HomeMy WebLinkAbout2205 N Poplar St - Misc. Permit (5)APPLICATION AND
PLUMBING PERMIT
(TYPEWRITE OB PRINT IN INK)
e o CITY OF SANTA ANA
206 W 4ih Slreet
667-273A
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,b(esidentiat (] lnduslrial E Commercial EACHJOB AOOFESSe26s ur)
NG AOOBESS
CITY--4 -[L."'Fil2D1,,
5.00
1.00
GAS SERVICE 1 to 4 Outlets
Repair or Replace Gas Piping
Ea. Add l Outlet
5.00
Ortf,-llrt(hr O.ct .!ron
I horeby afi.n rhar r em erenpl lrom tie Contr.cto/s trcolo ta* to, lhe ,ollophg re656 (S&
7031 5. Busrness and Poless'ons Cod? Any cny orcounty whrch.€qw€sa pe.mrt to construcl,
alter. rm9rove, demolEh. or repar riy slrucllre, prc, to (3 Bsuanca. atso requtres lhe appt'cs.tbr socn permrl lo lils r sgned 3t6teDe.t th.r he B trcens€d pu6ua to ttE p,ovB'ons o, the
Co.lr.cror's trce.se Le (Ch.prs 9 (comh€nctng *{h S€ctio. 7@) ot D'vi.lon 3 ot th€
Susrness ,hd Prol6sons Code) or ftat he
'3
er.mpt th€retrom and lhe bas's lo. the a .g€d
sxempl'on Any solanon ol SEton 7031 5by anyapptlcant lor 5 p€,mll sbiects th€.pptica.t lo
a civrr p.nally ol not oore th.n 6ve hundred drll66 (lslb)
E s*r,on rooa r. .s o,ner ol rhe prop€ny or my empoyeos *rlh wag6 .s thetr sote compen
sal'on. wrlldo he *ort and lhe sructu
d.^ ,*orr as o*ne, o, rh.
re 6 nor rnlended or oliered lor sale
:;;;/ru 100.00
5.00
10.00
8.00
4.00
ADOFESS
10.00CITYSTATE/ZIP
6.00
10.00
8.00
5.00
I h6..by allnh rhal r am lr@sed undorlhe provls@ns o, chrptd 9, Div.$on3otlheEusin6!and
Pro,o6.'ons Code, &d my lrcanse,s rn tull lor.e lnd 6fioct
$odd Co r.flruon O.ctr.tb. ,
I t€rebyatnrmlhat I have a cenrl.ar€ ol @.se. o setl ns!.e or3cen icateot wo d's com-
pensitDn lnsu,an@ Csrrned copy rs rrred * h the Ory burtdr.g rnsletr@ depanmenr
l, alid matrng lhrs C€.rrlcare oi Eremplo., you shootd be.ome slq€d to rh€ Wo.ke/s Comp*
sallo. prov6Dns ot lhe f.6o. code. y@ musi ,onhwtth con ry f,nh soch pdrsons o. thE
,€.mrr shall b€ demod r€voted
rs b$ed, l 3n.ll .ol mploy any
Expnos
-
verin€d 8y (S,9 )
I cenry lhal '.lhepenormarcepe6on rn .ny
C.hlorn'a
*,".//'r'Vffi ^*,
Device 2" or Less
(m tntmum $3s.00)
3.00
10.00
10.00
10.00
5.00
5.00
1.00
Deck Drain Syslem - Per Drajn
Repair/Att. Drainage or Vent
Vacuum Breakers 1-5
Over 2'
Vlhter Service Ea. 100'
Sublotal
Penalty Fee (when applicable)
Violalion Fee
Check (Adjusiment)
lssuance Fee
TOTAL PERMIT FEE
oarc / / -
(50.00)
Dale
(minimum 20.00)
PEFMIT NO.
Receipt f,lo.Pc#
Crrt?doi
Tha perhn sh.ll *p,e !y timiraio !.d becorn€ nul a.d vod il th. ro.t luthoriz.d by thi3p.rm( u nor comnr€ncod wihan r m dty! rroh tha date ot lni! p.rmi or n roA .ulho,tscd by nt3p..m[ is su6p€ndcd or .b.ndon€d ar a.y tm. .ft, the worr ir comG...d tor t periin ot t6O
&ys A ner p..m( $.fl b. obriinfir lirst D€to'3 .lJch woa cln t ocohrl€ncsd.
ltl..lll O.d-dal
I clniry lhal I niv6 ,e.d |hG apl icanon and stsrs thd $s .bo,o rnto.mrton b co..!ct. I 4r.. io
coDply *'rh .rr .,ry ordrha.cB .nd st.te rsE retat
aulhon2ed eorenlalDn ollhs c y to e.t6 upon the
::"LgA
TOTAL
FIXTURES
each plumbing f ixture/kap
Dental Unit or l\redical Gases
SEWER
lst 100'+Conn.
Ea. Add'l Conn.
Ea. Add l 100'or Fraction
ftivate Sewag€ Disp. System
GAS PIPING
Temporary Gas Service
MISCELLANEOUS
Whter Heater - Eleclric or Gas
Waler Piping Ea. 100'a
Water Sottner
Alt. or Bepair ol Drainage - Vent Piping
Lawn Sp.inkler
Rain Syslem - Per Drain
lnd. Waste lnterceptor
Pool Traps
10.00
o 5.00
10.00
15.00
5.00
5.00
30.00
5
A-&--E!*8,1P,{L{"\,,,,".,,",n,PEFMIT ISSUEO BY (SE )
ONLY)
0
{ACCOUNT TIT-ata
O'llnbunon t hspeclor Copy 2 FrreCopy 3 Finance
cs 6ri
APPLICANT FILL IN AREA BELOW
{.,
N!i\t-.I
l$
t.
i
NO,
Rain t /ater Piping (buried) Ea. 1OO'
O\€r 5
y'z
Plan Check 65% of subtotal
Conrraclor (Siq )
na- 5"
o a
PLUMBING INSPECTION RECORDS
Remarkg
Ground Work lwale0
Waler Servrce (Ground)
Gas Servrce and Unc,erground
. Lawn Sprinklers
Wasle lnlerceptor
PoolTraps
Sewer
Rool Orains
Water Healers
, Water Sotlner
Benlalor MedicalGases
nough Plumbrng
Frnal Plumbing
Temporary Gas Service
Notes
,
o6tc ln!gactoa Appaovel
tura)
*
Ground work (So,ll X
-APPI.ICATION AND O
MECHANICAL PERMIT
(TYPEWRITE OR PRINT IN INK)
o CITY OF SANTA ANA
206 W. 4th Street
667-2738
APPLICANT FILL IN AREA BELOW r$*
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MAILING ADORESS
CITY
.]OB AODFESS
Orrrlu*hr O..ar.Ur|l
I h6raby .ltr.m thal I .h orenpt l.om rh6 C@rracro/s tic€ie l& ld rho tollorino r66d (S&
7q31 5. Busin6s and Prolaio.s Cod. Any caly or counly whid r€qunos I pcrmh lo conllrld,
aller. rhprove demolan. or .epa, ary 3ltuclur.. prio. lo rl! su.n@, de r.quir6 lh€ applic..l
lor 3!ch psmil lo til. a sqn€d 3lllenE l lh.l na is hc€.!4d purslanl lo lile piovisbds ol lhs
Conl.ac163 licdle Lee/ GnaPler 0 (co,rxnencing rnh Serio. 7qE) ol OryBkr 3 or rh6
8usne65 and Proi6sios Co<,!) o, rhlr h6 is erdpr rh.,6lrm .nd rho b.s6 io. rh€ .rrog€d
ererpl'o. Any violalio. ot Sedion 7(ts1 5 by any applrc! t r . p€rnn lubjecrs rhe applicanr ro
. cNil pen.rly ol nor mo.e th6n rive hund.6d &1168 {35@)
704,r I 6 ownd ol lhe prcpe.ry. o. nydployB wnh wag6 6 rharel. cohpec.t rhe wort 5nd rhe strucrure E
^or 'nre..,ed ., drrded ior er.
E s".''""
d**"70448 l, 4 ownor ol the
I h€reby rltrm itul I d lic€ns€d un&. th6 p.@i.ao^s ot Ch.ptor 9. Orv'rDn 3 ol !h€ A6ins s.d
Pro,6eo.s Code, &d my rrce.se is '. lurr ,o.ce a.d e,t ct
STATE/ZIP
Li@$ fllo
-
ClEs
AOOF€SS
CITY
! Rosideftisl E lndustdai a Comrnercial
EACH FURNACE INCL. DUCTS ANO VENTS
EACH COMPRESSOF, BOILER, OR HEAT PUMP
Outdoor Dual Packaged Healing or Cooling
Range Hood with Ducl and Fan [fype D
EACH IOTALNO.
Heat Pump Compressor than 5 HP
Air Handling less than 2,CFM
Atr Add. lo any Healing/Cooling sys.
Up to 100,000 BTU
O\er 100.000 BTU
EACH ABSORPTION SYSTEM
100,000 BTU to 1,000,000 BTU
1.000,001 BTU to 2,000,000 BTU
5HPto30HP
31 to 50 HP
O\€r 50 HP
EACH AIR HANDLING oR vAv Box
2,000 CFM lo 10,000 C
O\€r 10,000 CFi/l
MISCELLANEOUS
Floor Furna@
H€ater; Susp€nded, Whll or Unit
Com'l Dryer Vents
Decorati\€ Fileplac€ (Wbod or Gas)
Each Vent Fan Connecied to a Duct
Fan C,oil lnslallation
Fare Extinguishing Syslem
Each E\aporali\re Cooler
lncidental Gas Piping
15.00
20.00
25.00
30.00
25.00
40.00
25.00
30.00
10.00
10.00
10.00
25.00
10.00
15.00
15.00
15.00
15.00
15.00
20.00
15.00
15.00
10.00
15.00
hrt,t Cor?. tbn D.Craton
I h€reby rn'im rh6r I have . cert icale ol @nst to $ltinsure, or . certillrte ot ubrt(ers coG
oer6alion l.su,a.ce cerlift€d @py E lal6d w h the City buitdi.g iBpecti@ dep.nment.
I conrt lhal rn rheFErlormanceolthework lorwh.ch
rl and m8*n! thrs Ce.lilaateol Exemptid. you sh@rd b€aom sobiet to rh€ Wdkeis Conp€c$no. prov.sions ol ltE t bor codr. yo! .n6t torth*rth compty *nn !!ch Drovisroos or thls
perD't stull b€ d€omed r€loted
person n any manner so as to b4ome
oare
-
Apptic.ni {Sig )
10.00
si
.// '2o
ustmenl(Adj )
Hood with Ducl and Fan Oype ll)
Fire Damp€r lnstallation
OATE
15.00
15.00
15.00
(50.00)
Dale
(minimum 20.00)
(minimum 535.00)
PERMIT NO.
Subtotal
TOTAL PERMIT FEE
Penalty Fee (wh€n applicable)
Violation Fee
Fee
Beceipt l,lo.Pc#
A!add!
Th6 p6mn 3h3ll 34ns by timndifi ..d b€.onr€ oul ,nd voad it rh€ rfil .uho.ized tly tha
p€.oir 6 mr comrienced warhin rq) dayr lrcrn the d€t. ot this p..mn or it wort r!rho.iz6.t by tnis
po,mll a srEpen<h d abandon.d Et ey tih. .ltsr th€ wort is conh.nc.d tor ! r'eri)d o, rx
d.y3 A .* permil shall b. obtained first b.ior€ slch eo.t .!n b€ .€commenc€d -
r9dc..fi O.draol!
I @nrty lnar I have read thE appn€non ..d stde th.t tho.bove
cohply erlh arl city ordinancs and state rtu3 retrt'ng lo
aulhonzed re9isenrano. ol this oty to enie. upo. the a
rnro.mdE. rs cdrel l€relo
ildr.g .onalldlon and hereby
,o^./4t1
?Wi,iF" &fuf"r*Fr€o By (s,s.)4.i4t6d1z-PEBMTT TSSUEO 8Y ($g )
4 0,315
VALIOATION {OFFICE USE ONTY)(accouNr 111-4ra
D6rnborron , rn.pecior copy 2 Firecopy 3 Fr.
cs-618
Plan Check 650/. of subtotal
Check
4,ull-o*t-
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MECHANICAL INSPECTION RECORDS
Ourdoo. OualPackage Un I
Bange Hood - DucI and fan
Appl€nco vent Ikough Fool
Bepair, Ane,anon. Du.rs
z- 26-8