HomeMy WebLinkAbout20169891 - Permit (2)City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Electrical
PermitCounter: (714)647-5800 lnspectlon Requests: (714)667-2738 lnspectorSection: (714)647-5853 K
Permit #:2O1 69891
Pin #: 52489
Project Address: 5015 W Edinger Ave
Assessor's Parcel: 108-381-25 Lot: NA
Unit. G
Block: NA
Bldg:
Tract: NA
Address Range: 501 5-5127
Historic: No
Suite Range:
Zoning: C1
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
Policy #:
Expires:
Philip Miller
5015 W Edinger Ave G
Santa Ana, CA 927041966
(310) 435-s766
TAN HOANG HUONG FOOD TO GO
H L S Electric
1509 N Ross Street, Apt D
Santa Ana, CA 92706
(714I- 9ss-8980
9234743
07 t11t2020
01 1 16002 51603
01 1 16002 5160".
01 1 16002 51603
01 1 16002 5160."
01 1 16002 5160C
01116002 5160.2
Fee Type Amount
125 Volt Receptacle 1 .51
Light Switches, Occ. Se 1.64
Light Fixtures 1 .09
Min Fee Adj 35.12
General Plan Update 22.95
f ssuance 57.20
Qty
7.00
10.00
13.00
1.00
1.00
1.00
Fee
$10.57
$16.40
$14.17
$35.1 2
$22.es
$s7.20
$?2. g5
$133.46
$409 .?1
State Lic #: 963886
.t ic Type: B, C-10
Bus. Lic #: 338870
Workers' Compensation lnsurance:Carrier: STATE COMPENSATION INSURANCE FUND
Botch*:52463 IA/10/2019 ID: LR0SALES
0f f i ce: CTYH Tr on si : l0 ? cif ?.Acctl: Refl: 2016?991
Rcpt*:02775019 l,lt/ l(r/2019 3:38 Fl1
Tronsoct ion Totol S4119 .?1
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By.
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #.
Commercial
Tenant lmprovement
TI
Hernan dez, Kathy
lollol tqL
10t10t2019
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
M
V B, SPK
cEc 2016
H L S Electric
Genernl Plon Updote Fee
01 I 16002- 51600000-
Electr i cnl
01116002- 51603000-
I CL Check' 0(r{066
Notes: Legalize the combination of Units G & H
Fee Total
Paid to Date:
Balance Due:
01 1 16002 51600
01 1 16002 51603
$22.9s
$1 33 46
$1s6.41
$0.00
$156.41
Every permitissued shall become invalid unless the work on the site
authorized by such permit is commenced within 360 days after its
issuance, or if the work authorized on fhe sife by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
lnspector MID#: 201 9-153826
ELECTRICAL-INSPECTOR RECORD
f)zrr n(l fi7 .)fii (
APPROVALS DATE ID/SIG.COMMENTS
Site-Work
Underqround
Pole Bases
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltaqe
Fire Alarm / Dampers
Communications Cable
Building
Under SIab / Floor
Bonding I Grounding I UFER
Transformers
Torqueinq
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilings (Hard & Soffit Rouqh ,/
7t-Att4euCeilings (T-Bar Rough)44/20 a
Meter Release (/ (,
,
Tt-*n<go,Rough >/+/It'o i {T))
Service Meter V
lah&tiFINALarVl"D',De)
Notes Re Etc.
OWNER BUILDER DELCARATTON
I hcrchy allirm undcr pcnalty of Frjury that I m cxcmpl tiom lhc Contracto6' Licen$ Law for the tbllowing rcason (Scc.70-1 1.5
Busincss arxl Prolcssiotr Culc): Any Cily or County which rcquircs a Jrrmit kr crnstruct. allcr. improvc. dcnrclish or rcpair any
slruclurc. pri(rr lo its issuancc, also rcquircs thc applicant lor such lEmit b lile a signcd slalcnEnt that hc or shc is licnsd pgNuant
kr lhc provisk)ns o[ thc Conlrack r's Liccn$d Law (Chaptcr 9. Commncing with Section ?m0 of Division 3 of thc Busircis and
PnrtcssionsCodc)orthathcorshciscxemptthcrcfromandthcbasisforthcallcgcdcxcmption. AnyviolationofSetionTO3l.5byany
applicant for a pcmil srhjr-ts thc applicant lo a civil penahy of nol morc lhan tivc hundrcd dolles ($500).
_1. as owncr of thc propcrty. or my cnrpklyccs with wagcs as their solc comJrcnsation, will do thc work and the structure ls not
inlcndctl oroll'crcd lirr sale (Scc.7044, Busincss and Prol'cssions CtxJc:'flrc Contractor's License Law does not apply to an owner of
thc pnrpcrly who builds or inrprovcs thcrcrln, antl who drrcs such wod< himsclf or hcrsclf or lhrough his or hcr own employees,
providcd that such impnrvcnrnts arc not intcndcd orollbrcd tirr salc. If, howcvcr, thc huikling or impruverncnt is sold within one year
ol'conrplction, lhe Owncr Builder will havc thc burden of proving that he or shc did not build or improvc thc prcpcrty tbr the purpose of
salc).
_1, asowncrol'thc proJ-^*rty, anrcxclusivelycontracting with liccnsetlcontractorstoconstruct the projcct (Scc. 7(X4, Busincss
and Pnltbssion Code: T'he Contractor's License Law docs not apply to an owner of proJrerty who builds or improves thereon,
and who conlracls ltlr such pnrjccts with a Conlractor(s) liccnscrl pursuant to thc Contractor's License Law).
-IamcxcmptundcrSectitln-'B.&P.C.forthisrcastrn'
Date:
TVORKERS' COI\ I PENSATION
DECLARATION
I hcrchy allirnr untlcr p^-nalty ol pr'rjury onc' ot'thc tolkrwinc dcclaratiotrs:
_l havc and will maintain a Ccrtiticatc of Consent to Sclf-lnsurc tor workcrs' compcnsation. as provided for by Section 3700 of the
Latxlr Crxle, lilr the grcrtbrmancc of the wrlrk for which the prmit is issuctl.
_lhavcantlwill nraintainwrlrkcrs'compcnsationinsurancc.as rcquircdbyScctionSTfi)oftheLahorCode.tbrthe;rcrtrlrmanccof
thc work lbr which this permit is issucd. My workcrs' conrlrcnsation insurancc carricr aml Jxrlicy numbcr are:
Policv Number: Exoires: - u
_l certily thal in thc pcrlilrmancc of thc work tbr which this Jrcrmit is issued. I shall not employ any pcrson in any manncr
so as lo hccomc subjcct to thc workers' compcnsation taws of Calitilrnia, and agrce that if I should becornc subject to tttc
workcrs' compcnsation pnrvisions of Section 1700 of thc Lahrr Ctxlc, I shall, lorthwith comply provlsions..
WARNTN(i: Failurc lo sccure workers' conrpcnsation covcratlc is unlawtirl, and shall
civil lincs up l() onc hundrcd thousand rlollars ($l00.Un), in addition to the cost of
to criminal Jrcnaltics antl
as provirled tirr the
attorney's f'ccs.
l)F.('1.,\R,\'l'l()N
I hcrc-hy al'lirnr undcr Jrcnalty of Jrcrjury that I am liccnscd undcr pruvision 9 Section 7m0) of Division J
ot' tlrc Busincss antl Prol'cssions Codc, and my liccnsc is in l'ull tirrcc and cffcct
Liccnsc Numht'r:
I hcrcby alfrm utrdcr lrmlty of Jrcrjury lhat thcrc is a @nstructhn bnlin8 agcrcy for thc [rcrfomre of the Mrrk for which this lrcmit is
issucd (Se. -1097, Civ. C.).
knrlcr's Namc:
l-cnder's Addrcss:
APPLICANT DECLARATION
I hcrcby all-rrn unrlcr pnalty of Jrcrjury onc of thc lblkrwing dcclarations:
Dcmolition Pcrmits-Asbcstos Notification Fedcral Regulations (Titlc 40, Pafl6)
_Requircd lrt tcr ol' Notil-rcation
_l ccrtiti that the I'cdcral rcgulations renxrvalarc not applicahlc to this projcct.
_l certity that I havc rcad this application and inlirrmation is correct. I agrce to comply
rcprcscntatives of this City
with all City and County
anrl County lo entcr uJxln thcordinanccs anrl Statc l-aws rclaling to building
abovc nrcnlioncd proJrcrty lilr inspcction
Applicnnt or Agent
Permitee nanre
aulh<lrizc
C)o 2n/f -