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7. APPLICATION AND <br />PLUMBING PERMIT <br />O o \ <br />CITY OF SANTA ANA <br />206 W. 4th Slreet <br />667-2738 <br />(TYPEWBITE OR PRINT IN INK)&*?P APPLICANT FILL IN AREA BELOW <br />(D <br />E-9zo <br />ooIm(t <br />Q'' <br />ut <br />s <br />s <br />t^ <br />N" <br />F <br />fl <br />S <br />N\ <br />{- <br />I <br />N <br />N <br />N <br />'*?Yio -U.-T* 7r. ZZ**P' <br />PHoNE (7/4) <br />J-9rb - ott oW/zaa<^a loo <br />TOTAL <br />FIXTURES <br />Dental Unit or Medical Gases 10.00UAILING AO,FESS- ; ,-i f 7,or-t-r-t_,5 ,,/*A_ <br />SEWERcrrY &rz:* h-'*'--STATE/ZIP <br />A, / ?L 2b 1st 100'+Conn.15.00 /r-. oo <br />Ea. Add'l Conn.5.00 <br />5.00Ea. Add'l 100' or Fraction <br />O[rr-lulld.r DadtalbG <br />I horoby sllirm thal I am oxmpl trom tho Conlractor's Lrcm* Law tor the lollowing rgaaon (S€c. <br />7031 5. Busioess and Prcl6sion3 Code. Any city or county which requires a pormit to con3truct, <br />all6r, rmprovo. demolash. or repair any slructure. prior to its issuance. al$ requires the applicant <br />lor such permit lo lile I signed 3tal6m6nt thal ho is licensed puBuanl lo the prcvisions ol the <br />Contractor's License Lil (Chaptsr 9 (commsncang with S€ction 7m0) ot Division 3 o, the <br />Busrness and Prol6sions Code) or lhal he is exempl thorotrom and lhe basis lor the alleg€d <br />erampllon. Any violetion ol Section 703t.5 by rny applicanl ,or I permil sbicE th6 applrcant to <br />a ciyil pomlly ol nol mors than livo hundr€d (bllrB (35(n)l <br />E SctronZOqa l.ssowneroltheprop€rty.ormyemployeswilhwagesaslhoarsolscompon- <br />salion. wrll do lhe mrt, and th€ slructure B rct inhded or otlered tor sale <br />E S."tion 70448 l. 8s ownd ol lh€ prop€rly. am gxclusively contrrcting with licanled <br />contracloG lo construcl the plojfil. <br />Oeto <br />- <br />olf,mr (Sig.) <br />ContIrio[ t !. Only <br />2lraA--.-,--;-lCONTRACTOR M.o'*;lz 1/ ' 47t2PHONE <br />l77g/ fu-b-- fuAOORESS <br />STATE/ZIPq L 33 A <br />crw -rt/- *--*:.-L <br />subiocl to th€ Worter's Compcnstion Les ol <br />tao{c. To ADDllcnl: <br />ll atler makrng lhrs Certrftcale ol Exemption. you should become subist to lhe Worker's Compen- <br />salron provrsrons ol the Labor Code. you musl tonhwilh comply w[h such provrsioos or this <br />permrl shall be demed revoked <br />3 0l the Bustn6s and <br />Lrcense No <br />of Wortd's Cofr <br />Class <br />my lien$o/3 <br />amI hcen*d <br />end <br />.lhe provBions o, Chapter <br />lorce end ettect. <br />which this permit is issued, I shell nol omploy 8ny <br />pgrson in any manner s s to. <br />Calilornra <br />pensaton lnsurence. Cstilied copy <br />I hereby atta,m that I have <br />ComFBrlbn Oclrallon <br />consenl to sll-ansure. <br />with ths City <br />Dare <br />- <br />Appliant (sig.) <br />Att. or Repair ol Drainage - Vent Piping <br />30.00 <br />I <br />1 <br />(minimum <br />t- oo <br />o.ao <br />6,. o <br />?..f{ <br />do <br />7 / LDate 2 7 <br />Water Service Ea. 100 <br />Owr2" <br />Backllow Device 2" or Less <br />Oler5 <br />Vacuum Breakers 1-5 <br />Repair/Alt. Drainage or Vent <br />Private <br />PIPING <br />GAS SERVICE 1 to 4 Outlets <br />Ea. Add'l Outlet <br />Repair or Replace Gas <br />Temporary Gas Service <br />MISCELLANEOUS <br />Water Heater - Electric or Gas <br />Water Piping Ea. 100' <br />Rain Water Piping (buried) Ea. 100' <br />Water Softner <br />Lawn Sprinkler <br />Rain System - Per Drain <br />lnd. Waste lnterceptor <br />Pool Traps <br />- Per DrainDeck Drain <br />5.00 <br />100.00 <br />1.00 <br />5.00 <br />oo <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 />s.00 <br />8.00 <br />5.00 <br />Subtotal <br />Fenalty Fee (when applicable) <br />lssuance Fee <br />Violation Fee <br />Plan Check (Adjustment) <br />Plan Chec* 65% of subtotal <br />Receipt No. I Pc# <br />(50.0o) <br />7.yO (minimum20.00) <br />DATE PERMIT lB_ <br />ErDkdo.r <br />Thrs parmit shall erpire by limilstim snd b6ore null and void al tho work aulho(iz€d by lhi3 <br />pormil is not commancod wilhin l&, deys rrom the date ot lhis p€rmit q it rcrt authdizod by this <br />p€rmil is 36p€ndcd or abandoned al any timc aner th€ wort is cmmenc€d tor r lEriod ol 180 <br />dty3. A ntr pdmil shall be obtein€d tiBt b€rora $ch worl @n bo rB@mmanced. <br />comply with 8ll ordrnanc6 and to <br />corrrc1 I a9r6 to <br />Applcanl'r hrTatlfi <br />I csrtaty lhst I hav6 r@d this <br />authonzed this city lo entd <br />purpos <br />Dale Applicanl or Agant <br />>tly I -o-PERMIT ISSUEO BY (Sio )54b!0 K*,oEUILOING <br />PEFMIT No <br />,l 1-'lt2) <br />o^/z:5 Pt <-0 <br />Orstnbutron 1 lnspector Copy 2 File Copy 3 Finance Copy 4 Applicent Copy <br />cs-61 r <br />0 <br />t <br />(Residential nlndustrial !Commercial NO.EACH <br />each plumbing fixture/trap /7 5.00 <br />/ <br />/,-4rZf <br />rOTAL PERMIT FEE <br />that <br />Code. <br />staie thal tho above <br />\