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APPLICATION AND <br />PLUMBING PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />e o CITY OF SANTA ANA <br />206 W. 4th Street <br />667-2738 <br />APPLICANT FILL IN AREA BELOW lhd <br />@ <br />C-Izo <br />oo <br />f) <br />ma <br />Jo <br />(l <br />3708 S. Santa Fe VlllageJOB AOORESS <br />OWNER <br />Sunflower Associates <br />PFiONE <br />MAILING ADDRESS3315 Falrview Rd. <br />crrY Costa Mesa YN'''9zoz6 <br />NO.EACH TOTALD lndustrial D Commercial <br />Repair or Replace Gas Piping <br />Ea. Add'l Outlet <br />GAS SERVICE 1 to 4 Outlets <br />each fixture/trap <br />Dental Unit or Medical Gases <br />SEWER <br />1st 100'+Conn. <br />Ea. Add'l Conn. <br />Ea. Add'l 100' or Fraction <br />Private Sewage Disp. System <br />PIPING <br />5.00 <br />10.00 <br />30.00 <br />5.00 <br />5.00 <br />5.00 <br />5.00 <br />1.00 <br />Temporary Gas Service 100.00 <br />Om.r-BulkLr O.drdbn <br />I hereby altirm thal I am exempt lrom the Contractor's License Law for the tollowing rsason (S* <br />7031 5. Busrness and Prot6srons Code Any crty or county whrch requires a p€rmit to construct. <br />alter, rmprove, demol€h, or repair any slructure, prior lo its isuance. d$ requires tha spplicant <br />lor such psrmrt to tile a srgn€d slatement that h€ rs lic€nsed puBuant to lhe piovisions Ol the <br />Conlractor's Lrcenss Law (Chapler 9 (commenong wrth Strtron 7@O) o, Oivasion 3 of the <br />Busine$ and Prolessions Code) or that he is exempt thererrom and lhe bsis lor the slleged <br />exemplron Any vroletron ol Seclron 7031.5 by any applicsnt lor a permit subj@ls the applacsnt lo <br />a crvrl p€nalty ol not more lhan trve hundred dollars (t50O) <br />E S*tion ZOala l. as own6r ol lhe property. or my €mployees wrlh wages as therr sole compen- <br />salion, will do the rcrt. and th€ structure rs nol rntondad or ollsod tor sale <br />E] S*tion 7O4,lB l. 8s owner ot the property. sm exclusively contrtrting with licensod <br />conlract06 to construcl lhe proi*t <br />Oale .- Owner (Srg )MISCELLANEOUS <br />Conli-lor t r. Only <br />CONTRACTOB <br />Eagle Pacific Ventures 75t-3222 <br />PHONE <br />P.O. Box 11388 <br />AOOR€SS <br />CITY Costa Mesa <br />STATE/ZIPcA 92627 <br />I he,eby allirm that I am ficensed under the provisions ol 3olthe Businssand <br />15 <br />9. <br />9 <br />2 9 0*n,r"",o. 1a,n.1 <br />, and my <br />2065 <br />tnis fullIcenseProtessronsCode. <br />4,1 C- <br />ClassLrcense No <br />Oale <br />Alt. or Repair of Drainage - Vent Piping <br />1 6.00 <br />10.00 <br />10.00 <br />8.00 <br />10.00 <br />4.00 <br />5.00 <br />10.00 <br />'r.00 <br />6.00 <br />5.00 <br />10.00 <br />10.00 <br />8.00 <br />3.00 <br />5.00 <br />Water Piping Ea. 100' <br />Water Service Ea. 100' <br />Rain Water Piping (buried) Ea. 100' <br />Owr2" <br />Water Soltner <br />Backflow Device 2" or Less <br />Orcr5 <br />Lawn Sprinkler <br />Vacuum Breakers 1-5 <br />Rain System - Per Drain <br />Repair/Alt. Drainage or Vent <br />lnd. Waste lnterceptor <br />Deck Drain System - Per Drain <br />Pool Traps <br />Subtotal <br />TOTAL PERMIT FEE <br />Fenalty Fee (when applicable) <br />lssuance Fee <br />Violation Fee <br />Plan Check (Adjustmenl) <br />Plan Check 65% ol subtotal <br />(50.00) <br />Date <br />(minimum 20.00) <br />10.00 <br />tx0 <br />Receipt No.Pc# <br />Uo.tan Coipanaalbn Oaclrrlton <br />I hereby arlirm that I hav6 I cortiradlo ot onsat to *ll-insre, or a cdlilacate ot Woatr's Com- <br />tao$c. lo ADPlbil: <br />ll alter makrng lhrs Cerlricate Ol Exemptron. yOU shOUld become SUbltrt lO the Worke/S COmpen- <br />salron provrsrons of lhe Labor Code. you must forlhwrth comply wtlh such provisions or lhis <br />permrl shall be demed revoked <br />Olpp,,"rnt 1S,9.12lLs lgOale <br />employ any <br />Laws ol <br />wrth lhe <br />rs rssued I <br />sub,scl lo the Worke/s <br />Dale <br />- <br />Applio.nt (Sig.) <br />p€nsatron lnsuralce Cdtrlied copy rs tilsdDare 4l9OExprre3 - Verified By (Sig ) <br />I cerrit thai in tho tE tormancsolthe work <br />pe6m ln any mnnor $ 6 to b6ome <br />Calitornia <br />Erplratlon <br />Thrs p€rmrl shall exprre by lamitalton and bocome null and void il th€ wort authorazod by this <br />p€rmit is not commnced within t80 days lrom the dalo ol this permit d il rcrk aulhtrized by lhis <br />IErmit is suspandod or abandoned al any timo atler lha worl is commnced lor I period ol 18O <br />days. A new permrt shall be obtarned ti6t b€lore such work can b€ recommenced. <br />AFlcrnt.. O.d.ratdr <br />I cerlity that I hava r*d this applicatron and statg that the ebova <br />authoflzed rep16€ntatron ot thts city to enler upon lhe <br />e"'e""n 2/15/90 <br />to <br />and <br />Dale <br />to <br />Applicanl or Agent (Sig.) <br />@mply wth 8ll cily ordinancG and stete lrws <br />EurLorNG 54622-26 <br />PERMIT No VERIFIEO BY (Siq } <br />PL P. Lomel-iPERMIT ISSUED BY (Sig,) <br />r1 1-t112)A11 fees paid M-l1585 e, <br />Dislnbulion I lnspeclor Copy 2 File Copy 3. Frnance Copy Applrcant Copy <br />CS-61I <br />FIXTURES <br />15.00 <br />Water Heater - Electric or Gas 5.00 <br />( <br />25.00 <br />(minimum $35.00) <br />1 9:.t I