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'V't"; Ah" t* Whzr-,th, - ) <br />YL lrt,rr.,l- Ct"r*-;*r-*41-dt/o <br />PHONE <br />uAtt-tNc lSDREqs L , <br />? 3 /f z2l-t-t<zt <rKZ - <br />c'tt @ahfuy"-"a-'Hffi2* <br />I(Residential !lndustrial ECommercial <br />EACH FURNACE INCL. OUCTS ANO VENTS <br />Up to 100,000 BTU <br />Over 100,000 BTU <br />EACH ABSORPTION SYSTEM <br />100,000 BTU to 1,000,000 BTU <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 I 25.00 ?fr oo <br />Ourr€dLLr D.djtbn <br />I heteby alrirm that I am exmpt lrom lho Contrsclor's Licms Law ld the lollowing rs8m (Soc. <br />703t.5. Busine3s and ProlBsions Code. Any cily or county which r6quires a pormil to con3truct, <br />alto7, improve. demolBh. or ropair any structuro. prior lo ilg isuancs, also roquirB tho q)plicanl <br />lor sch psmil lo lilo I signod 3tatgment lhst ho is licensod puGuanl lo ths provisions ot tho <br />Contrector's Lictrso Lil (ChrptE 9 (commsncing wilh S€clion 7O0) ot Oivision 3 ol the <br />Bu3in63s and ProlBsions Coda) or that ho is erompt thergtrom and the b8b lor tfu alloged <br />examplion. Any violllion ol Soclion 703I.5 by 8ny applicant tor I parmil $bjets the appllcant lo <br />a civil penally ol nol more lhan tivs hundr€d dollars (35m)i <br />E Section zOge l. as ownor ot lhs property. or my6mploy6s with wag€s astheirsolecompor <br />s8lion, will do the wort, and tha slruclure is not intsnd6d or otldod tor sale. <br />E S*tion 70448 l. I own6r ol the proporty. am exclusivaly contracting with licensed <br />conlracl06 lo construct the proiel <br />Date Owrer (Sig ) <br />I hereby alirm thst I am ltcens€d under lhe provisaons o, Chapts 9. Oivision <br />Cdtrx{o[ l,.lo Only <br />CITY STA*14^r 6a <br />3.ytlfra9in*srdd <br />Code. md my licens is in lull lorce and ettect <br />Cl6s <br />orr"l7-3,?fr @nrr8cro, (sie ) <br />Pro16sronst,if?!*"irv1n <br />EACH AIR HANOLING UNIT OR VAV BOX <br />Outdoor Dual Packaged Healing or Cooling <br />Repair, Alt. or Add. to any Heating/Cooling sys <br />Bange Hood with Ducl and Fan (Type l) <br />0t 0O <br />or by <br />abow <br />5HPto30HP <br />Fire Damper lnstallation <br />31 to 50 HP <br />Over 50 HP <br />Air Handling less than 2,000 CFM <br />2,000 CFM to 10,000 CFM <br />Owr 10,000 CFM <br />MISCELLANEOUS <br />Floor Furnace <br />Heater; Suspended, Wall or Unit <br />Com'l Dryer Venls <br />Decoratiw Fircplace (Wood or Gas) <br />Each Vent Fan Connected to a Duct <br />Fan Coil lnstallation <br />Fire <br />Each Evaporative Cooler <br />lncidental Gas <br />25.00 <br />40.00 <br />30.00 <br />10.00 <br />10.00 <br />10.00 <br />25.00 <br />15.00 <br />15.00 <br />15.00 <br />10.00 <br />15.00 <br />15.00 <br />20.00 <br />15.00 <br />15.00 <br />10.00 <br />15.00 <br />1 <br />/0i n <br />Wortm Con?.ratbn Oadr.lbn <br />I htreby stlirm that I hsve a certilicato ol @nsmt to sll-insure. or r certiticate ol Wort-'s Com- <br />I cofiity thal in tho portormanceol ths work lorwhich <br />p6Bon in any manngr so as to becom€ subjecl <br />Celitornia <br />iloto To ADgllcrt: <br />lf alls makrng lhrs Certrficate ol Exemptron. you shoutd become subitrt to the Wo,ke. s Compen- <br />sal,on provrsrons ol the Labor Code. you must torthwith compty with such provisions or this <br />fErmrl shall be deemed revoked <br />with lho <br />Oate Appricanr (sig.) <br />inspection department. <br />I shall rct employ any <br />lo the Compensation Laws ol <br />/?oa <br />10.00 <br />Hood with Duct and Fan (Type ll) <br />Plan Check 65"/o of subtotal / <br />15.00 <br />(minimum $35.00) <br />Subtotal <br />TOTAL PERMIT FEE <br />Fenalty Fee (when applicable) <br />lssuance Fee <br />Violation Fee <br />Plan Check (Adjustment) <br />(50.00) <br />(minimum 20.00) <br />DateReceipt No.Pc* <br />-e- <br />Erdribo <br />This permit shall exparo by hmitatrm and be@mg nul md void il the work authoriz€d by thispermrt6rcl@mmoncedwithin 180daystromthedateolthispsmatdilwortauthorizedbythis <br />permit is suspmd€d or ebandoned at any lime stts tha work is cmm€ncad lor a p€riod ol .l0O <br />days A nil p6mrl shall be ootrined liBt betore sch work can b€ reommmced. <br />Aeplc.lrt.t O.dr.alsr <br />I cerlily lhst I have read this spplicalim and 3tate that lhe sbove intormalion is sret. I agroo to <br />@mply with all city ordinanG and state laffi rolating to buitding cmstuclion. and heroby <br />authorized rsgr6entAtion o, lhis cily tO entAr upon th€ aboFmentioned prcptrty lor inspoctim <br />Applicanl or Agsnt (Sig.):::tu*D rE /)-?fr.6? PEFMrr r,lo. 1 3 7 5 5 <br />E!*',ffi$" ilbl&r,F,ED By (sis )PERMrrrssuEoBy($s) - l',lrS- el'V <br />knL //- /af/fUSE ONLY) <br />2l a-u <br />APPLicAnoN AND t <br />MECHANICAL PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />o CITY OF SANTA ANA <br />206 W 4th Street <br />667-2738 /ft,,- <br />APPLICANT FILL IN AREA BELOW <br />q,g-Izo <br />ooD <br />maa <br />S.s <br />(a <br />Orstflbutron t lnspecto, Copy 2 Ftle Copy 3 Frnance Copy 4 Applicant Copy <br />cs-618 <br />NO.EACH TOTAL <br />15.00 <br />20.00 <br />25.00 <br />15.00 <br />4 <br />I <br />PHONE <br />O