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APPLICATION AND <br />PLUMBING PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />a o CITY OF SANTA ANA <br />206 W. 4th Street <br />667-2738 Itr* <br />APPLICANT FILL !AREA BELOW <br />@g-Iz <br />ootmoo <br />o0J <br />Ir#r <br />n lndustrial ! Commercialfflesidential NO.EACH TOTAL3710 S. Sanra Fe VlllageJOB AOORESS <br />fixrunes <br />Sunfloser Assoclates <br />OWNER PHONE <br />each plumbing flxture/trap 5.00 <br />Dental Unit or Medical Gases 10.00 <br />MAILING.}ODBESS <br />3315 fatrview Rd. <br />SEWERCITY <br />Costa Mesa <br />STATE/ZIPcA 92626 1 st 1 00' + Conn.15.00 <br />Ea. Add'l Conn.5.00 <br />Ea. Add'l 100' or Fraclion 5.00 <br />Oxn r-&rLr.r lr.dftbn <br />I hereby 8ltarm lhal I am exmpt trom the Contracto/3 Lacense Law lor the tollowang rea3on (S€c <br />7031 5. Busrn$s and Prot6srons Code. Any cdy or county which requireg a permit to construct. <br />alter, rmprovs. demolish, or repaar any structurg, prior to its issuanc6, also requires the applicant <br />,or $ch permd to tile I sqned 3tat6menl lhat he as licons€d puEuanl lo th€ provi3ions ol the <br />Conlractor's Licens Law (Chapter 9 (commsncing with Section 7m0) o, Division 3 ot tho <br />Business and Prolasions @de) or that ho is exempl theieliom and the basis lor lhe allegod <br />sxemption AnyviolalronotSaclionT03l.5byanyapplianltorap€rmilsubitrlsthespplicantto <br />a civil p€mlty ot not more than liv€ hundr€d (bllars ($5m): <br />E S*t,on 7Oa4A l. as owner ot the properly. or myemployes wrth wage6 s lhoar sle comp6n- <br />Sation. will do the wort, and the slructure is nol intmded or ollsed lor sale <br />E S*tion 70448 l. as owner o, the property. am sxclusavely contractang wilh lacens6d <br />contrrctoG to construct the proiec,l. <br />Oate Owrer (Srg ) <br />Conlrrcton [r.. Only <br />"o""flogl" Pacif ic ventures PHONE75t-3222 <br />P.O. Box 11388 <br />ADORESS <br />Costa Mesa <br />CITY STATE/ZIPcA 92627 <br />I heroby sllirm that I 8m licensd under the provisions ol Chaptor 9, Oivision 3 ot the Busin6s and <br />Prol6sions Code, md my lrcense rs <br />Lic.nse No 420651 c,*.9 <br />or]c 2l L5 I g0conrracro, (s,e ) <br />andin tull lore <br />c-2 <br />Sorf a't Com9arlaf bo Daclrr0on <br />I h€rcby st irm thet I haw s cartilietc o, @nsl to slf-insurs. or a cdtilicateol Wbrlq's Com- <br />I certrly thsl rn lhe perrormancaollhe work lorwhach this Fnrmit is rssued. I <br />p€r8on in any mlnner 3o B to bocome subiact to tha Work6/B Componsalion Lils ot <br />Caliromia <br />t{otlc. To AP9llcrl: <br />ll atter makrng lhrs Certrficale o, Eremptron, you should become sublst to the Worker's Compen- <br />salron provrsrons of lhe Labor Code, you musl lorlhwrth comply wrlh such provrsrons or thrs <br />pe.mrt shall be demed revoked <br />pensatron lnsurance Certrled copy is frled the building <br />notemployany <br />Veflfied By <br />d6partment <br />P:;?", 419_0 <br />Dare 2 / 15 l90 orrr,canr (s,s ) <br />Dato <br />- <br />Applienl (Sig.) <br />Erparrdon <br />This permit shall expire by limitatim and bocome null and void it the work aulhorizod by thig <br />p€.mit is nol @mmsnced within tEO dsys lrom th€ dsla ot thb pgimil or it wort suthoriz6d by this <br />p€rmil is susp€nd€d or abandoned al any tim6 stler lhe wort is commencod lor 8 period ol 1E0 <br />days. A nil pormil lhall be obtsined ,iBt bolora $ch worl en b€ @mmn@d. <br />Applbrrill O.dr.[dr <br />I cerlily thet I have rsd this application and state that lha abov6 <br />@mply with all cily ordinancB and st8l6 laws rglating to <br />aulhoiized rapraentation ol this cily lo 6nld upon thc <br />purpos€s. <br />as <br />Applicant o, Agenl (Sig. <br />lor inspeclion <br />end haroby <br />I ag.e lo <br />o.," 2/15/go <br />Alt. or Repair of Drainage - Vent Piping <br />30.00 <br />I 6.00 <br />25.00 <br />Private Sewage Disp. System <br />Water Service Ea. 100' <br />Over 2" <br />Backflow Device 2" or Less <br />Over 5 <br />Vacuum Breakers 1-5 <br />Repair/Alt. Drainage or Vent <br />Deck Drain System - Per Drain <br />Pool Traps <br />lnd. Waste lnterceptor <br />Rain System - Per Drain <br />Lawn Sprinkler <br />Water Softner <br />Rain Water Piping (buried) Ea. 1@' <br />Water Piping Ea. 100' <br />Water Heater - Electric or Gas <br />MISCELLANEOUS <br />Temporary Gas Service <br />Repair or Replace Gas Piping <br />Ea. Add'l Outlet <br />GAS SERVICE 1 to 4 Outlets <br />PIPING <br />5.00 <br />100.00 <br />1.00 <br />5.00 <br />5.00 <br />10.00 <br />10.00 <br />10.00 <br />8.00 <br />5.00 <br />4.00 <br />1.00 <br />10.00 <br />5.00 <br />6.00 <br />10.00 <br />10.00 <br />3.00 <br />8.00 <br />5.00 <br />Subtotal <br />Penalty Fee (when applicable) <br />Violation Fee <br />Plan Check 650/o of subtotal <br />lssuance Fee <br />TOTAL PERMIT FEE <br />DATE <br />(50.00) <br />Date <br />(minimum 20.00) <br />(minimum $35.00) <br />PERMIT NO. <br />Receipt No.Pc# <br />EurLorNG 54627-33 <br />PERMIT No VERIF|EO BY (Sig ) <br />PL <br />PERMIT ISSUEO BY (S'g ) <br />P. Lom6Li <br />-?0 <br />(ACCOUNT t-1121 <br />Oislnbulron: I lnspoctor Copy 2 File Cogy 3 Fanance 4 Applrcant Copy <br />CS-61 1 <br />Plan Check (Adiustment) <br />.15 t <br />10.00__0- <br />I <br />1, <br />A11 fees paid M-1L585 C/L.