HomeMy WebLinkAbout20167716 - PermitI City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Electrical
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #= 201677{6
Pin #: 95625
Project Address: 3901 W Crystal Ln
Assessor's Parcel: 108-722-01 Lot: 1
Unit:
Block: NA
Bldg:
Tract: 8924
Address Range:
Historic: No
Suite Range:
Zoning: R1
Owner:
Address:
Phone
Shane Keheian
3901 W.Crystal Lane
Santa Ana, CA 92704
(7141 514-ss50
01 1 16002 51603
01 1 16002 51603
01 1 16002 51603
01 1 16002 51603
01 1 16002 51603
01 1 16002 5160C
01 1 16002 51603
Fee Type Amount
Light Switches, Occ. Se 1.58
Light Fixtures 1 .05
FWU 24.79
Dedicated Circuit 24.79
Serv Meter 53.28
General Plan Update 22.08
lssuance 55.04
Qty
11.00
20.00
100
2.00
1 .00
1.00
1.00
Fee
$17.38
$21.00
$24.79
$49.58
$s3.28
$22.08
$55.04
Tenant Name:
Contractor:
Address.
Owner-Builder
Phone
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance:
Carrier:
Policy #:
Expires:
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
Miscellaneous
Electrical
Occupancy:
Constr Type.
Code:
Date:
Date:
Date.
R-3
VB
cEC 2013
12t30t2018
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes: Electrical
Fee Total
Paid to Date:
Balance Due:
$243 1 s
$243.1 5
$0.00
Every permitissued shall become invalid unless the work on the site
authorized by such permit is commenced within 180 days after its
issuance, or if the work authorized on the site by such permit ts suspended
or abandoned for a period of 180 days after the time the work is
commenced.
lnspector tUlD#:201 8-148474
N/A - No Balance
/'n
ELECTRICAL.I NSPECTOR RECORD
f).'.'rlCI fl? -)/\{ lx'
APPROVALS DATE ID/SIG COMMENTS
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltase
Fire AIarm I Dampers
Communications Cable
Building
Under SIab / Floor
Bonding I Grounding / UFER
Transformers
Torqueing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Roush)
Ceilings (Hard & Soffit Rouqh
Ceilinss (T-Bar Rouqh)
[\4eter Release
'A rl.2l a /Rough UlrlM'r;L8)
Service Jt/eter 3.lt u --
'++,ffiFINAL
-Zl-Z)Remarks Etc.
OWNERBUILDERDEI,CARATION - , ID
I hqeby affrm undo pcnalty of pcfjury thst I m cxmpt from thc Contr.clors' Licensc Law for thc following r€en (F7031.5
BNin6s dd Profsior Codc): Any City or Counly rvhich requirG a p6mit to coNtruct. altq. improv€. danolish or npair ary
struc{w. prior to its issuocc. also rcquirc thc applicet for such psmit to filc a signcd stalmot tha trc or slrc b licmscd pmant
lo thc provisioE of thc Contraclor's Liccnsed lrw (Chapts 9, Commcncing with Sction 7000 of Division 3 of thc Buines md
Prcfcsions Codc) or that hc or shc is cxcmpt thsefrom ad thc besis for the allegcd cxmpion. Any violation of Scctbn 7031.5 by any
applicet for a pemit subjets thc applicut to a civil pcmlty of not morc ths fivc hun&cd dollus ($500).
-1.
as owner of the propeily. or my employecs with wages as their sole compensation. rvilldo the work and the structure is not
intended or offered for sale (Scc.7044, Business and hofessions Code: The Contractor's l,icense Law does not apply to an orvner of
the property who builds or improves thereon. and who does such work hinrself or herself or through his or her orvn employees.
provided that such improvonents are not intended or offered for sale. lf. horvsver. the building or improvement is sold within one year
of completion. the Orvner Builder will have the burden of proving tha he or she did not build or improve the propoty for the purposc of
sale).
-1.
as owner of the propoly. arn exclusively contracting with licensed contraclors to conslruct the project (Sec. 7044. Buiness
and hoftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon.
and who contracts for such projects with a Contracto(s) licensed pursuant to the Contraclor's License taw).
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arn exempt under Section-. B. & P.C. for this reason.
Il.r r a.()n'ner:
wonxrns'coNtp
DECLARATION
of the follou'ing declarations:I hereby aflirm under penalty of po'jury onc
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have and will maintain a Certificatc of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the
l-abor Code. for thc performance of the work for which the pennit is issued.
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have and will maintain workers' cornpensation insurance, as required by Section -i700 of the Labor Code. for the perfonnance of
the work for which this permit is issuod. My workers' compensation insurance can'ier and policy number are:
Policy Number: Expires:
_l certi& that in the performance of the work for which this pcrmit is issued, I shall not employ 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 Serrion 3700 of the labor Code. I stnll. forthwith cornply rvith thosc provisions..
WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an onployer to criminal penalties and
civil frnes up to one hundred thousand dollars ($100.000), in addition to the cost of compensation. damages as provided for the
Section 3076 of the Labor Code, interest and attorney's fees.
A rrrrlinonl.
LICENSED CONTRACTOR
DEC! {RATION
I hereby affirm under penalty of pojury that I am licensed under provision of Chapter 9 (cornrnencing with Section 7000) of Division 3
of the Business and Professions Code, and rny licerxe is in full force and effect.
License Number:
W
I h@by affm udq pcoalty of pajury th8t thqc is a onsrruabn knding agcy for thc pofomcc of thc work for which thig pqrnh b
issucd (56. 3097, Civ. C.).
Lender's Name:
Lender's Address:
APPI ICANT DECI 'AILATION
I hereby affinn under penalty of perjury onc of the following declarations:
Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6)
-Required
lrtter of Notification
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c6|iry that thc fedqal rcgulatiom rcguding sbGtos r@oval de not applicablc to this prcj$r.
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cdiry that I have rad this application ed state that the above infomtior is corst. I agre to comply with all City ild County
ordimncG od Slate laws rclaling to building construction, ed h6eby authorizc rc?rslativc of this City md Couty to mtq upon thc
above motioned prcpcrty for iGpction purpos.
Applicnnt or Agent Signuture:
l'errrritce nanre (prinl):
Date:_
Contrrctor:_