HomeMy WebLinkAbout20173561 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA92702 Electrical
Permit Counter: (714)-647-5800 lnspection Requests: (714) 667-2738 lnspector Section: (714\ 647-5853
Permit #:2017356{
Pin #: 637002'c/
Proiect Address: 3811 S Bristol St- -a-
Assessor's Parcel: 410-301-15 Lot: NA
Unit:
Block: NA
Bldg:
Tract: NA
Address Range:
Historic: No
Suite Range:
Zoning: CR
Owner:
Address:
Phone:
Tenant Name:
Contractor:
Address.
Phone:
Run the Race Ministries
405 W Sierra
Newport Beach, CA 92660
(7141 351 4107
Run The Race Ministries
KC Electric
4440 Charlemagne Ave
Long Beach, CA 90808
17141 6ee-0106
Fee Type
01 1 16002 51603 FWU
01116002 5160C General Plan Update
01 1 16002 51603 lssuance
01116002 5777C Microfilm Records
Amount
26.71
23.79
59 30
405
Qty
100
1 .00
1 .00
0.00
Fee
$26.71
$23 79
$5e 30
$0 00
State Lic #: 699521
Lic Type: C-10
Bus. Lic #: 3914
Workers' Compensation lnsurance:
_ Carrier: Exempt\
Policy #:
Exp ges:
Building Use:
Job Type:
Nature of Work:
Planning Conditions:
Planning Approval By:
Plan Checked By:
Permit lssued By:
Subject to Field:
Building Permit #:
Other
Miscellaneous
Fireworks Stand
Zuniga, Allissa
Occupancy:
Constr Type.
Code:
Date:
Date:
Date:
N/A
N/A
cEc 2019
06t22t2021
Account#
Misc. Receipt: 75635
Misc. Receipt:
Misc. Receipt:
Total
Notes: Hand out given/All fees paid on M-75635
Fee Total
Paid to Date:
Balance Due:
$1 09 80
$1 09 80
$0.00
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 fhe sife by such permitis suspended
or abandoned for a period of 360 days after the time the work is
commenced.
lnspector MID#: 2021-166897
N/A - No Balance
ELECTRICAL.INSPECTOR R ECORD
APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION
I hcrcby affirm under pcnalty of pcrjury thal I m cxcmpt frcm thc ContEctm' Liccnrc hw for thc followitrg msn (Ss.7031.5
Busincss and Profcssion Codc): Any City or County which rcquircs a Frmit to onslruct, altcr, improvc, demlish or rcpair any
structurc. prior to its issuoncc. also rcquircs thc applicdt for such pcrmit to file a signcd statemnt thal h. or shc is liccnrcd pursuilt
to thc prcvisions of the Con[&tor's Liccnscd law (Chaptcr 9, Comcrcing with Scction 7000 of Division 3 of thc Busircss and
ProfcssionsCodc)orthathcorshciscxcmptthscfromandthcb{sisforthcallcgedcxcmption. AnyviolationofscdionT03l.5byrny
applicant for a pcrmit subjets lhc applicant to a civil pcn8lty of not mrc lhan fivc hundrcd dollus ($500).
_1. as owncr of thc prof,erty, or my ctnployccs with wagcs as thcir solc comlrcnsation, willdo thc work and thc struc'turc is not
intcndcd or offcrcd for sale (Scc.7044. Busincss and hofcssions Code: Thc Contractor's Liccnsc l;tw does not apply to an owncr of
thc proprty wtxl builds or improvcs thcrcon. and who docs such work himsclf or hcrsclf or through his or hcr own cmployccs.
providcd that such inrprovernents arc nol intcndcd oroffcrcd for salc. If. howcvcr, ttrc building or improvcnrcnt is sold within one year
of conrplction. thc Owncr Builder will havc thc burdcn of proving that hc or shc did not build or irnprovc the propeny for thc purprsc of
salc).
-1,
as owncr of thc prolrcrty, am cxclusivcly contracting with licenscd conlraclors to conslruct lhc projcct (Scc. 7U4, Business
and hofession Code: The Contraclor's Liccnsc Law docs not apply to an owner of propcrty who builds or improves thcrcon.
and who contracts for such projccts with a Contractor(s) liccnscd pursuant to thc Contractor's Liccnsc taw).
-l
am cxempt under Scction-, B. & P.C. for this reason.
Datc:
1VORK IrRS' COM PIiNSA'f I(lN
DTiCI ARA'I'ION
I hcrcby aflirrn undcr penalty of pcrjury ortc of the following dcclaralions:
_l have and will maintain a Certificate of Consent to Self-lnsure tbr workers' compcnsation, as provided for by Section 3700 of the
labor Codc, for the pcrformancc of ttrc work for which the pcrmit ls issucd.
_l havc and will maintain workcrs' compcnsation insurance. as rcquircd by Sect ion 37fi) of thc labor Code. for the pcrformance of
the work for which this permit is issucd. My workers' comJrcnsation insurance carrier and plicy number are:
Policy Number: / Expires:
_l ccrtily that in thc lrcrformancc of thc work for which this lrcrnrit is issucd. I shall not cmploy any person in any manncr
so as to bccomc subjcct to the workcrs'comp€nsation laws of California. and agree that if I should bccorne subict lo the
workcrs' compcnsation provisions of Scction 3700 of the L-abor Code. I shall. forthwith comply with thosc provisions. . '
WARNING: Failurc to sccurc workcrs' conrpcnsation covcragc
civil fines up to one hundred thousand dollars ($100.000). in
ts and
the
Scctiort 3076 of interest and fecs.
I hcrcby affirm undcr pcnalty of pcrjury that I arn licensed provision of Chapter 9 (cornmcncing Section 70m) of Division 3
of thc Busincss and Profcssions Codc. and my license is in full forcc rutd effcct.
.)ry;LtLicense
I hcrcby uflirm undcr penalty of pcrjury that thcrc is
issucd (Scc. 3097, Civ. C.).
agcncy for thc pcrfornuncc of the work for which this permit is
lrnder's Name:
lrndcr's Addrcss:
APPLICANT DF'CT ^ IL{IION
I hcrebyaftirmundcr penalty of prjury one of the following declarations:
Demolition Permits-Asbcstos Notification Fedcral Regulations (Titlc 40, Part6)
-Rcqu
ired l-cttcr of Notification
_l certify that the federal regulations regarding asbestos removal arc not applicablc to this project.
-l
ccrrify that I have rcad this application and state that the\vc information is corrcct. I agree to comply with all City and County
ordinanccs and Statc laws rclating to and hercby authorizc rcprcscntatives of this City and County lo cnler upon the
abovc mentioncd propcrty for zlzrApplicant or Agent
Permitee name
Site-Work
Underground
Pole Bases
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Safety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Buildinq
Under Slab / Floor
Bonding I Grounding / UFER
Transformers
Torqueinq
Sub-Panels
Air Conditioners
Roof Top Equipment
Factorv Wired Unit
Walls (Conduit)
wails (Roush)
Ceilings (Hard & Soffit Rouqh
Ceilinqs [-Bar Rouqh)
Meter Release
Rouqh
Service JMeter /.'\
FINAL b-4-71 \,1[p\4
Notes Re Etc.
r ACI n7 Onl tr
Owner:-
I a
)
l,tltL-