|
JOB ADDRESS
<br />CITY
<br />b EACH FURNACE INCL. DUCTS AND VENTS
<br />EACH COMPRESSOS, BOILER, OR HEAT PUMP
<br />Heat Pump Compressor less than 5 HP
<br />Up to 100,000 BTU
<br />Ovell00,000 BTU
<br />! lndustrial ! Commercial
<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 25.00
<br />31 to 50 HP 30.00
<br />Over 50 HP 40.00
<br />EACH AlR HANDLING UNIT OR VAV BOX
<br />Oill;{ul.d.r O.drtbn
<br />I hsreby sltirm that I am exmpt lrom the Contrecto/s Lacenso Law lor tho lollowing reaon (S€c.
<br />7@1.5, Businas and Prol83sions Coda. Any city or counly which rsquirs 8 p€rmil to con3trucl,
<br />aller. improv6. domolish, or roptir arry Btrucluro. prior to its i$uance, also roquiros tho spplienl
<br />for $ch permit to ,il6 a signod strtomont lhal h6 6 licmssd pur3ust to lho provisions ot tha
<br />Contraclor's Licslo Law (Chapler I (comancing with S€ction 7@0) ot Oivision 3 ol tho
<br />Busin6s and Pror6sions Cod€) or that he i! exompt lhoretrom and the ba3rs for tlre all6g6d
<br />exmption. Any vrolslion ot S€clpn 7ctr|1.5 by any applicant lor a permit subi€cts th6 applicenl to
<br />8 civil p€nalty ot nol more lhan livo hundr€d (bllsr3 (t500):
<br />E S""tion Zolll l, as owner ol the property, or myemployoes with wages B theirBolecompon-
<br />sation. will do the work. and lh€ structure is not inlend€d or otlsed tor sale.
<br />E S*tion 70448 l, 6 owns ol lhe property, am exclusavely contrrting wnh licms€d
<br />@ntracloB to construcl lhe p,oist
<br />Date Owner (Sig.)
<br />Cont Eton t.l. Only
<br />-720
<br />STATE/ZIP ,7/75/
<br />PHONE
<br />cr
<br />I her€by allirm thel I am lcms€d under the provlsom ol Chapter 9.
<br />ProlGsrons Code, ild mv hconso rs(,il("!*.@Lz- c,*"
<br />oa'f*.iU-$. contracror
<br />andOrvisionPol tFusin6s
<br />in full lorce and gtlst.
<br />(sig )
<br />Range Hood with Duct and Fan (Type l)
<br />I
<br />2
<br />n
<br />15.00 7o.oo
<br />10.00
<br />10.00
<br />10.00
<br />Each Vent Fan Connecled to a Ducl
<br />Air less than 2,000 CFM
<br />2,000 CFM to 10,000 CFM
<br />Over 10,000 CFM
<br />MISCELLANEOUS
<br />Outdoor Dual Healing or Cooling
<br />Floor Furnace
<br />Heater: Suspended, Wall or Unit
<br />Com'l Dryer Vents
<br />Decorati\re Fireplace (Wood or Gas)
<br />Repair, Alt. or Add. to any SYS,
<br />25.00
<br />15.00
<br />15.00
<br />15.00
<br />15.00
<br />10.00
<br />15.00
<br />20, e'o
<br />/arttt
<br />tvoilm Coi?.rlalbn Oaclralbn
<br />I hereby alllrm that I hav6 a cortiticato ol @nsent to $ll-insurs. or I cerlilicetool Worktr's Com-
<br />I certaty that rn the fErlormance ollhe work lor which this
<br />person in tny manner $ s to be@me subloct to the Worke/s Comp€nsation Laws ot
<br />Califo.nis
<br />l{oto To Appll6l:
<br />ll attq maktng thts Certiftcale ol Eremptton. you should become subltrt to lhe Worker's Compen-
<br />Satron provrsrons Ol lhe Labor COde, yOU musl lorthwtth comply w[h such provrstons Or thrs
<br />permrt shall be deemed revoled
<br />t
<br />Oate Applicant (Sig.)
<br />building inspection deparlmant
<br />I shall not employ any
<br />Hmd with Ducl and Fan fl'ype ll)15.00
<br />(50.00)
<br />Fan Coil lnstallation
<br />Fire Extinguishing System
<br />Each Evaporative Cooler
<br />lncidental Gas Piping
<br />Fire Damper lnstallation
<br />by
<br />20.00
<br />15.00
<br />15.00
<br />10.00
<br />15.00
<br />Subtotal
<br />Violation Fee
<br />Penalty Fee (when applicable)
<br />Plan Check 65% ot subtotal rtr 6n (minimum 20.0O)
<br />Receipt No.Pc#Date7
<br />Plan Check (Adjustment)6 i{'o
<br />lssuance Fee 10.00
<br />TOTAL PERMIT FEE (minimum $35.00)+
<br />Erpkdon
<br />This p€rmit shall oxpire by limitation and bo@ma nult end void it the work authorizod by this
<br />parmat B nol commenc€d withln 180 days ,rom the dsto ol this permit or i, work 8uthorized by this
<br />p€rmil is suspad€d or abendongd al any timo alls tha work is commonc€d ,or a poriod ol 180
<br />days. A nd pdmil shall b€ obtained ti6t berora such work can b€ recommsncsd.
<br />AD9{cma'. D.drdcr
<br />I certity thal I hsve read this rpplicatim and st8t6 thlt tho aboe inlormstbn is correct. I aoroe to
<br />@mply with all city ordinanG and stete laB rglsting to buitding constuc{bn. and heroby
<br />authori2ed .oprosentstbn o, thi! city to ents upon tha eboFmmtioned pop€ity t6 iBp6ction
<br />lzaq frz**Applicant or Agenl (Sig )
<br />purpos6
<br />Dale o rE / 2- 7fifl PERMTT No.
<br />ByA.,li$" 5_1bl b u,^,,,,o ",)PERMIT ISSUEO BY (S'9 )
<br />CL d,
<br />Ul fi* f*"U <-4-/or/r TL-:27=nVVALIOATION (OFFICE USE ONLY)
<br />(ACCOUNT t11-412)
<br />eppr-icAnoN AND e
<br />MECHANICAL PERMIT
<br />(TYPEWRITE OR PRINT IN INK)
<br />o CITY OF SANTA ANA
<br />206 W. 4th Street
<br />667-2738
<br />4?,*
<br />APPLICANT FILL IN AREA BELOW
<br />(!q-oza
<br />ooI
<br />m
<br /><n
<br />U)
<br />\
<br />Oislrabution: t lnspector Copy 2. File Copy 3 Fiobnce Copy 4 Applrcant Copy
<br />cs-618
<br />filed
<br />(S€ )
<br />NO.EACH TOTAL
<br />15.00
<br />20.00
<br />25.00
<br />30.00
<br />/25.00 tlm
<br />15.OO
<br />\
|