HomeMy WebLinkAbout20170573 - Permit (2)City of Santa Ana " 20CpicCenterPlaza(M-19), Santa Ana,CA92702
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Electrical Permit #:ZOi70573
Pin #: 63403$t
Project Address: 1521 3/4 N Wright St
Assessor's Parcel: 400-242-02 Lot: 25
Unit: METO1 Blds:
Block: NA Tract: 3505
Address Range:
Historic: No
Suite Range:
Zoning: C5
Owner:
Address.
Phone:
Tenant Name:
Contractor.
Address:
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires:
City of Santa Ana/Tyrone Chesanek
20 Civic Center
Santa Ana, CA 92706
(7141 647-5045
Owner-Builder
01 1 16002 51603
01 1 16002 51603
01 1 16002 5160."
01 1 16002 5160C
01 1 16002 51603
01 1 16002 5777C
Fee Type
Serv Meter
Fee Exempt
Min Fee Adj
General Plan Update
lssuance
Microfilm Records
Amount
55.37
-156.41
16.98
22.95
57.20
3.91
Qty
100
1.00
1.00
1 .00
1.00
1.00
Fee
$5s.37
$-156.41
$16 e8
$22.95
$57.20
$3.91
Building Use:
Job Type:
Nature of Work.
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field.
Building Permit #:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
PND
JFN13?i
Other
Miscellaneous
Meter Pedestal
Occupancy:
Constr Type:
Code:
Date:
Date:
Date.
UnKnown
UnKnown
cEc 2019 Notes: Serv Meter. No fee permiUmemo on file/city project.
l'[
Brodowski, Teri, '| \01t13t2020
Account#
$ia
nce
Balance
BalaN/A - No
N/A - No
Fee Total
Paid to Date:
Balance Due:
$0 00
$0 00
$0.00
Every permit issued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
issuance, or if the work authorized on the sife by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
lnspector MID#: 2020-1 56856
U
/.)
ELECTRICAL.I NSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS I hdcby arrm undq pcnaifif pcd,o ?"* ,"X1:$#H'.tL'f"1i[l#t1l*" ** ror the rotlowing r"*n (se.7o-tt.s
Businas and Prof*sion Codc): Any City or County which require a po'rnil to construct, alt6, improvq demolish or rcpeir any
structue. prior to its issumcc ds requirB thc applicml for such pemit to file a signcd statqnEt that hc or shc i5 liccEcd pmuant
to the provisiom of thc Contnctor's l-icosed l:rv (Chapt6 9, Commocing wilh Sction 7000 of Division 3 of thc Bwins md
Prcfoions Code) or that h€ or shc is cxmpt thqcfrom ild thc besis for thc allegcd cxmpion. Any violation of S61ion 7031.5 by any
applicantforapcmitsubjctsthc applicanttoacivilp@altyofnotmorcthilfivchundreddollm(t500).
syt. 6 omr of thc poJrry. or my cmplolm with wagc c their rcle compffilion. willdo thcwrk ud the struclw is nol
intoded or ofIqcd for $lc (Se.7044. Busire ud Profcssioro Codq Thc Contraclor's Liccm lrw do6 not apply to m oms of
thcprotEty whohitdsorimprccthoatratdwhodo6Mhrcrthirelforhffilforthrcughhisorhromoployc.
providcd that such imFovqruils rc rct intadod or offscd for slc. lf. horvws. thc building or imptovmt is mH within onc )a
ofcomplaion thc Owno BuiH6 will harc thc hldo ofprcving thd he or strc did not build or imFove thc prcpdy for thc purpos of
sle).
_1. as owner of the property. am exclusively contracting rvith licensed contraclors lo construct the project (Sec. 7044. Business
and Proftssion Code: The Contractor's License Law does not apply to an orvner of property who builds or improves therctrn.
and who contracts for such projeds wilh a Contracto(s) licensed pursuant to the Contractor's License larv).
-l
am exempt under Section u /this reason.
Date:_L1 9- 7a
I hereby affirm un}ff pWalty of perjury one of the following declarations:
*fu*llE:X;:fli,T:;:It;"ffi1[i"::iHl"J"L,;:;lers'compensation'
as providcd rorbvSection3T00orthe
_l have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code. for the performance of
thc work for which this permit is issued. My workers' compensation insurance carrier and policy number are:
c*iot /
Policv Nurnber:Expires:
r- l.cerlify that in the performance of the rvork for rvhich this permit is issued. I shall not anploy any person in any manner
so as to become subject to the rvorkcrs'compensation larvs of California. and agree that if I should become subject to lhe
work€rs' compensation provisions of Section 3700 of the Labor Code. I shall. forthu'ith cornply rvith those provisions..
WARNING: Failure to secure workers' compensation coverage
civil fines up to one hundred thousand dollars ($1001000). in
Section -j076 of the Labor Code. interest and attorneyrs fees.
is unlarv[ul. and shall subject an empkryer to crirninal pcnalties and
'compensation. darnages as provided for theadditioncost of
\
I hereby affirm under penalty of perjury that I arn licenserJ under provision of Chapto' 9 (cornmencing with Section 7000) of Division 3
of the Business and Professions Code. and my license is in full force and effect.
l,iccrrsc ('lass:
l)nte:
License Number:
Contractor:
W
I hcby aflirm undo pc! alty of pgjury that thqe b I con$rucrion lmding agmcy for thc pqfot1mcc of thc work for which this pqmit is
issucd (Se. 3097. Civ. C.).
Lender's Name: _
Lender's Address:
APPI ICANT DECLARATION
I hrlrby affirm under penalty of perjury one of the folbwing declarations:
Dcmolition Permits-Asbestos Notificatioo Federal Regulations (Title 40. Part6)
-Required
lrtter of Notification
_l certify that the federal regulations regarding asbcstos removal are nol applicable lo this project.
and state that u'ith all City and County
and County to exter upon the
abovc rnentioned propcfly for
Applicant or Agent
l'crrn ilee rrnme ( prinl ):€Dr-4aPo
Ihlc:-13-bb
Site-Work
Underqround
Pole Bases
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Building
Under Slab / Floor ,
Bonding I Grounding / UFER 4VUqP (W tfur)
Transformers I I ur \-
Torqueincl ..,4.
Sub-Panels zltTl ge',W lw)
Air Conditioners I I ur ,-/
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Roush)
Ceilings (Hard & Soffit Roush
Ceilinqs (T-Bar Rouqh)
[\4eter Release
Rough
Service Meter I
FINAL 4zll"a w ,tfu )
N Rema Etc.
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