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<br />APPL1CATION AND
<br />ELECTRICAL PERMIT
<br />(TYPEWRITE OR PRINT IN INK)
<br />o o CITY OF SANTA ANA
<br />206 W. 4rh Sr.
<br />667 -2738
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<br />t-azo
<br />00ama
<br />/APPLICANT FILL IN AREA BELOW
<br />\n
<br />s
<br />P
<br />$
<br />\
<br />/x Residentral lndustnal Commercral NO EACH
<br />E
<br />?.03
<br />02
<br />TOTAL
<br />Gar. or Carports Sq. Ft.
<br />Res. Hotels, Motels, Apt. Sq. Ft.
<br />.50
<br />,JOB ADDBESS
<br />)RESS
<br />?,3t 5
<br />&- ?262h
<br />5
<br />S T T
<br />37 0 e J
<br />Ad-f,a-?aq-t a-
<br />V;*t-',-,o ,e Receptacles
<br />Switches 50
<br />50
<br />Air Conditioners
<br />Each I 20.00 )o.oo
<br />Approved Factory Wrred Unit D la/.
<br />Lisr Olgpl - *ood (.5.00 3o,oo
<br />5.00
<br />Busways, special raceways, under floor
<br />duct, trolley or plug-in busways ea. I l0 or
<br />traction thereof
<br />Fire Signaling System. Minimum lee
<br />Outlet, smoke or heat sensor I 10.00
<br />.50 €o
<br />Lighti
<br />Each
<br />ing Standards with One Lamp
<br />Add'l trxlure on same slandard
<br />5.00
<br />1.00
<br />Maintenance Permit (annual)50 00
<br />Fa-A"",Z;z ;:;rli,t #tu Service Meters
<br />Up to 400 amps, per meter
<br />Over 400 amps, per meter
<br />Over 1200 amps, per meter
<br />I 15.00
<br />35.00
<br />75.00
<br />/.f. o o
<br />tJ--44- 4--
<br />fT-tY. v-, 3)V -E..
<br />=-E',,.o Sb. 3ru-4r,,4L4J-.4 t|*Signs and high potential gas tube lighting 15.00
<br />4ruT -7740 Swimming pools, tountains, spas 35.00
<br />CITY H.r S TA T t tzlP ?,7,Switchboard.
<br />,afim)
<br />tach
<br />molor control center or1@l 15.00hw /fr oo
<br />afi .tl the ptovrsr orl
<br />oLs Code Icer ts I rill and Temporary construction meter service
<br />pole
<br />Each dislribution pole
<br />25.00
<br />5.00Lrceo,2t"?,4 3 a x Temporary construction lighting
<br />500 lamps or less
<br />Over 500 lamps
<br />Contraclor (Srg )
<br />2.00
<br />4.00
<br />Workers Comp6nsation
<br />I herebv allrm thal I have a certricale of consent 1o self-rnsure, or a ceilrlrcate ol Worker's Compen Time clock or photo electric cell 3.00
<br />{":"inffi
<br />?'b rth he Crly ,l,1r,rt lft POWER APPARATUS: Generators,
<br />motors, transformers, rectifiers, industrial
<br />red By lStg )
<br />Appl rcant {Srg and
<br />U p to 2.00
<br />5.00
<br />10.00
<br />20.00
<br />30.00
<br />40.00
<br />cer that he perlor ol work OI lr hrs not ernploy an Over
<br />person ln any mAnner SO lo become lo ker s Compen ron aw of Calif or nra Over 10 and nol over 50 HP, KW KVA
<br />Over 50 and not over 100 HP, KW KVA
<br />Over 100 and nol over 500 HP KW KVA
<br />Over 500 HP, KW KVA
<br />Date Applrcant {Srg )
<br />Notlcs To Appllc.nt:
<br />ll, atter making lhrs Cerlrtrcate ol Exemptron, yoe should become s!blect to ihe Worker's Compen
<br />satron provrsrons of the Labor Code, Vou musl lorlhwrth conlply wrlh such provrsrons or thrs permrt
<br />shall be deemed revoked
<br />Subtotal o
<br />Jhrs permrr shar exprre blrm,ratron and b":X::[: "" a I ihe work aurho.zed by lhrs permrr rs
<br />not commenced wrthrn 180 days from the date ol rhrs p€rmrt or rl work authoilzed by lhrs permrl rs
<br />suspended or abandcned at any lrme alter the work rs commenced lor a penod ol l80 davs A new
<br />trErmrl shall be oblarned trsl belore such work can be recommenced
<br />Penalty Fee (when applicable)
<br />(s0.00)
<br />Plan Check 65% of subtotal 70. O (minimum 20.00)
<br />Applicant's Declaration Receipt No.1 'l ec*Date
<br />Plan Check (Adjuslment)
<br />lssuance Fee
<br />,","/1-2'fq PERMIT FEE (minimum S35.00)
<br />Appl€anl or Agenr (S,g
<br />o^rE // -z-F1 PERMIT NO.
<br />BUITDING
<br />PERMIT No 54 boj VERIFIED BY lSrg Y1,0t-r:lflf,lll r:,51 {i)Ljv,:;,,r l^!> 3e,
<br />VALIDATION IOFFICE USE ONLY
<br />tACCOUNT fl 1-413)&5LY 4 tt/E/99 S:SSPfi +1I tll?.m
<br />10.00
<br />Distribution: 1. lnspector Copy 2. File Copy 3. Finance Copy 4. Applicant Copy
<br />71c/
<br />ntC
<br />Fixlures
<br />I
<br />violatrl*g'+'l/2 pl 4 r, 7 A
<br />I,'l,RCI
<br />Owner Builder Oeclaration
<br />(/
<br />rs rssued, I
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