HomeMy WebLinkAbout20173962 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA927O2 Electrica!
PermitCounter: (714)647-5800 lnspection Requests: (714)667-2738 lnspectorSection: (714)647-5853
Permit #:20173962
Pin #: 879{9hv
Project Address: 2021 W Twelfth St
Assessor's Parcel: 004-171-15 Lot: 15
Unit:
Block: NA
Bldg:
Tract 1685
Address Range:
Historic: No
Suite Range:
Zoning: R1
Owner:
Address.
Phone:
HENRY DO
2021 W 12TH ST
Santa Ana, CA 927031926
(7141 657 -2280
01 1 16002 51603
01 1 16002 51603
01 1 16002 5160C
01 1 16002 51603
01 1 16002 5777C
Fee Type
Air Conditioner
Serv Meter
General Plan Update
lssuance
Microfilm Records
Amount
104.40
57.40
23.79
59.30
4.05
Qty
100
1 .00
1.00
1.00
1.00
Fee
$1 04 40
$57.40
$23.79
$se.30
$4.05Tenant Name:
Contractor:
Address:
Owner-Builder
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation I nsurance:
Carrier:
Policy #:
Expires:
t(ot,ch+:6l"lJl6
fif t- i ce: (:T YH
.lr--!1,!HL.L Lr r
RrrP[+: tt3"i777.'.
Troneocf t cln
't
Ir
lui or/ I cf,0r I
2 of ?.
2tt17.J96?
s:43 An
$+33. ?5
$248.94
$0.00
$248.94
l-.t{fi Y DU
I tienernl FIon updcrt
Ltl I 1 6ULU- itO[t[tt:t[tr
Ulectrtcnl
rtl I l6rtu:7- SiouSti[rt
ll i cror i 1m ,I Do,:Lrtttc
[r111o[tt-t2- !:7 7 7[t[tt-t
UisoNotes: lnstall an compressor in rear yard. Upgrade service -
handout provided.
ee
Building Use:
Job Type:
Nature of Work:
Single Family Dwelling
Alteration
AC & Service Meter
Julie
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
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 sife by such permitis suspended
or abandoned for a period of 360 days afterthe time the work is
commenced.
Occupancy:
Constr Type:
Code:
Date:
Date:
Date:
R-3, U
VB
cEc 2019
08/1 2t2021
Account#
Misc. Receipt:
Misc. Receipt:
Misc. Receipt:
Total
v
01 1 16002 51600
01 1 16002 51603
01 1 16002 57770
$23.7e
$221 .1 0
$4.05
Fee Total
Paid to Date:
Balance Due:
lnspector MID#: 2021-1 67993
J
ELECTRICAL-INSPECTOR RECORD
APPROVALS DATE ID/SIG COMMENTS
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Siqns (monument)
Life Safety /Low Voltaqe
Fire Alarm / Dampers
Communications Cable
Buildinq
Under Slab / Floor
Bondinq I Groundinq I UFER Q-Za'Ol D-4 4a,-
Transformers
Torqueinq
Sub-Panels
Air Conditioners
Roof Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rouqh)
Ceilinqs (Hard & Soffit Rouqh
Ceilings (T-Bar Rouqh)
[Vleter Release g-?rt - 14 >-.-( ttl
Rough 9.97 . ?l Je-( 7+
Service N/eter
FINAL ?-19-Ll G--'-(
Notes, Remarks, Etc.
I hcrcby affirm undcr Fnally of Frjury that I m cxcmpt frcm tlE Contracto6' Licens hw for thc following rcun (Sc.7031.5
Busincss md Prcfcssion Codc): Any City or County which rcquircs a lrcrmit to @nstruct, altcr, improvc, dcmlish or rcpair sny
struclurc, frior lo its issusncc, also rcquires thc applicant for such lrcmil to filc a sigrcd stslcmnt Ihal he or shc is liccnrcd puuant
to thc prcvisions of thc Contracttr's Liccnsed L:w (Chaplcr 9, Comrcrcing with Scction 7000 of Division 3 of the Eusincss ud
PmfcssionsCodc)orthathcorshciscxcmptlhcrcfromandthcbasisforth€allcgcdcxemption. AnyviolationofsectionT0-3l.5byany
applicant for a pcrmit subjets the opplicant to a civil pcnalty of not mrc than fivc hundrcd dollas ($500).
as owncr of thc property, or my employecs with wages as lheir solc comgrcnsation, willdo the work and the stnrture is not
intendcd or offcrcd for salc (Scc.7044, Business and Professions Codc: Thc Contractor's Liccnse law does not apply to an owner of
thc profrcrty who builds or improvcs lhcrcon, and who docs such work hinrsclf or hcrsclf or through his or hcr own employccs.
providcd that such improvcnrcnls arc not intcndcd or oflcrcrl for salc. If. howcvcr. thc building or ilnprovcrEnt is sokl within onc )lcar
of comphtion. thc Owner Buildcr will havc thc burden of proving that hc or she did not build or improvc thc propcrty for the purynsc of
salc).
-1.
as owncr of the proprty. am exclusively contracting with licensed contraclors to construct thc projcct (Scc. 7W. Busincss
and hofession Codc: The Contractor's License Law does not apply lo an owncr of pro;rcrly who builds or improvcs thcrcon.
and who contracts for such projects with a Contractor(s) liccnscd pursuant to the Contractor's Licensc Law).
_l arrr cxcntpt undcr for
I hcrcby affirrn undcr pcnalty of pcrjury one of thc following dcclarations:
-l
havc and will maintain a Ccrtificate of Conscnt to Self-lnsure for workcrs' com;rcnsation. as providcd for by Scction 3700 of the
I-atxrr Code, for thc performance of thc work for which the ;rcrmit is i.ssucd.
-l
havc and will maintain workers' compensation insurancc, as rcquired by Scction 3700 of the labor Code. for the performance of
thc work for which this pcrmit is issucd. My workers' comlrcnsation insurancc carrier and plicy numbcr are:
Policv Number: Exoires:
ccrtify that in the pcrformance of thc work for which this pcrmit is issued. I shall not cnrploy any person in any manncr
so as lo bccomc subject to thc workcrs'compcnsation laws of California. and agrcc that if I should becornc subjcct to thc
workcrs' compcnsation provisions of Scction 3700 of thc kbor Codc. I shall. forthwith conrply with thosc provisions..
WARNING: Failure to sccurc workcrs'comyrcnsation covcrage is unlawful. and shall subjcct an cnrploycr to crirninal pcnaltics and
civil fincs up to one hundred thousand dollars ($100.000). in to thc cost damages as providcd.for thc
Scction 3076 of thc Code, intcrcst and attorney's
DECLARATION
I hercby affirrn under pnalty of Jrcrjury that I am liccnsed undcr provision of Chaptcr 9 (comnrcncing with Section 7000) of Division 3
of the Busincss and Profcssions Codc, and my liccnse is in full force and effect.
License Class: License Number:
C(TNSTRUCTION LENDING AG['I{CA
I hcrcby amrm undcr Fnalty of pcrjury that thcrc is a @nstruction hnding agcncy for thc pcrfomre of thc work for which this lEmit is
issucd (Scc. 3097, Civ. C.).
lrndcr's Narc:
Lcndcr's Addrcss:
APPLICANT DECL{RATION
I hcrcby affrnn undcr pcnalty of perjury onc of thc following dcclarations:
Demolition Permits-Asbeslos Notification Federal Regulations (Titlc 40. Part6)
_Requircd l.ettcr of Notihcation
-l
certify that the federal rcgulations rcgarding asbcstos rcmoval arc not applicable to this propct.
ccrl ify that havc rcacl this application with all City and County
and Statc [-aws rclating and County to cnlcr upon thc
abovc nrcntioncd proprty for
Applicant or Agent
Pernritee name (
to
and strtc that thc
,-rt, nA n'7 Onl tr
Iu'ur
Carrier:
Conlrnclor:
information