HomeMy WebLinkAbout20274465 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Electrical
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Permit #:20274465
Pin #: 4980{
.4.A
Proiect Address: 1020 N Raitt St- -a-
Unit:
Block: NA
Bldg:
Tract: 521
Address Range:
Historic: No
Suite Range:
Zoning: R1Assessor's Parcel: 405-1 14-13 Lot: POR 8, POR E
Owner:
Address:
Cuong Pham
1O2O N Raitt
Santa Ana, CA 927032033
(7141 260-8844
01 1 16002 51603
01 1 16002 5160C
01 1 16002 51603
01116002 5777C
Fee Type
Serv Meter
General Plan Update
lssuance
Microfilm Records
Amount
57.40
23.79
59 30
4.05
Qty
100
1 .00
100
100
Fee
$57 40
$23 79
$se.30
$4.0s
Phone:
Tenant Name:
Contractor:
Address:
Phone:
Larry Nguyen
4920 Ariano Drive
Cypress, CA 90630
(7141 280-5e1s
State Lic #: 1032529
Lic Type: C-10
Bus. Lic #. 368654
Workers' Compensation lnsurance:Carrier: STATE COMPENSATION INSURANCE FUND
Policy #: 9222922
Exprres: 1211612021
Building Use:
Job Type
Nature of Work:
Single Family Dwelling
Miscellaneous
Service Meter
Occupancy.
Constr Type:
Code.
R-3, U
VB
cEc 2019 Notes: handout given/all fees pd on 20272887lreplaces
canceled perm it #2027 2887
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permrt lssued By:
Subject to Field:
Building Permit #:
\dU.rnandez Kathy
Date:
Date:
Date.10t't1t2021
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
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.
N/A - No
N/A . No
Balance
Balance
Fee Total
Paid to Date:
Balance Due:
$144.54
$144 54
$0.00
lnspector MID#: 2021-164648
ELECTRICAL.! NSPECTOR RECORD .t
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hercby affrrn undr pemlty of pojury thar I m cxmpt from the ContractoB' Licw law for the following rcen (5€.703 1.5
Businss md Prof*ion Code): Any City or County which require a pennit to @struct, altq. improvq dcrnolish or rcpair uy
structuq prior to its isumcc, also requirB thc applicmt for such psmit to filc a signed stamot that hc or drc b licoscd pmuut
to thc provisioN of thc Contractor's Liccnscd Law (Chaptq 9. Comocing with Sction 7000 of Divisiotr 3 of the Buincs ud
Prcfcsions Codc) or that h€ or shc is cxcrtrpt th@fiom ad thc basis for the allcgcd ex@ption. Any violation of Selion 7031.5 by any
applicant for a pcrmit subjats the applicant ro a civil pcmlty of not morc thil livc hundred doltus ($500).
-1,
as owner of the propcrty. or my cmployees with wages as their sole compensation, rvilldo the work and thc stnrcture is not
intended or offered for sale (Se.7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of
the property who builds or improves theron. and who does such work hirnself or herself or through his or hsr own employees,
provided that such improvonents are not intended or offered for sale. I[, however. the building or improvemett is sold within one ]Ear
of cornpletion, the Owner Builder will have the burden of proving that he or she did not build or improve the propoty for the purpose of
sale).
_1, as owner of the property, arn exclusively contracting with licensed contractom to construct the p,roject (Sec. 7M4, Business
and Profession Code: The Contractor's License Law does not apply to an owner of propcrty who builds or improves thereon.
and who contracts for such projects with a Contracto(s) licensed pursuant to thc Contractor's License l-aw).
-l
am exempt under Section-. B. & P.C. for this rcason.
WORKER.S' COMPBNSATIO N
DECLARATION
I hereby alTirrn under penalty of perjury one of the following declarations:
-l
have and will maintain a Ceflifrcate of Consent to Self-lnsure for workers' compensation. as p,rovided for by Section 3700 of the
Labor Code, for the performance of the work for which the permit is issucd.
-l
have and will maintain workers' compensation insurance, as rcquired by Section 3700 of the Labor Code, for the performance of
thc work for which this pennit is issued. My workers' compensation insurance carrier and policy numbcr are:
sT-|ffi Tuf{D
lto /zo LtPolicy1rLn
-l
certi& that in the pcrformance of the work for rvhich this perrnit is issued. I shall not ernploy any person in any manner
so as to becorne subjcct to the workers' cornporation laws of California, and agree that if I should become subject to the
workers' conrpensation provisions of Section 3700 of the Labor Code, I shall. forrhwith comply with those provisions..
WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an anployer to criminal penalties and
civil lines up to one hundred thousand dollars ($100.000), in addition to the cost of compensation, damages as provided for the
Scction 3076 of the Labor Code, interest and attorney's feqs.
l,lC IiNSITD C()N't'RAC'I'OR
DECI,i\RATION
I hereby aflinn under penalty of perjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3
of thc Business and Professions Code, and my license is in full force and effect.
Licenseclass, CIO LicenscNumbcr:l-\LfLq
I contrectory/ I
-,N_r
CONSTRUCTTON I F,NnrNG AGENSY
there is a construction lording agency for the performance of the work for which this perrnil isI hereby affirm under penalty of perjury that
issued (Sec. 3097. Civ. C.).
Lcrrtlcr 's Nlrrrrc.
Lender's Address:
APPLICAIIT DECT {RATION
I hqtby affirm undq po8lty of pojury onc of thc followiag dclaratioro:
Dmolition PmitsAsbet$ Notifiqtior Fcdqal Rcgulatiore (Titlc 40, Pan6)
-Rcquircd
Lrttq of Notification
-l
catiry that thc fcdqal rcgulatioro rcgarding rbctos rmoval uc not qplicabh to this projcl.
f\ ceriry tha I We md this application rd statc that thc above infomdion is orct. I agre to omply with all City ud Couty
6rdimcq ud State Laws rclating to building mNtruclion ad h@by 8uthorirc rcprMtativ6 of this City ed Couty to 6tq upotr th€
above mentioned property for
Applicant or Agent
Pernritee namc
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltase
Fire Alarm I Dampers
Communications Cable
Building
Under Slab / Floor
Bonding / Grounding / UFER /o-T-?.II-IR +z
Transformers
Torqueing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factorv Wired Unit
Walls (Conduit)
Walls (Roush)
Ceilings (Hard & Soffit Roush
Ceilinqs (T-Bar Rouqh)
l\Ieter Release lb tlo -7)0/P lt-
Rouqh lb,2o-2t\3
Service Meter f D-Lo -?-t l (it'\1/
FINAL lo-Lo'Zl I \
Notes, Remarks, Etc.
Drrv nO n7 nn4R
\
Expires:
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