HomeMy WebLinkAbout20174349 - PermitCity of Santa Ana 20CivicCenterPlaza(M-19), Santa Ana,CA927O2 Electrical
PermitCounter: (714)647-5800 lnspection Requests: (7141667-2738 lnspectorSection: (714)647-5853
Permit #:20174349
Pin #: 83513
Proiect Address: 3822 S Birch St-a
Assessor's Parcel: 410-121-24 Lot: 24
Unit:
Block. NA
Bldg:
Tract: 6697
Address Range.
Historic. No
Suite Range:
Zoning: R1
Owner:
Address:
Phenesy Sivoraphonh
3822 S Birch St
Santa Ana, CA 927075104
(7141 600-e637
01 1 16002 51603
01 1 16002 5160C
01 1 16002 51603
01 1 16002 5777C
Fee Type
Serv Meter
General Plan Update
I ssuance
Microfilm Records
Amount
57.40
23.79
59.30
4.05
Qty
100
1.00
1.00
100
Fee
$57 40
$23 79
$se 30
$4 05
Phone:
Tenant Name:
Contractor:
Address:
Owner-Builder
Phone
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires:
EcrLch* :6t-tSl[r ? i23i2r.r;itlli'iceI uT'YH Ii"'crns*: 14
Arrcf *; F(eflt
[',,:pt*:tt341+16i-t ti?3i?ir'ir0rrscr,:L it:n Total
f 'hEnes$ 5 ivor'nphonh
handout given/auth on file
IO: N(:AZAI.I1uf':
2rl1 7 43+yI 1tr ; r.16 Afl
tL44 .\tr
Building Use:
Job Type.
Nature of Work:
Planning Conditions:
Planning Approva! By:
Plan Checked By.
Permit lssued By:
Subject to Field:
Building Permit #:
Hernan dez, Kathy 09t23t2021
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total
Paid to Date.
Balance Due:
Single Family Dwelling
Miscellaneous
Service Meter
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
R-3, U
VB
cEc 2019 tTAu
,rs
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 the 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
$23 79
$1 t6 70
$4 0s
$144 54
$0 00
$144.54
lnspector MID#: 2021-168986
ELECTRICAL.I NSPECTOR RECORD
APPROVALS DATE ID/S!G COMMENTS OWNER BUTLDER DEICARATION
I hocby affim undo pcnalty of pcrjury that I m cx€mpt from thc ContracloE' Licw hw for thc following r@n (S6.7031.5
Buincs and Profasion Code): Any City or County which rcquire a pamit to coctruct, altc, improvc dqnolish or trpair uy
structurq prior to its issumce, als rcquira thc applicut for such psrnit to file a signcd statmot that hc or shc b licoscd pmust
to thc prcvisions of thc ContEctor's Licqscd taw (Chapt6 9, Comcncing with Sation 7000 of Division 3 of thc Busincs ud
PrcfcsionsCodc)orthathcorshciscxcmptth@ftomedthcb6sisfortheallegedexilption. AnyviolatiotrofScrionT03l,5byuy
applicut for a pcrmit subjcts thc applicant to a civil pcmlty ofrct more thil five hundrcd dollm ($500).
_1, as owner of the property. or my employecs with wages as their sole compensation. will do the work and the structure is not
intcnded or offered for sale (Sc.7044, Business and hofessions Code: The Contractor's Licensc [aw does not apply to an owner of
the propoly who builds or improves thereon. and who does such work himself or herself or through his or her own cmployees.
provided that such improvonents are not intended or offered for sale. If, however. the building or improvement is sold within onc )er
of complaion. the Orvncr Builder will have the burdcn of proving thd he or she did not build or improve the propo'ty for the purpose of
salc).
--1. as owner of the properly, am exclusively contracting rvith licensed contractors to construct the project (Sec. 7044. Business
and hofession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thercon.
and who contracts for such projects with a Contracto(s) licerued pursuant to the Contractor's Licerse taw).
_l am under B.
DECLARATION
I hereby affrrm under penalty of po'jury one ofthe following declarations:
_l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensalion. as provided for by Section 3700 of the
Labor Code, for the performancc of thc work for which the permit is issued.
_l havc and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code, for thc performance of
the work for which this permit is issucd. My workers' compensation insurance carrier and policy number are:
Policv Nurnber: Exoires:
_l ccrtify that in the perforrnance of the work for which this permit is issued, I shall not anploy any person in any manner
so as to become subject to the workers'compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall. fonhwith cornply with those provisions..
WARNING: Failure to serure workers' conrpensation coverage is and
civil fines up to one hundred thousand dollars ($100.000), in thc
attorney's fees.
I,I(: I'NS ED CO N'TRAC'I'OR
DECT,ARATION
I hereby affrm under penalty of pcrjury that I am licensed under p,rovision of Chapter 9 (cornmencing with Section 7000) of Division 3
of the Business and Professions Code, and my licerue is in full force and effect.
License Class: License Number:
Il.r t o.
W
I hcby affm undo psulty of pojury that th@ is 8 @Eiructbo leoding agacy for thc pcfomcc of the work 6r which this ponit b
issucd (56. 3097. Civ. C.).
Lndtr's Nmc:
I-errder's Address:
APPLTCANT DECLARATION
I hcreby allirm under pe'nalty of perjury one of the follorving declarations:
Demolition Perrnits-Asbestos Notification Federal Regulations (Tille 40, Pan6)
_Required Letter of Notification
_l cerrify that the fcderal regulations regarding asbestos removalare not applicable to this project.
-_-l ccrtify that I have read this application and state that the above infonnation is correct. I agree to comply with all City and County
ordinances and State Laws rclating to building
above rnentioned property for inspection
A;rplicnrrt or Agertt
Perrnilee nanre
and hereby authorize representatives of this City and County to enter upon the
Site-Work
Underground
Pole Bases
Liqht Standards
Spas, Poot, Fountains
Signs (monument)
Life Safety /Low Voltaqe
Fire Alarm I Dampers
Communications Cable
Building
Under Slab / Floor
Bonding I Groundinq / UFER lol iz /r,lAlao
Transformers (I
Torqueincl
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Wails (Roush)
Ceilings (Hard & Soffit Roush
Ceilinqs (T-Bar Rouqh)tl
Meter Release tol Lfl-4D
I lv
Rouqh
Service Meter I IL
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