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I o <br />APPLICATION AND <br />PLUMBING PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />CITY OF SANTA ANA <br />206 W. 4th Street <br />667-273€W <br />APPLICANT FILL IN AREA BELOW <br />(Dc <br />I <br />9zo <br />oo <br />f) <br />mo) <br />o) <br />\ <br />*T75'i )rrft-Yo U)llr.z, *G. <br />"ffr-JJ*,,r,- fiour,-- . <br />.flioNEuq4lo- E // b <br />Cl <br />Our.r-Bdld.r O.dr.lbn <br />I hereby atlarm that I am exempt trom the Contraclor's Lrcmse Law lor the lollowing reason (Sec. <br />7031 5. Business and Pror6sions Code. Any city or county which .€quiras a pormil lo construct. <br />alter, improre. demolBh. or repair any structure. prior lo ils itsuance. al3o roquiras the applicant <br />lor such permit to lile 8 3igned statemenl lhal he is licensed pursuant to tho provisions ot the <br />Contrsclor's Licens€ Law (Chapter I (commencing wilh Setion 7(m) ol Oivision 3 ot the <br />Busines and Pror$ron3 Code) or lMt ha rs axompl thorerrom and the b63i8 tor the alloged <br />oxmption. Any violstrm ol Section 7m1.5 by 8ny applrcanl lor a p€rmat subiocls the spplicrnt lo <br />a civil penally o, not mor6 than riva hundrBd dollaE (tsoo)l <br />E S*tion 7(x4A l. as ownsr ol th6 proporly. or myemploy$s wrthwag€sas thearsolocompen- <br />salion. will do the mrt. rnd the gtructure is rcl inlmdod or otldsd lor sale <br />E S*tlon 70448 l, as owner ol the properly, am axclu8ively cont.actrng with licons€d <br />conlraclors lo conslruct the prolet <br />Oale Owner (Sr9 ) <br />Conlrcto[ t r. Only <br />B€sidential !lndustrial ECommercial <br />Alt. or Repair of Drainage - Vent Piping <br />5- <br />NO.EACH TOTAL <br />5.00 <br />10.00 <br />15.00 <br />30.00 <br />5.00 <br />5.00 <br />s.00 <br />100.00 <br />1.00 <br />5.00 <br />Water Heater - Electric or Gas <br />Water Piping Ea. 100' <br />Water Softner <br />Rain Water Piping (buried) Ea. 100' <br />5.00 <br />10.00 <br />10.00 <br />4.00 <br />8.00 <br />Dental Unit or Medical Gases <br />Temporary Gas Service <br />SEWER <br />Repair or Replace Gas Piping <br />'lst 100'+Conn. <br />Ea. Add'l Outlet <br />Ea. Add'l Conn. <br />GAS SERVICE't to 4 Outlets <br />Ea. Add'l t00' or Fraction <br />Prilate Sewage Disp System <br />PIPING <br />each plumbing fixture/trap <br />FIXTURES <br />/.7 4-070 7 <br />PHONE <br />J*t-bz-? --t <br />"'" Xr-L, f/o STATE/ZIPQ773o Larn Sprinkler 6.00 <br />Rain System - Per Drain 10.00 <br />lnd. Wbste lnterceptor 8.00 <br />. Pool Traps 5.00 <br />I hereby affirm lhat I am licensd unde, the provisions ot Chapter 3ol the Busia/ <br />(SE ) <br />my licens is in lull lsce and ellect <br />Deck Drain System - Per Drain 3.00 <br />Repair/Alt. Drainage or Vent 10.00 <br />Vacuum Breakers 1-5 I 5.00 <br />1.00Owr5 <br />d/rfi*, Danice 2" or Less 5.00 <br />10.00 <br />10.00 <br />taodc. To ADellcrl: <br />It aller mahrng thrs Cenrficateo,Eremplron. you should b6omesubistlotheWorke/sComp€n- <br />provrsrons ol the Labor Code, yo must lorlhwilh comply wilh such provisaons or this <br />shall be dsmed rsvoked. <br />Wo,t6r's Com- <br />Vefl fied <br />Calilornia <br />I hereby sltirm thal I have 8 <br />OGlratlon <br />ol @nsml to sll-insure. <br />copy is liled wrth the Cily <br />Applicent (Sig.) <br />lhe perltrmErceolth€ <br />subjoct <br />pensatron lnsuaance <br />Oats <br />- <br />Applicanl (Sig.) <br />this permit is issusd, I shall not6mployany <br />to the Wo.ke/s Compen$lion Laws ol <br />Oate <br />Erprres <br />L8.79 (minimum 20.00) <br />Pc#2Q l$ oate <br />(s0.00) <br />Over 2" <br />Water Service Ea. 100' <br />Subtotal <br />Fenahy Fee (when applicable) <br />Plan Check (Adjustment) <br />Violation Fee <br />Plan Check 650/" of subtotal <br />Receipt No. <br />lssuance Fee <br />TOTAL PERMIT FEE <br />DATE PERMIT <br />10.00 <br />o- <br />Errr.do.r <br />ThB p€rmit shall erpirs by limitrlion end bocomo null and void if tho wort ruthoriz€d by thls <br />ftsrmit is not commncod wilhin 180 d8ys from lhe dalo ot lhi3 p€rmil or il mrk rulhorizod by thas <br />is suspended or absndon€d at any time alter the work is commncod lor a penod ol 180 <br />A n* pdmit shall be obt8ingd tact belora such work can ba Gcommncad. <br />Appl8 nll D.d.rdqr <br />I cerlity that I hsve rcad this applielion and 3lale lhat tlr€ sboyo I a9,6 to <br />Applicant or Aganl (Sig.) <br />ol this cily to 6nttr <br />with 8ll end stste laws to <br />Y1^0-slbal (sig )VERIFIED <br />BUILOING <br />PERMIT No PERMIT ISSUEO BY (Sig.) <br />lrt t 17O <br />It <br />Oistnbution I ospeclot 2 File Copy 3 Frnance Copy 4 Applrcsnl Copy <br />cs-61 I <br />b <br />I lS- <br />I <br />M]SCELLANEOUS <br />/ <br />c <br />4(minimum $35.00) <br />-ra o-