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-APPI.ICATION AND O <br />MECHANICAL PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />o CITY OF SANTA ANA <br />206 W. 4th Street <br />667-2738 <br />APPLICANT FILL IN AREA BELOW r$* <br />o <br />E <br />Izo <br />ooD <br />\L\ <br />1 <br />s <br />.,|ofh <br />MAILING ADORESS <br />CITY <br />.]OB AODFESS <br />Orrrlu*hr O..ar.Ur|l <br />I h6raby .ltr.m thal I .h orenpt l.om rh6 C@rracro/s tic€ie l& ld rho tollorino r66d (S& <br />7q31 5. Busin6s and Prolaio.s Cod. Any caly or counly whid r€qunos I pcrmh lo conllrld, <br />aller. rhprove demolan. or .epa, ary 3ltuclur.. prio. lo rl! su.n@, de r.quir6 lh€ applic..l <br />lor 3!ch psmil lo til. a sqn€d 3lllenE l lh.l na is hc€.!4d purslanl lo lile piovisbds ol lhs <br />Conl.ac163 licdle Lee/ GnaPler 0 (co,rxnencing rnh Serio. 7qE) ol OryBkr 3 or rh6 <br />8usne65 and Proi6sios Co<,!) o, rhlr h6 is erdpr rh.,6lrm .nd rho b.s6 io. rh€ .rrog€d <br />ererpl'o. Any violalio. ot Sedion 7(ts1 5 by any applrc! t r . p€rnn lubjecrs rhe applicanr ro <br />. cNil pen.rly ol nor mo.e th6n rive hund.6d &1168 {35@) <br />704,r I 6 ownd ol lhe prcpe.ry. o. nydployB wnh wag6 6 rharel. cohpec.t rhe wort 5nd rhe strucrure E <br />^or 'nre..,ed ., drrded ior er. <br />E s".''"" <br />d**"70448 l, 4 ownor ol the <br />I h€reby rltrm itul I d lic€ns€d un&. th6 p.@i.ao^s ot Ch.ptor 9. Orv'rDn 3 ol !h€ A6ins s.d <br />Pro,6eo.s Code, &d my rrce.se is '. lurr ,o.ce a.d e,t ct <br />STATE/ZIP <br />Li@$ fllo <br />- <br />ClEs <br />AOOF€SS <br />CITY <br />! Rosideftisl E lndustdai a Comrnercial <br />EACH FURNACE INCL. DUCTS ANO VENTS <br />EACH COMPRESSOF, BOILER, OR HEAT PUMP <br />Outdoor Dual Packaged Healing or Cooling <br />Range Hood with Ducl and Fan [fype D <br />EACH IOTALNO. <br />Heat Pump Compressor than 5 HP <br />Air Handling less than 2,CFM <br />Atr Add. lo any Healing/Cooling sys. <br />Up to 100,000 BTU <br />O\er 100.000 BTU <br />EACH ABSORPTION SYSTEM <br />100,000 BTU to 1,000,000 BTU <br />1.000,001 BTU to 2,000,000 BTU <br />5HPto30HP <br />31 to 50 HP <br />O\€r 50 HP <br />EACH AIR HANDLING oR vAv Box <br />2,000 CFM lo 10,000 C <br />O\€r 10,000 CFi/l <br />MISCELLANEOUS <br />Floor Furna@ <br />H€ater; Susp€nded, Whll or Unit <br />Com'l Dryer Vents <br />Decorati\€ Fileplac€ (Wbod or Gas) <br />Each Vent Fan Connecied to a Duct <br />Fan C,oil lnslallation <br />Fare Extinguishing Syslem <br />Each E\aporali\re Cooler <br />lncidental Gas Piping <br />15.00 <br />20.00 <br />25.00 <br />30.00 <br />25.00 <br />40.00 <br />25.00 <br />30.00 <br />10.00 <br />10.00 <br />10.00 <br />25.00 <br />10.00 <br />15.00 <br />15.00 <br />15.00 <br />15.00 <br />15.00 <br />20.00 <br />15.00 <br />15.00 <br />10.00 <br />15.00 <br />hrt,t Cor?. tbn D.Craton <br />I h€reby rn'im rh6r I have . cert icale ol @nst to $ltinsure, or . certillrte ot ubrt(ers coG <br />oer6alion l.su,a.ce cerlift€d @py E lal6d w h the City buitdi.g iBpecti@ dep.nment. <br />I conrt lhal rn rheFErlormanceolthework lorwh.ch <br />rl and m8*n! thrs Ce.lilaateol Exemptid. you sh@rd b€aom sobiet to rh€ Wdkeis Conp€c$no. prov.sions ol ltE t bor codr. yo! .n6t torth*rth compty *nn !!ch Drovisroos or thls <br />perD't stull b€ d€omed r€loted <br />person n any manner so as to b4ome <br />oare <br />- <br />Apptic.ni {Sig ) <br />10.00 <br />si <br />.// '2o <br />ustmenl(Adj ) <br />Hood with Ducl and Fan Oype ll) <br />Fire Damp€r lnstallation <br />OATE <br />15.00 <br />15.00 <br />15.00 <br />(50.00) <br />Dale <br />(minimum 20.00) <br />(minimum 535.00) <br />PERMIT NO. <br />Subtotal <br />TOTAL PERMIT FEE <br />Penalty Fee (wh€n applicable) <br />Violation Fee <br />Fee <br />Beceipt l,lo.Pc# <br />A!add! <br />Th6 p6mn 3h3ll 34ns by timndifi ..d b€.onr€ oul ,nd voad it rh€ rfil .uho.ized tly tha <br />p€.oir 6 mr comrienced warhin rq) dayr lrcrn the d€t. ot this p..mn or it wort r!rho.iz6.t by tnis <br />po,mll a srEpen<h d abandon.d Et ey tih. .ltsr th€ wort is conh.nc.d tor ! r'eri)d o, rx <br />d.y3 A .* permil shall b. obtained first b.ior€ slch eo.t .!n b€ .€commenc€d - <br />r9dc..fi O.draol! <br />I @nrty lnar I have read thE appn€non ..d stde th.t tho.bove <br />cohply erlh arl city ordinancs and state rtu3 retrt'ng lo <br />aulhonzed re9isenrano. ol this oty to enie. upo. the a <br />rnro.mdE. rs cdrel l€relo <br />ildr.g .onalldlon and hereby <br />,o^./4t1 <br />?Wi,iF" &fuf"r*Fr€o By (s,s.)4.i4t6d1z-PEBMTT TSSUEO 8Y ($g ) <br />4 0,315 <br />VALIOATION {OFFICE USE ONTY)(accouNr 111-4ra <br />D6rnborron , rn.pecior copy 2 Firecopy 3 Fr. <br />cs-618 <br />Plan Check 650/. of subtotal <br />Check <br />4,ull-o*t- <br />7a