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. <br />APPLICATION AND <br />PLUMBING PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />o o CITY OF SANTA ANA <br />206 W. 4th Street <br />667-273€ <br />APPLICANT FILL IN AREA BELOW rN <br />cDg-Izo <br />oof,m <br />ct'ta <br />(,, <br />-.Jo <br />9J <br />p <br />VResidentiall\r, <br />E lndustrial E Commercial NO.EACH3702 S. Santa Fe Vill-aee <br />JOB AOORESS <br />Sunflower AssociatesOWNER PHONE <br />3315 Fairview Rd. <br />MAILING AODRESS <br />Costa Mesa <br />CITY STATE/ZIPcA 92626 15.00 <br />5.00Ea. Add'l Conn. <br />Ea. Add'l 100' or Fraclion 5.00 <br />30.00 <br />5.00 <br />Private Sewage Disp. System <br />GAS SERVICE 1 to 4 Outlets <br />Ea. Add'l Outlet 1.00 <br />Repair or Replace Gas Piping 5.00 <br />100.00 <br />5.00 <br />Oun -Bulld.7 O.dratbn <br />I hereby allirm thrt I em oxmpt lrom lhe Conlrrcto/s License Lew tor lhe tollowang r6con (Sec. <br />703 1 5, Busines 8nd Professrons Code Any cily or counly which roqurres I p€rmit to con3truct. <br />alte.. improve. d6molish. or .epair eny slructur€. prior to ils issuance. also requirGs the applicant <br />lor such psrmrl lo lrla a sqned stalement thst he is licensed puBuanl to the provisions ol lhe <br />Contractor's Lica* Ltr (Chapl6i 9 (commansng with S6l,on 7m0) ol Divisaon 3 ol the <br />Busrness and Pror6sims Code) or thal he is erempt theralrom 8nd the basis lor lhe ,lleged <br />exempllon AnyvlolationolSactionToi!'l.5byanyapplicanltorapermitsubistrlh€applicantto <br />a ci$l penalty ol nol more than tiva hundred dollsrs (t500): <br />El S*,lon 7044A l. 8s ownar ol tho property. ormyemployes with wagGaslhearslecomp€n- <br />salaon. will do lhg wor*, and the slructure i3 nol inlended or orrored for sale <br />E S*t,on 70448 l. as owna ol lh€ property, am exclusryely cmlrelang wrth liconsod <br />contiactoB to construct the pro,el. <br />Oate Owner (Srg.) <br />Temporary Gas Service <br />Water Heater - Electric or Gas <br />ConlrElo[ lrra Only <br />Water Piping Ea. 100'10.00VenturesCONTRACTOR <br />Easle Paeifie RXXXXXT{7 5r-3222 <br />PHONE <br />Rain Water Piping (buried) Ea. 100'8.00 <br />Water Softner 4.00P.O. Box 11388 <br />AODRESS <br />10.00CITY <br />Costa Mesa <br />STATE/ZIPcA 92627 1 6.00 <br />10.00 <br />8.00 <br />5.00 <br />I hereby Bllirm that I am licensed uoder the provisions of Chapler 9, Oivision 3olthe Busin6s and <br />o*" -U-L5-129 conrractor (s,s ) <br />Lrcense No 42065t <br />Prol6sions Code, and my hconse is rn lull lorc€ <br />Class 49tog <br />3.00 <br />10.00 <br />Alt. or Repair of Drainage - Vent Piping <br />Rain System - Per Drain <br />Deck Drain System - Per Drain <br />Repair/Alt. Drainage or Vent <br />Lawn Sprinkler <br />lnd. Waste lnterceptor <br />Pool Traps <br />Vacuum Breakers 1-5 5.00 <br />Owr5 100 <br />Backflow Device 2" or Less 5.00 <br />Over 2"10.00 <br />Water Service Ea. 100'10.00 <br />Subtotal <br />hrt.rr Conp1Idbn D.dr.lba <br />I hgroby attirm that I hav6 a canitiets ol @nsonl to $lt-insro. or a @rlitielool Wbrtd's Com- <br />pensatron lnsu.ance Certrted copy rs trled wrlh the Crty <br />p€rson in any manner s s to b$ome sub,trl to the Worler's Compenstaon Lils ol <br />Calilornra <br />No$c. To ApDllcil: <br />ll atter makrng lhrs Certrficate of Eremptton. you should become subl*t to lhe Worker's Compen- <br />salron provrsrons ol lhe Labor Code. you musl forthw(h comply with such provrsrons or thrs <br />permrt shall be demed revoked <br />buildrng rnspectron <br />4 90 Venried 8y (S49.) <br />2lrsl90Date Applrcanl (Si9 ) <br />Oate Applrcant (Sig.) <br />I certrfy that rn the perlormance of the work lor permit rs issued, I shall not employ any <br />Oate <br />Erpires <br />Penalty Fee (when applicable) <br />Violation Fee (s0.00) <br />Plan Check 650/o of subtotal (minimum 20.00) <br />Receipt No.Pc#Dale <br />Plan Check (Adiustment) <br />lssuance Fee <br />TOTAL PERMIT FEE <br />DATE <br />(minimum <br />PERMIT NO. <br />TOTAL <br />each plumbing lixture/trap <br />Dental Unit or Medical Gases <br />SEWER <br />'lst 100'+ Conn. <br />PIPING <br />MISCELLANEOUS <br />6.00 <br />25.00 <br />5.00 <br />10.00 <br />Erdrrton <br />This permit shall sxpiro by limitation and b€come null and void il lhe rcrk authorizsd by this <br />p€rmil is not commnced wilhin 180 days trom the dato of lhis p€rmil or it work luthoritsd by thig <br />,Ermit as susp€ndad or abandon€d at any ti,no atter the work is comrpnced tor a p€riod ot 180 <br />days. A n* permit Shall be obleaned liBl betore $ch work can b€ recommonced. <br />Apefc.dl D.drdo0 <br />I certify that I have rsd this applrcation and state that th€ rbde <br />aulhorized reprBentalion ol this cily to ents upon the <br />ourms 2l15l90 <br />Oste <br />- <br />is <br />lo <br />Applrcant or Agent (Srg ) <br />inspactron <br />I agrs lo <br />her6bycomply wrth all cily ordinsncB and state laws <br />rLorruc 54603-07 <br />VERIFIEO BY (Sig )No <br />P. Loemli <br />PERMIT ISSUED BY (Sig,)P. Lomell <br />A11 fees paid M-11585 C.L <br />1-112!. <br />Orstribution. I lnspector Copy 2 Ftle Copy 3 Fr Copy 4 Applicant Copy <br />cs-6r r <br />10.00 <br />0- <br />I