilttrulstFINAL #>7
Notes, Remarks, Etc.tJ
Permiteennme ,oXr&qM €K5
\-U;l; - ^-s--/f
l)ale:
and
I