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APPLICATION AND I <br />MECHANICAL PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />t CITY OF SANTA ANA <br />206 W. 4th Street <br />ffi7-2738 <br />APPLICANT FILL IN AREA BELOW W <br />@g-Izo <br />oo <br />f) <br />ma <br />U, <br />\ <br />N <br />il <br />NP <br />0 <br />NO.EACH TOTALFBesid€ntial ! lndustrial ECommercial*':;"ii7 fr4b 7t-V)Zta- d". - e-EACH FURNACE !NCL. DUCTS AND VENTS <br />TIA^ r% (tz/t"-;*:,f,(('otroPHONE <br />Iifu-rrc lbontss*ij"irM <br />t'" ('*r*- h.-ooa,STATE/ZIP?ilzC <br />EACH COMPRESSOR, BOILER, OR HEAT PUMP <br />Heat Rrmp Compressor less than 5 HP <br />15.00 <br />20.00 <br />Up to 100,000 BTU <br />Over 100,000 BTU <br />EACH ABSORPTION SYSTEM <br />100,000 BTU to l,000,0@ BTU <br />1,000,001 BTU to 2,000,000 BTU <br />5HPto30HP <br />25.00 <br />30.00 <br />25.00 <br />25.00 <br />Orn t€ulorD.drtbn <br />I hereby allirm thel I am gxmpt lrom lho Contracto/3 Licmss L8w for ths ,ollowing roaon (S€c. <br />703t 5. Bu3inats 8nd Profa$ions Cods Any city or munty which requir6 e psrmil lo con3trucl, <br />alter, amprove. d6moligh. or raperr any 3lruclure, prior to its isuance, alSo rcquirs the applicant <br />lor such permil to lilo I signod staloment that he is licensod puBuanl to the provision8 ol lho <br />Conlracto.s Licmso Lil (Chspts I (@lmencing with S6tion 7m) ot DivBion 3 ol lh8 <br />Bu3in6ss and Prot6sioos Codo) or thal he i3 €xmpt therolrom 8nd the b8i3 lor tho dbged <br />exomption. Any violstion ol S€ction 7O31.5 by 6ny 8pplicant tor a pstmil 8ub,oc1s the applicsnt to <br />a crvrl penrlty of not more than live hundrod (bll8B (35@): <br />ES""tionZOaa l,aSownorolthoproperty,ormyamployffiwithwtg€66theirsolecompen- <br />sstion. will do the work. and tho structure b not intgndsd or otlsed lor 3al€. <br />E S*tion 7oil48 l. as owner ot the prope.ty. 8m exclusively contr*ting with licmssd <br />conlractors lo conslruct the prolel <br />Oate <br />- <br />Owner (Srg ) <br />Conlrrlm t,!. orrly <br />I hereby alfirm that I am licensed under lhe provisaons ol Chapls 9. <br />Prol$srons Code. md my lrcensa rs <br />(ll&"o". &7/7 c,o" <br />o"r, lZtlftconrracror <br />STATE/ZIP <br />PHONE <br />CITY /o <br />C) <br />in tull lorc€ and eflect <br />(sig ) <br />Divisi.n 3oufe Busin€ss and <br />tlbltit Co0?a6tlon D.dribn <br />I hdsby allirm that I have a certilicate o, @n8€nt to s€ll-insur6. or a cerlilicale ot Wort-'s Coc <br />I certrty thal an the portormanceol the work <br />peGon in any manner I I to bo@me <br />Califomia <br />Date <br />-- <br />Applicant (Sig.) <br />,'otle To Apdl6l: <br />ll alls makng lhrs Cerlrlrcaleol Exemptron, you should become sublsl lo lhe Worker's Compen- <br />salion provrsrons ol lhe Labor Code. you musl lorthwrlh comply wilh such provrsions or lhrs <br />permil shall be demed revoked <br />or" lz-z?s? Apprienr <br />lor whrch thrs <br />subject lo the Worke/s <br />wilh the City inspection departmenlpemation lnsurtnc€. Cstiliod copy is lilod <br />?:f,* {/90 veririod By (sE ) <br />EACH AIR HANDLING UNIT OB VAV BOX <br />Outdoor Dual Packaged Healing or Cooling <br />Hood with Duct and Fan (Type ll) <br />or by <br />.l-2 <br />oO <br />Date <br />30.00 <br />40.00 <br />31 to 50 HP <br />Fire Damper lnstallation <br />Over 50 HP <br />lncidental Gas Piping <br />Each Emporatile Cooler <br />Air Handling less than 2,000 CFM <br />Fire Extinguishing System <br />2,000 CFM to 10,000 CFM <br />Fan Coil lnstallation <br />Over 10,000 CFM <br />Each Vent Fan Connected to a Ducl <br />MISCELLANEOUS <br />Range Hood with Duct and Fan (Type l) <br />Floor Furnace <br />Heater; Suspended, Wall or Unit <br />Com'l Dryer Vents <br />Decoratiw Fircplace (Wood or Gas) <br />Repair, Alt. or Add. to sys. <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 />ttfl <br />Subtotal <br />Penalty Fee (when applicable) <br />Plan Check 65% of subtotal <br />Violation Fee (s0.00) <br />Receipt No.Pc# <br />'r& (minimum 20.00) <br />72rPlan Check (Adjustment) <br />lssuance Fee 10.00 <br />Erplrdo.r <br />Thas p€rmil shall erpire by limitation and bocom€ null and void i, tho wdk suthorized by lhis <br />permit is not commenc€d within l80 days lrom tha dats of this pormit or il work suthorizod by this <br />p€rmil is suspendod oa abandoned et my lims attgr tho worl is cmmned ,or! psiod ol 180 <br />days A nil psmil shall bo oblained li6l b€tor6 sch work can be mommoned. <br />Apdlc.rft O.drdlon <br />I certity that I have .oad thas applicatim and ilA€ that the abov6 intormation is corr6cl. I ere to <br />@mply wilh all cily ordinancB end state laws relating to building co.rstuclion, and her€by <br />authori:ed reprBenlation of this cily to 6ntd upon thg above,mentionGd proprty lor inipection <br />Applicant or Agenl:::tu6a TOTAL PERMIT FEE (minimum $35.00) <br />37DATB /2-,PERMIT NO. <br />BUILDING <br />PERMIT No <br />s?6 0#,",,PERMIT ISSUEO BY (SIg ) <br />d?L 4- /o7/r11 1-4r2)<-)4/2 <br />Dlstribulion 1 lnspeclor Copy 2. File Copy 3. Finance Copy 4. Applacsnl Copy <br />cs-6r8 <br />g <br />Ns <br />/.21o-o <br />? <br />hot* <br />)- <br />0