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""^"*VTt 9a+uVzbrrtodo. - -D
<br />! lndustrial D Commercial NO.EACH TOTAL
<br />EACH FURNACE INCL. DUCTS AND VENTS
<br />Up to 100,000 BTU 15.00
<br />Owr 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 fito
<br />5HPto30HP 25.00
<br />31 to 50 HP 30.00
<br />-0
<br />MAILING
<br />CITY ST
<br />Orn aull(brD.drabo
<br />I he,sby attirm thet I am exmpl lrom lh€ Conlracto/s Licen3e Law lor th6 ,ollowing ra8m (Soc.
<br />7031 5. Busin6s and Prolsions Cod€. Any city or county which r€quire3 a p€rmit to construcl,
<br />aller. imprcva. demolBh. or ropair any struc1uro, pris lo its isuance. d$ r6quir6 tha applicant
<br />lor uch permit to lile 8 signsd statem€nl thst h€ is lims€d puBusnt to lho provigions of th€
<br />Contractor's Licons Lsr (Chepler 9 (commoncing with S€ction 7m0) ol Oivision 3 ot the
<br />Business and ProtBsims Coda) or thst ho i3 sxampl therelrom and the basb lor the alleg€d
<br />exemptaon. Any violalion ol Soclion 7031 5 by any spplicant tor I pormat subjels the applicant to
<br />a civil ponally ol not more lhan live hundr€d (bllars (S5O0):
<br />E S""tion ZO44l l. !s ownor ol the prop8rty. d myemployGwalh wa96 G lheirslecompon-
<br />3ation. will do the wort. and the struclure is rct intended or otlsod tor sale.
<br />E S*tion 70448 l. I owner ot the properly, am exclusively cmtretang wth licmg€d
<br />cont,acto6 lo conslrucl the p.olel.
<br />Oate Owner (Sig )
<br />Conlrclon t ra Only
<br />PHONE
<br />ADORESS
<br />P
<br />a
<br />Over 50 HP 40.00
<br />EACH AIR HANDLING UNIT OR VAV BOX
<br />Air Handling less than 2,000 CFM 10.00
<br />2,000 CFM to 10,000 CFM 10.00
<br />Over 10,0@ CFM 10.00
<br />MISCELLANEOUS
<br />Outdoor Dual 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 />Decoratile Fireplace (Wood or Gas)15.00
<br />Repai( Alt. or Add. to any 10.00
<br />Hood with Duct and Fan (Type l)15.00
<br />Each Vent Fan Connected to a Duct 15.00 dtO?
<br />Wortm Cofirg.naJbn O.drdbn
<br />I htr€by Etrirm that I hav€ a ceniri€to ol consst to slf-insur6. or a certiricate ot Worts's Com-
<br />[EHton lnsu,gnce. Cstrtied @py is litgd
<br />?:i9."" +fud veririod By (sis )
<br />wrth lhe insp6tion daperlmenl.
<br />o"" L77) 8? Appricanr (sis )
<br />I ce.tify thal in the parlormanceof th€ work for which this I shsll nol employ any
<br />pe6on in any manner s 6 to b€@me sublst to the Worker's Compensation Les of
<br />Calirornia
<br />Dsto
<br />-=-
<br />Applicet (Sig.)
<br />No0,ct To Appllcrl:
<br />lf aller making thrs C6rlrtrcateol Eremption, you should be@me sub,st to theWorker's Compen-
<br />salon provrsrons o, lhe Labor Code. you musl torthwith comply w(h such provlsions or thrs
<br />permtl shall be demed revoked
<br />Fan Coil lnstallation
<br />Fire Extinguishing System
<br />Each Elaporative Cooler
<br />lncidental Gas Piping
<br />Fire Damper lnstallation
<br />Hood with Duct and Fan (Type ll)
<br />/20.00 20, tO
<br />15.00
<br />15.00
<br />10.00
<br />15.00
<br />15.00
<br />15.00
<br />Subtotal /af,oa
<br />Penalty Fee (when applicable)
<br />Erpkdo.r
<br />This pormit shall erpiro by limitation and bocoma nul and void il the work authori:od by thi3
<br />permil F nol commncod wilhin l&) dryr lrom tho dste o, thi3 tE mit d it wort authffhod by this
<br />permit is suspsded tr abandonod at my timo elt6r the wort is cmmnced lor e pcnod ol tEO
<br />dayg. A na pdmil 3hall bo obttinod fiBt belora such wort can be recommencsd. "
<br />Aeglbdl O.drdoo
<br />I cerliry lhal I have read this application and state that the above inlormation is corroci I agroe to
<br />comply with all city ordinancG
<br />authorized repres€ntalbn ot lhis
<br />purpos.
<br />hereby
<br />on"ltfl'fr Applrcanl or Agenl
<br />Violation Fee (50.00)
<br />Ptan check 65% of subtotatffi .oo1
<br />Beceipt No.Pc#Date 3
<br />Plan Check (Adjustment)/7, c'o
<br />lssuance Fee 10.00
<br />TOTAL PERMIT FEE (minimum $35.00)+
<br />DATE /2_>7.*y PERMIT NO.
<br />Bll|,li$.5-qlz0 h..,,,.o ",,.,n,
<br />PERMrrrssuEo ,rrr,n, -t/. )a eL
<br />Ad d>r- /L/- /of/f
<br />vALroATroN {oFFtcE usE oNLY)
<br />(ACCOUNT rr 1-412))
<br />APPLICATION AND O
<br />MECHANICAL PERMIT
<br />(TYPEWRITE OR PRINT IN INK)
<br />o CITY OF SANTA ANA
<br />206 W. 4th Street
<br />667-2738 W
<br />APPLICANT FILL IN AREA BELOW
<br />u,g-Izo
<br />oo
<br />f,
<br />ma(,
<br />s\
<br />L
<br />t^lE
<br />Drslribulion: I lnspector Copy 2. Fite Copy 3. Finance Copy 4. Appticant Copy
<br />cs-618
<br />/
<br />to*'^ot'{fuD f ,o/rr-2'7?-r: oo
<br />I heieby allirm thEl I am licens€d un@r the provBions o, Chspts 9. OivisEn 3ot tEB-usif6s and
<br />Pr_otn rons Code. md my lrconse rs In lutt fore and otlEt. /l.Ufl"?(,{i,ryZZ c,o" u4) c*yL,cilse a(Cotl7
<br />oa"kTlfl conrracrors,n@
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