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APPLTcATToN AND a <br />MECHANICAL PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />O CITY OF SANTA ANA <br />206 W. 4th Street <br />667-2738 /h* <br />APPLICANT FILL IN AREA BELOW <br />ogrIzo <br />ool, <br />m <br />U)a <br />JOB <br />R <br />cr <br />6 -r EACH FURNACE INCL. DUCTS AND VENTS <br />EACH COMPRESSOR, BOILER, OR HEAT PUMP <br />Up to 100,000 BTU <br />Over 100,000 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 />Heat Pump Compressor less than 5 HP /25.00 2r, rc <br />5HPto30HP 25.00 <br />3l to 50 HP 30.00 <br />40.00Over 50 HP <br />Orr-Bulld.r O.dr.lbo <br />I hersby arlirm lhat I am sxempl lrom tho Contrac,lo,'s Limsa Lew lor lhe lollowino rsaon (S6c. <br />781.5. Busrn* and Prof63ions Cod€. Any city or county which requirs a pormit to contlruct. <br />tlter, ampove, demolBh. or ropair any 3lruclure. prior lo its isuanca. also i€quirer th€ Spplimt <br />lor strch pdmit to ,ile a sonod ststemont that ho 6 licssod puBuent lo tha provisbns ot lh6 <br />Conlrac,lor's Licff3e Lrw (Chapl6r I (commencing with Seclion 7O0) o, Division 3 o, lh€ <br />gusiness and Prol€3sions Codo) or lhat he is exempl lhorefrom and lhe basis td lho sllsg€d <br />exmption. Any violalion o, Socl.on 7031.5 by any applicanl ror a pormil subiects the applicant to <br />8 civil penally ol nol more than tivs hundied dollars (0500): <br />E Section zOgl l, as owner ol lhe propsrly, or myemployffiwith wagB a th6ir sole compen- <br />salion. will (b the wort. and the slructuro is not intended or oltar€d lor sale <br />E S*tion 70448 l, I own6r ot lh€ propony. am oxclusively cmtr*ling with licans€d <br />@nlractm lo construct tho proiet <br />O.le <br />- <br />Owncr (SrC.) <br />I harsby etrrrm thal I am licmsod und€r the provisions ol Chaptr I <br />Cotrlrrton t.b. Only <br />rE/ztP <br />2 o <br />andoivisionyryPsin*s <br />Proretsrons Code. ild mv hcense rs <br />fiil,ffi" @7!_z .,u" <br />in full fq@ End etlst. <br />-2o <br />Contractor (Sig ),""1?-21..'? <br />EACH AIR HANDL]NG UNIT OR VAV BOX <br />Outdoor Dual Packaged Healing or Cooling <br />Bepair, Alt. or Add. to any Heating/Cooling sys. <br />Range Hood with Ducl and Fan (Iype l) <br />Each Vent Fan Connected to a Duct <br />Air Handling less than 2,000 CFM <br />2,000 CFM to 10,000 CFM <br />Orcr 10,000 CFM <br />Decoralive Fireplace (Wood or Gas) <br />MISCELLANEOUS <br />Com'l Dryer Vents <br />Heater; Suspended, Wall or Unit <br />Floor Furnace <br />10.00 <br />'t0.00 <br />10.00 <br />25.00 <br />15.00 <br />15.00 <br />15.00 <br />15.00 <br />10.00 <br />15.00 <br />15.00 <br />Zo,,to <br />?aoz <br />tlo.t.rt Coiplraibn Dadralbn <br />I hsoby aflirm thst I hav€ e cartali@te o, @nsmt to $ll-insur6, or e cdtiticate ol Workd's Com- <br />ponsrtion lnsqrance. Cerlited @py B til€dosto UlqnE\gre3 'l tv VdifisdBy(Sq) <br />o"r" lZ'27' g? <br />Appr,canr (s,s. ) <br />I cenrry lhal an the pertormancaolthswork ldwhichthis <br />potaon in any mennor so I to be@mo gubjecl to the <br />Calitornia <br />Notle To Appllcnt: <br />ll alts makrng lhrs Certrficateo, Eremptron. you should becomesub,et to the Workc/s Compen- <br />salon pfovrsrons ol lhe Labor Code, you musl lorthwrth comply wtth such provtsions or thrs <br />permrt shall be deemed revoked <br />with the <br />Date Applicanl (Sag ) <br />inspetion deparlment. <br />I shall nol mploy any <br />Comp€nsation Laws ot <br />Hood with Duct and Fan (Type ll) <br />Each o(by <br />Fan Coil lnstallation <br />Fire Damper lnstallation <br />Fire <br />Each Evaporative Cooler <br />20.00 <br />15.00 <br />15.00 <br />15.00 <br />15.00 <br />15.00 <br />10.00 <br />Subtotal <br />Penalty Fee (when applicable) <br />Violation Fee (s0.00) <br />Plan Check 65% of subtotat 57r{? (minimum 20.00) <br />Receipt No.Pc#Date <br />Plan Check (Adiustment)3,Zf <br />lssuance Fee 10.00 <br />TOTAL PERMIT FEE (minimum $35.00)+ <br />Eplrdon <br />This p€rmit shsll sxpire by limitstion and bocome null and void it lhe work suthdizod by this <br />permit E not commenced within 180 days lrom the dete ol this pormil or it work authorizad by this <br />pormit is suspend€d or abandoned at any lime atttr the work is commencod foi 8 period ol t8O <br />days. A n* ptrmt lhall b€ obt8inod llr3t b€fore $ch work can bg rgcommenced. <br />Aprlb.rft D.drdon <br />I cortiry thal I havs read thE applicalion and 3tata that the above inrormation is cqrct. I 4rc to <br />@mply wrth all city ordimnG and 3tate laws rolsting to buitding cmstuclbn. and hgreby <br />repr6entatbn ol this cily to enttr upon the abocmmtioned grccgly totauthonred <br />purpos6 <br />o""t1.-uq Atlplianl or Agent (Sig.)oArE /z PERMIT NO. <br />2!L2o*FrEo BY (sis.) <br />BUILOING <br />PERMIT No CL.PERMIT ISSUEO BY (Sig ) <br />6u//>L /L/- /ordrvALTDATTON (OFFtCE USE ONLY)(ACCOUNT 111-ill2)e I\ <br />Drslnbutron I lnspectorCopy 2 FtleCopy 3 FinanceCopy 4 Appticant Copy <br />cs-6 r 8 <br />4//o <br />NO.EACH TOTAL <br />15.00 <br />20.00 <br />25.00 <br />30.00 <br />lncidental Gas Piping