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APPLICATION AND <br />PLUMBING PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />o <br />APPLICANT FILL N AREA BELOW <br />CITY OF SANTA ANA <br />206 W. 4th Street <br />667-273a <br />a <br />ltt* <br />(! <br />E-q <br />zo <br />ooI <br />m(,(, <br />(.p <br />U\ <br />3712 S. Santa Fe VilJ-age <br />JOB AOORESS <br />Sunflower Associates <br />OWNER PHONE <br />MAILING AOORESS3315 Fairview Rd. <br />Costa MesaCITY EK"'Tzoz6 <br />Ounr-Bulld.r Dccl*rllon <br />I hereby allirm lhat I am exempt from the Contractor's License Law for the lollowrng reason (S* <br />703 1 5 Eusrness and Prorssrons Code Any crty or counly which roqurres a p€rmrt to conslruct. <br />aller rmprove.demolrsh.orreparranystruclure.p.roatorlsrssuance.alsorequirestheapplrcant <br />lor sch permrt to trle a sqned statemenl lhal he ts hcensed pursuant to the provisrons ot the <br />Contractor's Lrcense Law (Chagter 9 {commencrng wrth Seclron 7mO) ol Orvrsron 3 ol lhe <br />Eusrness and Prol6srons Code) or thal he rs erempt lheretrom and lhe basis for the alleged <br />exemptron Any vrolalron ol Seclron 7031 5 by any applrcant lor a permtl sublels lhe applrcant to <br />a crvrl penalty ot not more than ive hundred dollars (S50O) <br />E S*t,on 7Orl4A I, as owner ol lhe propedy, or my emptoyes wrth wages as therr sote compen- <br />satron. wrll do the rcrl. and the struclure is not Intended or otfered lor sale <br />E S*tion 70448 l, as owner ol ihe properly, am ercluspely contracting with lacensed <br />contract06 to conslrucl the project <br />Date Owner (Srg ) <br />ConlirioD tb. Only <br />Eagle Paciflc Ventures <br />CONTFACTOB <br />75L-3222 <br />PHONE <br />P.O . Box 11388 <br />AODRESS <br />CITY Costa Mesa {i"'Tzozt <br />Rssidential Dlndustrial nCommercial NO.EACH TOTAL <br />each fixture/trap 5.00 <br />Dental Unit or Medical Gases 10.00 <br />SEWER <br />1 st 1 00' + Conn.15.00 <br />Ea. Add'l Conn.5.00 <br />Ea. Add'l 100' or Fraction 5.00 <br />Private Disp. System 30.00 <br />GAS PIPING <br />GAS SERVICE 1 to 4 Outlets 5.00 <br />Ea. Add'l Outlet 1.00 <br />Repair or Gas Piping 5.00 <br />Temporary Gas Service 100.00 <br />MISCELLANEOUS <br />Waler Heater - Electric or Gas s.00 <br />Water Piping Ea. 10O' <br />Rain Water Piping (buried) Ea. 10O'8.00 <br />Water Soltner 4.00 <br />Alt. or Repair of Drainage - Vent Piping 10.00 <br />Lawn Sprinkler 6.00 <br />Rain System - Per Drain 10.00 <br />lnd. Waste lnterceptor 8.00 <br />Pool Traps 5.00 <br />Deck Drain System - Per Drain 3.00 <br />Repair/Alt. Drainage or Vent 10.00 <br />Vacuum Breakers 1-5 5.00 <br />Over 5 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 650/" ol sublotal (minimum 20.00) <br />Receipt f.lo.Pc#Date <br />Plan Check (Adjustment) <br />lssuance Fee <br />TOTAL <br />DATE NO. <br />I hereby allirm lhat I am licensed under lhe provisions ot <br />Prot6sions Code. and my licanss is in lull lorce and <br />9. Orvrsron 3ot the Busrn6sa6d <br />Class42065t <br />lrs /e0 <br />Oate Contractor (Sig.) <br />License No. <br />2 <br />Worim Comptillbn Dclrrllon <br />I hereby alfirm lhal I have a ce.trficale of consent lo sell-lnsure. or a certricale of Worker's Com- <br />pensation lnsurance. Certrtied copy is filed with the City building <br />t{ollc. to ApPllcsl: <br />ll aller makrng thrs Cerlrtrcate of Exemplron_ you should become subt4l lo the Worker's Compen- <br />satron provrsrons ol the Labor Code, you must forthw(h comply wtlh such provistons or thts <br />permrl shall be deemed revoked <br />Lils ot <br />4 90 <br />Dare 2l-lr5Jg.OAepricanr (sis ) <br />lhis permit rs rssued. I shall <br />subiEt to the Worker's <br />degartmenl. <br />Veritied By (Sig ) <br />Dal€ <br />- <br />Appticant (sig.) <br />lcertit thal rn the p€rlsmarceolthework <br />p€Eon rn any manner so 6 to bEome <br />Celilorn€ <br />Osle <br />Exprres <br />Erdradon <br />This p€rmil shall oxpire by limitation and beome null and void il th€ wort ruthoriz€d by this <br />p€rmil i3 not commonc€d wilhin t80 days lrom tha date ol lhis p€rmit oi it work rulhoriz€d by fhis <br />p€rmit i3 susponded or abandoned st any time atter the wort is commoncod tor a fEriod ol 18O <br />days A nes p6mrl 3hall be obtained ,iBt b€lorc such wort can b€ rocommoncod. <br />Arplc.na.. O.d.r.0o.r <br />I certrty lhal I have rsad this appltcatron snd state that the above <br />@mply uth ell oty ordinancE and state laws relaling to <br />rulhorized reprGsntation ol this city to snt6r upon <br />purpos6. <br />is correl. I agre to <br />lor insp*lion <br />end horeby <br />on" 2l 15 l g0Appricanr or rsent <br />s4634-38 <br />VERIFIEO BY (Srg ) <br />PL <br />EUILDING <br />PERMIT No PERMIT ISSUEO BY (Sig.) <br />P. Lomeli <br />rr r-412) <br />Y) <br />Orstflbution: I lnspector Copy 2 File Copy 3 Frnance 4 Applrcant Copy <br />CS-61 1 <br />FIXTURES <br />10.00 <br />t Ann <br />,5.On <br />10.00_T- <br />(minimum <br />149109