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-APPLrcATtoN AND a <br />MECHANICAL PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />o <br />APPLICANT FILL IN AREA BELOW <br />CITY OF SANTA ANA <br />206 W. 4th Street <br />667-2738 <br />u,c-ozo <br />oof, <br />ma(t <br />t <br />\ <br />NO.EACH TOTAL_rffHesidential Elndustrial ECommercial <br />EACH FURNACE INCL. DUCTS AND VENTS <br />JOB AOORESS <br />4//O <br />-F <br />MArLr^rG AEDRESs <br />CITY Cocb-25.00 <br />15.00 <br />20.00 <br />Up to 1@,000 BTU <br />100,000 BTU to 1,000,000 BTU <br />Over 100,000 BTU <br />EACH ABSORPTION SYSTEM <br />1,000,001 BTU to 2,000,000 BTU 30.00 <br />EACH COMPRESSOR, BOILER, OR HEAT PUMP <br />Heat Pump Compressor less than 5 HP /25.00 2f,-ttt <br />25.005HPto30HP <br />31 to 50 HP 30.00 <br />40.00olrer50 HP <br />EACH AIR HANDLING UNIT OR VAV BOX <br />Orrrr€u[d.r D.drlbo <br />I horaby alrlrm thrt I 6m oxmpt lrom the Contracto/s Liffise Ltr td the tollowing rsason (Soc. <br />7()31.5. BuJin€3s and Protffiions Code. Any city 07 county which r€quiros a pormit to construcl. <br />alts., improve, domolEh, or repair any struciurs. praoT lo its isuanco. alrc roquiiB lh6 applicSnl <br />tor $ch p6mil to ,ile I sign€d slalem€nt lhst he i! lacmsad puBuml lo the ptovisbns ol lhe <br />Conlraclor's Licms Ls (Chaptd 9 (commoncing wilh S€clion 7@0) ol Oivision 3 ot ths <br />Bu3anes and Prol6sims Code) or thal he is sxsmpt th€Terrom 8nd th6 baE td the allog€d <br />exmption. Any vaolslion of S€cllon 7031.5 by any applicanl lor a p€tmat $biocG the applicant lo <br />a civil p€nalty ot rct more lhan tive hundr€d (bllars (tso): <br />E S*ron zoal l, a owner o, the propony, or myemploye$with wag6 a their solecomper <br />sation. will (b the work. and ths structure is nol anlmd€d or olter€d ,o7 381e. <br />E S*tion 7o.l4B l. I owntr ol lhe properly. am axclu3ively contreting wilh licensed <br />conlractoB lo construct the proiet. <br />Date Owner (Sig.) <br />Contrrton ll. Only <br />,/aCITYST <br />AOORESS (llrt t r-?oo <br />Outdoor Dual Packaged Healing or Cooling <br />Range Hood with Duct and Fan (Type l) <br />10.00 <br />10.00 <br />10.00 <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 />Decorati\,e Fireplace (Wood or Gas) <br />Repair, Alt. or Add. to sys. <br />25.00 <br />15.00 <br />15.00 <br />10.00 <br />15.00 <br />15.00 <br />15.00 <br />I <br />I hs6by sttirm thet I em liconsed under lhe provBion8 of Chaptor 9. Divirbn <br />Prol{srons Code. sd my lrcense rs <br />l""4"tL r91t7 "'*, <br />orr" ILZ?$? conrractor <br />and3YWn* <br />-,c <br />in tull lorce and etlet <br />Each Vent Fan Connected to a Duct ?15.00 {f.oo <br />I 20.00 Ao.tt) <br />15.00 <br />15.00 <br />10.00 <br />15.00 <br />Fire Extinguishing System <br />Each Evaporative Cooler <br />Fire Damper lnstallation <br />Each Appliancs or Equipmenl Regulated by <br />lhis fuo but mt smiticallv listed abow <br />Fan Coil lnstallation <br />lncidental Gas Piping <br />15.00 <br />7a,o-z.t <br />Wod(ar Coip.naalbn Dadrtbo <br />I hseby atlirm thst I hev€ a ertilicste ol @nsmt to slt-insure. or a cerlilicale ol Workd's Com- <br />I certity thal in thepedormanceolthewo.k tdwhichthis <br />person rn any manner $ as to be@me subiecl lo the Worke/s Comp€nsalron Lils ol <br />Calilomra <br />150c. To ADgllc'rl: <br />l, atttr making thr3 Certiticateol€xemplim. yoush@ld bo@m.subicl lolheWsk"t/sCompeft <br />sotion prdrsims o, the Labor Code. y@ m6l lonhwith comply with sch prflBims d lhis <br />!E mil shall b€ demed raoked. <br />with the <br />I shsll rcl employ any <br />O8te <br />- <br />Applient (Sig.) <br />inspeclron dapartment <br />Hood with Duct and Fan (Type ll)15.00 <br />Subtotal <br />funalty Fee (when applicable) <br />Violation Fee (s0.00) <br />Plan Check 650/o of subtolal (minimum 20.00) <br />Receipt No.Pc#Date <br />Plan Check (Adjustment) 67/7 s-21" <br />Erdr.tbn <br />This permit shall expire by limitetion end become null snd void il ths work 8uthoriz6d by this <br />permit 6 nol commenced within 180 days lrom the dato ot this permit or i, work authorized by this <br />fErmrt is suspended or abandonad et any lime attd the worl ig commenced ,or a period ot 'lEO <br />days. A n* psmit shall be obtsinod liBt bsforo such work can bo recommencsd. <br />Appab.nll O.clrr0cr <br />I certily thst I havo read th6 applac8tion and slste thal lhe above inlormation is coarecl I sgrs to <br />comply wilh all city ordinanc€s and state lsws relating to building con3tuclion. and horeby <br />aulhorazed rcprBanlltion o, this city to entd upon lrE aboFmentionad prop€rly tor insp€ction <br />:::;fufi App,icanr n on n,,"',@ orE /2- <br />lssuance Fee <br />TOTAL PERMIT FEE <br />10.00+(minimum $35.00) <br />PERMIT NO. <br />VERIFIEO BY (S€ } <br />BUILDING <br />PERMIT PERMIT ISSUEO BY (Sig ) <br />AZ 7/-tof{r I 1-VALIOATION (OFFICE USE ONLY) <br />(ACCOUNT ,r t-412) <br />Oistributron 1 lnspector Copy 2 File Copy 3 Frnance Copy 4 Applicant Copy <br />cs-618 <br />2-G <br />oo <br />my'-,,.sa ?Z-