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o IAPPLICATION AND <br />PLUMBING PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />CITY OF SANTA ANA <br />206 W. 4lh Street <br />667-273a W <br />APPLICANT FILL IN AREA BELOW <br />u,grIzo <br />ooIma <br />U) <br />$ <br />X <br />U) <br />JOA ADDFESS ^i7o L *-*,7,- U;t/z-- UKL <br />oA)r^l/-.,,u- fi rn,u-E,ONEStb- o)./a <br />ING A <br />"''Ukfr,ST.PTE,'ZI G2-e b <br />//5.00 <br />10.00 <br />NO.EACH TOTAL! lndustrial ! Comm€rcial <br />each plumbing fir:tue/trap <br />Dental Unit or Medical Gases <br />15.00 <br />30.00 <br />5.00 <br />5.00 <br />SEWER <br />Private Sarage Disp. System <br />lst 100'+Conn. <br />Ea. Add'l 100'or Fraction <br />Ea. Add'l Conn. <br />GAS PIPING <br />GAS SERVICE 1 to 4 Outlets /5.00 a5 <br />Ea. Add'l Outlet 1.00 <br />Repair or Replace Gas Piping 5.00 <br />Oma?-Bulld.r D.cNr.tlon <br />I hereby allirm that I 8m erempl trom ttE Contracto/g Lacens Law lor lhe rollowing ro8on (Sc <br />7031 5. BusinN and Prol6sions Code Any cily or county which r€quires a p€rmit lo cmslruct. <br />aller, improve. dmolBh. or repair any llructure. pnor to its issuan@. also r€gurrB the applicanl <br />lor sch p€rmil lo ,ile ! s€ned slatsmonl thal ha B licen3ed pursurnl lo the provisions of lho <br />Conlractor's Licenso Lil (Chaptsr 9 (commencing wilh Soction 7OO) ol Division 3 ot the <br />Busaness and Protsasions Code) or lhat ho is oxempt thoretrom and lh6 basis tor th€ allog€d <br />eremption Any violaliofl o, Seclion 7031 5 by any spplient lor a fErmil &rbjects lho tpplicanl to <br />a civrl penalty ol not more than tivo hundrsd (bllars (t500): <br />E S*tion ZOlu l. a3 ownerol the piop€rty. or myemployegswithwlg€3 rs lhGirsolocompen- <br />3alion, wrll do the ryort. and lhe slruclure is not intended or ottorod tor sele. <br />f] S""tion 70448 l. as owner of the prop€rty. am exclusively cmlreting with licl3rllod <br />contracloB to comlruct the proi€ct <br />Oate Owner (Srg ) <br />Temporary Gas Service <br />Water Heater - Electric or Gas <br />100.00 <br />5.00 <br />Conlrrlo[ lrt. ODly <br />10.00 <br />W::h,-,),,! nlaL)-t;, t7*- o7o7 <br />PHONE <br />8.00 <br />4.00 <br />Rain Water Piping (buried) Ea. 100' <br />Alt. or Repair of Drainage - Vent Piping <br />Water Piping Ea. 100' <br />Water Softner <br />10.00CITY <br />Lawn Sprinkler 6.00 <br />Rain System - Per Drain 10.00 <br />lnd. Waste lnterceptor 8.00 <br />fud Traps 5.00 <br />3olthe Busrn6sand <br />*4 <br />Deck Drain System - Per Drain 3.00 <br />Repair/Alt. Drainage or Vent 10.00 <br />Vacuum Breakers 1-5 5.00 <br />1.00 <br />5.00 <br />10.00 <br />/10.00 <br />pensation lnsuranco C€rtilisd copy B liled wilh th6 <br />subject to the Worker's Compensatron Laws ol <br />taotlc. To AD9llclrl: <br />ll alte. makrng lhis Certrlrcate of Exemplron. you should become subict to the Worker's Compen- <br />salon provrsrons ol lhe Labor Code. you must lorthwrlh comply w(h such provrsioos or lhis <br />permrt shall be d@med revoked <br />Oclrtlbn <br />I <br />venri€d By <br />Applacenr (Sig.) <br />I horaby arli,m that I hsv6 a <br />Date Applicanr ($9 ) <br />lhis permit is issued. I shall notomploysnythatp6rlormsnceol <br />person rn 8ny mSnner rc as to <br />Calilornia <br />a cerlitcatg ol Wod(s's Com- <br />inspaction dspartment. <br />Oste <br />Exprres <br />Receipt l'.1o.!'1 Pc# <br />Over 5 <br />Water Service Ea. 100' <br />.Backflow Device 2" or <br />Over 2" <br />Subtotal <br />Penalty Fee (when applicable) <br />Violation Fee <br />Plan Check 650/o of subtotal <br />(s0.00) <br />Date <br />S- (minimum20.0O) <br />Plan Check (Adjustment) <br />&dr.0on <br />Thb permil shall oxpirt by limitrtion and bocomo null and void i, tho worl luthorirod by this <br />permil B nol commnccd wilhin 1E0 d!y! irom the drte o, this permrt o. it work authorized by thir <br />p€rmil a3 su3rmd€d or rbandon€d st rny time attor lho worl i3 cof,rmenced tor a parird ol too <br />dBy3. A nes pdmit 3hall bo oblainod liirt b€lorffi can be r€common@d. <br />I cerlily thst I heve .md this applicatron and state that the ab@a <br />Applicanl or Agenr (Sig.) <br />I a9r6 to <br />@mply wrlh all city ordimncG and stale <br />ol lhrs crty lo entd lssuance Fee <br />TOTAL PERMIT FEE <br />DATE <br />10.00 <br />(sig.)vLs -o-PERMIT ISSUEO BY (Sig ) <br />f "* oL Maq 7D / /r*1-412)6-e.a-s.t"81 <br />Orslribulron l lnspector Copy 2 Frl€ Copy 3 Frnance Copy il Applicsnt Copy <br />cs-61 1 <br />/t <br />FIXTURES <br />/t€ <br />MISCELLANEOUS <br />/ <br /><- <br /><-v <br />- <br />* <br />I v#at), l <br />No Class <br />Date (si9 <br />affrrm lhal I am <br />Code. and <br />ol constrt to <br />the