HomeMy WebLinkAbout20174391 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Electrical
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspector Section: (714) 647-5853
Permit #:20174391
Pin #: 43148
ProjectAddress:unitPUE01Bldo:AddressRange:3601-3685
Assessor's Parcel: 412431-OG Lot: 1, 2, 3 Block: NA Tracl:10212 Historic: No
Suite Range:
Zoning: R4
Owner:
Address:
Phone
Tenant Name:
Contractor:
Address:
Phone
City of Santa Ana
20 Civic Center
Santa Ana, CA 92704
(7141 647-5626
Crosstown Electrical & Data
5463 Diaz Street
Baldwin Park, CA 91706
(7141 779-6e99
01 1 16002 51603
01 1 16002 51603
01 1 16002 5160C
01 1 16002 51603
01 1 16002 5777C
Fee Type
Serv Meter
Fee Exempt
General Plan Update
lssuance
Microfilm Records
Amount
57.40
-144.54
23.79
59 30
4.05
Qty
1 .00
1 .00
100
100
100
Fee
$57 40
$-144.54
$23 7e
$s9.30
$4.05
State Lic #: 756309
Lic Type: C-10
Bus. Lic #: 193742
Workers' Compensation lnsurance:Carrier. lnsurance Company of the West
Policy #: WLV50303405
Expires: 0610312022
PAID
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Hernan dez, Kathy 09t30t2021
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
City
Miscellaneous
Service Meter
Occupancy:
Constr Type:
Code:
Date:
Date.
Date:
N/A
N/A
cEc 2019
sEP 30 2021
City of Santa Ana
Notes: for traffic signal/city project-fee exempt
Fee Total
Paid to Date:
Balance Due:
N/A
N/A
No Balance
No Balance
$0 00
$0.00
$0.00
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#: 2021-169158
ELECTRICAL.INSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hcrcby affrm undcr penalty of JErjury thst I m cxcmpt frcm thc ContretoN' Liccnrc law for llE follosing re.sn (Ss.7031.5
Busincss ard Prcfcssion Cqlc): Any City or Counly which rctuircs s pcrmit to construcl. altcr imprcve. dcmlish or rcIEit my
structuc. prior to its issuancc, aLrc rcquircs Ihc applicant for such prmit to filc a sigrcd statcmnt that hc or slrc is licensd purruail
to thc povisions of thc Contractor's Liensed lrw (Chaptcr 9, Comncing with Sfftion 7000 of Division 3 of the Busiress and
PDfcssionsCodc)orthathcorshciscxcmptthcrcfrommdthcbasisfortheallcgcdcrcmption. AnyviohlionofScdionTo3l.5byany
applicant for a Jrcrmit subjsts thc applicant to a civil pemlty of not rmrc lhan fivc hundrcd dollus ($500).
-1.
as owncr of thc propcrty, or my cmployees with wages as thcir solc compcnsation. will do thc work and thc stnrcture is not
intendcd or offcred for sale (Scrc.7044, Busincss and hofessions Codc: Thc Contractor's License l-aw docs not apply to an owner of
thc property who build.s or improves thcreon, and who does zuch work himsclf or hcrself or through his or her own cmployces.
provided that such improvcnrcnts are not intcrdcd or offcrcd for sah. lf. howevcr. thc building or improvcrrcnt is sold within onc )tar
of completion, the Owncr Builder will have thc burdcn of proving that he or she did not build or improve the propcrty for the purpose of
sale).
_1. as owncr of thc propcrty, am exclusivcly contracting with licenscd contractors to construct the project (Sec. 7W, Business
ard Professkrn Codc: The Contractor's Licensc Law docs not apply to an owncr of propcrty who builds or improves thcrcon,
and who contracls for such projccts with a Contracto(s) licenrcd pursuant lo thc Contractor's Licensc taw).
-Iamexcmr,tunderSection-'B.&P'C.forthisreason.n..a^.
WORKERS' COMPENSATION
DECLAITATION
I hcrcby afllrrn undcr pcnalty of prjury onc of thc following dcclarations:
-l
have and will maintain a Ccrtificate of Consent to Self-lnsurc for workers' compensation, as providcd for by Section 3700 of thc
l^abor Codc. for thc lrcrformancc of thc work for which thc pcrmit is issucd.
-l
havc and will maintain workers' compcnsation insurance, as requircd by Scction 3700 of thc labor Code, for the pcrformancc of
thc work lbr which this Jrermit is issued. My workers' compensation insurancc carrier and Jrclicy number arc:
Policy Numbcr: Expircs:
_l ccrtify that in lhc performance of the work for which this permit is issued. I shall not employ any pcrson in any manncr
so as to bccornc subpct to the workers' com;rcnsation laws of California. and agrcc that if I should beconrc subject to the
workcrs' compcnsation provisions of Section 3700 of the Labor Codc, I shall, forthwith comply wilh those provisions..
WARNING: Failurc to sccure workcrs'compcnsatiotl coveragc is unlawful. and shall subject an cmployer to criminal Jrcnaltics and
civil fincs up to one hundred thousand dollars ($100,000), in addition to thc cost of com;rcnsalion, damagcs Bs provided for the
Scction ol'thc Codc, intcrcst and attorrrcy's fccs.
(4 Aoolicnnt: W \{"\rl%
udNsiu-c6xrnnc'rtrn@
I hcrcby affirm undcr pcnalty of Srcrjury that I am licenscd under provision of Chaptcr 9 (cornrncncing with Scction 7000) of Division 3
of thc Busincss and hofcssions Codc. and my liccnsc is in full force and effcct.
Liccrrsc o Numbcr:15bzoel
L
I hcrcby affirm under pcnalty of perjury that thcrc is a construction lending agency
issued (Scc. 3097, Civ. C.).
[.endcr's Name:
thc pcrfonnancc of thc work for which this permit is
Lrnder's Address:
APPI ICANT DECLARATION
I trcrcby affrrm undcr ;rcnalty of pcrjury one of thc following declarations:
Demolition Pcrmits-Asbestos Notification Federal Rcgulations (Title 40, Part6)
_Requircd lrttcr of Notification
_l ccrtify that the federalrcgulations regarding asbcstos rcmovalarc not applicable to this projcct.
_l ccrtify that I havc rcad this application and information is corrcct. I agree to comply with all City and County
ordinanccs and Statc [:ws rclating to authorizc representativcs of this City and County to cntcr ulnn thc
above lncntioncd proprty for inspection
Applicant or Agent
Pernrilee name ( print ):
tlrc
ci L
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Buildinq
Under SIab / Floor Ir /^
Bondinq I Groundinq I UFER f(,)-T ,\b,it{+Y7
Transformers tl
Torqueing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilinqs (Hard & Soffit Rouqh
Ceilings (T-Bar Rouqh),I .-,
lMeter Release IC Dkfrr>'7
/
Rough
Service N/eter o ')7t >kY>7
FINAL
Notes, Remarks, Etc.
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