HomeMy WebLinkAbout20167647 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA92702
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714) 647-5853
Electrical Permit #:20167647
Pin #: 3{
Project Address: 1638 E Seventeenth St Unit:
Assessor's Parcel 400-251-03 Lot: NA Block: NA
Bldg:
Tract NA
Address Range:
Historic: No
Suite Range:
Zoning: C5
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address:
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires:
Trinidad Cisneros
'1125 E Seventeenth Street, W-17
Santa Ana, CA 92701
Owner-Builder
Fee Type
01 1 16002 51603 TPP
01116002 5160C General Plan Update
01 1 16002 51603 lssuance
Amount
103.07
22.08
55.04
Qty
1.00
1 .00
1.00
Fee
$103.07
$22.08
$5s.04
liil L 3/;lrj l li Iis*: 47
Ref*:
"ir'Lrlzt:tl g
't
Ni
2rr 16 i
11:4
tSrl . I
ti
A'
t'r.ts Fee
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Gommercial
Miscellaneous
Temp Power Pole
Zuniga, Allissa
Occupancy:
Constr Type:
Code.
Date:
Date:
Date:
B
VB
cEc 2016
K 12t13t2018
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
Notes:
Fee Total
Paid to Date:
Balance Due:
01 1 16002 51600
01 1 16002 51603
$22.08
$1 58.1 1
$1 80.1 I
$0.00
$180.19
Every permitissued shall become invalid unless the work on the site
authorized by such permit is commenced within 180 days after its
issuance, or if the work authorized on fhe sife by such permitis suspended
or abandoned for a period of 180 days after the time the work is
commenced.
lnspector MID#: 201 8-147302
I 1
APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
I hocby aflirm undcr pef,slty of pojury that I m cxcmpt ftom thc Contraclon' Licre Larv for thc following rwn (Se.7031.5
Businas ud Profosion Code): Any City or County which rcquire a pcrnil to eNtrucl. alte. imprcvc dmolish or repair a:y
structuc pior to its issumce. also rcquirc thc applicmt for such pcflnit to file I signcd statmot that he or shc b liccnscd pEuut
to thc provisioN of thc Contractor's Licenscd Law (Chapts 9. Commmcing with S6tion 7000 of Division 3 of thc Buins md
Prcfc$ions Codc) or that hc or shc is cxempt thqefiom md thc basis for thc allcgcd exmption. Any violatiotr of Scction 7031.5 by any
applicant for a pmit subjets thc applicant lo 8 civil pmalty of not morc thil five hundrcd dollus ($500).
-_1.
as owner of the property. or my ernployees with wages as their sole compensation. rvilldo the rvork and the struclure is not
intended or offered for sale (Sec.7044. Business and hofessions Code: The Contractor's License Law does not apply to an owner of
the properly who builds or itnproves thermn. and rvho does such \r'ork himself or herself or through his or her own employees.
provtdd that such improvonents are not intended or offered for sale. lf. horvet/er. the building or improvement is sold rvilhin one )€tr
of complaion. the Orvner Builder will have the burden of proving tha he or she did not hrild or improve the propoty for the purposc of
sale).
_1. as o\.\,ner of the Fnoperty. am exclusively contracting with licensed contracloni to construct the project (Sec. 704t1. Business
and hof€ssion Code: The Contractor's License Law does not apply to an ou'ner of property rvho builds or improves thereon.
and u'ho contracts for such projects rvith a Contracto(s) licensed pursuant to the Contractor's License taw).
_l am exempt for this\
I hereby affirm under penalty of pcrjury one of the follon'ing declarations:
_l have and will maintain a Certiflrcate of Consent to Self-lnsure for rvorkers' compensation. as provided for by Section 3700 of the
Labor Code, for the performance of the work for which the pa'rnit is issued.
_l have and rvill maintain rvorkers' compensation insurance. as required by Section 3700 of the Labor Code. for the performance of
the rvork for rvhich this permit is issued. My workcrs' compensation insurance carrier and gnlicy numkr are:
Policy _Expires:
_l certify that in the performance of the work for rvhich this perrnit is issued. I shall not employ any person in any manner
so as to beconre subject to the rvorkers' compensation larvs of California. and agree that if I should bccome subject to the
rvorkers' comperuiation provisions of Section 3700 of the labor Code. I shall. forrhrvith cornply rvith those provisions..
WARNING: Failure to secure rvorkers'is unlarvful. and shall subject an to and
thousand dollars to the cost of the
and
I hereby affrrm under penalty of perjury that I am licensed under provision of Chapter 9 (comrnencing with
of the Business and Professions Code. and rny license is in full force and effect.
3
[.icense
-License
Number:
Date: Contrnctor:_
W
I hrcby affirm undo pcnalty of pqjury thst thsc is a connrucion landing agocy for thc psfommcc of thc work for which this pcrmil is
issucd (56. 3097, Civ. C.).
Lender's Name:
Lender's Address:
APPLICANT DECLARATTON
I herelry aftinn under penalty of perjury one of the following declarations:
Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Pat16)
_-Required Letter of Notification
-l
cstiry that thc fcdqal rcgulalioG rEgading rbelos rmoval uc not eplicablc to this prcj61.
_l cdiry that t hflc rad this application md statc Iha thc abovc infomation b cor6t. I agreto comply with all Cityed County
ordinmce md Ststc t ws rclding to building condruction, and hscby authorirc rcpreotarivs of tlis Chy od Couty to otq upon thc
above rnentioned property for
Applicant or Agent
B.&
7000)
Permitee nanre
purposes.
Dete:_
Site-Work
Underground
Pole Bases
Light Standards
Spas, Poo!, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm I Dampers
Communications Cable
Building
Under Slab / Floor
Bondinq I Groundinq / UFER
Transformers
Torqueing
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilinss (Hard & Soffit Rouqh
Ceilings (T-Bar Roush)
Meter Release
Rough D,
Service Meter It \
+ISIAL- Vrrb 0'r-7)\IqN,[,I
Notes Remarks Etc.
\v
ELECTRICAL.I NSPECTOR RECORD
)
no n7 ?n{ r
Carrier:_
v