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APPLICATION AND T o CITY OF SANTA ANA <br />206 W. 4th Street <br />667-2738- MECHANICAL PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />APPLICANT FILL IN AREA BELOW <br />(! <br />srIzo <br />oot <br />mao <br />\ <br />tr"rbJOB € <br />4//a <br />MAILING <br />'ATE/ZIP <br />,t44v I <br />Orr-ldld.t D.dtibn <br />I horsby attirm thal I am sxempl trom tho Contrsclor's Licon3€ Llw lor the tollowing roaon (Soc. <br />7031.5, Busin€.s md Prol6sions Code. Any city or @unly which require3 a psrmit to conslrucl, <br />aller. imprcvo, dmolBh, or repair arry strucluro. prior to itE irguancg, al3o r€quird th6 applicent <br />lor $ch permit to lilo I3ignad statomsnl thal he B licens€d puBusnt to tho prcvisions ol lhe <br />Contractor's LicerB€ Law (Chaptd 9 (commoncing with S€c,tion 7q)) ot Division 3 ol tho <br />8u3in€3s 8nd Proto$ions Cods) or lhsl ha is oxompt lherelrom and the basE lor th€ allegod <br />exomplion. Any violalion ol S€dion 7031.5 by any applicenl tor a pormil subiects tho applianl to <br />a civil ponslly ol not more lhan ,ive hundr€d (bllars (35@): <br />E S*tion zOUl l, s3 om6r ot th6 proprny, 07 my employG wilh wag€3 as thoar 3ol3 comper <br />salbn. will do the work. and the slructuro 6 not intended or otls€d lor sslo. <br />E S*tion 704{8 l. 8s owner ot the prop€rty. am oxclusivsly conlrrcling wilh licens€d <br />@ntreclofs lo construcl the pfol€ct. <br />Oale Owre. (Sig.) <br />I horeby allirm lhat I am lrc6sed under th€ provisions ol Chaptd 9, Orvision <br />Conlrelon (,3. Only <br />?o <br />CITY <br />andfl@,"o" <br />C-7Prolssrons <br />#{^k" <br />Cod€. md my license is in lull lorce and 6tl*1. <br />Conlractor (Sig ) <br />&ala <br />",o"o",h'ilfi <br />So.f.6 Corf.oibo O.dr.lbn <br />I hereby altirm lhal I have a cortilicate ot @nsent to rlf-ansure. or a corlilicato ol Workff's Com- <br />I cerlity lhat in lhe p€rlormance ol the work lor which this <br />p€r3oo in any manner s a lo bG@mo lubiod to lho Worto/3 CompaIr3rlbn L!w3 ol <br />Caliromia <br />ilo$c. To Ap9llc l: <br />ll atler making lhrs Certrficate ol Eremption. you should become subi&t to the Worke/s Compen- <br />salron provrsrons ol lhe Labor Code, you must forthwrth comply wrth such provrsrons or thrs <br />permit shall be deemed revoked <br />lil6d wilh the <br />(sig ) <br />Oate Applicant (Sig.) <br />anspection dopartment. <br />I shall nol employ any <br />EACH FURNACE INCL. DUCTS AND VENTS <br />EACH COMPRESSOR, BOILER, OR HEAT PUMP <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 />Zfr rtt <br />15.00 <br />/OO <br />EACH TOTAL <br />or by <br />E lndustrial D Commercial NO. <br />15.00 t({tz <br />Hood with Duct and Fan (Type ll) <br />Up to 100,000 BTU <br />Over 100,000 BTU <br />EACH ABSORPT]ON SYSTEM <br />100,000 BTU to | ,000,000 BTU <br />1,000,001 BTU to 2,000,000 BTU <br />Heat Pump Compressor less than 5 HP <br />5HPto3OHP <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 Fiteplace (Wood or Gas) <br />Range Hood with Duct and Fan (Type l) <br />Each Vent Fan Connected to a Duct <br />Fan Coil lnstallation <br />Fire Extinguishing System <br />Each Evaporative Cooler <br />Fire Damper lnstallation <br />15.00 <br />20.00 <br />25.00 <br />30.00 <br />25.00 <br />40.00 <br />25.OO <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 />10.00 <br />15.00 <br />20.00 ,,r? <br />15.00 <br />15.00 <br />10.00 <br />15.00 <br />Subtotal <br />Penalty Fee (when applicable) <br />Violation Fee (s0.00) <br />Plan Chec*65%of subtotal STAO (minimum 20.00) <br />Receipt No.Pc#'/ 7 Date <br />Plan Check (Adiustment)i.zf, <br />lssuance *e 10.00 <br />TOTAL PERMIT FEE (minimum $35.00)€ <br />Erpktfo,r <br />This p€rmil shell expire by limitation and bacome null and void it lhe work suthdized by lhis <br />petmil B not commoncod wilhin IEO dsys rrom lhc dste ot this permit or il wort suthorizod by this <br />fprmit is suspsded or sbandonsd at any time alls the work i3 comrnenced tot I poriod ol l@ <br />days A new permil shsll b€ obtainod lirst belore such work csn be rrcommmcod. <br />AoDfcrta3 Nrdo.r <br />I certiry that I hevo r6ad this spplicalio and stste that the abovo intormatbn is corr61. I agr6 to <br />comply with all cily ordinancG and state laB rolsting to building cmEtuclion, and her.6y <br />aulhorizod rcprmnlrtion ol thB city to antor upon lhc <br />pu7po36.izr€e*Oate Applicanl or Agent (Sig <br />lor insp€clion <br />DATE l2-2u--t7 PERMIT NO. <br />BUTL'TNG a4bt> <br />PERMTT r'ro g__l_l_i vEHtFtEO By (Sig )+r PEBMTT rssuEo ev rsis1 Ln"(* <br />l2 -/o 84//-rVALIOATION (OFFICE USE ONLY)(ACCOUNT <br />'11-412) <br />Drstribulion I lnspeclor Copy 2. File Copy 3. Finance Copy 4. Appl,cant Copy <br />cs-6r8 <br />'4 <br />/ <br />lncidental Gas Piping <br />'15 00 <br />6a <br />Date Applrcant <br />(L.