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APPLICATION AND <br />PLUMBING PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />I o CITY OF SANTA ANA <br />206 W. 4th Street <br />667-2738 <br />APPLICANT FILL IN AREA BELOW l'n/ <br />q,q <br />Tszo <br />oo! <br />m(t(t <br />VResidential <br />EIYTI <br />! lndustrial E Commercial NO.EACH3706 S. Sanaa Fe VillageJOA ADDRESS <br />Sunflower Associates <br />OWNER PHONE <br />5.00 <br />10.003315 Fairview Rd. <br />MAILING AODRESS <br />Costa Meea <br />CITY STATE/ZIPcA 92626 15.00 <br />5.00Ea. Add'l Conn. <br />Ea. Add'l 100' or Fraction 5.00 <br />Private Sewage Disp. System <br />GAS SERVICE 1 to 4 Outlets <br />30.00 <br />5.00 <br />Ea. Add'l Outlet 1.00 <br />Repair or Replace Gas Piping 5.00 <br />Oum-Bdld.r lrcdr.ibn <br />I hereby attrrm lhal I am exempt trom the Conlractor's Lrcense Law lor lhe lollowrng reason (Ss <br />T03l5.BusrnessandPro16sronsCode Anyotyorcountywhrchrequrresape.mrttoconstruct. <br />alter, rmprove. demolrsh, or reparr any slructure, pilor lo rts rssuance, also requrres the applrcanl <br />for such pormrt lo trle a srgned slalemenl that he rs [censed pursuanl lo the provrsrons ol lhe <br />Conlraclor's Lrcense Law (Chapler 9 (commencing wath Selron 7@0) ol Divrsion 3 ol the <br />Busrness and Prol6srons Code) or thal he rs exempl the.efrom and the basrs lor the alleged <br />eremptron AnyvrolatronofSectron70315byanyapplrcanltorapermrtsublectstheapp[canlto <br />a crvrl penalty ol not more than five hundred dollars ($5O0) <br />O SetronZO4A l.asownerollheproperiy.ormyemployeswrthwagsaslherrsolecompen- <br />salron. wrll do the mrt. and lhe struclure rs nol Inlended or ollered lor sale <br />E Sel'on 70448 l. as owne. ot lhe property, am exclusrvely conlractrng wrth lrcensad <br />contracloB lo conslrucl lhe p,otrcl <br />Oste <br />------__- <br />Owner {Sr9 ) <br />- <br />Temporary Gas Service <br />Water Heater - Electric or Gas <br />100.00 <br />5.00 <br />ConlI*-toE l,t. Only <br />Water Piping Ea. 100'10.00 <br />Paclflc VenturesCONTRACTOREagle '19f-tzzz Bain Water Piping (buried) Ea. 100'8.00 <br />Water Softner 4.00AOORESSP.O. Box 11388 <br />Alt. or Repair ol Drainage - Vent Piping 10.00 <br />Costa Mesa <br />CITY STATE/ZIPeA 92627 Lawn Sprinkler i 6.00 | 6.OC <br />10.00 <br />8.00 <br />5.00 <br />I hereby al,rrm that I am lrcensd under the provrsions ol Chapter 9. <br />Prol6sions Code. and my lrcense 6 rn lull ldce and <br />L,cense No 4-29611- crass2l ts leo <br />ol the Busrness and <br />9109 <br />(S'g ) <br />3.00 <br />10.00 <br />5.00 <br />1.00 <br />5.00 <br />10.00 <br />Rain System - Per Drain <br />Deck Drain System - Per Drain <br />Repair/Alt. Drainage or Venl <br />Backflow Device 2" or Less <br />Water Service Ea. 100' <br />lnd. Waste lnterceptor <br />Pool Traps <br />Vacuum Breakers 1-5 <br />Over 5 <br />Over 2" <br />10.00 <br />Subtotal <br />I lEreby altrm that I havo a certiridto ot conssnt lo sll-insure. <br />person rn any manner so as lo b*ome subiecl lo <br />Calrlornia <br />tlo[c. To ADellcil: <br />lf afier makrnq lhrs Certrfrcale ol Exemplron. you should bsome subiel lo lhe Worker's Compen- <br />satron provrsrons ol lhe Labor Code. you musl lorlhwrlh comply wrlh such provrsions or lhrs <br />permrt shall be demed revoked <br />a cadilicale <br />2lLs le0 Applicant (Sr9 ) <br />trled the <br />I certrfy thal rn the performance ol lhe work <br />Worker's Com- <br />Date <br />Oale Applicant (S9 ) <br />Worltr! Comp.rutbn O6lIallon <br />gensatron Insurance Cstrtied coov rsoere 4l9O <br />Exprres <br />- <br />Vwilied By <br />Penalty Fee (when applicable) <br />(50.00)Violation Fee <br />Plan Check 650/o ol subtotal (minimum 20.00) <br />Receipt No.Pc#Date <br />Plan Check (Adjustment) <br />Erdr.ton <br />This p€rmit shall expiro by limitetion and become null end void al th€ work authorizod by this <br />permil i3 nol commencad within lE0dayg lrom the data ol lhis p€rmit or itwork 8ulhdiz6d bylhis <br />,Ermil is suspondad or abandonod at any tima ellsr th€ work i9 commoncrd tor 8 period ol IEO <br />days. A now pormil shsll b€ oblaaned lirsl b€tore such work can b€ racommanced. <br />ArDIc.nl'. D.d.r.odr <br />I certrty lhal I have .ead this spplicaton and stale thal the <br />lulhorized ropr€a6nlslion ol this cily to onler upon <br />pu7po3a3. <br />I agrtr to <br />hergbycomply wrlh all oly ordinancB and state las <br />or," LJ)!!LO Appr.anr or Aeant <br />lssuance Fee <br />TOTAL PERMIT FEE <br />DATE <br />(minimum <br />PERMIT NO. <br />TOTAL <br />each fixture/trap <br />Dental Unit or Medical Gases <br />SEWER <br />1st 100'+Conn. <br />GAS PIPING <br />MISCELLANEOUS <br />10.00 <br />0 <br />BurLorNG \L6.1 \-) 1 PL PERMIT ISSUEO BY (Sig.) <br />P. Lomeli <br />A11 fees paid M-1r585 CL . l1r/r- L-/{ - I n <br />vALroATroN (oFFtcE USE ONLY) <br />(ACCOUNT r1!-412) <br />Drslnbution. I lnspector Copy 2 Frls Copy 3 Fr Copy 4 Applrcanl Copy <br />cs-61 1 <br />,5.0O <br />IUJgI <br />1 <br />t