HomeMy WebLinkAbout20170097 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Electrical
Permit Counter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714)647-5853
Permit #:2O17OO97
Pin #: 3836{{
Proiect Address: 1528 S Standard Avea
Unit.
Block: NA
Bldg:
Tract: NA
Address Range:
Historic: No
Suite Range:
Zoning: OAssessor's Parcel: 014431-02 Lot: NA
Owner:
Address:
Madison Parkcarnivalffi
11278 Los Alamitos Blvd., #101
Los Alamitos, CA 90720
(310) 560-9122
Fee Type
01 1 16002 51603 Special Event
01 116002 51600 General Plan Update
01 1 16002 57770 Microfilm Records
Amount
1 66.53
22.95
3.91
Qty
1.00
1.00
1.00
Fee
$166.53
$22.e5
$3.91Phone:
Tenant Name: Fiesta De Carnival
Contractor:
Address:
Jack's Electric
5706 Pennswood Avenue
Lakewood, CA 90712
(562) 868-1605Phone.
State Lic #: 591 173
Lic Type: C-10
Bus. Lic #: 344853
Workers' Compensation lnsurance:Carrier: exempt
Policy #:
Expires:
Building Use:
Job Type:
Nature of Work:
Other
Miscellaneous
Special Event
Occupancy:
Constr Type:
Code:
N/A
N/A
cEc 2016 Notes: Special City Sponsered Event Nov. 8 thru 11, 2019.
Letter of auth on file.
Planning Conditions:
Planning Approval By:Date:
Date:
Date:
Misc. Receipt:
Misc. Receipt:
Misc. Receipt.
Total
Plan Checked By:
Permit lssued By:
Subject to Field.
Building Permit #:
Amsden, Julie 11t07 t2019
Account#\
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 fhe site by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
01 1 16002 51600
01 1 16002 51603
01 1 16002 57770
$22.95
$166.s3
$3.e1
Fee Total:
Paid to Date:
Balance Due:
$193.39
$0.00
$193.39
lnspector MID#: 2019-151311
(
ELECTRICAL.I NSPECTOR RECORD
DATE ID/SIG,COMMENTSAPPROVALS
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Siqns (monument)
Life Safety /Low Voltage
Fire AIarm I Dampers
Communications Cable
Buildins
Under SIab / 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
Ceilinqs (T-Bar Rouqh)
Meter Release
Rough
Service Meter
FINAL tt -g-/ g t)*rJtn<
Notes, Remarks, Etc.
I hereby affm under pcnalty of pojury that I m exempt fiom the Contracto6' l-icme tarv for the following r@n (Sc.7031.5
Businss md Profssion Codc): Any City or County which requirc a po'rnit to construct. altc. improve. dmolish or repair tny
structurc. fior to its issudcc. also rcquiE the applicut for such pennit to file a signed statomt tha he or she is licoscd pmumt
to thc trovisiom of the Contractor's Liccnscd law (Chaptq 9. Commencing with Sstion 7000 of Division 3 of thc Busines md
Profsions Code) or that he or she is excmpt thqefrom and the basis for the allcged exondion. Any violation ofsetion 703 I .5 by any
applicantforapsrnitsubjststhc applicanttoacivilpcnaltyofnotmorethmfivehundreddollrs($500).
_1. as owner of the properly. or my employees rvith wages as their sole compensation. will do the rvork and the structure is not
intenderJ or offered for sale (Sec.7044. Business and hofessions Code: 'l'he Contractor's License Law does not apply to an olvner of
the property who builds or improves thereon. and rvho does such rvort hirnself or herself or through his or her own ernployees.
provided that such improvonerts are not intended or offered for sale. lf. hou'ever. the building or improvement is sold wilhin one )€ar
of complaion. the Owner Builder will have the h.rden of proving tha he or she did not build or imp,rove the property for the purgnsc of
sale).
_1. irs owner of the prop€rty. an exclusively contracting rvith licensed contractors lo construct the project (Sec. 7044. Business
and Profission Code: The Contractor's License Larv does not apply to an os'ner of property rvho builds or improves thereon.
and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License [arv).
-l
am exempt under Section-. B. & P.C. for this reason.
Date: Owner:_
WORKER,S' COMPENSATION
DECLARATION
I hereby affrm under penalty of perjury one of the follorving declarations:
-l
havc ard will msintain a Ccatificate of CoG6t to Sclf-lmurc for $orkm'compeNalion. o providcd for bySation 3700 of thc
tabor Code for thc pqfomficc of thc wort for which thc pmit is issucd.
-l
havc and will maintain work6' compcmtion irourancc. re rcquircd by Setion 3700 of Ihc l.:bor Codc. for thc pqfonmcc of
the work for which this pcfmit is iscd My workm' compqtsation irouruce wiq and policy numba re !
('irr r icr :
Policy Nurnber:__Expires:
that in the perforrnance of the work for rvhich this perrnit is issued. I shall not ernploy any person in any manner
so as to becorne subject to the n,orkers' compensation larvs of California, and agree that if I should becotne subjett to the
workers' cornpensation provisions of Section -1700 of the Labor Code. I shall. fonhrvith comply with those provisions..
WARNING: Failure to secure workers' cornpensation coverag,e is unlawful. and shall subject an etnployer to crirninal penalties and
civil l-rnes up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the
Section -3076 of the l-abor Code. interest and attorney's fees.
DECI,ARATION
I hereby alTirm under pcnalty of perjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code. and my license is in full force and effect.
x'/ License Number:sq\nz
\\ --? - \q z\(rr,.r.,o,, SJCK V(r\a{€S,
CONSTRUCTION LENDING AGENCY
I h@by aflm und6 pcnslty of prjury thd th@ is a mnsrucrion hoding agmcy for thc pafommcc of thc wort 6r which this pcrnit b
issucd (56. 3097, Civ. C.).
Lender's Narne:
lrnder's Adclress:
APPLICANT DECLARATTON
I hereby affirm under penalty of perjury one of the following declarations:
Demolition Permits-Asbestos Notification Fcderal Regulations (Title 40. Parr6)
-Required
Letter of Notification
I cerrifu that the federal regulations regarding asbestos removalare nol applicable to this project.
that I have read this application and state that the ahrve inforrnation is comect. I agree to cornply with all (.ity and County
and State Larvs relating to building construction. and
above nrentioned properly for inspection
or Agenl
representatives of this City and ('ounty lo enter upon the
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