HomeMy WebLinkAbout2655 S Orange Ave Bldg 5 - Misc. Permit (5)! Residential E lndr.:strial E Commercial NO EACH TOTAL
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MAILINGAODRESS
I Ci-
FIXTURES
each plumbing fixture/trap 4 400 /a.at
10 00
CITY STATE/Z PC"- c z)/ 41 t,J,*e SEWER
1st 100' + Conn 10.00 /0, ao
Ownr.-Build6r Docl.rarlon
lhe@byalltm ihar lam erehpr lrom rheConractor's L cen$ Law lor rhe I
7031.5. Alsinos and Prol€ss,ons Code: A.y ciry o. colhry which €
aller, imprde, demolish, or ropaira.y strucluB, piorlo its I aoroqulcslh6sppli.anrlor
such pomir ro til. a siqn.d st6temo.l rhal h€ is ticaas.d r ro rhe prd'sionsof rho corrac
ror's Licsns€ Liw lch8pld 9 lcmme.cinq wirh S I or D'vB'on 3 ol lhe Susrne$ a.d
P.otesions Code I or thd he 'serem rheref ih€b€sislorihealleqedexemp on.A.yviola.
ion of Seclion 7031.5 by any.pplicrnr subiecls $6 applicanl lo a civil pqnalty oi .or
mno ftan livehundred doll.rs (S
r ot rho proporlt, or my €mployees w h wages as lhetr sole com
end fie svucluo rs .or inrended or oilered lorsare
S I, as wn€r ot lhe properv, am oxclusiwly co.tracmo wlh lE6.*d con-
O*re,lSE.,-
Ea. Add'lCon.3.00
Ea Add'1100'orFraction 3.00
Privale Sewage Disp. System 30.00
GAS PIPING
GAS SERVICE 1 to 4 Outlets 5.00
Ea. Add'iOurlet 1.00
Temporary Gas Service 20 00
MISCELLANEOUS
Water Heater - Electric or Gas 5.00 .{, noContractor Uso Only
Wator Piping Ea. 100'400G.V' Pl"-L + D*..; .Rain Water Piping (buried) Ea. 100'400
ADD_FESS
Zt Ur\ C i._(u,*),n Waler Softener 4.00
Alt. or Repairof Drainage -Vent Piping 300Z,* C"
^t-Cozr-
STAT€/ZIPqLbl?Lawn Sprinkler 3.00
I he,oby ,tlim rh8r I a6 lic6.sd u.&, rhs p.ovi$ons ot Chaprer L OMdon 3 ol lh€ 8osires ..d
Protsrsbns Cod6, and my lic.n$ is in tull lorc€ and .lr*r,
,*"*""gttt&ll Cily
oare,(7EJ6:EL- contracror rsrq I
l/lbrloB Compcnratlon Dcchr.don
I hereby alfih rhal L have a csnincate ol co.*nr lo sell insu@, or a conii'cate ot Worker's ComDen
salio.lnsuranco. Confied copy siledwnh theC ry bulldinq nsp€.rion depa.lment
O.leErpto. Verilied By lsig.I
Dale- applicanrlS'9.)-
rsued, I shall nor 6molov .hv
\2iLa:cd1'o'n'aI
ll, 6hor maki.g rhis Cenifier€ ot Exempiion, Vo{ sholld b6com6 subj6ct lo th6 Wo.ko. s Comp€n-
satio. ,rovisio.s oi lne Labor Cod6. you musl torthwith comply with such p@isions or lhis pemn
shall bo de€mod Bvoked.
Bain System - Per Drain (inside)4.00
lnd. Waste lnterceptor 8.00
PoolTraps 5.00
Roof Drain System - Per Drain
Repair/Ah. Drainage or Venl
Vacuum Breakers l-5 5.00
Over 5 100
Backflow Device 2" or Less s00
O\et 2"i0.00
SubtotalE(pffiorl
This pomir shall6rpie by limitadon and b@omo null and rcid tf trs wort auhonzad bV this p€mn is
.ot comm€ncsd wi$i. 18O &ys f,om rho dat6 of this p6di oi il wo* aothoized by this pdmt it
ssr.nd€d or abanrto@d ar €ny lime ofie. rho work is com@rc.d d a poiod ol 1aO davs. A rew
oomir sh.ll be obbi.ed fi,n beroro such wolt can b€ r6comm.6d.
Applic.nr'! D.d.rutl,on
I cerli'y lhar I have rcad $'s appr caron and $ale lhal th€ above rnlormaron rs cotrecr I asree ro
comply with all c lv ordinances 6nd sbre laws rolarnq ro borrd onsrucron, a.d h6rebv aulhc
rize Epresntanves of ihis c'ty ro 6.16r opon lh€ abow,m€perly lor i.spec o. purposes
.* L^4A<b Aprri.anr or Agonr rsis
3j cc
Penalty Fee (when applicable)
Violation Fee (minimum 035.OO)
Plan Check Fee (minimum $ 15.O0) Acct-+ 1 1 -402
Receipt No PC No
lssuance Fee,10 0q')
TOTAL {minimum S35.oO)\5ry
PEFMIT NO.
SUILDING 31618,,,,,,,o"",",n,PEFMITISSUEOaYISig.)
l 3500c1 310VAIIOATION IOFFICE USE ONLY)
taccouNI111,4r2t
O oAPPLICATION AND
PLUMBING PERMIT
(TYPEWBITE OR PFINT IN INK)
CITY OF SANTA ANA
20 CIVIC CENTER PLAZA
834-4186 {hrt
APPLICANT FILL IN AREA BELOW
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Distribution: 1. lnspector Copy 2. FileCopy 3. Finance Copy 4. ApplicanlCopy
ce-
JOBAOORESS
E S*ti* zOl,or r.
{
I cenitv rh.r in the oeriomanco ol lhe wo.k ror
pe.en io any ma.n6r e as to becom€ subj.ct to
o"n L-&b
Notic6 To Appllcant:
Dental Unitor Medical Gases
f .ao
3oo I
3.00
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