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JOB ADORESS <br />CITY <br />Ortrt{uflbt D.dtabn <br />I horeby altirm thst I am srempt lrom th€ Contraclo/8 License Law tot the lollowing reason (Soc. <br />761.5. Busin6s end Prcr6sions Code. Any city oi county which rcquirsa s pormil to conrttud. <br />altor, improv€, d€molbh. or replii any slruclure. prior lo its isuan6. also r€quitgs th€ tpplicet <br />,or such pormil lo ,ile e signod rtetemenl that h€ i3 lioonsod puBuanl to tho provi3bns ot th€ <br />Conlrector's Licens€ Ley (Chapter I (@mmoncing wilh S*tion 7m) o, Oivision 3 ot the <br />Bu3inos and Prol63ions Codo) or that ho i3 exempt thorolrom 8nd the ba3b ,or lh3 sllegod <br />oxonplion. Any viol8lion of S€clion 7@1.5 by any applicrnt ,or I Pormil $bi6ts th€ applicant to <br />a civil pGnalty ol not more than fivo hundrod (bll8B {$5@): <br />E S."tion zOae l, s owner ol ths propany, or myamployswilh wag€a ar thoir3olocompcn- <br />gstion. will do th€ work. end th6 slructure E nol intended ot ottdad ,ot 3alo. <br />E S*tlon 70448 l. I ownd ol lhs prcperry. am erclusivoly cmtrrcling with licanlod <br />conlractm to comtruct the proiffl. <br />Oate Owmr (S€.) <br />Conl?r1on tjr. Only <br />8o <br />CITY <br />Pro126srons <br />4l^?A"Cl6s#(t?t7 <br />I heroby altirm that I am lictrsed under the <br />Code, md my licsnse is in fu <br />orn l24G? conr'ador (s,e) <br />(Residential trlndustrial ECommercial <br />EACH FURNACE INCL. DUCTS AND VENTS <br />EACH COMPRESSOR, BOILER, OR HEAT PUMP <br />Heat Rrmp Compressor less than 5 HP <br />EACH AIR HANDLING UNIT OR VAV BOX <br />Repair, Alt. or Add. to any Heating/Cooling sys. <br />Range Hood with Duct and Fan (Type l) <br />Hood with Ducl and Fan (Type ll) <br />EACH TOTAL <br />aQ <br />(fr <br />Each or by <br />Subtotal fr <br />NO. <br />Up to 100,000 BTU <br />Over 100,000 BTU <br />EACH ABSORPTION SYSTEM <br />100,000 BTU to 1,000,000 BTU <br />1,000,001 BTU to 2,000,000 BTU <br />5HPto30HP <br />31 to 50 HP <br />Over 50 HP <br />Air less than 2,000 CFM <br />2,000 CFM to 10,000 CFM <br />Over 10,000 CFM <br />MISCELLANEOUS <br />Outdoor Dual Healing or <br />Floor Furnace <br />Heater; Suspended, Wall or Unit <br />Com'l Dryer Vents <br />Decoratiw Fireplace (Wood or Gas) <br />Each Vent Fan Connected to a Duct <br />Fan Coil lnstallation <br />Fire Extinguishing System <br />Each Elaporative Cooler <br />lncidental Gas Piping <br />Fire Damper lnstallation <br />15.00 <br />20.00 <br />25.00 <br />30.00 <br />25.00 <br />40.00 <br />25.00 <br />30.00 <br />10.00 <br />10.00 <br />10.00 <br />25.00 <br />15.00 <br />15.00 <br />15.00 <br />15.00 <br />15.00 <br />10.00 <br />15.00 <br />15.00 <br />20.00 <br />15.00 <br />15.00 <br />10.00 <br />15.00 <br />'I <br />ol @nsont to sell-insure. or a cedificate ot Work6r's Com- <br />I ce.irly lhal rn lhs tprformance of the work lor which lhrs <br />po6on in rny mannor 8o a to b€como Eubiod to the <br />Crlitomi! <br />t{oilc. fo ApE{lcal: <br />ll atltr makrng thrs Certrficale ol Ersmplion. you should become subimt to the Wo.ke/s Compen- <br />satron provrsrons ol lhe Labor Code. you must forthw(h comply with such provrsrons or thrs <br />permtt shall be d@med revoked <br />filed with the building rnspection departmant. <br />(srg ) <br />Oate Applrcant (Sig.) <br />Compensation Lils ol <br />I shall not employ any <br />Wo.lm Conreamdbn Oclrdbn <br />Fenalty Fee (when applicable) <br />Violation Fee (50.00) <br />Plan Check 65o/o ol subtotal 34, n (minimum 20.00) <br />Pc#No./ 7 Date <br />Plan Check (Adiustment)/6 ..Zr <br />lssuance Fee 10.00 <br />TOTAL PERMIT FEE (minimum $:|5.00)-€- <br />Etplrdon <br />This permit shsll oxpire by limilslid and be@me null and void il lhe wtrk ethtrirod by lhis <br />permit is nol commencad wilhin 180 days lrom lho dale or lhis permil q it work aulhorized by this <br />permit is suspondad oi abandonod at any lima alld th6 work is commncsd tor 8 irariod ot 180 <br />days A ne* psmit 3hall be obtainod tirst borore such work can b€ rsommmcod. <br />Appalcdl O.drauqt <br />I cerlity thet I havs read this spplication 8nd slsle that lh€ abov€ inrormalion is coirecl. I a9ra6 to <br />comply with 8ll cily ordinancB snd state laws roleting to building consluction, and horoby <br />authori:ad rcpr€s€ntrtbn ol lhis city to onld upon the <br />purpo36. <br />ApplicEnt or Agenl (Sig.l <br />tor insp*tim <br />on" l2'a?fl PERMIT NO.D^rE/2 <br />/1-BUILD <br />PERMI <br />ING <br />TNO flLo3 VERIFIEO BY (Sis )PERMIT ISSUED BY (Sig ) <br />ou /c2+Fa;4 *zo y'/- /0f6f l) - J 7Y87VALIDATION (OFFICE USE ONLY) <br />(ACCOUNT fi1-412) <br />APPLICATION AND . <br />MECHANICAL PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />o CITY OF SANTA ANA <br />206 W. 4th Street <br />667-2738 <br />APPLICANT FILL IN AREA BELOW W <br />og-q <br />zo <br />ooll <br />mo) <br />U' <br />q <br />t <br />cs-6 r 8 <br />o <br />12.4 <br />I <br />/ <br />/2rt.n <br />Utt4 <br />0 <br />o <br />Lics$ <br />_c1 <br />Oaslflbution: 1 lnspelor Copy 2. Fila Copy 3 Finsnce Copy 4 Applicsnt Copy