HomeMy WebLinkAbout20170006 - Permitcity of Santa Ana 20 civic center Plaza (M-19), Santa Ana, cA927O2
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Electrical Permit #:2O170006
Pin #: 1354q\_\
Proiect Address: 3 E Hutton Center Dra
Assessor's Parcel: 411-092-38 Lot: NA
Unit:
Block: NA
Bldg:
Tract: NA
Address Range:
Historic: No
Suite Range:
Zoning: SD76
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
Cypress 3HS LLC
3 Hutton Center Drive
Santa Ana, CA 92707
ABM Electrical & Lighting S,
14202 Franklin Ave
Tustin, CA 92780
(s4s) 888-2340
Fee Type Amount
01 1 16002 51603 Over 1-1 0 HP, KW or K\ 24.20
01 116002 5360' PIC - 650/o 0.65
01 1 1 6002 51 60C General Plan U pdate 22 .95
01 1 16002 51603 lssuance 57 .2O
Qty
4.00
96.80
100
1 .00
Fee
$96.80
$62 e2
$22.95
$57 20
Bntch* 212997 ll/ 13/2tr1? ID:
Off i ce: CTYH Trnnsi: 6?Acct*: Ref *: 2t-t
Rcpti: tr2806344 Il/ 13/2tr19 1
Trsnsoct i on Tobo I $6,t
ABn Electricql & Lishtins SoIu
Generol Plon Updote Fee
r"rl 1 l6tttt?- 5l6tttt0tltt-
Electr i cqI
Lr1 I 16(102- 516(r3tr00-
Visq
CC+: r**r**r*r***5949
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State Lic #: 967676
Lic Type: B, C-10
Bus. Lic #: 340343
Workers' Compensation lnsurance:Carrier. lndemnity lnsurance Company on North America
Policy #: WLR CG5895852
Expires'. 1110112020 t 6,tt
Aubhi: t-t2696$
Building Use:
Job Type:
Nature of Work
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Smith, Mark
Hernan dez, Kathy
10t29t2019
1111312019
Account#
Misc. Receipt: 73690
Misc. Receipt:
Misc. Receipt:
Total
Commercial
Alteration
EV Chargers
\[Y
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
N/A
N/A
cEc 2016
Notes. EV chargers for private use on (4) existing stalls.
01 1 16002 51600
01 1 16002 51603
$22 9s
$1 54 00
Fee Total
Paid to Date:
Balance Due:
$239.87
$62.e2
$176.95
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 MtD#' 2019-155429
A
ELECTRIGAL.! NSPECTOR RECORD
APPROVALS DATE !D/SIG COMMENTS
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltase
Fire AIarm lDampers
Communications Cable
Building
Under SIab / Floor
Bonding I Groundins / UFER
Transformers
Torqueing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilinss (Hard & Soffit Rouqh
Ceilings (T-Bar Rough)
Meter Release
Rough
Service Meter
FINAL /l-2?-t g Br?ta>
Notes, Remarks, Etc.
I h6eby affm unda pcnalty of perjury that I on cxmpt from the ContracloB' Licmc Law for the following r€en (Se.7031.5
Busincs ard Profcssion Codc): Any City or County which rcquirs a pmit lo construct. alt6. improvc. &molish or npair uy
structue. pdor to its isumcc. drc requirs the applicilt for such pcmit to filc a signcd statmot thd he or $c b licsed prmet
to the provisiore of the Contractor's Liccnscd [aw (Chapt6 9. Commencing with Sslion 7000 of Division ] of the Buinas md
ProfcssionsCode)orthathcorshcisexemptthcefromudthebasisfortheallcgedcxqnption. AnyviolationofsstionT0Sl.5byany
applicantforapmitsubjelsthe applicanttoacivilpcnsllyofnotmorethefivehundreddollus($500).
--1. as owner of the properiy. or my ernployees with wages as their sole compensation. will do the rvork and the structure is not
intended or offered for sale (Sec.7044. Business and hofessions Code: The Contraclor's License larv does not apply to an owner of
the property rvho builds or improves thereon, and who does such r.r'ork himself or herself or through his or her own employees.
provided that such improvernents are not intended or offcred for sale. If. horvever. the building or improvement is sold within one )€ar
of cornplaion. the Orvner Builder will have the burden of proving tha he or she did not build or improve the propory for the purposc of
sale).
_1. as owner of the propeny. am exclusively contracting with licensed contraclors to construct the project (Sec. 7044. Business
and Profession Code: 'l'he Contractor's License Larv does not apply to an orvner of property who builds or improves thereon,
and who contracts for such projects rvith a Contracto(s) licensed pursuant to the Contractor's License Law).
_l am exempt under Section_. B. & P.C. for this reason.
Dnte:_ Owner:_
WO RKER,S' COI}I PENSATION
DECLARATION
I hereby affirrn under penalty of perjury one of the follorving declarations:
_l have and rvill maintain a Certificate of Consent to Self-lnsure for rvorkers' compensation. as provided for by Section 3700 of the
Labor Code. for the perfonnance of the rvork for which the permit is issued.
and s'iII nraintain workers'700 of the Labor Code.[or the performance of
for s'hich this is and policy number
l'olicy 8a+--
_ -l cerrify that in the performance of the rvork for r.r'hich this perrnit is issued. I shall not onploy any person in any tnanner
so astobecomesubjecttothervorkers'compensationlarvsofCalifornia.andagrecthatiflshouldbecomesubjecttothe
workers' compensation provisions of Secrion 3700 of the l-abor Code. I shall. forthrvith comply rvith thosc provisions..
WARNINC: Failure to secure rvorkers' cornpensation coverage is unlarvful. and subject an onployer to crirninal penalties and
civil fines up to one hundred thousand dollars ($100.000). in addition the of damages as provided for thel
Section -j076 of the Code. interest and attorney's fees.
I hc'reby affrnn under penalty of perjury that I arn licensed of Chapto 9 (cornmencing u'ith Section 7000) of Division 3
of the Business and Professions Code. and my license is in full force and effect.
[.icense
o^,u,4/0//9
I hereby aflirm under pcnalty of perjury that there is a
issued (Sec. 3097. Civ. C.).
[rndcr's Name:
agency for the pcrfonnance of the u'ork for s'hich this p,ornit is
Lender's Address:
APPLICANT DECLARATION
I hetby affrnn under penalty of perjury one of the follorving declarations:
Dernolition Permits-Asbestos Notihcation Federal Regulations (Title 40. Part6)
_Required Letter of Notification
_l certi$ that the federal regulations regarding astrestos removal are nol applicable to this project.
_ I cerrifu that I have read this application and state lhat is correct. I agree to rvith all City and County
and County to enter upon theordinances and State Larvs
above mentioned property for
,tpplicalrl or Agent
Pernritee name (print):
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