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! Residential E lndr.:strial E Commercial NO EACH TOTAL
<br />8.,!c
<br />MAILINGAODRESS
<br />I Ci-
<br />FIXTURES
<br />each plumbing fixture/trap 4 400 /a.at
<br />10 00
<br />CITY STATE/Z PC"- c z)/ 41 t,J,*e SEWER
<br />1st 100' + Conn 10.00 /0, ao
<br />Ownr.-Build6r Docl.rarlon
<br />lhe@byalltm ihar lam erehpr lrom rheConractor's L cen$ Law lor rhe I
<br />7031.5. Alsinos and Prol€ss,ons Code: A.y ciry o. colhry which €
<br />aller, imprde, demolish, or ropaira.y strucluB, piorlo its I aoroqulcslh6sppli.anrlor
<br />such pomir ro til. a siqn.d st6temo.l rhal h€ is ticaas.d r ro rhe prd'sionsof rho corrac
<br />ror's Licsns€ Liw lch8pld 9 lcmme.cinq wirh S I or D'vB'on 3 ol lhe Susrne$ a.d
<br />P.otesions Code I or thd he 'serem rheref ih€b€sislorihealleqedexemp on.A.yviola.
<br />ion of Seclion 7031.5 by any.pplicrnr subiecls $6 applicanl lo a civil pqnalty oi .or
<br />mno ftan livehundred doll.rs (S
<br />r ot rho proporlt, or my €mployees w h wages as lhetr sole com
<br />end fie svucluo rs .or inrended or oilered lorsare
<br />S I, as wn€r ot lhe properv, am oxclusiwly co.tracmo wlh lE6.*d con-
<br />O*re,lSE.,-
<br />Ea. Add'lCon.3.00
<br />Ea Add'1100'orFraction 3.00
<br />Privale Sewage Disp. System 30.00
<br />GAS PIPING
<br />GAS SERVICE 1 to 4 Outlets 5.00
<br />Ea. Add'iOurlet 1.00
<br />Temporary Gas Service 20 00
<br />MISCELLANEOUS
<br />Water Heater - Electric or Gas 5.00 .{, noContractor Uso Only
<br />Wator Piping Ea. 100'400G.V' Pl"-L + D*..; .Rain Water Piping (buried) Ea. 100'400
<br />ADD_FESS
<br />Zt Ur\ C i._(u,*),n Waler Softener 4.00
<br />Alt. or Repairof Drainage -Vent Piping 300Z,* C"
<br />^t-Cozr-
<br />STAT€/ZIPqLbl?Lawn Sprinkler 3.00
<br />I he,oby ,tlim rh8r I a6 lic6.sd u.&, rhs p.ovi$ons ot Chaprer L OMdon 3 ol lh€ 8osires ..d
<br />Protsrsbns Cod6, and my lic.n$ is in tull lorc€ and .lr*r,
<br />,*"*""gttt&ll Cily
<br />oare,(7EJ6:EL- contracror rsrq I
<br />l/lbrloB Compcnratlon Dcchr.don
<br />I hereby alfih rhal L have a csnincate ol co.*nr lo sell insu@, or a conii'cate ot Worker's ComDen
<br />salio.lnsuranco. Confied copy siledwnh theC ry bulldinq nsp€.rion depa.lment
<br />O.leErpto. Verilied By lsig.I
<br />Dale- applicanrlS'9.)-
<br />rsued, I shall nor 6molov .hv
<br />\2iLa:cd1'o'n'aI
<br />ll, 6hor maki.g rhis Cenifier€ ot Exempiion, Vo{ sholld b6com6 subj6ct lo th6 Wo.ko. s Comp€n-
<br />satio. ,rovisio.s oi lne Labor Cod6. you musl torthwith comply with such p@isions or lhis pemn
<br />shall bo de€mod Bvoked.
<br />Bain System - Per Drain (inside)4.00
<br />lnd. Waste lnterceptor 8.00
<br />PoolTraps 5.00
<br />Roof Drain System - Per Drain
<br />Repair/Ah. Drainage or Venl
<br />Vacuum Breakers l-5 5.00
<br />Over 5 100
<br />Backflow Device 2" or Less s00
<br />O\et 2"i0.00
<br />SubtotalE(pffiorl
<br />This pomir shall6rpie by limitadon and b@omo null and rcid tf trs wort auhonzad bV this p€mn is
<br />.ot comm€ncsd wi$i. 18O &ys f,om rho dat6 of this p6di oi il wo* aothoized by this pdmt it
<br />ssr.nd€d or abanrto@d ar €ny lime ofie. rho work is com@rc.d d a poiod ol 1aO davs. A rew
<br />oomir sh.ll be obbi.ed fi,n beroro such wolt can b€ r6comm.6d.
<br />Applic.nr'! D.d.rutl,on
<br />I cerli'y lhar I have rcad $'s appr caron and $ale lhal th€ above rnlormaron rs cotrecr I asree ro
<br />comply with all c lv ordinances 6nd sbre laws rolarnq ro borrd onsrucron, a.d h6rebv aulhc
<br />rize Epresntanves of ihis c'ty ro 6.16r opon lh€ abow,m€perly lor i.spec o. purposes
<br />.* L^4A<b Aprri.anr or Agonr rsis
<br />3j cc
<br />Penalty Fee (when applicable)
<br />Violation Fee (minimum 035.OO)
<br />Plan Check Fee (minimum $ 15.O0) Acct-+ 1 1 -402
<br />Receipt No PC No
<br />lssuance Fee,10 0q')
<br />TOTAL {minimum S35.oO)\5ry
<br />PEFMIT NO.
<br />SUILDING 31618,,,,,,,o"",",n,PEFMITISSUEOaYISig.)
<br />l 3500c1 310VAIIOATION IOFFICE USE ONLY)
<br />taccouNI111,4r2t
<br />O oAPPLICATION AND
<br />PLUMBING PERMIT
<br />(TYPEWBITE OR PFINT IN INK)
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA
<br />834-4186 {hrt
<br />APPLICANT FILL IN AREA BELOW
<br />(!q
<br />Izo
<br />IIn
<br />Distribution: 1. lnspector Copy 2. FileCopy 3. Finance Copy 4. ApplicanlCopy
<br />ce-
<br />JOBAOORESS
<br />E S*ti* zOl,or r.
<br />{
<br />I cenitv rh.r in the oeriomanco ol lhe wo.k ror
<br />pe.en io any ma.n6r e as to becom€ subj.ct to
<br />o"n L-&b
<br />Notic6 To Appllcant:
<br />Dental Unitor Medical Gases
<br />f .ao
<br />3oo I
<br />3.00
<br />L
<br />Nn("\
<br />M
<br />N
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