|
7
<br />APPLICATION AND t t
<br />MECHANICAL PERMIT
<br />(TYPEWRITE OR PRINT IN INK)
<br />CITY OF SANTA ANA
<br />206 W. 4th Street
<br />667-2738
<br />4T'"APPLICANT FILL IN AREA BELOW
<br />(!q-9zo
<br />ool,
<br />m(t
<br /><l)
<br />NO.EACH TOTAL.8[Resid€nlial E lndustrial ECommercial'o' ^Wfu -A*ruvil&4-,il-, - G EACH FURNACE INCL. DUCTS AND VENTS
<br />15.00Up to 100,000 BTU€//o
<br />Over 100,000 BTU 20.003EACH ABSORPTION SYSTEM
<br />"'" &z;*:Y77,-et*STAIE/ZIP.lzl-zt-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 />e{i.nHeat Pump Compressor less than 5 HP i 25.00
<br />5HPto30HP 25.00
<br />Out t€sL.LtOadttbn
<br />I haroby sllirm lhal I am 6xmpl ,rom th€ Contrscto/s Licons Law lor lho tollowing roasm (Se.
<br />7031.5. Busin68s md Prol63ion3 Code. Any city or @unly which roquires a pormil to construcl.
<br />alter, improv6. (hmoli3h, or repair 6rry 3lructure, prior to its isuance, ds r€quird th€ applicanl
<br />lor sch permil to tile I signed slrloment that he is licmr€d puBuant to lho prcvBbns ot tho
<br />Contractor's Licens€ Low (Chspls 9 (commencing wilh S*tion 7@0) ol Divbbn 3 ol tha
<br />Bulinas and Prol€8sioru Cods) or that ho is axampl tho,orrom and lhe b6is lor the alleged
<br />sxompllon. Any violslion ol S€ction 7031.5 by any applicant tor r pormil subiels the applicant lo
<br />a cavil penalty ol not moio than tive hundrod dollars ($lrc)l
<br />E S."t'on 7O{4A l, aa ownar ot th6 prcporty, or myemployawith wa96 B theirsolecomp€r
<br />salion, will do ths wort, and the structure is not intendad or otlerod lor sele.
<br />E S*tion 70448 l, a owner ol the prcperty. am exclusively contreling wrth lrcensod
<br />contractoB lo construct the proiet.
<br />Ddc
<br />-
<br />Osnor (Sig.)
<br />ContrElor t,'. Of,ly
<br />TY*zzo,
<br />o
<br />Cr o
<br />AOORESS
<br />EACH AlR HANDLING UNIT OR VAV BOX
<br />Outdoor Dual Packaged Healing or Cooling
<br />31 to 50 HP
<br />Range Hood with Duct and Fan (Type l)
<br />Orcr 50 HP
<br />Air Handling less than 2,000 CFM
<br />2,000 CFM to 10,000 CFM
<br />Orcr 10,000 CFM
<br />MISCELLANEOUS
<br />Floor Furnace
<br />Heater; Suspended, Wall or Unit
<br />Com'l Dryer Vents
<br />Decorative Fireplace (Wood or Gas)
<br />Repair, Alt. or Add. to
<br />30.00
<br />40.00
<br />10.00
<br />10.00
<br />10.00
<br />25.00
<br />15.00
<br />15.00
<br />10.00
<br />15.00
<br />15.00
<br />15.00
<br />I hereby allirm Ihai I em licssed undgr ths provBioN of Chapter 9. OivisEn
<br />Proldg,oos Code, md my lrcense rst?d{k&j!a
<br />",*"
<br />on" lL-27 8? contraclor
<br />and3:W"6s
<br />in tull force 8nd €tlect.
<br />(sis.)
<br />Each Vent Fan Connected to a Duct 15.00 /f. o-z> I l\
<br />2,o,0'o
<br />60, oo
<br />Woil.?a Cofl ?.Batbn Dc'lrdbn
<br />I hereby allirm that I havs a cerlrticate of consst to sslt-insuro. om csrliticato ol Wort6r's Com-
<br />pc.lon in any mann€r !o as lo bocomo subFcl to th3
<br />Cditomh.
<br />taotlc. To Appllcrl:
<br />ll atter makrng thrs Cerlrlicate ol Exemption. you should become subtet to lhe Worker's Compeo-
<br />satron provrsions ol the Labor Code. you musl lorthwith comply wath such provtsions or thrs
<br />permrl shall be deemed revoked
<br />Dal e Applicanl (Sig.)
<br />i nsp€clion deparlment.C€rtitied @py is liled with the
<br />Verilied By (Sig )Expri6
<br />Date Applicant
<br />work lorwhich thisI carlily lhal an lhe lshallrct mployany
<br />Lils ot
<br />pensatron
<br />Oate
<br />Hood with Duct and Fan (Type ll)15.00
<br />Each or
<br />bulthis
<br />Fan Coil lnstallation
<br />Fire Extinguishing System
<br />Each Emporatirre Cooler
<br />lncidental Gas Piping
<br />Fire Damper lnstallation
<br />by
<br />20.00
<br />15.00
<br />15.00
<br />10.00
<br />15.00
<br />Subtotal
<br />Penalty Fee (when applicable)
<br />Violation Fee (50.00)
<br />Plan Check 650/0 of subtotal -Zq. arr (minimum 20.@)
<br />Receipt No.Pc#Date
<br />Plan Check (Adjustment)f.Lo)H /L.2r
<br />lssuance Fee 10.00
<br />TOTAL PERM]T FEE (minimum $35.00)-e
<br />ErplTrlbn
<br />This pormil shall expiro by limitalion and b€coma null 8nd void if the work suthorizod by this
<br />permit b nol commencod within 180 days lrom tha date o, thi3 permit or i, work suthori:6d by thig
<br />patmit i3 suspendod or absndoned al any timo atter the work is cmmnced lor 8 poriod ol 180
<br />dsys. A n€{ psmit 3hall b€ obt8ined liBt belora such work can b€ rmmmmced.
<br />ADgalcd'r D.drdo.r
<br />I csrtify thal I have rgad thB applicslim and slale that the ab@o inlormation is co.rect. I eree to
<br />comply wilh lll city ordinanG and state lrws r€lating to building cmatuc,tion. 8nd horoby
<br />authorazod reprentetion ot this city to enld upon th€ lbove.m6filidrsd poporty tor inspclione&r)iApplacant or Agent (Sig.)::7,=?,4 oerc12-2f-ffi PERM]T NO.
<br />5_!w1,, ,,,.o.,BUILOING
<br />PERMIT No PERMIT ISSUEO BY (Sig )
<br />/er--,*aHaz 4*lattrONLY)
<br />121 Iazl.
<br />Orstrlbutron 1 lnspector Copy 2 File Copy 3 Frnance Copy 4 Applicant Copy
<br />cs-618
<br />15.O0
<br />Ct-,n-1, *1
|