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\TION AND <br />NG PERMIT <br />PBINT IN ]NKI sPh CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />834-4186 <br />o o \^ <br />APPLICANT FILL IN AREA BELOW <br />@g <br />Izo <br />Fhesrdentiar ! tnousrriat E Comrnerc,at | *O. I eacx <br />I <br />TOTAL <br />FIXTURES <br />JOB 22>< <br />each plumbing f ixture/trap 4.00 <br />Dental Unit or Medical Gases 10 00 <br />SEWERc[Y STATE/ZIP <br />lst 100' + Conn 10.00 <br />Ea Add'lConn 3.00 <br />3.00 <br />30.00 <br />GAS PIPING ) <br />GAS SERVICE I lo4OutLets 500 <br />Ea. Add'lOutlet 1.00 <br />Temporary Gas Service 20 00 <br />MISCELLANEOUS <br />Own -&dld.r O.d.rldoo <br />lh€@byafinm |harlam erempr fiom 6e Conraclor's Lic6nse Law lor rhe tottownq .6as l5@ <br />7031 5, Ausin6$ 6.d Prolessids Code: Any crly orcounty which.equnes a pormrl roconslruct, <br />alDt .mprove, demolish, or .epair any slruclure, pnor ro rc issuance, slso equtres the applicant ,or <br />such p6rmn lo tile a signod slaromenr rhar he ls !6en$d pursuanl lo lhe provisions ot lhe Con[ac. <br />lor'sLicens Law lchagrerI lcommenchgwnh S€clron 7000r of Division 3 ol $e Blsrnossa.d <br />Proloseons Code, or 6al he is oxempllhor€l.oh and rhe basis lor fie.rreged exempnon Any!iol6. <br />lion ol Section 7031.5 by a.v applrcanr lor a p€rm I subjecB lhe applicanl ro a civi penalty of .ot <br />more than tive hund.ed dollars l$5001' <br />Ul S@noh /O.aA r.asowne'orrr6r,oo€rry.orrlerr'oveesw,lisdgesssrl-erso.ecom. <br />! <br />lsig , <br />B l, as Mno. ol the prop..lY, <br />and ihe struclu@ Enor ini.nded or olleBd lq$16 <br />Water Healer - Electric orGas 5.00 <br />Contractor ue6 Only .---? <br />Water Piping Ea. 100'CONTfrACIOS <br />Rain WaterPiping (buried)Ea. 100'4.00 <br />Water Soflener 4.00 <br />AODRESS <br />Ah. or Repair of Drainage -Vent PipingCITYSIATE/Z P <br />Lawn Sprinklor 3.00 <br />Sain System - Por Drain {insidel 4.00 <br />lnd. Wasle lnterceptor 800 <br />!^dd rho provrs'on3oi Chaphr S, DNision 3 ol the Bosin€s5and <br />Clas. Clvl$ne <br />my li.en* isin lull lorc6 and all€ct <br />Rool Drain System Per Draln 3.00 <br />Repair/Alt. Drainage or Vent 3.00 <br />Vacuum Breakers 1-5 5.00 <br />Over 5 1.00 <br />BacKlow Device 2" or Less I 'n,/l I 5.00 <br />Ovet 2"10.00 <br />5'4 <br />Wo.L,l Corlp.n''rbn Hrrt oll <br />Ih€reby6tli.mihatIhawacorrilicabolconse to s6rl-ins!E. d a csrtilic6t6 ot Wbrk6.'s Comp€n <br />$lion lne.a.@. ConifEd eopy b ft6d wnh rh6 Cilt buildi.g inspe$on dep3nmsnt. <br />O6t€Exorc. Ver''sd8v(Srg , <br />I c.nily tnar in rh8 p€riomance ol lhe work for which <br />ll, 6116, m.li.g ihiB Conjfi.aro ol Exemprion. you shdld b*om. $birt to th€ 1 /o.ter! Comp6.- <br />slio.r provirro.s ot na [abo. C{d6, you Dusr tdrhwith cmpt wirh such pbvisions or rhis ,.mn <br />lral b6 derEd Gwt6d. <br />o€r€- Appricanitsig <br />so as ro b4omo sobjer lo r <br />Water Service <br />Subtoral <br />Penalty Fee (when applicable) <br />Violation Fee {minimum S35.OO) <br />Plan Check Fee (minimum $ I 5.OO) Acct.# 1 1-402 <br />Receipt No PC No <br />lssuance Fee / /10.09\ <br />FEE (mi s.oo)TOTAL 3r;" <br />DNET/ > /b)PEBJT4IT N{ <br />Explrrtlon <br />ThBpemirshallexpnebylmilaronandbecomenullandvodilrhswor!authorzedbyth'spermnrs <br />nolcomme.c€d wilhin lSOdaysrion rhe daleof thrs perm r or r, work.urhorzed by thrs p€rmrr rs <br />sospondedorab3nd@edaiany Iime 6,10r rhewdk rscohmen@drora period ol180 days A n6w <br />pe,mn stulLbeobtal.ed nrsr b6toG suchqorkcan b6recommenced <br />Appllclnt'a Doclffadon <br />I ceni,y thal I haw r€ad thls applicaton and sbro rhar th6 abow information is co.recr I agree ro <br />comply with allcity ddi.aocesand sral. laws r€larinq to buiding consruct,on, aod hereby aulho. <br />rE repro$.r8tiws of this city lo entor upo. th6 6bov6-menrined <br />Applica.rorAgenl rsig.)610? <br />?i#iit" ? / 2b 7 "EF'F'ED <br />BY'sis )w,PERMIT ISSUED SY ISi <br />,l <br />v <br />35p0: b 805ts8VALIDATION IOFFICE T]SF ONIYI <br />Distribution: 1. lnsp€ctor Copy 2. FileCopy 3. Finance Copy 4. Applicant Copy <br />t <br />PJ <br />r <br />R <br />Ea. Add'l 10O' or Fraction <br />Private Sewage Disp. System <br />3.00 <br />PoolTraps 5.00 <br />il,r,"/y'r <br />PHONE <br />.-SATR 3?5