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APPLICATION AND <br />PLUMBING PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />O o CITY OF SANTA ANA <br />206 W 4lh Street <br />667-2738 <br />[ti" <br />APPLICANT FILL N AREA BELOW <br />q)g <br />aIzo <br />oo!m <br />@a <br />JOB AODRESSXruX 3704 s. Santa Fe Villaee <br />Sunflower Assoclates <br />OWNER PHONE <br />3315 Falrview Rd. <br />MAILING AOOBESS <br />Gosta Mesa <br />CITY STATE/ZIPcA 92626 <br />olrnr-Bulld.r O.df,dlon <br />I hereby alirfi that I am exempl lrom the Contraclor's Lrcense Law for the tollowrng reason (Str <br />T03l5.EusrnessandProt6sronsCode Anycrlyorcountywhrchregurresapermiltoconslruct. <br />aller. rmprove demolrsh, or reparr any struclure, pflor lo rls rssuance. also requrres the applrcant <br />for such permrt to file a srgned stalemenl lhat he rs lrcensed pursuant to the p.ovrsrons ol the <br />Conlraclor's Lrcense Law (Chapter I (commencrng wrth S&tron 7m0) ot Orvrsron 3 ol the <br />Eusrness and Prof6sions Code) or thal he rs erempt therelrom and the basrs lor the alleged <br />exemptron Any vrolalron ol Sectron 7031 5 by any applrcanl tor a permrl sublecls the applrcanl lo <br />a crvrl penalty ol not more than ive hundred dollars ($500) <br />E S*t,on 7044A I. as owne. ol lhe properly. or my employes wrlh wages as therr sole compen- <br />satron. wrll do the mrl. and lhe struclure rs not rnlended or oltered lor sale <br />E S*t,on 70448 l. as owner ol the propeny, am exclusrvely contractrng wrlh lrcensed <br />contracloG lo conslruct the proi*l <br />Dale <br />- <br />Owner (Sig.) <br />ContrEton L,!a Only <br />CONTRACTOR <br />Eaele Pacific Ventures 75r-3222 <br />PHONE <br />P.O. Box 11388 <br />AOORESS <br />Costa Mesa <br />CITY STATE/ZIPcA 92627 <br />I hereby allirm that I am lrcen*d undar the provrsions ot Chapter 9. Orvason 3ollhe Busin6send <br />Prolessrons Code. 8nd my lrcens rs <br />42065t <br />Lrconse No <br />- <br />ClBs <br />9 09 <br />2 15 9 <br />Cily <br />in lull <br />Date ocontracro, 1s'9 1 <br />Residential !lndustrial !Commercial NO.EACH TOTAL <br />each plumbing fixture/trap <br />Dental Unit or Medical Gases <br />SEWER <br />1st 100'+Conn.15.00 <br />Ea. Add'l Conn.5.00 <br />Ea. Add'l 100' or Fraction 5.00 <br />Private Sewage Disp. System 30.00 <br />GAS PIPING <br />GAS SERVICE't to 4 Outlets 5.00 <br />Ea. Add'l Outlet 1.00 <br />Repair or Replace Gas Piping 5.00 <br />Temporary Gas Service 100.00 <br />MISCELLANEOUS <br />Water Heater - Electric or Gas 5.00 <br />Water Piping Ea. 100'10.00 <br />Rain Water Piping (buried) Ea. 100'8.00 <br />Water Softner 4.00 <br />Alt. or Repair of Drainage - Vent Piping 10.00 <br />Lawn Sprinkler 6.00 <br />Rain System - fur Drain 10.00 <br />lnd. Waste lnterceptor 8.00 <br />Pool Traps 5.00 <br />Deck Drain System - Fer Drain 3.00 <br />Repair/Alt. Drainage or Vent 10.00 <br />Vacuum Breakers 1-5 5.00 <br />Orcr5 1.00 <br />Backflow Device 2" or Less 5.00 <br />Over 2"10.00 <br />Water Service Ea. 100'10.00 <br />Subtotal <br />Penalty Fee (when applicable) <br />Violation Fee (50.00) <br />Plan Check 65% of subtotal (minimum 20.00) <br />Receipt l'.1o.Pc#Date <br />Plan Check (Adjustment) <br />lssuance Fee 10.00 <br />TOTAL PERMIT FEE <br />2 15 90 <br />5.00 <br />10.00 <br />Sbrtm Comp.illbn Dclr.lbn <br />I heteby attirm lhat I have a certrfi@le o, @nsmt lo sll-rnsure, or a <br />I ce.lrty thal rn lhe perfo,mance ol the work lor which lhis permil <br />p€7aon in ,ny manmr so oB to bocome subiocl to lho Wtrto/3 ComporEalion Lff3 ol <br />Caliromia <br />Notlc. To APPllcxl: <br />It aller makrng lhrs Certrtrcate ol Exemptron. you should become subjet to the Worker's Compen- <br />salron provrsrons of lhe Labor Code. you musl lorlhwrth comply wrlh such provrsrons or lhrs <br />permrl shall b€ demed revoked <br />,;l;",,"" lnsurmFgce.t'r'ed copv rs ,rred with <br />6sued. I shall <br />o, workoas Com- <br />deparlment <br />Etprres <br />- Verified By (Sig <br />o.ru 2 / 15 / 90 Appr'canr (sre ) i <br />Osle <br />- <br />Applimnl (Sig.) <br />Erpliatlon <br />This pe.mit shall expire by limitAion and become null and void il the work aulhorized by this <br />pe.mrt 6 nol commancad withan l80 deys lrom the dsle ol thii permil q if work tuthtrized by thig <br />permat is susponded or abandoned al any time atttr the wort is comrencod ,or a period ol t8O <br />days. A new parmit shall be obtained li6t belore such work can b€ recommencod. <br />I certity lhal I have raad this application and gtalo thal lhe abov6 <br />comply wilh 8ll city ordinancG and slate lam ralaling lo <br />authorized rep.6entalion ol this city to ents upon lhe <br />outms6.2/Lsl90 <br />to <br />Oate Applicanl or Agant (Sig.) <br />L4 <br />VERIFIEO BY (Sig ) <br />BurLorNG 54608- <br />PERMIT No <br />PL <br />PERMIT ISSUED BY (Srg ) <br />P. Lomeli <br />A11 fees paid M-11s8s 0] ')l t ? 0 <br />vALroATroN (oFFrcE usE oNLY) <br />(ACCOUNT rr 1-412) <br />Oistnbution: 'l lnspector Copy 2 File Copy 3 Frnance Copy 4 Applicanl Copy <br />cs-61 1 <br />I 6.00 <br />(minimum $35.00) <br />,5. OO <br />----o_- <br />) <br />+_