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JOB ADORESS -a0
<br />ING
<br />CITY
<br />n lndustrial D Commercial NO.EACH TOTAL
<br />EACH FURNACE INCL. DUCTS AND VENTS
<br />Up to 100,0@ BTU 15.00
<br />Over 100,000 BTU 20.00
<br />EACH ABSORPTION SYSTEM
<br />100,000 BTU to 1,000,000 BTU 25.00
<br />1,000,001 BTU to 2,000,000 BTU 30.00
<br />EACH COMPRESSOR, BOILER, OR HEAT PUMP
<br />Heat Rrmp Compressor less than 5 HP 25.00 UA
<br />5HPto30HP 25.00
<br />31 to 50 HP 30.00
<br />Owr 50 HP 40.00
<br />EACH AIR HANDLING UNIT OR VAV BOX
<br />Air less than 2,000 CFM 10.00
<br />Oilrar-Ould.r D.drtbn
<br />I hsr€by sltirm that I am exmpt trom lho Contracto/s Licmla Law ,or the tollowing ro8on (Soc.
<br />7G)1 5. Busin6r md Prot63sims Code. Any city or @unty which r€quires a p€rmil to conslrucl,
<br />aller, imprcve. (bmoligh. or rspair any slruclure, prior to itg i3tuanc6. algo roquirgg th€ rpplicant
<br />lor sch pormit to fil6 a signed statment thal hs is licons€d pursuanl to lhe provisions ol lho
<br />Contraclor's Licen* Law (Chapter 9 (commancing wilh Seclion 7@0) o, Div6ion 3 ol lhe
<br />Busaness and Prol6sions Cods) or that hs is sxmpt lher€lrom 8nd the begB lor ths allegsd
<br />oxemplion Any violelion ot S€clion 7031.5 by any epplicant ,or a pormil $biect the applicanl lo
<br />I cival pooslty o, not more than rive hundr€d dollers (t500):
<br />E S*tion ZOal l. I owner ot lha pr@srly, d myemployes with wag€6I theirsole comp€F
<br />setion. will do lhe work. and lhe slructuro is rct intondod or olltred lor sala
<br />E S*tion TOil,lB l. 8s owner ol the properly. am exclusivaly contreting with licansed
<br />conlracloB lo construcl the pro,ect.
<br />Oale Owner (Sig.)2,000 CFM to 10,000 CFM 10.00
<br />Over 10,000 CFM 10.00
<br />MISCELLANEOUS
<br />Outdoor Dual Packaged Healing or Cooling 25.00
<br />Floor Furnace 15.00
<br />Heater; Suspended, Wall or Unit 15.00
<br />Com'l Dryer Vents 15.00
<br />Decorati\re Fireplace (Wood or Gas)15.00
<br />Repair, Alt. or Add. to any 10.00
<br />Range Hood with Duct and Fan (Type l)15.00
<br />Each Vent Fan Connected to a Ducl 15.00 ,O-n
<br />Fan Coil lnstallation 20.00 fr
<br />Fire Extinguishing System 15.00
<br />Each Evaporati\,e Cooler 15.00
<br />lncidental Gas Piping 10.00
<br />Fire lnstallation 15.00
<br />Each OT by
<br />this but
<br />Hood with Duct and Fan (Type ll)
<br />Subtotal
<br />funalty Fee (when applicable)
<br />Violation Fee (50.00)
<br />Plan Check 65% of subtotal 6b (minimum 20.00)
<br />'Receipt No.Pc#Date
<br />ContrEloo t.b. Only
<br />CITY STATE/ZIP?tzla
<br />I hereby 8lti,m that I am licensed under th6 provisions ol Chapts g Division 3ol rlf!!g"""no
<br />Proldsrons Code. md mv [cens B
<br />l,*I0"" ffazr 1 .,n
<br />o"" ITD'fi contractor
<br />in lull lorce and erlacl.c License
<br />(si9
<br />Uo.tm Coipirlabn Oadraabn
<br />I hsgby atli.m tiat I havs a cenaticale o, conEont lo slr-insuro. or a cartilicata o, Worttr's Com-
<br />pemallon lnsurtnce Certifigd @py is liled
<br />?ii",* tko vdiried By (sie.)
<br />with ths Cily inspsclion departmsnt.
<br />""" ltZgS? Appric8nr (sis
<br />I certrly lhal rn the performanceof the work tor which this I shall not mploy any
<br />person in any manner s 6 to be6me sub,ect to the Work6r's Compensation Lils of
<br />CalilornE
<br />Oate Applicant (Srg )
<br />Nollc. To Applbil:
<br />ll after makrng lhrs Ce.lilrcalool Eremptron. you shoutd be@mesubitrt lo theWorke/s Compen-
<br />salron provrsrons o, the Labor Code. you must torthwith comply with such provtstons or lhrs
<br />permrt shall be deemed revoked
<br />Erdrdo.!
<br />Th6 permit shell expiro by lamitalion 8nd become nul and void it the work autho([ed by this
<br />permit€nolcommencedwithtn 180dayslromlhodateotthi3pormilorilworkauthorizedbythis
<br />permit is suspended or abendoned at any limo stt€r the work is commencsd for a poriod of 180
<br />days. A nil permit shall be obtained li6t beloro such work can b€ r6commencod.
<br />AFDIcmal O.drdo.t
<br />I certit thst I have .oad thB applicstim 8nd st8l6 that th€ above inlormation is corrocl. I agie to
<br />@mply wrth all city ordimnG and state lawg rolating to buitding constuclion, and hereby
<br />authorized rop.ffilalaon or lhis cily to enld upon the abocmalioned proptrly ltr insp€clion
<br />purpos6
<br />:":ikntn App,cant n on"n'r.,@
<br />-Plan Check (Adiustment)7. )(
<br />lssuance Fee 10.00
<br />TOTAL PERMIT FEE (minimum $35.00)-€-
<br />D^rE / * Ar4 PERMTT No. -_37 41
<br />EHr.,1ifi" flbo Y,,,,,, ",)PERMIT ISSUEO BY (Stg.) -t^-t- sl Ct
<br />a// fu prz.d-*,'"- /o 76t-?- fTvALroATroN (oFFrcE USE ONLY)
<br />(ACCOUNT fi 1-412)l)
<br />APPLICATTON AND .
<br />MECHANICAL PERMIT
<br />(TYPEWRITE OR PRINT IN INK)
<br />a CITY OF SANTA ANA
<br />206 W. 4th Street
<br />667-2738
<br />APPLICANT FILL IN AREA BELOW
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<br />Drstilbutron ! lnspector Copy 2 Frle Copy 3 Frnance Copy 4 Apptrcanl Copy
<br />cs-618
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<br />?t-o-a-t*STATE/ZIPq 2/2-C
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<br />'15 00
<br />15.00
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