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epplicAnoN AND I
<br />MECHANICAL PERMIT
<br />(TYPEWRITE OR PRINT IN INK)
<br />o CITY OF SANTA ANA
<br />206 W. 4th Street
<br />ffi7-2738 ,fu
<br />APPLICANT FILL IN AREA BELOW
<br />(I)grIzo
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<br />JOA AOORESS -4-
<br />ING
<br />Ef?esidential !lndustrial OCommercial NO.EACH TOTAL
<br />EACH FURNACE INCL. DUCTS AND VENTS
<br />Up to 100,000 BTU 15.00
<br />Over 100,000 BTU 20.00
<br />EACH ABSORPTION SYSTEM
<br />100,000 BTU to 1 ,000,000 BTU 25.00
<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
<br />5HPto30HP 25.00
<br />3'l to 50 HP 30.00
<br />Orcr 50 HP 40.00
<br />EACH AIR HANDLING UNIT OR VAV BOX
<br />Air Handling less than 2,000 CFM 10.00
<br />2,000 CFM to 10,000 CFM 10.00
<br />Over 10,000 CFM 10.00
<br />MISCELLANEOUS
<br />Outdoor Dual Packaged Healing or Cooling 25.00
<br />Floor Furnace 15.00
<br />Heater; Suspended, Wall or Unit 15.00
<br />Com'l Dryer Vents 15.00
<br />Decorative Fireplace (Wood or Gas)15.00
<br />Repair, Alt. or Add. to 10.00
<br />Range Hood with Duct and Fan (Type l)
<br />Omrlunfit o.drrlblr
<br />I heraby alrirm lh8t I am sxmpt lrom the Contrecto/s Licms Las ,or lh6lollosing roson (S€c.
<br />7031.5, Eusin6s 8nd Prol6sions Cods. Any cily or county which r€qui1o3 r p€rmil lo construct.
<br />all6r. improv6, domolBh, or r€pair any slructu16, prior to ils isuance, al3o l€quiroE tha applicsnt
<br />lor sch permit to tile 8 sign€d statsmenl thsl he b licons€d puBuml lo tho provisions ol lho
<br />Contrsclor's Licmss L* (Cheptar 9 (commoncing with Smlion 7(x)0) o, DivBion 3 ot the
<br />Eusin* and Pror6saons Codo) or that he i3 exgmpt tlErelrom 8nd the b&!i! ttr the ellgg€d
<br />exomption. Any viol8lion ol Selaon 7031.5 by any spplicanl tor 8 Fsmit $tt ocls the spplicant to
<br />a civil penally ot not mora lhan tive hundr€d doll6'3 (ts@)l
<br />E S*tion ZO44e l. s owns o, the propsrty, or myemployffiwilh wag€3 rs lhei.solecomp€n-
<br />gation, will do the wort, and the 3lrucluro is not intended or otltrod tor sale.
<br />E S*tlon 70448 l, as own6r ot the propsrty. am exclusiv6ly contreling with licon3od
<br />cDntraclors to coBtruct lhe proiml.
<br />Oate Owner (Sig )
<br />Cmlncton t.b. (hly
<br />I hereby aftirm thal I am licmsod under th€ piovisions olChaptd 9. Division 3 o)1p'"'no
<br />ProlGsronswq0
<br />Lrc6nse No
<br />Code. gld my lacense is an tull ltrc. 8nd otltrt.
<br />SAlh- ",o" 4'20
<br />o"," 124? {f1 contr8clor (sie }
<br />Each Vent Fan Connected to a Duct 15.00
<br />Fan Coil lnstallation 20.00
<br />Fire Extinguishing System 15.00
<br />Each Elaporatiw Cooler 15.00
<br />lncidental Gas Piping 10.00
<br />Fire Damper lnstallation 15.00
<br />or by
<br />Hood with Duct and Fan Oype ll)15.00
<br />Subtotal
<br />Penalty Fee (when applicable)
<br />Violation Fee (50.00)
<br />Plan Check 65% of subtotal (minimum 20.00)
<br />Lo,r1
<br />Uo.tart Co.rparlabn Oadribo
<br />I hseby arlirm that I havo 8 cartiliete o, @nsl to sltinsure, or a @rtalicateol Worttr's Coft
<br />Certitied @py is tilod withEEnsation inspeclion department
<br />Oate
<br />Expires 0 Vsalied By (Sig.)
<br />Oate Applrcant (Si9.
<br />I certity that in ths thework lorwhichthis I shall not any
<br />pe6on in any manner s es to be@me subjecl to the Worker's Compensation Lils ol
<br />Calrlornia
<br />Dale Applicent (Sig )
<br />]{olc. To ADpalcrtt:
<br />lt 8rt6( making this Cortilicatoot Exemption. you should bocomesubiacltolheWort6/sCompor
<br />Salion provisions ol llE Lebor Code. you must ,orthwilh comply wilh such prei3ions or lhis
<br />permit shall be dsamod rsvoked.
<br />) D,tlo
<br />/afi fl
<br />Erd?ibo
<br />This permil shall expire by limitation and become null and void ir lhe work authdi2sd by lh6
<br />p€rmit is not commenced within 180 dey3lrom the dal6 ol this psmit q it wort !uthorized by thb
<br />p€rmil is suspend€d or abandonod at any tim€ atls lho work is cornmenced lor I period of 180
<br />days A nev permit Shall be obtainod tiBt b€rore $ch work mn be recommencod.
<br />AD9lc.ol'. Nrdo.r
<br />I certily lhst I have road this applicalion and stats that the abfla inlormation B corroct. I a0r6 to
<br />@mply with all city ordinancG and st6te laws relating to building constuciion. and horoby
<br />authorized roprBantation of this city to ents u[pn the abovemtrtioned prop€rty lor insBclim
<br />:::"fu.fr Appric.nrof Ac6nr (sis) &/4, t
<br />Receipt No.Pc#Date
<br />Plan Check (Adjustment)/?,oo
<br />lssuance Fee 10.00
<br />TOTAL PERMIT FEE (minimum $35.00)+
<br />DAIE /)-2147 PERMrrNo. 1,37 5.4
<br />Bi'l[?i$. 5fu7,.,,.,=o u",",n,{/PERM,T TSSUEO " t",g1 -'h-b *f cL
<br />fu (rr*pr-Z e?, ,//- /o8/rVALIDATION (OFFICE USE ONLY)
<br />(ACCOUNT f1r-4r2)l)
<br />Dislribution I lnspeclor Copy 2. File Copy 3 Finance Copy tl. Applicant Copy
<br />cs-618
<br />.4//0
<br />I 20ta
<br />15.00
<br />4
<br />/
<br />15.OO
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