HomeMy WebLinkAbout20145056 - Permita
I nspection Requests : (7 14) 667 -2738 lnspector's Section: (7 14) 647-5853
Suite Range:
Zoning: C5
Proiect Address: 1570 E Seventeenth Sta
-
Assessor's Parcel: 400-251-07 Lot: NA
Unit: A
Block: NA
Bldg:
Tract: NA
Address Range:
Historic: No
City of Santa Ana
Permit Counter: (714) 647-5800
20 Civrc Center Plaza (M-19), Santa Ana, CA 92702 Electrical permit #: 2t|{45056
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Easter Seals of Southern Calif
1801 E Edinger Ave #190
Santa Ana, CA 92705
(7141 834-1 111
Easter Seals of Souther Calif
Tl's By Design
3595 Cadillac Avenue, #103
Costa Mesa, CA 92626
(7141434-0596
Fee Type
01 1 16002 53601 Revision
Amount
204.00
Qty
1 .00
Fee
$204.00
Phone:
State Lic #: 565438
Lic Type: B
Bus. Lic #: 148210
Workers' Compensation I nsurance:Carrier: State Compensation lnsurance Fund
Policy #: 713-0034531
Expires: 0912912011
COPY
Building Use:
Job Type:
Nature of Work:
Commercial
Revision
Revision - Tl
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
B
VB
cEc 2010 Notes: Revision to EP# 20'144381- change location of lighting
fixtures and low voltage outlets.
Planning Conditions:
Planning Approval By:
Plan Checked By: Davis, Scott
Permit lssued By: Hernan dez, Kathy
Subject to Field:
Buirdins Permit #: 10169777
03102t2011
03108t2011
Account#
Misc. Receipt: 57383
Misc. Receipt:
Misc. Receipt:
Total
N/A - No Balance Fee Total:
Paid to Date:
Balance Due:
$204.00
$204.00
$0.00
Every permitissued shall become invalid unless fhe work
on the sife authorized by such permit is commenced within
180 days afterifs issuance, or if the work authorized on the
sife by such permif is suspen ded or abandoned for a peiod
d 1 80 days after the time the work is commenced.
lnspector MID#: 2010-93765
ELECTRICAL-I NSPECTOR RECORD
APPROVALS DATE ID/SIG.COMMENTS Omer-Builds Dcluarion
I hacby rllim undo pcoslty of pcrjury rh&t I m qcmpt fom the Contractom' Lietrrc LEw for thc following wn (s.70l I . 5 Businc$
ud Prof*sion Codc): Aay City or County which rcquiro r pcrmit to ourruct" altc( improvc, dcmlish or rcpair my stmuq prior to it
issure, also requirs thc applimt for ruch pcmit to lilc s signcd ltsremant thrt hc or Ehc is li@nsd purMr to thc provisions of thc
Cotrt rctor's Lienscd Law (Chaprer 9, Comcrcing with Scrion 7000 of Division 3 of thc Buritrc$ ad Prof6sioN Codc) or rhlt hc d
shc ir cxcmpt thcrcfrom ud thc bqir for thc allcgcd cxcmptioa .Aay violation of Sction 7031.5 by ay Epplimt for ! pcmit subjrcE thc
applicmt to a civil pcndty of rct morc thu fivc hurlrcd dollus (t500).
_I, s omcr of thc prcpcny, or my cmployco with wrgo as thcL $lc mmpcnstiot\ will do thc work ud thc ltructuc h rct intctrdcd
or ofcrcd for sslc ( Se.7044, Buincss md Prof.ssion! Codq Thc Contrrctor's Licre Llw dcs trot spply to u omq of thc propcny
who builds or improva rhuoq md who de3 sh work him*lf or harclf or rluough hi3 or hs om cmploycct, providcd rhlt such
improvcmcots uc oot intcndcd or offcrcd for rdc. lf, howcvcr, thc building or improvcmcnt is iold withitr onc yu ofomplctioq thc
Owner-Builda will hrvc thc budcn ofproving that hc or rhe not build or improvc for thc purpos ofs.lc).
_1, u omcr of thc propqty, m cxclusivcly @nrrcting with li@ns€d @ntrrctoE to @6hd fic projer ( S@. 7044, BusiD6s md
Profession Codci Thc Contrrctor'E Liesrc kw doca not spply to 6 omcr of propcny who builds or improvca thq@n , ud who
conErcts for sch prcj€ts sith I Contrsdor(3) liqs€d pur$ut to rhe Contnctor's LieNc Lrw.).
_l arn exempt under Section B. & P.C. for this re&son.
Date:
WORIGRS COMPENSATION DECT"ARATION
I hcrcby alfirm undo pcnalty ofpajury onc ofthc followitrg dclanrioN:
_l havc ud will mainoin r Ccnific*c of Corent to Sclf-IMc for rcrkm' ompcnstioq u providcd for by S61ior 3700 of rhc
Lsbor Codc, for thc p*fomue of thc work for which thc pmit is imcd.
_lhavcedwillmsintainworkqs'ompcmtionin$rue,r rcquircdbyScaion3T00ofthchborCodqforthcpcforrrueofthc
work for which rhis pqmit is imcd. My workc' @mpcnsrtion in$ree trid atrd IDlicy numbq [c:
Cuis:
Policy Number: Expires:
(This scction n. oi less)
_I ccrtify that in the performancc of the work for which this pcrmit is issucd, I shall not employ any pcrson in any manner so as to
became subject to the workers ' compensation laws of Californiq and agrec that if I should becomc subject to the workers!
compcnsation provisions of Section 3 700 of thc Labor Code I shall, forthwith comply with thosc provisions. .
WARNING: Frilurc b !@rc workss' @mpcnsdon @vorgc is unlawful, ud shall rubjct m cmployq to qimiod pcElti6 rnd civil
fina up to one hundrcd thourud dollm (S 100,000),in sddition to thc rcn of ompcnutio4 damagcs u prcvidcd for the Scrion 3076 of
rhc Llbor Codq intscst rnd anmcy's fe.
LICENSED CONTRACTORS DECI.ARATION
I hocby altrrm under pamlay of pcrjury thsl I m li@nlad unds prcvision of Chapto 9 (omcncing with Sctioo 70oo) of Divilion 3 of
thc Busiocs ud Profqsiotr Codg ed my liccre is in full fore md cffct.
Liccnse Class. Liccnse Numbcr
Date: Contractor:
CONSTRUCTION LENDING AGENCY
I hccby allim uodo p€ndty of psjury ttut thqc is r omtruction lctrdiDg rgcmy for &G pcrfurme of thc wuk for which thir lmit ii
issued (S@. 3097, Civ. C.).
Lrndcr's Nrmc:
Lender's Address:
APPLICAN?S DECI,1\RATION
Dcmlition Pdmit&Albcstos Notilicarion Fcded Rcgulrtioru (Iitlc /rc, Plrt 6)
_ Rcquircd Lttq of Notificrrion
I ccrti& thst thc fcdanl rcgulationr rcguditrg .!bqro! movr.l uc not rppliceblc o thir prcjcct.
-
I cotiS that I havc rod ths lpplicrtiotr ud Eratc that rlE ibovc idomEtiotr i! @rcct. I lgre to @mply with sll City rnd Cmtyqdire rnd Statc Lawr rclrtiog to building ourructioo, md hccby uthoriz rcpreotetivcr of thir City rnd Couoty to 6t6 upoi tbc
rbovc mcntioaod propsty for iupetion [ro4ps.
Applimt or rgcnt sig.: DEtc:_
Pcrmitre |mc lgrinr)
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Building
Under SIab / Floor
Bonding I Grounding / UFER
Transformers
Torquing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rough)
Ceilings (Hard & Soffit Rough
Ceilings (T-Bar Rough)
Meter Release
-\Rough b/ff'tr \2 /l 4\zzn ce /(s/)
Service Meter I I
FINAL t0lblTl D/l,#-Y,'fuJd//t
Notes, Remarks, Etc.
Forms\Electrical-lnspection Record.doc 03.31 .06