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3714 S . Santa Fe VlllageJO8 ADORESS <br />Sunflower AssociatesOWNER PHONE <br />"o'''*SSlTtTalrvlew Rd . <br />Costa MesaCITY seAE/2192626 <br />Oilt.r-tdld.t D.dtdbn <br />I he,eby a,rirm thal I am axmpt lrom the Contracto/8 Lrcmse L8w lor the tollowing reasm (S€c <br />703'l 5. Businoss and Prol6sions Code. Any city or county which roquiros a permit lo con3lrucl. <br />aller, rmprovo. demolish. or repair any slructure, prior to ils issuance. ds rsguires lhe applicant <br />tor such permit to lile I s€ned stetsment thal h6 is licen3ed puBuant lo the provisroN ol the <br />Conlraclor's Lrcense Lil (Chepler 9 (commencing with Seclion 7m0) o, Division 3 ol thg <br />Busrness and Pror6sions Code) or thst he as exampt theretrom end the basis tor the alleged <br />exemptron Any violalm ol SoclDn 7031 5 by any applient lor I permit subjEts lhe spplicant to <br />a civil p€nalty ol nol mora lhan tive hundrsd dollars (t500) <br />E S*tlon zolla l. as ownero, the prop€rly. or mygmployeeswith wa96 as theirslecomp€n- <br />salion, will do the rcrk. snd lhs structura is mt intondgd or otler€d ,oi sl6 <br />E S*tion 70448 l. as ownar ol th€ prop€rry. !m exclusivoly cmlreling with licensd <br />contraclors to construct the proiect. <br />Dale Owner (Sr9 ) <br />Contrrcton lra. Only <br />CONTRACTOFI <br />E^-1 ^ Daa{fi^ \f6nl-rrfoa 7 \1 -3222 <br />PHONE <br />loones5-o- - - - <br />P-O- Box 11388 <br />STATE/ZIPcA 92627 <br />CITY <br />Costs Mesa <br />Alt. or Repair of Drainage - Vent Piping <br />15.00 <br />5.00 <br />5.00 <br />30.00 <br />NO.EACH TOTAL <br />1 <br />I lndustrial D Commercial <br />6.00 <br />1 st 1 00' + Conn. <br />Private Sewage Disp. System <br />Ea. Add'l Conn. <br />Ea. Add'l 100'or Fraction <br />5.00 <br />10.00 <br />5.00 <br />100.00 <br />1.00 <br />5.00 <br />5.00 <br />5.00 <br />10.00 <br />8.00 <br />8.00 <br />10.00 <br />4.00 <br />6.00 <br />10.00 <br />each plumbing tixture/trap <br />SEWER <br />Dental Unit or Medical Gases <br />Pool Traps <br />lnd. Waste lnterceplor <br />Rain System - Fer Drain <br />Lawn Sprinkler <br />Water Soflner <br />Rain Water Piping (buried) Ea. l0O' <br />PIPING <br />GAS SERVICE 1 to 4 Outlets <br />Ea. Add'l Outlet <br />Repair or Replace Gas Piping <br />Temporary Gas Service <br />MISCELLANEOUS <br />Water Heater - Electric or Gas <br />Water Ea.100' <br />3.00Deck Drain System - Per Drain <br />10.00Repair/Alt. Orainage or Vent <br />Vacuum Breakers 1-5 5.00 <br />1.00Over 5 <br />Backflow Device 2" or Less 5.00 <br />Over 2"10.00 <br />Water Service Ea. 100'10.00 <br />Subtotal <br />I hereby allirm that I am lic6nsd under the provisaons ol Chaptor 9. Oivision 3 ol lhe Busin6s and <br />Uo*an ComFrutbn D.clrrlbn <br />I lErcby attirm thal I havs a cortatiete ol const lo sll-insure, or a csrllricate ol Wottd's Com- <br />tlolb. To ApPllcil: <br />ll atler makrng lhrs Cerlrfrcate ot Exemptron. you should become sub,ct to lhe Worker's Compen- <br />satron provrsrons ol lhe Labor Code. you musl lorthw{h comply wrth such provrsrons or thrs <br />permrl shall be dtrmed revoked <br />ilding insp€ction dep8rlmentoensalion lnsuranceoare 4l cdrtirGd @py is lilad with <br />lor <br />subist to <br />Prol6sions Code. and my lrcense rs rn lull lorce and etfect <br />0 9109Licens No 420651 cE""C- <br />o,r" ---2 l.lj19ocon,,"",o, t.,s r <br />Oata <br />- <br />Applicsnt (Siig.) <br />Expires <br />- <br />Veriliad By (Sig <br />o.n 2 I 15 lg0ppicant 1sie.l <br />I cerlity that in theperrormrncoolthswork <br />pe6on an any mnn€r s as lo becomo <br />CalifoinB <br />Penalty Fee (when applicable) <br />Violation Fee (s0.00) <br />Plan Check 65% ol subtotal (minimum 20.00) <br />Receipt No.Pc#Date <br />Plan Check (Adjustment) <br />ErFa?doa <br />Thb pe.mit shell exprre by limilatio snd become null and void it the work sulhdizod by lhi3 <br />pErmit is not @mmgncd within 180 dsys lrom the data ol this pormit or il work aulhorized by this <br />p€rmit is susponded or abandonad at 6ny tim€ stlor the work i3 cmmncod tor I p€riod ol 180 <br />days. A nil psmit shall be oblainsd ti'st balora 3uch work can bo mmmoncod. <br />AEtc.nl'. O.dr.Idr <br />I corliry thet I have road this applicatim and slat6 thal lh€ abovo intormation B corrcl. I agrs to <br />comply wrlh all crly ordinancG and state lam rolating lO <br />sulhorized reprBontation ol this city lo €nter upon tho <br />purpos6 <br />2lrs leo Applrcanl or AgentOate <br />and hereby <br />tor insp€ction <br />NO. <br />lssuance Fee <br />DATE <br />TOTAL <br />25.00 <br />10.00 <br />PERMIT ISSUEO AY (Sig ) <br />P. Lomel-iBUILDTNG 54639-43 <br />PERMTT No. vERtFtEO BY (Sig.) <br />PL <br />n? -lI - ? nAl 1f ees Daid I'1-11585 <br />VALIDATION (OFFICE USE ONLY) <br />(ACCOUNT r1 r-4r2) <br />APPLICATION AND <br />PLUMBING PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />t o CITY OF SANTA ANA <br />206 W. 4th Street <br />667-273a WAPPLICANT FILL IN AREA BELOW <br />(I,g-Izo <br />oof, <br />mU,o <br />I <br />Daslnbulron I lnspector Copy 2 Frla Copy 3 Frnance Copy 4 Applrcant Copy <br />cs-61 r <br />FIXTURES <br />--T-- <br />Worker's