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JOB AOORESS fa.* <br />CITY <br />ilo.- D <br />Ourr-3ulkar Mralbo <br />I hereby srlirm lhat I am axmpt lrom lh€ Contracto/s Licmse Law ,o.lh€ tollorying roam (S€c. <br />7(x}1.5. Busin# and ProlGsions Codo. Any city o. counly which roquiros I p€rmil to conslruct. <br />sltar, improve. domolBh. or repair any structura. prior lo its isuance, ds roquira tha epplic8nt <br />tor $ch ptrmil to ,ila e signed statmenl that ho B licmsad puBuml lo th€ provi3ion3 ot tho <br />Conlractor's Lic€ns€ L& (Chapter 9 (@mmoncing with S€clion 7CD0) ol Oivision 3 ot tha <br />Busin6ss rnd Pror€3sions Codo) or that he is exempl lhererrom and the bsis ,tr th€ slleg€d <br />axemption. Any violslion ol S€ciion 7091.5 by any applicsnt lor 8 permil sbiocB the spplicant to <br />a civil p€nalty ol not more lhan liv€ hundred (bllsrc ($5m): <br />E S*tion uoaa I. a ownar o, the propeny, or mysmploy$wilh wa96 ss thairslacompoc <br />salion. will do the f,ork. and the slructure 6 not intsdod or ot ssd lor Sale <br />E S."tion 70448 l. c owner ot lhc property, am exclusivsly contreting with licensod <br />conlraclffi to @nstruct the p.oloct <br />Dale Owner (Sig.) <br />Residontial !lndustrial ECommercial <br />EACH FURNACE INCL. DUCTS AND VENTS <br />EACH COMPRESSOR, BOILER, OR HEAT PUMP <br />Heat Rrmp Compressor less than 5 HP <br />EACH AIR HANDLING UNIT OR VAV BOX <br />Outdoor Dual Packaged Healing or Cooling <br />Repair, Alt. or Add. to any Heating/Cooling sys. <br />Range Hood with Duct and Fan (Type l) <br />EACH TOTALNO. <br />Up to 100,000 BTU <br />Owr 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 />Over 50 HP <br />Air Handling less than 2,000 CFM <br />2,000 CFM to 10,000 CFM <br />Over 10,000 CFM <br />MISCELLANEOUS <br />Floor Furnace <br />Heater; Suspended, Wall or Unit <br />Com'l Dryer Vents <br />Decorative Fireplace (Wood or Gas) <br />15.00 <br />20.00 <br />25.00 <br />30.00 <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 />10.00 <br />15.00 <br />15.00 <br />'t 5.00 <br />I heroby allirm thst I am licmsed under the provisions olCheptq 9, Oivision <br />ConllElo[ l.b. Only <br />CITY <br />a <br />Contractor (Srg ) <br />0/f-a (27Code, md my liceme is in lull fq@ and ettsct. <br />oa" ltTlS? <br />Prol6srons <br />Ll"{A"t9'2-22.,o" <br />ilefiNytnasana <br />6ara-o <br />2D.n <br />/Of.oo <br />Wortm Coip.mabo O.drtbo <br />I hsaby stlirm that I have I certilicate ol @nsl lo sll-insure. or s certificale of Wo.ttr's Com- <br />manner s es to be@ms subjecl to the Worke/s <br />Nollc. To Appllcit: <br />ll arls makng lhrs CerlrtrcateolExemptron, you should becomesubtdllotheWorke/sCompen- <br />satron provrsions ot the Labor Code. you must lorthwrlh comply wath such provrsDns or thrs <br />permrt shall be deemed revoked <br />nilt-n <br />the psdormance ol the worl ld whrch lhis <br />Oate Applicsnt (Sig.) <br />Oate Applicant (Sig.) <br />with ilding impection depsrlment.pemation lna/ance. Cortilisd copy B lilsd <br />?:i",* 7 f a ver,ftod By (s,e ) <br />I certrfy that rn I <br />pecon in any <br />Calilornia <br />Each Vent Fan Connected to a Duct <br />Hood with Duct and Fan fl-ype ll) <br />(50.00) <br />Fire Damper lnstallation <br />Fan Coil lnstallation <br />lncidental Gas Piping <br />Each Ewporatiw Cooler <br />Fire System <br />15.00 <br />15.00 <br />20.00 <br />15.00 <br />15.00 <br />10.00 <br />15.00 <br />1 <br />Subtotal <br />Violation Fee <br />Penalty Fee (when applicable) <br />Plan Check 65% of subtotal )1f lminimum <br />Receipt No.Pc#Date <br />Plan Check (Adjustment)/ 3,oo <br />lssuance Fee 10.00 <br />TOTAL PERMIT FEE (minlmum $35.00)+ <br />Erp&tlba <br />This p€rmit shall expire by limilstion and become null rnd void i, th€ wort luthdizod by this <br />permil E nol @mrenced within l80 days lrom the dale ol this psrmit or il worl authorizsd by lhis <br />lErmit rs susp€nd€d o, abandonod al any lime arler th6 work i3 commncod lor a poriod ol 180 <br />days. A n* pdmil ghall be oblainsd ti6l b€lore sch worl can bo re@mmenced. <br />Aprllclra'r O.drdo.r <br />I certity thal I have read lhis applicalim and stsle that tha above intormation B corr€ct. I 60ree to <br />comply with all city ordinanca 8nd stale laws rolating to building cmsluclion. and her66y <br />aulhorized roprGmtrtion ot this cily to mtd upon lhe abo\+ mentionod propsty lor inspoc-lion <br />purpos6.:::ru4 App,ianr o, <br />^n <br />n*'.M o rE / z-Zf- 37 PmmlT r,ro. 1 3 7 4 8 <br />BUTL,,NGSU l, ll <br />PERMIT No \J----:- VERIFIEO BY (Sig.)z!r-x-Cl.-PERMIT ISSUEO BY (Sig ) <br />A/L fu Vdzril*-- 4'/a/sr tt;j7-7,vALTDATTON (OFFTCE USE ONLY) <br />(ACCOUNT tl r-412) <br />T <br />,apbucATtoN AND a <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 />E)qrIzo <br />oo1' <br />m <br />U)a <br />G <br />Nt\ <br />b. <br />Dislrabulion: 1 lnspeclor Copy 2 File Copy 3. Finance Copy 4. Applicant Copy <br />cs-6r8 <br />"W-,Lfui*r-0/r4";b 'Wu4//o <br />I )f,o-o <br />4 <br />I <br />Each Appliance or Equipment Begulatsd by <br />this C.rlc hrl d snmifi.rllv lisled etM