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KQesidentiat E lndustrial E Commercial NO.EACH TOTAL'TTB'," ,le.^to-Lo Vit-l4r/- oe- <br />"Yrr-r/-1,*),.r1) ) C ., * .'q+b-nI)o/pxor.rE <br />ING A <br />q zbzuL- <br />STATE/ZIP"'lL.b}lr^*(_ <br />I 5FIXTURES <br />MISCELLANEOUS <br />each plumbing lixture/trap <br />Temporary Gas Service <br />Dental Unit or Medical Gases <br />SEWER <br />1st 100'+Conn. <br />Ea. Add'l Conn. <br />Ea. Add'l 10O' or Fraction <br />Private Sewage Disp. System <br />PIPING <br />GAS SERVICE 1 to 4 Outlets <br />Ea. Add'l Outlet <br />Gas PipingRepair or <br />5.00 <br />10.00 <br />15.00 <br />30.00 <br />5.00 <br />5.00 <br />5.00 <br />100.00 <br />'r.00 <br />5.00 <br />Our.r-Au[&? Oadralbn <br />I heraby sltrrm lhal I am erempl trom lho Contraclor's License Law loi tha lollowing rcBon (Sec <br />7031.5. Busine$ and Prorossions Cod€. Any city or county which roquirs 8 pormil to construcl, <br />aller, improve. domolilh. or repair any slructure. prior lo its assuance. also Taquiras th6 applicant <br />tor such pormit to ,il€ a signed statemonl ttlat he is licensod pursuent lo ths provirions ot tho <br />Contrrclo.s Lrcons Lru (Chapls I (commencing with S€ction 7m0) ot Oivision 3 ot the <br />Eusrns3s and Prote$ims Code) or lhat he is orempl theratrom and tha besis lor the alleg€d <br />€xgmption AnyviolationolSoction7@1.5byanyapplicrntlorap€rmitsubiectslh€applicsnlto <br />a civil penalty ot nol more than rive hundrod (bllsr3 (1500): <br />E SrectionTO44A l.ssowneroltheprop€ny,ormyemF,loyoerwithwag€saslhoirsolocompsn- <br />salion. will do th6 nort. and tho strGturs is ml intmded or otlerad ,or sal6. <br />E S*tion 7(N48 l. as omor ot th€ propeny. tm oxclusivoly cmtrrciing wilh lic.nrad <br />conlracloB lo construct thg proiecl. <br />Date Owner (Sig ) <br />/5.00 5- <br />Conlrrclon t !c Only <br />10.00 <br />L7Y- d7 6 7 <br />PHONE <br />8.00Wtrfi^;,-L Llllinb*,; <br />Water Heater - Electric or Gas <br />Rain Whter Piping (buried) Ea. 100' <br />Water Softner <br />Water Piping Ea. 100' <br />4.00AOORESS <br />Alt. or Repair of Drainage - Vent Piping 10.00STATE/ZIPq233a Lawn Sprinkler I 6.00 <br />Rain System - Per Drain 10.00 <br />lnd. Whste lnterceptor 8.00 <br />Pool Traps 5.00 <br />I hereby aflirm lhal I am lac€n$d under lhe provisions ol Chapler 3orth€ <br />Wt:: <br />Contractot <br />Code, and my license rs in lull lorca and etlect. <br />Deck Drain System - Per Drain 3.00 <br />Repair/Alt. Drainage or Vent 10.00 <br />Vacuum Breakers 1-5 1 5.00 <br />1.00 <br />1 5.00 <br />10.00 <br />/10.00 <br />3ubiact to the Workg/s Comp€Nlion Lr3 ol <br />Lo0c. To Appllcil: <br />ll atier makrng lhrs Cerlricate ol €xemption. you should become sublel lo lhe Worker's Compen- <br />provrsrons ol lhe Labor Code. you must torlhwrlh comply wrlh such provrsrons or this <br />shall be demed revoked <br />ol Wo.i(a. s Com- <br />the <br />Verilied By <br />Applicanl (S,9.) <br />Dale Applicant (Srg ) <br />I hergby alfirm thal I have <br />pensatron lnsuTance <br />this parmit rs issuod, I shall nol smploy any <br />Oclfrtlon <br />of consonl to $lt-insure, or <br />copy is tiled wilh the City <br />in eny mnner so as to <br />Calrfo.nra <br />Oate <br />Exprres <br />Plan Check 65o/o of subtotal (" <br />Owr5 <br />Device 2" or Less <br />Over 2" <br />Water Service Ea. 100' <br />Subtotal <br />Penalty Fee (when applicable) <br />Violation Fee <br />Pc#Receipt No. <br />Check (Adlustment) <br />(s0.00) <br />Date <br />(minimum 20.00) <br />lssuance Fee <br />TOTAL PERMIT FEE <br />Erplr.don <br />This permrt shall oxpir€ by limitatio and bocome null and void it the work authdized by lhis <br />rs nol commenc€d within 180 days lmm lho dato ot this permil d il work authorizod by this <br />is susp€nded or sbandoned at any time stler lhe work is commncod tor a p€riod ol l8O <br />A nor pormit shell ba obtrincd ,i6t bgloro such wort can bo rEcommoncsd. <br />ArDlcd'. O.drdor <br />I corlity lhsl I have rs6d lhis rpplicalim 8nd thal the lbove <br />Applrcant or Agent <br />lo <br />towrth all and stste <br />of this city to ents '10.00 <br />o4 <br />?i*3,is.5%17 (Sig 1 ^b PERMIT ISSUEO 8Y <br />(ht- k7 7a 7 7 O-/tosptt-a-!J-(ACCOUNT r-41 2) <br />e oAPPLICATION AND <br />PLUMBING PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />CITY OF SANTA ANA <br />206 W. 4th Street <br />667-273€f?-- <br />APPLICANT FILL IN AREA BELOW <br />trg-ozo <br />oo <br />f, <br />ma <br />Dist,ibutaon 'l lnspector Copy 2 Frle Copy 3 Finance Copy 4 Applicant Copy <br />CS-61 1 <br />//<- <br />z <br />5- <br />E(minimum $il5.00) <br />I