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Planning & Building Agency <br />Building Safety Division <br />20 Civic Center Plaza <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />\cAN 07E <br />3O-DAY TEMPORARY <br />GAS SERVICE <br />www.santa-ana.o <br />PROPERTY ADDRESS lr2 N <br />BUILDING OWNER'S NAME <br />BUILDING PERMIT NO <br />APP'11 CPC 2016 Rev 6-'17-2019 <br />C <br />.>t ol45oo4 ornen prnurrs 2 \_L)0te \q33::('\2,f t- <br />Request is hereby made for the temporary release of gas service on the subjeit fjrbFeiy5n e purpose of test- <br />ing equipment and/or mechanical systems prior to final releases <br />I am fully aware of Section 1 09.1 of the California Building Code which indicates, in part, that no building or structure <br />shall be used or occupied until the Building Official has issued a Certificate of Occupancy for the building. <br />Furthermore, it is not our intent to use or occupy this building until all City regulations and conditions concerning this <br />building have been complied with, and the City of Santa Ana is hereby authorized to order discontinuance of service <br />for any violations of the above conditions pnor to the final approval of the structure by the Building Official. <br />AT THE TIME OF APPLICATION FOR TEMPORARY GAS SERVICE, THE OWNER SHALL POST A ONE THOUSAND <br />DOLLAR (S1,000.00) CASH OR SURETY BOND CONFORMTNG TO THE SANTA ANA MUNtCtpAL CODE SECTTON 8- <br />1768 FOR EACH SERVICE METER. THIS BOND SHALL BE RELEASED UPON REQUEST AFTER THE CERTIFICATE <br />OF COMPLETION OR CERTIFICATE OF OCCUPANCY IS ISSUED. <br />THE ISSUANCE OF A TEMPORARY GAS SERVICE PERMIT DOES NOT IMPLY NOR CONSTITUTE APPROVAL OF OC- <br />CUPANCY OF THE PROPERTY, <br />Each Meter .................$253.66 <br />o_ <br />Sig nature - O r or Authorized Aoent <br />€ 9A V,F{ t\" L /r/'..ti <br />DateTtvezto. qL\2 50=6 <br />Print Name <br />lz lo'L Ct€N] \ t-ttW h:'tD + Z <br />Telephone No <br />LDe kN&] Es C* 4crtn <br />Zip Code <br />(OFFICE USE ONLY) <br />L\,Approvals Required <br />Electrical <br />Total Fees Pd <br />t)r u1) <br />Date tvtisc. neceipt*-/38 lc <br />Skuctural <br />Date Date l'l-:ru,^\9 <br />Date Surety Bond # <br />t..\o.I <br />Gas Co. Notifled by Processed by <br />SUITE <br />Address City Statelb @tyo,st coast d ttcKen 6/ . c) 'N\ <br />Email Address (Strongly Recommended) <br />Plbg./Mech._ <br />Date