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JOB AOORESS I
<br />CITY *7ST
<br />3 r
<br />EACH FURNACE INCL. DUCTS AND VENTS
<br />EACH COMPRESSOR, BOILER, OR HEAT PUMP
<br />Heat Pump Compressor less than 5 HP
<br />EACH TOTAL
<br />oo
<br />E lndustrial E Commercial NO.
<br />up ro 100,000 BTU
<br />Over 100,000 BTU
<br />EACH ABSORPTION SYSTEM
<br />100,000 BTU to 1 ,000,000 BTU
<br />1,000,001 BTU to 2,000,000 BTU
<br />5HPto30HP
<br />31 to 50 HP
<br />15.00
<br />20.00
<br />25.00
<br />30.00
<br />25.00
<br />30.00
<br />25.00
<br />EACH AIR HANDLING UNIT OR VAV BOX
<br />Owr 50 HP
<br />Air Handling less than 2,000 CFM
<br />Ourai-Ou*abr O.draba
<br />I her€by arlirm lhst I am oxempt lrom llE Cdtrlclo/3 Liffise Lm d th€ lollcwino roason (S€c
<br />TGtl 5. Busin6s 8nd ProlBsions Coda. Any city or county which require3 I p€rmit to construcl.
<br />alt6r. imprcve. domoligh. or repair any slruclure, prioi to il3 iSsuance. rl3o requirgg the applicant
<br />lor such psmit lo til6 r 3ionsd slatement thel h€ is licons€d puBuant to the provisbns ot lhe
<br />Conlractor's Licms€ Law (Chaplor I (commoncing with Section 7m) ot Oivision 3 o, lh€
<br />Eusins 8nd Prol63iof,s Code) or that he is axempt thorotrom rnd lhe b8is lor the allsg€d
<br />aramption. Any violslion ot Section 703 1.5 bry any applicsnl lor a p€rmit sbjecls the applicant lo
<br />8 civil p€nalty ot nol more than ,ivo hundrod dollars (ts(D):
<br />E S*tion 7044A l. I ilns or th€ propeiy. or myemployG wilh wag€ 6 thearsole comp€n-
<br />Sation. will (,o tho wort. and ths slrucluro is nol intended or otlded lor sels.
<br />E S*tion 70.!18 l. 6 owner ol the prop8rty. am €xcluspoly contrrctang w[h licensod
<br />conlracloB Io construct the prortrl
<br />Oale Owrer (Sig.)
<br />Cml?rto[ t,3c Orly
<br />CITY
<br />o
<br />Repair, All. or Add. to any Heating/Cooling sys.
<br />10.00
<br />10.00
<br />2,000 CFM to 10,000 CFM
<br />Over|0,000 CFM
<br />MISCELLANEOUS
<br />Outdoor Dual Packaged or Cooling
<br />Floor Furnace
<br />Heater; Suspended, Wall or Unit
<br />Com'l Dryer Vents
<br />Decorative Fireplace (Wood or Gas)
<br />Hood with Duct and Fan (Type l)
<br />25.00
<br />15.00
<br />15.00
<br />10.00
<br />15.00
<br />15.00
<br />15.00
<br />f n"r"f#fir. ti"t r
<br />"m
<br />licased under the provisions ot Chaptd 9, Oivisrn
<br />o/tz/27
<br />and3,Wrya3
<br />Pro,e$ions
<br />til{?"Licsse
<br />Conlrsclo. (Sig.)
<br />Code. md my licanse is in lull lorce and eftecl.
<br />o,r"tTtl8l
<br />frz_?.,o"
<br />Each Vent Fan Connected to a Duc't 4 15.00 k,ao
<br />2a,rlO
<br />/or,dl
<br />t|ortan Corf .llalbn D.drlbn
<br />I heroby atlirm that I hav€ a cartiti€te ol @nsfit lo solf-insur6. or o cgrtilicate ot Wortd's Com-
<br />I certify lhal in the gerlormanceol the work lor which thas
<br />poBon in any mnnd !o as to bocome subjcl to the Wo.te/s Compen$tion L8rr ol
<br />Csliromia
<br />t{o$o To Arl9llc0l:
<br />lf atter makrng lhrs Cerlitrcate o, Exemption. you shoutd become subist to the Worke/s Comper
<br />salron provrsrons of the Labo. Code, you must forlhwrlh comply with such provasrons or thas
<br />permrt shall be demed revoked
<br />(s'9.)
<br />liled with
<br />Oale Applicant (Si9 )
<br />br.rilding inspction dopartment.
<br />I shall rct employ any
<br />by
<br />15.00lt)
<br />OT
<br />this notbut
<br />Fan Coil lnstallation
<br />Fire Extinguishing System
<br />Each Evaporalirre Cooler
<br />Hood with Duci and Fan
<br />lncidental Gas Piping
<br />Fire Damper lnstallation
<br />20.00
<br />15.00
<br />15.00
<br />10.00
<br />15.00
<br />Subtotal
<br />Fenatty Fee (when applicable)
<br />Violation Fee
<br />Plan Check 65% of subtotal
<br />(50.00)
<br />(minimum 20.00)
<br />DateReceipt No.Pc#
<br />Plan Check (Adjustrnent)/7ru-o
<br />lssuance Fee 10.00
<br />TOTAL PERMIT FEE (minimum $35.00)-€-
<br />This permit shatl expire by rimitation ""o*i#ru 8nd void i, th€ worr suthdizod by this
<br />parmil ts nol commonc€d wlthin 180 dsys trom the dat8 ot this permit or it work suthorizod by this
<br />tErmit is suspended or abandonod at any timo arld the work is commgncod for a period ol 160
<br />days A n€w psmit shsll bo obtainod liBt botore 3uch work can bo rgcommanced.
<br />r cerrity rhst r have read rhr app,,"",ffi:rffiffi-o inrormarion is correcr. r erae ro
<br />comply wilh all city ordinanc€6 and state taws rolating to buitding cmstuciion. and hsroby
<br />authorized raprBontation ol this cily lo enler upon the abovlmentioned frcrEty tor inspetion
<br />:::fuq App,icsnr n on",,",n@ PERMIT NO.DArE ta-a?- El
<br />Bi'A.,?i$, 6!bl Q,,,.,,, "")PERMIT ISSUEO BY (Srg )CL.*20v tq
<br />o-ru//448fail //VALIOATION (OFFICE USE
<br />(ACCOUNT 111-412)
<br />APPLICATION AND (l
<br />MECHANICAL PERMIT
<br />(TYPEWRITE OR PRINT IN INK)
<br />a
<br />APPLICANT FILL IN AREA BELOW
<br />CITY OF SANTA ANA
<br />206 W. 4th Street
<br />667-2738
<br />@g-Izo
<br />oo
<br />f,
<br />m
<br />U)a
<br />(\
<br />Distribution: t. lnspectorcopy 2. FilaCopy 3 FinanceCopy 4. AppticentCopy
<br />cs-618
<br />/
<br />40.00
<br />10.00
<br />/
<br />15.00
<br />o
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