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o o <br />APPLICATION AND <br />PLUMBING PERMIT <br />(TYPEWRITE OR PFIINT IN INK) <br />CITY OF SANTA ANA <br />206 W. 4th Street <br />667-273a lw <br />APPLICANT FILL IN AREA BELOW <br />@qrIzo <br />ool, <br />m <br /><n(t <br />t,tro <br />[^ <br />E <br />..1 <br />f,rl) <br />9. <br />o <br />G\ <br />or <br />so <br />Copy 2 Copy \ Frn.nce Copy 4 Applicant Copy <br />""8frTo :G$rrA Fe uiut-ng Dr^.#frG <br />OWNER <br />SUNFI^ouJC{C- ftSSOL .sq6-0lto <br />PHONE <br />35 tS €arQuiao nO <br />MAILING ADORESS <br />CITY C-o9-\\ [he-sA,"dij'Tzazt <br />Oun -eullar Oadrrlbo <br />I heroby atlirm lhel I am exompt lrom lhe Crntractor's Lacmsc Law lor thg lollowing rga3on (Sec <br />7(Xll.5, Business and Prol6sions Code. Any city or county which .oquirgs a permrt to construct. <br />aller. rmprove, d6molBh. or repeir eny slruclure. prior to rls r8suanc6. elso roquiros th€ applicSnt <br />lor sch permil lo til3 a srgnad slalemenl th8t he is licensod puBuent to lhe provasions ol th€ <br />Contraclor's Lics$ Las, (Chsptor 9 (commencing with Soclion 7m) ol Davision 3 ot th€ <br />Busrnoss and Prol6sims Code) or lhat he is erempt thorelrom and the bagis lor lhe Sllog€d <br />exemplion AnyviolationofSoclionT03l.5byanyapplicsnllorsp€rmilsublectslhelpplicanllo <br />8 cival penalty ol not moro than tave hundred &llaB (tsm) <br />E SctronZOAa I.asownerolthsproperly.ormyemployeswithwag66thoirsolocompen- <br />salron, will do lhe mrt. and th€ slructure 19 not rntsnded or olls€d lor sale <br />E S*t,on 70448 l. 8s ownd of lhe property, am exclusively contractrnq wilh hccnsed <br />onlractm lo conslruct the prcj*i. <br />Oale otrner (Sig.) <br />Conlreloa t ta Only <br />Residontial !lndustrial !Commercial <br />s.00 <br />10.00 <br />NO.EACH TOTAL <br />ct(t <br />FIXTURES <br />each plumbing fixture/trap <br />Dental Unit or Medical Gases <br />15.00 <br />30.00 <br />5.00 <br />5.00 <br />5.00 <br />100.00 <br />1.00 <br />5.00 <br />Water Heater - Eleclric or Gas <br />Water Piping Ea. 100' <br />5.00 <br />10.00 <br />SEWER <br />Temporary Gas Service <br />1st 100'+Conn. <br />Repair or Replace Gas Piping <br />Ea. Add'l Conn. <br />Ea. Add'l Outlet <br />Ea. Add'l 10O'or Fraction <br />GAS SERVICE 1 to 4 Outlets <br />Private Sewage Disp. System <br />PIPING <br />A14 ^o-t o-t <br />PHONECONTRACTOR <br />lne 4*PtcA.L APda ck'TtoAJ <br />t e7f,l o;xr€? Av€ <br />ADDRESS I <br />cttY hKE r LSt fi*€ ca <br />STATE/ZIP <br />rl Q-9bo <br />I hereby afi.m thal I am licen*d under the p.ovrsions ol Chapler <br />sub,ect to the Worte/s Comp€nsation Lars ol <br />No$c. To AlDllcnl: <br />It alter makrng lhrs Cerlrtrcale ol Eremptron. you should become subifft lo the Worker's Compen- <br />pf@rsims ol tlE Labor Code. you mugl torlhwilh comply walh such provisions or this <br />shell be dEmed ravoled <br />Erphdo6 <br />This peimit shall exprre by limitatim and become null and void il thc mrk ruthdizod by lhis <br />parmil is nol commonc€d wilhin 180 days lrom the dele ol lhis permil d il work aulhorazsd by lhas <br />pormil is suspondod or rbandonsd sl 6ny timo aftor ths wolt is commnced tor a period ot 180 <br />days. A ntr pdmit shell bo ootained tirsl b€tde sch wort en bo rscommncod. <br />3ot the <br />Compantalbn Dclf,allon <br />,4Pro16srons <br />{LLq" <br />Conlracto. <br />Exprres <br />I <br />,) <br />tnt5 lu ll <br />I sgrs loI certity thal I hav€thB application and 3late that lh€ abor6 <br />Applicanl or Agenl <br />Code, and my elltrl <br />Calilornia <br />Date Applient (Sig ) <br />I heraby alfirm that I <br />pensation <br />Oate <br />permil is Bsed. lshallnot employany <br />cerliimle ol consent lo slt-rnsu,e, <br />Certified copy is liled with lhe City <br />Applrcanl <br />the perfdmerceof <br />in any ronn67 so a <br />Apgloni't Madm <br />with all 8nd stil6 lews relatino to <br />horizsd this city to entd 10.00 <br />I <br />Receipt No.7b <br />Wbter Service Ea. 100' <br />o'.pvr2" <br />Backflow Device 2" or Less <br />Orcr5 <br />Vacuum Breakers 1-5 <br />Repair/Alt. Drainage or Vent <br />Deck Drain System - fur Drain <br />Pool Traps <br />lnd. \rVaste lnterceptor <br />Bain System - Per Drain <br />Lawn Sprinkler <br />Rain Water (buried) Ea. 100' <br />Water Softner <br />- VentAlt. or Repair of <br />8.00 <br />10.00 <br />4.00 <br />10.00 <br />10.00 <br />5.00 <br />6.00 <br />1.00 <br />10.00 <br />5.00 <br />8.00 <br />10.00 <br />5.00 <br />3.00 <br />Subtotal <br />Penalty Fee (when applicable) <br />Violation Fee <br />Plan Check 650/o of subtotal <br />Pc# <br />Plan Check (Adiustment) <br />lssuance Fee <br />TOTAL PERMIT FEE - <br />-tDATE <br />(s0.00) <br />(minimum 20.00) <br />Date <br />Bi'A.-,li$"593]PERMIT ISSUED 8Y <br />fiv A7?721-4t2)dlz <br />Drslnbulron 1 <br />CS-61 1 <br />6 3C)g)- <br />I -5 er <br />MISCELLANEOUS <br />I 4e <br />BY (Sig