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'5Pi6? sNwA re uir.ree # e <br />OWNER <br />Sulftowoa- ASSa-,4qa-otto <br />PHONE <br />b3\s fa\nurlc RD <br />MAILING ADDRESS <br />CITY <br />C.csrn rv\esA. <br />STATE/ZIP&, 1z62a <br />5.00 <br />10.00 <br />c4 <br />I <br />FIXTURES <br />each plumbing fixture/trap <br />Dental Unit or Medical Gases <br />SEWER <br />1st 100'+Conn. <br />Ea. Add'l Conn.5.00 <br />Ea. Add'l 10O' or Fraction 5.00 <br />ftivate Sewage Disp. System 30.00 <br />Oxr!.r-Bdl(br O.d-tfbn <br />lhereby atfirm that lam exmpl trom lhe Conlraclo/s Licms L8w ld the lollowing reason (S€c <br />7(I)1 5. Busrnoss and Prole6srons Code. Any city or county which roquiros r permil to construcl, <br />aller. rmprova. domolish. or rsp6ir any struclur6, praor to rts i$uanco, dso r6quirgS the applic8nt <br />lor such permit to ,ile I s€ned slllemont that he is lrcens€d pursuanl lo the provisions ol lhe <br />Conlractor's Licm3. Law (Chapler 9 (commencing wilh S€ction 7@0) ot Oivision 3 ol lhe <br />Busrn6s and Proldsaons @de) or lhal he is exempl lherelrom and the bssis lor the allegod <br />eremption. Any violahon ol Soclion 7031.5 by 8ny rpplionl lor r p€rmil subiEls the 8pplicant to <br />e crvil pemlty o, not more th6n liv€ hundred dollaB (35@): <br />E S*tionlola l.ssowneroltheproporty,o.myomployeBw(hwag€sasth€irsolecompon- <br />salion. will do tha wort, and the slructuro is nol intendod or orler€d ,or s8le. <br />E S."tion 7(N4B l. as own6r ot ths prop€rty. rm exclusuely conlrscting wrth liconlod <br />conlncloB to conslruct thg prol€cl. <br />Oste Owre. (Sr9 ) <br />Conhtctoo L,'. Ooly <br />CONTFACTOR"iilgrh <br />nnt rc rt L ftPpicn na,07{-ot07 <br />PHONE <br />CITY ,- L,qtg EkrataLe t"'^Vbgzo <br />I hereby lhst I em lrcmsed under lhe provisions o, Chapter 3olthe Busin6s <br />Contrsctor (Sig ) <br />and ellftt.lnts lorce rnd3LlullcClass <br />sub,ecl to lhe Work6r's Compensalion Laws ol <br />t{olb. Io ADglb0l: <br />ll slls makrng thrs CslrlcateolEremptron, you should become sublet to the Wdker's Comp€n- <br />setton provrsrons ol lhe Labor Code, you must torthwith comply wrth such provistons or lhis <br />p€rmrl shall be demed revoled <br />ol Worter's <br />that lhe perlsmanceollheI <br />Oate Applicant (Si9.) <br />Dclr.llon <br />ol @nsent toI h€reby attirm thal I haw a <br />Cortified copy is tiled with the City <br />VeriliedExpires <br />whichthisperm( is issu€d. I shall nolemployany <br />Calafornra <br />Applicant (Sig.) <br />rn any manngr s a lo <br />pamalion <br />Oate <br />Erdr.llO <br />This tErmil 3h8ll expiro by limit8lion and bcom6 null and void a, lhe mrk sulho(izod by thi! <br />p€rmit i3 not commonc€d within t80 days trom the dsr6 ol lhis pormil or il work authorizod by thig <br />permit i3 sBp€ndod or abendongd rt any time afttr the wort is comaEncod tor s p€riod ol '180 <br />deys. A n* permit shall bo obtEinsd lirst b€tore such worl can be rgcommenc€d <br />Atlc.nllO.ddo <br />I have road lhis appliolaon and stlle lhet th€ sboE <br />all ordimncB and state laws relaling to <br />Applicanl or Agent <br />I a0r6 <br />and <br />of lhrs city to enter upon the <br />I cerlity lhal <br />comply with <br />authonzad <br />purpos <br />10.00 <br />\ <br />I <br />IReceipt No.9 Pc# <br />Water Service Ea. 100' <br />Over 2" <br />Backtlow Device 2" or Less <br />Orcr5 <br />Vacuum Breakers 1-5 <br />Bepair/Alt. Drainage or Vent <br />Deck Drain System - Fer Drain <br />PIPING <br />GAS SERVICE 1 to 4 Outlets <br />Ea. Add'l Outlet <br />Repair or Replace Gas Piping <br />Gas Service <br />MISCELLANEOUS <br />Water Heater - Electric or Gas <br />Water Piping Ea. 100' <br />Rain Water Piping (buried) Ea. 100' <br />Water Softner <br />- VentAlt. or Repair of <br />Sprinkler <br />System - Per Drain <br />lnd. Waste lnterceptor <br />Traps <br />5.00 <br />'100.00 <br />1.00 <br />5.00 <br />5.00 <br />10.00 <br />10.00 <br />10.00 <br />8.00 <br />5.00 <br />4.00 <br />'r.00 <br />10.00 <br />5.00 <br />6.00 <br />'t 0.00 <br />10.00 <br />3.00 <br />8.00 <br />5.00 <br />Subtotal <br />Penalty Fee (when applicable) <br />Violation Fee <br />Plan Check 650/0 of subtotal <br />Plan Check (Adjustment) <br />lssuance Fee <br />TOTAL PEBMIT FEE-q-DATE <br />(s0.00) <br />(minimum 20.00) <br />Date <br />fl',:ts. gw VERIFIE (s'9 )- <br />(F)- <br />PERMIT ISSUED AY <br />A1t_ leCS pD ofu t^_o?q? <br />.Y):o ful-2l <br />o oa <br />APPLICATION AND <br />PLUMBING PERMIT <br />(TYPEWRITE OR PBINT IN INK) <br />CITY OF SANTA ANA <br />206 W 4th Street <br />667-273a <br />APPLICANT FILL IN AREA BELOW <br />q,g <br />Iozo <br />oo <br />f, <br />m <br />U,a <br />Hs <br />Orslnbulron 1 lnspector Copy 2 File Copy Frnance Copy 4 Applicant Copy <br />cs-6r 1 <br />XResidential Elndustrial ECommorcial NO.EACH ToTAU <br />n <br />15.00 <br />\5e <br />i <br />-p- <br />.<EIA <br />--toq <br />ns93. <br />(minimum $35.00) <br />(sig )