HomeMy WebLinkAbout20173991 - PermitCity of Santa Ana 20CivicCenterPlaza(M-19), Santa Ana,CA927O2 Electrica!
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #: 2017399{
Pin #: 364{64t
Proiect Address: 104 E Fourth St-a- -
Assessor's Parcel: 398-501-02 Lot: POR 7 & POR 10
Unit:
Block: 10
Bldg: Address Range:
Tract: TOWN OF SANTA Allistoric: Yes
Suite Range:
Zoning: SD84
Owner:
Address:
Phone
Tenant Name:
Contractor:
Address:
Phone:
TAVISTOCK INVESTMENTS
104 E 4TH ST
Santa Ana, CA 927014602
D J Z Construction
23806 Elyce Court
Moreno Valley, CA 92553
(e4e) 836-2631
01 1 16002 51603
01 1 16002 5160..
01 1 16002 5160-2
01 1 16002 5160C
01 1 16002 5160;'
01 1 16002 5777C
Fee Type Amount
125 Volt Receptacle 1 .57
Light Switches, Occ. Se 1 .70
Min Fee Adj 71.74
General Plan Update 23.19
lssuance 59.30
Microfilm Records 4.0S
Qty
1.00
1.00
1 .00
1.00
1.00
1.00
Fee
$1 s7
$1 .70
$71 74
$23.79
$5e.30
$4.05
$4, [15
$23 .79
$134,31
$2t-ttt. I 5
( $38, t-t t-t l
State Lic #: 1029251
Lic Type: B
Bus. Lic #: 378364
Workers' Compensation Insurance:Carrier: State Fund
Policy #: 92GG2S3
Expires: 1212112021
Botch*:60348 g/16/}it?i ID: o,ilorolesll
0f f i ce: (:TYH Trarr s* : 35 I of' IAcct+r Rei*: 201 73991
Ficpti:t-ts38tt7,+2 8r 16i7it2l ltt:39 A|'|'[ransocttCIn lcrtnl t162. 15
D J Z (:onstr'uction
Building Use:
Job Type:
Nature of Work:
Commercial
Tenant lmprovement
TI
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
4.2, B
V B, SPK
cEc 2019 electrical for Tl
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By: Verduzco, Violet-
Subject to Field:
Buirdins Permit #: 1 01105998
\-l\08/1 6t2021
Account#
Mrsc. Receipt:
Misc. Recerpt:
Misc. Receipt:
Total
Notes:
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
$23.7e
$134.31
$4.05
$162 1 s
$0 00
$162.15
lnspector MID#: 2021-164238
ELECTRICAL-! NSPECTOR R ECORD
APPROVALS DATE ID/SIG.COMMENTS
Site-Work
Underground
Pole Bases
Liqht Standards
Spas, Pool, Fountains
Siqns (monument)
Life Safety /Low Voltaqe
Fire Alarm / Dampers
Communications Cable
Buildinq
Under Slab / Floor
Bonding I Grounding I UFER
Transformers
Torqueing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilinqs (Hard & Soffit Rouqh
Ceilinqs (T-Bar Rouqh)
Nleter Release
Rough g I8 .-7-(ruru
Service JMeter
FINAL ?-zA-?l /ZC/,,ub"ln
Notes, Remarks, Etc.
, "" ,'XT",I?ykl",["'J""fl#L[ns kw ror thc rorhwitrs**nf,l
Busincss and Pmfcssion Codc): Any City or County which rcqutcs a yrrmit to construcl. altcr. improvc, dcmolish or rcflu
structurc. prior to its issuancc, alm rcquircs the applicant for such lrc]mit to {ilc a sigrcd statcmnt lhat hc or shc is liccnscd pursudht
to thc pmvisions of thc Contractor's Liccn$d llw (Chaptcr 9, Comcncing with Scction 7000 of Division 3 of thc Busircss ud
Pmfcssions Codc) or that hc or shc is cxcmpl thcrcfrcm and the basis for thc alhgcd cxcmption. Any violslion of Scttion ?03 I.5 by iny
trpplicant for a Frmit subjccts lhc applicant to a civil pcmlty of not mrc than fivc hundred dolles (S5u)).
_1. as owrcr of lhc pro[Eriy, or my cmployccs with wagcs as thcir elc comlEnetion. willdo thc wtrk and thc slrE{N is mt
intcrdcd or ollcrcd for slc (Se.7O44. Busircss and Prcfcssions Codc: The Conractor's Liccns llw dGs not .pply to an owncr of
thc pmFny wln builds or irnpmrcs lhcmn. atd wlb d@s such mrk himself or hcr*lf o] threugh his or hcr own cmploycts.
providcd that such impmwmnts m rct intcrded or olfcrci for sh. lf. horcE, thc huilding or imJrercmnt is mld wilhin onc }rU
of complction. thc Owrcr Buildcr will haw thc burdcn of prcving that he or she di, rct buiH or impmw thc pDtEty for thc purF)s of
slc).
_1, as owncr of thc pmpcny, am cxclusivcly contmcting wilh licenscd contradom to onstrucl thc prcjcct (56. 7(X4, Busincss
and Pmf.ssionCode:ThcContractor'sLiccnscLrwdoesnotapplyloeownqofpmlEnywhobuildsorimprorcslhcrcon.
lnd who crrntmcls for such projccts with a Contmcto(s) liccnpd pursuant to thc Conlraclor's Liccnsc kw).
-l
am cxcmpl undcr Setion-, B. & P.C. for lhis rcasn.
l)tlc.
WORKERS' COMPENSATION
DECLARATION
I hcrcby afl'irrn undcr pcnalty of perjury onc of the following declarations:
_l have and will rnaintain a Certificatc of Conscnt to Sclf-lnsure for workers' compcnsation, as providcd for by Section 3700 of thc
Labor Codc, for thc pcrfornrancc of the work for which thc pcrmit is issucd.
-l
havc and will maintain workcrs' cornpcnsation insurance. as required by Scclion
for which this pcrmit is issugl My worf,crs' compcnsation insurancc carricra\^\q k,*t 3700 of thc Labor Codc. for thc pcrfornuncc of
thc work and prlicy numbcr arc:
Policy qz \7-71
_l ccrtify that in thc Jrcrfornrancc of thc work for which this pcrmit is issucd. I shall not cnrploy any lrcrson in any manncr
so as to bccomc subjccl to thc workcrs' comlrcnsation laws of California. and agrce that if I should bccome subjecl to thc
workcrs' conrpcnsation provisions of Section 3700 of thc L:bor Code, I shall, forthwith comply with thosc provisions..
WARNING: Failurc lo sccurc workcrs'
civil fincs up to one hundrcd thousand
comlrcnsation coverage is unlawful.^and shall subict an employer to criminal pcnaltics and
dollars (S100,000).\addition to ff cost of compcnsation. damagcs as provided for the
":j*:.s'icesScction 3076 of C<xlc. inlcrcst
?
LICT'NSED CONTRACTOR
DECLARATION
I hcrcby alfirnr undcr pcnalty of pcrjury that I am liccnscd under provision of Chaptcr 9 (comnrcncing with Section 7000) of Division 3
of thc Busincss and Profcssions Code, rurd my license is in full force and cft'ect.
Licensc D Z-S\
Z
W
I hcrcby affirm undcr Fnalty of pcrjury that thsc is a @nstruction lcnding {gercy for thc pcrformncc of the work for which this lEmit is
issucd (Sc.3097, Civ. C.).
[-crrdcr's Nanrc:
lrndcr's Addrcss:
APPI ICANT DECLARATION
I hcrcty affinn undcr pnalty of pcrjury one of the following dcclarations:
Demolition Pcrmils-Asbcstos Notitication Fedcral Regulations (Title 40, Part6)
_Rcquircd l.ctter of Notification
_l ccrtify that thc fcdcralrcgulations regarding asbcstos rcmovalarc nol applicablc to this projcct.
_l ccrtify that I havc rcad this application and stBte that thc above information is corrcct. I agrcrc to cornply with all City and County
ordinances and Statc l.aws rclating to and hcrcby authorizc reprcscnlativcs of this City and Itt ugln thc
abovc mcnti<lncd propcrty for
Applicant or Agent
Pernrilee n$nrc s
Y l./7
no ont
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