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APPLTCATION AND I <br />MECHANICAL PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />t CITY OF SANTA ANA <br />206 W. 4th Street <br />667-2738 W <br />APPLICANT FILL IN AREA BELOW <br />q,grIzo <br />oof,, <br />m <br />U)(, <br />(, <br />! <br />o <br />Ll) <br />0)p <br />rrp) <br />ri{ <br />o <br />ts.HH <br />0r <br />0ao <br />Ui <br />F <br />H.rt <br />U <br />Distflbution 1 lnspeclor Copy 2. File Copy 3 Finan€a Copy 4. Applicent Copy <br />3710 Santa Fe Vlll-age Dr., Unit D <br />JOB AODRESS <br />lower Associates <br />"^5'StfT"trview Rd. <br />"''[osta Mesa <br />Orn -!rr[d., O.clrtloo <br />I h€rsby altirm thrt I am srdnpt lrom tho Contrec'to/s Licons Law lorthe lollowing re.son (Sec. <br />7@l 5, Bu3in6s and Por6sims Codo. Any city or county which r€quiros I p€rmil lo construcl, <br />alter. improve. demolish. or ropair any struclura. prior to ils issuance. also roquires tho lpplicsnl <br />fo, such pormit lo lile a signod stltGmsnl lh8t ho b licmlod purluant lo th€ provi3ions o, lhc <br />Conlraclor's Licmse Lar (Chapl6r I (commencing with Soction 7m0) o, Oivirion 3 ot lh6 <br />Business 8nd ProtGions Codo) or thal ho ir exempl tharelrom and lhe blsis ror lhe alog€d <br />oxemption. Any violetion o, S€clion 7031.5 by any applicant lor a pdmit subiecls the applicsnt to <br />s civil penalty of nol more lhan lave hundrod (bllers (3500): <br />ES""tion7(f4A l.asowndollheproparty,ormyemployswithwag€3esthearsolecompoft <br />3ation, will do the work, and tha 3lruclur6 is not intgnd€d or ottorod lor g6le. <br />E S*tion 70448 l, I owner ol the pop6rty. em exclusively conlr*ting wifh licsnled <br />@nlractors to conslrucl lhe prcjocl. <br />Dale <br />- <br />Owm. (Sig.) <br />ConlTatoil l..o Only <br />3180 Broken Arrow <br />CITY STATE/ZIP <br />9t760 <br />CONTRACTOR <br />C <br />AOORESS <br />el T <br />I heroby alrirm that I am licensod under th€ provisions otCheptar g Oivi3ion 3oltheBugnesgri, <br />Prote3sions Cods. and my licanso is in lull ,orc6 and etfacl. .4Zb/ <br />orrcll'tlfi conrraaor (s.s ) <br />c20 0150127..J?./"90 5507 1 7",*" <br />EACH FURNACE INCL. OUCTS AND VENTS <br />Heat Pump Compressor less than 5 HP <br />EACH AIR HANDLING UNIT OR VAV BOX <br />Repai( Alt. or Add. lo any Heating/Cooling sys. <br />Range Hood with Duct and Fan (Type l) <br />20.00 <br />NO.EACH TOTAL <br />1 <br />Up to 100,000 BTU <br />Otaer 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 <br />EACH COMPRESSOR, BOILER, <br />5HPto30HP <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 />Outdoor Dual Packaged Healing or <br />Floor Furnace <br />Heater; Suspended, Wall or Unit <br />Com'l Dryer Vents <br />Decoratile Fireplace (Wood or Gas) <br />Each Vent Fan Connec.ted to a Duct <br />Fan Coil lnstallation <br />15.00 <br />20.00 <br />25.00 <br />30.00 <br />25.00 <br />40.00 <br />25.00 <br />30.00 <br />10.00 <br />10.00 <br />10.00 <br />25.00 <br />20.00 <br />15.00 <br />15.00 <br />15.00 <br />15.00 <br />15.00 <br />10.00 <br />15.00 <br />Residsntial !lndustrial nCommercial <br />105 .00 <br />tlo*.n CorD.lrdbn O.clrtbo <br />I hareby arlirm lhal I have a cortiliota o, @nsmt to self-insuro. or 8 certiticato ol Workr'9 Com- <br />pensation lnsurenc€ Cstified @py is lil€d with ths City brrilding inspection dcpsrtmont. <br />I certity thal in lhe fprlormanco of the work rorwhich this <br />peBon in any manner so rs lo bocomg subioct to tho <br />Calitomia <br />tlolb. To Appilcnl: <br />lt 6fttr m8king this C€rtiticatgolExomption. you Bhoutd b€come3ubisct to theWdke/sCompor <br />aalion provisions ol th€ Lrbor Code. you mBt lorthwith comply wilh such pr@isions o, thi8 <br />permil shsll b€ deemad ravokod. <br />orr" t7414 Applicanl <br />Oate <br />- <br />Appticsnt (Sig.) <br />3i;?". 4/90 veriried By (sis ) <br />Hood with Ducl and Fan (Type ll)15.00 <br />by <br />abow <br />Fire System <br />Each Evaporatiw Cooler <br />lncidental Gas Piping <br />Fire Damper lnstallation <br />or <br />but nol <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% ot subtotal 68. 25 (minimum ZO.OO) <br />Receipt No.pc # 6917 Date 2l I <br />Plan Check (Adjustment)Credit 13.00 <br />lssuance Fee 10.00 <br />TOTAL PERMIT FEE \1]ninimu]n $3s.oo)-0- <br />Erpl?.tbn <br />This pormit shall erpiro by limitetion and b€come null end void it the work 8uthdi26d by this <br />parmat b not commonc.d *ilhin 1@days trom the dats ol thls p€rmit or it work authoriz€d by this <br />fErmil is susp€ndod or abandoned at any tim6 atls lh€ work is commnced tor a period o, IEO <br />deys A nfl pormit shall be obl8insd li6t b€toro such wdk can bo rsommof,cod. <br />ApDllc.nl'. D.dribn <br />I certity thal I hsve read this application 8nd stste that the above inlormation is correct. I agroa to <br />comply with all city ordinancss and stete taws,eletino to buitding cmstuclion. and heroby <br />.uthorized reprmtstbn ot lhis cily to enl6r upon thG <br />purpoS€3. <br />o"6t24?-$- Appri*nr or Ae€nr (sis.) <br />inslElionabov*mmtoned property lor <br />."Jr -tDATE NO. <br />BUILOING <br />PERMIT No FIEO BY (Sig,)r-!r,YtPERMIT ISSUEO BY (SIg ) <br />USE ONLY) <br />(ACCOUNT ALL FEES PAID ON M 108651-4'2l <br />cs-6r8 <br />l"1T[/sao-or rc <br />l"tff'9'zozo <br />I Z). UU <br />4 bU. UU <br />15.OO