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APPLICATION AND a o CITY OF SANTA ANA <br />MECHANICAL PERMIT <br />(TYPEWRITE OR PRINT IN INK) <br />206 W. 4th Street <br />667-2738 lhl <br />APPLICANT FILL !N AREA BELOW <br />(! <br />E-9zo <br />ool, <br />m <br />U''a <br />U){ <br />o <br />U) <br />0)Irt <br />0, <br />hd <br />o <br />H.HH <br />0, <br />0eo <br />t,I <br />p <br />H. <br />r.t <br />6) <br />n Residential D lndustrial E Commercial NO.EACH TOTALJOB ADDRESS--37IO-Santa Fe Vlllage Dr., Unlt G <br />EACH FURNACE INCL. DUCTS ANO VENTS <br />15.00Up to 100,000 BTU"tT6/s+o-ortoo*Stfr,f lorer As soc iates <br />20.00Over|00,000 BTUMAILING AOOFESS <br />3315 Fairview Rd. <br />Costa Mesa <br />CITY STATE/ZIPcA 92626 <br />EACH ABSORPTION SYSTEM <br />100,000 BTU to 1,000,000 BTU <br />30.001,000,001 BTU to 2,000,000 BTU <br />HEAT PUMPEACH COMPRESSOB, BOILER, <br />1 25.00 25.00Heat Rrmp Gompressor less than 5 HE-. <br />5HPto30HP 25.00 <br />30.0031 to 50 HP <br />Over 50 HP 40.00 <br />EACH AIR HANDLING UNIT OR VAV BOX <br />Air Handling less than 2,000 CFM 10.00 <br />Orrat€ulot O.dt abo <br />I hsreby aflirm that I am exmpl lrom tho Cmtrtcto/s Lic63e Law lo( lhe lollowing rosm (Soc. <br />703 1.5. Businffi and Proto$ions Code. Any city or counly which rsquiro3 a permil to construcl. <br />eltei. improv€, demolbh. or ropair eny slructuro. prioi to ils isuance. al$ r6quir6 lh€ lpplicant <br />tor Buch permal to lilo s sioned statomonl lhat he b liconsed puBuanl to the provision3 ol tho <br />Conlraclor's Licon$ Lil (Chapld 9 (comencing wilh Selion 7mO) ol DivBim 3 o, ths <br />BBinoss and Proressims Codo) or that ha is sxompl lhoralrom and lho bsis lor the allog€d <br />eremplion. Any violalim ol S€c1bn 7@1.5 by my eppli$nt lor 8 pormit subiecils lhe spplicsnt to <br />I civil p€nalty ot not more than live hundr€d (bll8B (S500)l <br />ES""tionroat l,asownerotthoproperty,ormysmployesswrthwag6alheiisolecompen- <br />salion. will do the wort. and thg structure E not inlended or olrored to. sale. <br />E S*tion 70448 l. ss owner ol the prcperty, am oxclusively contrmling wilh licensed <br />conlreclm to con3trucl lhe protel <br />One <br />- <br />Oxnor (Sig.) <br />I horeby srlirm that I am licensed un@r the provisaons ol Chaptor 9. Orvision 3ol <br />AODRESS <br />3180 Broken Arrow <br />C|TY N-rA-rEz-,PNorco | 91760 <br />Conlrrton t,tc Only <br />'2yryrvProlessrons Code. ild mv lrcense rs <br />,-,","13 /.9 ol5o7l- <br />7 <br />"' <br />*" <br />CONTRACTORSteel T. AIC <br />rn lull lorG 8nd 6tlel <br />o"r"lT21 47 conr.eroi <br />Outdoor Dual Packaged Healing or Cooling <br />Repair, Alt. or Add. to any Heating/Cooling sys. <br />15.001 <br />10.00 <br />10.00 <br />2,000 CFM to 10,000 CFM <br />Fan Coil lnstallation <br />Owr 10,000 CFM <br />Each Vent Fan Connected to a Duct <br />MISCELLANEOUS <br />Floor Furnace <br />Heater; Suspended, Wall or Unit <br />Com'l Drler Vents <br />Decorative Fireplace (Wood or Gas) <br />Hood with Duct and Fan r) <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 />15.00 <br />15.00 <br />10.00 <br />15.00 <br />15.00 <br />15.00 <br />Fire Extinguishing System <br />Each Evaporatilre Cooler <br />Fire Damper lnstallation <br />Each Appliance or Equrpment Begulalad by <br />this Code but not specifically listed abow <br />Hood with Ducl and Fan (Type ll) <br />lncidental Gas Piping <br />Suoto\l 60.00 <br />*b.i.rr Coile.ildbn Oadrtbn <br />I hdeby affirm lhat I heve a cerlalicale ol @nsmt to selr-insure, or 8 cortilicate ot WoAd's Com- <br />p€mation lnsurence. @(tilied @9y B liled wilh the City brrilding <br />I cortrly that in the Frrormanceolthowork lorwhichlhig <br />p€Bon in eny mannd s as lo b@m€ lubi€cl to th€ Wtrto/3 Compons.lion Lrs ot <br />Calitomla <br />Nolle To Appllcrt: <br />ll alts makrng thrs Certrtrcateof Exemplron. you should be@mesub,*ttolheWqkeasCompen- <br />satron provrsrons ol the Labor Code, you musl lonhwrlh comply with such provrsrons or lhrs <br />permii shall b€ deemed revoked <br />anspetion dopartment <br />I shall nol employ any <br />Dale <br />- <br />Applicant (Sig.) <br />Oate <br />Erprres 4190 veriried By (sis ) <br />on tt'L?'V7 Appricanr (sis <br />Penalty Fee (when applicable) <br />Violation Fee (s0.00) <br />Plan Check 65% ol subtotal 39. QQ (minimum 20.00) <br />Receipt No.Pc # 6917 Date 213 <br />Plan Check (Adiustment)Cred\16.25 <br />lssuance Fee 10.00 <br />TOTAL PERMIT FEE (minimum $35.00) \r -0- <br />Erplr.llon <br />ThE permit shall oxpirs by limitatam and bocome null md void if lho work authsiz€d by lhis <br />permit B nol commsncod within 180 deys from th€ date of this parmit or it work aulhoriz€d by this <br />petmit is suspmd€d or abandonod al any limg arts the wort is cmm€nced lor a p€riod ol 180 <br />days. A new ptrmit shall b6 obteinsd lirgt beloro such work cen be recommencod. <br />ADplb.Ga'3 hrrbn <br />I cartity thal I have read lhis spplicatim 8nd ststo thal lho above inlormalion B corr*t. I egre to <br />@mply wath all city ordinancG and slale l8ws rolstino to building con3tuction, and hsroby <br />authorized roprBsntetbn o, this city to ents upon lhe abovlmillionod prcp€rly tor i,|lpctim <br />o"a?a247 Applicent or Agent <br />purpos6 <br />DATE / X.24-A 1 PERMtrNo. 1,37 7l l <br />Egl"fis"5L633 VERIFIEO BY (Sig.)PERMTT rssuEo BY (srs.) -- ailZ sn <br />vALroATroN (oFFrcE usE oNLY)ALL FEES PAID ON M 10865 <br />t2 - LT - 8? <br />lion l lnspeclor Copy 2 Ftle Copy 3 Finance Copy 4 Applicant Copy <br />cs-6r8 <br />25.00 <br />I ?n nn <br />\