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APPLTcATToN AND e <br />MECHANICAL PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />a CITY OF SANTA ANA <br />206 W. 4th Street <br />667-2738 <br />APPLICANT FILL IN AREA BELOW &N <br />t!gr <br />9zo <br />ool, <br />m <br />@a <br />(f,) <br />! <br />O <br />U) <br />0) <br />rf <br />0) <br />r!, <br />o <br />P.HH <br />pr <br />@o <br />U <br />H <br />c <br />E <br />H.rt <br />IE <br />\ <br />JOB AOORESS <br />3710 Santa Fe V Unit B <br />Sunflower Assoclates <br />Dr <br />OWNER <br />MAILING <br />CITY <br />Omr&lld.r t.drdbn <br />I haraby slliim thet I am oxmpt irom tho Contraclo/3 License Law ,or thg tollowinO reason (S6c. <br />7@t 5. Busin€as md Prolmions Code. Any city or county which roquiras a p€rmil to conStrucl. <br />altsr, improve, demolBh. or ropeir sny slruclure. prior to rls i$uance. also roquir$ thg rpplicant <br />,or such pormil lo lil€ a signod statement that hs is licgnsod pursuanl to lhe provisions ol lhe <br />Conlraclor'3 Licms Lil (Chapter 9 (@mmncing with Ssction 7d)0) o, Oivision 3 o, tha <br />Busin6s and Prot€3dms Codo) or that ha i8 erempt th€relrom and the basb tor lho allagd <br />oxGmplion. Any violalion o, Soclion 7031.5 by any Epplicanl lor a permil sbjects the applicant to <br />a civil penally ot not more than five hundr€d (bllaB (t5&): <br />E S."tion 7O{4A l. as owner ol lhe propsrly. or myamployoes wath wag€6 as thsrrsolgcompoft <br />sation. will do the wort, and th6 structure i8 nol intonded or otlgred for 3a16. <br />E S""fion 7Orl4B l, I ownd ol the pDpany, sm exclusively cmtEting wilh licmsod <br />conlraclors lo construcl lh€ proiect <br />Oale Owner (Sr9 ) <br />Cmliactoft t.b. orrly <br />CITY <br />Norco <br />STATE/ZIP <br />9L760 <br />Steel T. LIC <br />ADORESS <br />3180 Broken Arrow <br />EACH FURNACE INCL. DUCTS AND VENTS <br />Heat Pump Compressor less than 5 HP <br />EACH AIR HANDLING UNIT OR VAV BOX <br />Range Hood with Duct and Fan (Type l) <br />25.00 <br />15.00 <br />30.00 <br />NO.EACH TOTAL <br />PUMP <br />1 <br />2 <br />15.00 <br />20.00 <br />25.00 <br />30.00 <br />25.00 <br />40.00 <br />25.@ <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 />15.00 <br />10.00 <br />15.00 <br />15.00 <br />Up to 100,000 BTU <br />Each Vent Fan Connected to a Ducl <br />Owr 100,000 BTU <br />EACH ABSORPTION SYSTEM <br />100,000 8TU to 1 ,000,000 BTU <br />1,000,001 BTU to 2,000,000 BTU <br />EACH COMPRESSOR, BOILER, <br />5HPto30HP <br />31 to 50 HP <br />Orcr 50 HP <br />Air Handling less than 2,000 CFM <br />2,000 CFM to 10,000 CFM <br />Over 10,000 CFM <br />MISCELLANEOUS <br />Outdoor Dual Fackaged or Coding <br />Floor Furnace <br />Heater: Suspended, Whll or Unit <br />Com'l Dryer Vents <br />Decoratirae Fireplace (Wood or Gas) <br />Repair, Alt. or Add. to any <br />Flesidential fl lndustrial n Commercial <br />20 .00 <br />90.00 <br />of @rusnt to slf-ansure. or a cartiticata ot Worker's Com- <br />tiled with lhe City building inspection department. <br />I certaty thal in the pertormanceolths work torwhichthig <br />person in any manner so as to be@me subiocl to the Work€/s Compensation Laws of <br />Calarornra <br />l5llc. To App0crll: <br />lr alls making this Ctrtilicatoof Exsmptiofl. you shoutd bmmo subict tothoWorks/sComtpr <br />salion provisions ol ttc Labor Code. you must lorlhwilh comply with such provisions ot this <br />p€rmit shall ba deemed revokod <br />t](-^ c7 <br />I hsoby aftirm that I hava a certili@te <br />pensatron lnsuaanc6 C6rtrtr6d @py isDat€ 4 l90Exprres -----:--- Vtrrfied By (sig.) <br />Date Applicant <br />Woitm Compentdbn O.drrtbn <br />I shall nol employ any <br />Dale <br />- <br />Applacant (Sig.)Hood with Duct and Fan (Type ll)15.00 <br />Each or <br />bulthis <br />Fan Coil lnstallation <br />Fire Extinguishing System <br />Each Evaporatirc 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 />Fenalty Fee (when applicable) <br />Plan Check 65% of subtotal <br />Violation Fee (50.00) <br />58.50 (minimum 20.00) <br />DateReceipt No.Pc# <br />CTedffPlan Check (Adjustment)6.50 <br />lssuance Fee 10.00 <br />TOTAL PERMIT FEE (minimum S5.00)-0- <br />Erpa?r0o.r <br />This p€.mil shall exprro by limilstion and bocome null and void it th€ work authortred by this <br />tErmit is not commencod within 1€() dsys lrom ths dste ot lhis psrmit or il work authorizod by this <br />FErmil is susp€nded or abandon€d at any time alts the wdk is cmmnced lor a p€riod o, tth <br />days A n* permil shall be obtsined liBl b€rora such wdk cen be rtrommencad. <br />I corlity thal I havo ro6d lhis applcation snd st6le that lhe abfla anldmetlon is cdrel. I agr@ to <br />comply wilh all city ordinancB and stete laws relating to building cmstuclion, snd heroby <br />lulhorizod reprsntatbn ol this city to antof upon the <br />purpo36. <br />Applicant or Agonr (Sig.) <br />ptoperty lot <br />"""11:4fr o^rE I2.zq-a:PERMIT NO. <br />SAheYrr rFrEDaY(sie) <br />BUILOING <br />PERMIT No PERMIT ISSUEO BY (SIS,) _ <br />(ACCOUNT r11-4r <br />VALIDATION <br />H -t7-ALL FEES PAID ON M10865 <br />,Y) <br />Dislrabulion: t lnslEtor Copy 2 File Copy 3 Finance Copy 4 Applicsnt Copy <br />cs-6r8 <br />s46-01 17 <br />-L <br />I <br />15 00 <br />CONTRACTOR PHONE <br />279-3200 <br />I horeby artirm that I am licensed under the provisions ot Chepter g Diva3pn 3otthe Businqa a4rP <br />Prolqsg{orl9ed6. ond my licsnse is in lull lorco and oltGct. ./2L.tr <br />..".'*'d"'aII9Z17.,o" cLo c,rAL,cons 0150L27 <br />on" fa'L7 4 conrrscror snr@