HomeMy WebLinkAbout20170184 - PermitProiect Address: 925 N Lowell St-a
Assessor's Parcel: 405-183-01 Lot: 43
Unit:
Block: NA
Bldg:
Tract: 455
Address Range:
Historic: No
Suite Range:
Zoning: Rl
City 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 Permat #:20170184
Pin #:262tt{
Owner:
Address.
Phone:
Tenant Name:
Contractor.
Address:
Phone:
Beth Thomas
925 N Lowell St
Santa Ana, CA 927032323
(7141 30s-1915
K L C Construction
5482 Oceanus Dr #F
Huntington Beach, CA 9264
(7141 7024780
01 1 16002 51603
01 1 16002 5160C
01 1 16002 51603
01 1 16002 5777C
Fee Type
Light Fixtures
General Plan Update
I ssuance
Microfilm Records
Amount
109
22.95
57.20
3.91
Qty
1.00
1.00
1 .00
1.00
Fee
$1 .0s
$22.e5
$s7.20
$3 e1
State Lic #: 601 217
Lic Type: B
Bus. Lic #: 374329
Workers' Compensation lnsurance:Carrier: State Compensation lnsurance
Policy #. 9234343
Expires: 0710312020
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0f f i ce: CTYH Tr 0n si : 7'-, 'i. of'
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Rcpb*:028r-166112 lL/13/2Lrl9 3;36 ['i1
Tnsnsoct ion Totnl t6t L.')-'l
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Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Single Family Dwelling
Alteration
Fixture
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
R.3, U
VB
cEc 2016
11113t2019
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total
Paid to Date:
Balance Due:
contractor doing (2) unrelated trades/auth on file
\0t\ Hernan dez, Kathy
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.
lnspector MID#: 201 9-155845
01 1 16002 51600
01 1 16002 51603
01 1 16002 57770
$22 e5
$s8 29
$3 e1
$8s.1 5
$0.00
$85.15
ELECTRICAL.I NSPECTOR RECORD
().r,nQ n7 ')n,t fi
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hoeby aflirm undr pcnslty of perjury that I m cxmpt from the Contmcton' Licffc tiw for thc followiag rcen (Sfi.7031.5
Busin6s and Prof6sion Codc): Any City or County rvhich requira a pemit to comtruct. altc. inprova dernolish or rcpair my
structue. prior to its isuuce. also require the applicilt for such pemit lo filc I signcd stahmt thal he or shc is licosd puEuut
to thc provisiore of thc Contractor's Lic€nscd lzw (Chapt6 9. Commmcing with Seclion 7000 of Division 3 of thc Busine md
Prcfesions Code) or that hc or she is eempt thqcfrom ud the bssis for the allcged exmption. Any violation of Ssiion 70-f 1.5 by any
applicant for a pdmit subjBts thc applicant to a civil pcnalty of not morc thm livc huodrcd dollus ($500).
_1. as owner of the property. or my employees with wages as their sole compensation. rvilldo the w'ork and the structure is not
intenderJ or offered for sale (Sec.7M4. Business and Professions Code: The Conlractor's License Larv does not apply to an owner of
the property rvho builds or improves thereon. and rvho does such $'o* himself or herself or through his or her orvn employees.
provided that such irnprovonents are not intended or off€red for sale. If, horvever. the building or improvement is sold within one year
of cornplaion. the Orvner Builder s'ill have the burden of proving that he or she did not build or improve the propory for the pu4nse of
sale).
___1, as owner of the propeny. am exclusively contracling rvith licensed contraclors to construct the project (Sec. 7044. Business
and hoftssion Code: The Contractor's License Larv does not apply to an ou'ner of property u,ho builds or improves thereon.
and rvho contracts for such projects rvith a Contracto(s) licensed pursuant to the Contractor's License Larv).
I arn exemot under Section _. U. & P.C. for this reason.
l)nte:Orr rrcr:
WO RKER,S' COM PENSATION
DECT.ARATION
I hereby affrrm under penalty of pcrjury one of the following declarations:
_l havc and will maintain a Ccrtificate of Consent to Self-lnsure for workers' comSrcnsaion, as provided for by Section 3700 of the
Labor Code. for the poformance of the work for which the permit is issued.
_l have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code, for the pcrformance of
the work for which this permit is issued. My workers' compensation insurance carrier and policy numb are:
c^**, S*c.k Fctu/
poricyNr^b*, q23Ll 3L/3 Expires: O^ S/t-tlt-
-l
certi& that in the pcrformance of the work for which this pomit is issued. I shall not employ any person in any manner
5
so ns to become subject to the workers' compensation taws 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 with those provisions..
WARNING: Failure to secure s,orkers' compensation coverage is unlarvful. and shall subject an onployer to crirninal penalties and
civil fines up to one hundred thousand dollars ($100.000). in addition to the of cornpensation, damages as provided for the
Section 3076 of the Labor Code. interest and attorney's fees.
o*e: ll- lb-l-,>tl
DECI..ARATTON
I hereby affrnn under penalty of perjury that I am liccnsod under provision of Chapter 9 (commencing with Section 7000) of Division 3
of the Business and Profcssions Code, and my liceirse is in full force and effect.
License cr*, 6 _License
ll-tL\-L>tl Contractor, (1
(]ONS'I'RU("I'ION LI'NI)IN(; ACI'N('\'
I heeby affim unda pei, alty of pqjury that th6c is a comtruction lqrding agacy for thc pofomuce of the work for *'hich this Fmh b
issued (Sec. 3097, Civ. C.).
tendcr's Name:
APPLICANT DECLARATION
I heneb), aflirm under penalty of perjury one of the following declarations:
Demolition Permits-Asbcstos Notification Federal Rcgulations (Title 40, Part6)
-Required
Latcr of Notification
-l
certi$, that the federal regulations regarding asbestos removal are not applicablc to this project.
_ ,I certify that I have read this application and state that u'ith all City and County
and County to enter upon theordinances and State Laws relating to building
above mentioned property for inspection
Applicrnt or Agent Signature:-6 l)ale: //-1J'*o!?
IDernritee name (prirrt): E t 9a loc L
Site-Work
Underground
Pole Bases
Lisht Standards
Spas, Pool, Fountains
Siqns (monument)
Life Safety /Low Voltage
Fire Alarm lDampers
Communications Cable
Buildins
Under Slab / Floor
Bondinq I Groundinq / 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
Service Meter I /
FINAL / L/Zo/7 / oLl
Notes, Remarkb, Etc.I
/// /-/l/-/ /Cad
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Lender's Address:t