HomeMy WebLinkAbout20173778 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa ena, CA92702 Electrical
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #:20173778
Pin #: 20495
Project Address: 1611 S Van Ness Ave
Assessor's Parce!: 013-193-10 Lot: 38, 39
Unit:
Block: E
Bldg:
Tract: 531
Address Range:
Historic: No
Suite Range:
Zoning: Rl
G 57'
U
uflL
't!-'b
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
State Lic #: 884094
Lic Type: B, C-10
Bus. Lic #: 370311
Workers' Compensation lnsurance:Carrier: State Fund
Policy #. 9219016
Expires: 0710412022
Carlos Marquez
1611 S Van Ness
Santa Ana, CA 92707
(909) 529-6047
Pacific Southern Developme
5482 WILSHIRE BLVD #243
Los Angeles, CA 90036
(323) 35e-1ess
01 1 16002 51603
01 1 16002 51603
01 1 16002 51603
01 1 16002 5160C
01 1 16002 51603
01 1 16002 5777C
Fee Type
Res Rewire
Garage Rewire
Serv Meter
General Plan Update
lssuance
Microfilm Records
Amount
016
0 16
57.40
23 79
59.30
4.05
Qty
1,650.00
250 00
1.00
1.00
1.00
1.00
Fee
$264 00
$40 00
$s7 40
$23.7s
$59 30
$4 05
Building Use.
Job Type:
Nature of Work:
Planning Conditions:
Planning Approva! By:
Plan Checked By:
. Permit lssued By:
Subject to Field:
I Building Permit #:
Single Family Dwelling
Miscellaneous
Service Meter
lrt Hernan dez,Kathv
Occupancy:
Constr Type:
Code.
Date:
Date:
Date.
R-3
VB
cEc 2019
07 t14t2021
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:handout given
Fee Total
Paid to Date:
Balance Due:
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
$420 70
$4 05
$448.54
$0 00
$448.54
lnspector MID#: 2021-167434
I.
J
ELECTR !CT{L-I NSPECTOR R ECORD
, nc, n7 r)n{tr
APPROVALS DATE ID/SIG COMMENTS -OWNER EUILDER DELCARATION
I hcrcby .ffirm undcr Fnalty of pcrjury thtrt I m exempt fmm Ihc Contractos' Liccns hw for thc following rcarcn (Scc.7031.5
Busincss and Pmfcssion Codc): Any City or County which rcquircs a Ismit to conslruct. olter. improvc. dcmlish or rcJuir any
structurc, prior to its issuarcc, ds rcquircs thc applicant for such Frmit to filc a sigrcd slstcmnl that hc or shc is liccnsd pustnt
to the pmvisions of tlrc Contractor's Liccnrcd law (Chaptcr 9. Comrencing with Sstion 7000 of Division 3 of thc Busincss and
PrcfcssionsCodc)orthathcorshciscxcmptthcrcliomandthcbasisforthcallcgcdcxcmplion. AnyviolotionofscclionT03l.5byany
applicant for a pmit subjsts thc applicant to tr civil pcnaky of mt mrc tho fivc hund,cd dollas (5500).
_1. as owncr of thc propcrty, or my cmployccs with wagcs as thcir xllc compcnsalion. willdo thc work arxl thc structurc ls not
intendcd or ofl'crcd for salc (Scc.7044. Busincss and Professions Code: The Contractor's Liccnsc Law docs not apply to an owner of
thc proJrcrty who builds or improves thercnn, and who docs such work hirnself or hcrsclf or through his or hcr own cmployces.
provided that such inrpr<lvemcnts are not intcndcd oroffercd frlr sale. If, howcver, thc huilding or improverncnt is sold within onc ycar
of complction. thc Owncr Buildcr will havc thc burden of proving that hc or she did not build or improvc the propcrty for thc purposc of
s{lh).
-1.
as owncr of thc prolrcrty, am exclusivcly contracting with liccnscd contractors lo conslruct thc project (Scc. 7W. Busincss
and Pnrfcssion Codc: The Contractor's Liccnse Law docs not apply to an owner of property who builds or improvcs thcrcon,
and who contracts for such projccts with a Contracto(s) liccnscd pursuant to thc Contractor's Liccnsc Law).
-l
am exctnpt under Scction-, B. & P.C. for this rcason.
Date: Owner:-
WORK E l(S' C(ITVT PENSA'I'I ON
DFCI ARATION
I hcreby atfirrn undcr pnalty of pcrjury onc of thc following dcclarations:
-l
have and will maintain a Certiticatc of Consent to Self-lnsurc for workers' compcnsation, as provided for by Scction 3700 of thc
Labor Codc, lbr thc pcrformancc of thc work for which the pcrrnit is issued.
_l havc and will maintain workcrs' compcnsalion insurancc, as rcquircd by Section 3700 of the [:bor Codc. for thc pcrformancc of
thc work for which this pcrmit is issued. My workers' comlrcnsation insurance carricr and plicy number arc:
)
poricyNumber: 9Llg016-t",') Expires: )-Lt--
_l certify that in thc perfornrancc of thc work for which this pcrnrit is issued, I shall not crnploy any pcrson in any manncr
so as to beconrc subjcct to thc workcrs'compcnsation laws of California. and agrec that if I should bcconrc subpct to thc
workers' comJrcnsation provisions of Section 3700 of thc latror Codc. I shall. forthwith comply with thosc provisions..
ii
WARNING: Failurc to sccurc workcrs' comlrcnsation covcrugc is unlawful. and shall subict an cmploycr to criminal Jrcnaltics arkl
civil fincs up lo onc hundrcd thousand dollars ($100,00tt;. in addition to the cost of conrgrcnsation. darnagcs as providcd for thc
Scction 3076 of thc l,abor Codc,
Date: )-lY- )-t
intcrcst and attorncy's
o-
DECI-ARATION
I hcrcby aflirm undcr pnalty of pcrjury that I am licenscd undcr provision of Chaptcr 9 (comrrrencing with Scction 7000) of Division 3
of the Busincss and Professions Codc. and my licensc is in full forcc and effcct.
Liccnsc C-(t)Nurnbcr:SltoQ ?
W
I hcrcby afftrm undcr Fnrlty of pcrjury that thcrc is a conslruction hnding agency for thc pcrfomrcc of thc work for which Ihis lrmil is
issucd (Scc. 3097. Civ. C.).
lrndcr's Name:
t
[,cnder's Addrcss:
APPLIC ANT DECLAITATION
I hcreby affirm under penalty of prjury one of thc following dcclarations:
Demolition Permits-Asbcstos Notification Federal Rcgulations (Title 40. Part6)
_Requircd lrtter of Notification
_l ccrtify that thc fedcral regulations rcgarding asbcstos renrovalarc not applicablc to this projcct.
_l certify that I havc rcad this application and statc that thc atnve intbrnration is corrcct. I agrcre to comply with all City and County
and County to cntcr upn thcorrlinanccs and Statc l.aws relating to construction. and hcrcby authorizc rcprcscntativcs of this City
above mcntioncd property for
UJ//
Applicant or Agcnl 7-->/
Permitee name (prlnt):
Site-Work
Underqround
Pole Bases
Liqht Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Buildinq
Under Slab / Floor Ir
Bondinq I Groundinq / UFER o \W "t bA-1fl4 7
Transformers
Torqueing ^l , I I
Sub-Panels 1lLK -A hl/\,'td-T7
Air Conditioners t I /
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilinqs (Hard & Soffit Rouoh
Ceilinqs (T-Bar Rouqh)I tA
N/eter Release (\\g '7\b(\41t2 IV
\
Rouqh I
Service N/eter v 1.9 7L t),t ffi8 7
FINAL I',N\ArU .Kl
Notes, Remarks, Etc.
v - \ l- l T
1