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T <br />APPLICATION AND <br />MECHANICAL PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />ia O CITY OF SANTA ANA <br />206 W. 4th Street <br />667-2738 tur <br />APPLICANT FILL IN AREA BELOW <br />(Dc- <br />9zo <br />oo <br />f, <br />ma <br /><n <br />l <br />n'f <br />L <br />\h <br />cs-618 <br />trResidential Elndustrial ECommercial NO.EACH TOTAL*ei'irV (o-iln]*ln/ndl", - E EACH FURNACE INCL. DUCTS AND VENTS <br />15.00up to 100,000 BTU <br />PHONE 4//0 <br />20.00Over 100,000 BTU <br />EACH ABSORPTION SYSTEM <br />"'" wYnoaa-100.000 BTU to 1,000,000 BTU 25.00 <br />30.001.000,001 BTU to 2,000,000 BTUOur.r€ufabr Dadrtlon <br />I ho.6by alfirm thal I em ermpt ,rom tho Ctrl.ac1or's Licgns Law lor ths lollowing resm (Se. <br />7031 5. Busin63 and Prol6sims Code. Any city or @unty which roquira3I pormit to construcl, <br />alter, improve, demolish. or repair any slructuro. prior to its isuancs, also requirgs the applicml <br />for sch parmit to lile e 3ignsd stalment thal ha B licssad pureuanl to the provBions ol lhe <br />conlrectois Licms6 Lil (Chapter 9 (@mmencing with Section 7@0) ol Oivision 3 ol the <br />Busino3s and ProlGs3ions Code) or lhat h6 is exompt lherelrom and the bais lor lhs sllegad <br />6xsmption. Any violllion ol Section 7031.5 by any applicant tor I permit sbjets the applicanl to <br />a civil penally ol not mor6 than liva hundrod dollars (t5@): <br />E S""tion 7O44A l. as ownfi ol lhe proparty. or mysmploy€oswith wag6 s lheirsolecompen- <br />setion. will do the worl, end the structure is nol intmded or otlorod lor sale. <br />E S*tion 70448 l. I owns ol the prop€rty, am oxclusively conlreling walh licensod <br />contraclors lo conslruct the proltrl <br />Osle <br />-- <br />Owner (Sig.) <br />CdtrEtor l.lr Only <br />TtPo <br />CITY STATE/ZIP <br />6a <br />AOORESS C/-*rtau <br />lhat I am licmsed under the provisions ot Chspts 9. Orvision <br />ProlqB3ions Code. md my license rst?{?"0*.-&Ja .,*" <br />o", tL?jl-T contracror <br />I hereby and"YEy*"rn lull torc€ and etlftt <br />(sr9 <br />Uortn Corpfiabn D.drtbn <br />I haeby attrrm that I have a cenilldte ol @n!mt to sll-insura, or e cedilicate ol Works's Cofr <br />I certity that in the perlormance olthe work ror which lhis <br />p€Gon in any manner I as to b6@ma subiGcl to lhe Worke/3 Compensation LawB ol <br />l{odc.Io lrDalcrll: <br />lt 8n€t making lhis CorlilicateolExemplion, you should bocom€subiocttoth€Wo.ke/sComper <br />salron prorisaonB ol th€ Labor Code. you must todhwith comply with such provisions or this <br />p€rmat shall be d€omod revoked. <br />tbLT+7Oale Applicant (Sig.) <br />wrth lhe inspelion department. <br />lshall rct employany <br />Crlitomie <br />Orte <br />- <br />Applicant (Sig.) <br />p€nsatron lnsu,rnce. Cstitied @py B liled <br />?:f,,* 4/?? ve,r,ed By (sis ) <br />EACH COMPRESSOR, BOILER, OR HEAT PUMP <br />Heat Pump Compressor less than 5 HP <br />EACH AIR HANDLING UNIT OR VAV BOX <br />R@air, Alt. or Add. to any Heating/Cooling sys. <br />(50.00) <br />I tJo <br />by <br />abow <br />Hood with Ducl and Fan (Type ll) <br />5HPto30HP <br />3l to 50 HP <br />Over 50 HP <br />Air Handling less than 2,000 CFM <br />2,000 CFM to 10,000 CFM <br />Owr 10,000 CFM <br />MISCELLANEOUS <br />Outdoor Dual Packaged Healing or <br />Floor Furnace <br />Heater; Suspended, Wall or Unit <br />Com'l Drpr Vents <br />Decorative Fireplace (Wood or Gas) <br />r)Range Hood with Duct and Fan <br />Each Vent Fan Connected to a Ducl <br />Fan Coil lnstallation <br />Fire Extinguishing System <br />Each Evaporative Cooler <br />lncidental Gas Piping <br />Fire Damper lnstallation <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 />15.00 <br />10.00 <br />15.00 <br />15.00 <br />'10.00 <br />15.00 <br />15.00 <br />20.00 <br />15.00 <br />Subtotal <br />Penalty Fee (when applicable) <br />Violation Fee <br />Plan Check 65% of subtotal (minimum <br />DateBeceipt No.Pc# <br />&pardo.r <br />This pormil shall €xpire by limitation and bsom6 null and vord al the work aulhorized by lhrs <br />permil E not commenced wilhin 180 dsys lrom the dste ol this permit or il work authorized by thB <br />fErmil is suspanded or abandoned al any time stter tho work is commencad lor a EEriod ol l8O <br />days. A n* pormit shall b€ obtained tiBt b€lore such work can be rocommenced. <br />ADpllc.nl'. D.d.rdon <br />I cenity lhel I have raad this application and state thal lh€ obove inrormation is correct. I agre to <br />comply with all city ordinances and state laws relating lo building constuclion. and hergby <br />authorized reprBentalion o, this city to enl6 upon lhe sbovemenlioned grcgqly lot <br />BY (S'g I <br />tzal-91Date Applicant or Agent (Sig.) <br />purpos6 <br />BUILOING <br />PERMIT No PERMIT ISSUEO BY (Sig ) <br />0-2 <br />10.00 <br />Plan Check (Adjustment) <br />lssuance Fee <br />TOTAL PERMIT FEE <br />D rE /2- <br />(minimum $35.00) <br />PEHMIT NO. <br />& fu fa--r\o>4- //-/aP/r l) -7-rVALIDATION (OFFICE USE ONLY} <br />(ACCOUNT r11-4r2) <br />Orstilbutron 1 lnspector Copy 2 Frle Copy 3 Frnance Copy 4 Applicanl Copy <br />I STATE/ZIP <br />I azzz L <br />/ <br />or <br />+ <br />PHONE <br />oo <br />zo-S ct.{ilb