HomeMy WebLinkAbout3700-3710 S Raitt St - Misc. Permit (5)APPLICATION AND
PLUMBING PERMIT
(TYPEWRITE OR PRINT IN INK)
I o CITY OF SANTA ANA
206 W. 4th Street
667-2738
APPLICANT FILL IN AREA BELOW l'n/
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VResidential
EIYTI
! lndustrial E Commercial NO.EACH3706 S. Sanaa Fe VillageJOA ADDRESS
Sunflower Associates
OWNER PHONE
5.00
10.003315 Fairview Rd.
MAILING AODRESS
Costa Meea
CITY STATE/ZIPcA 92626 15.00
5.00Ea. Add'l Conn.
Ea. Add'l 100' or Fraction 5.00
Private Sewage Disp. System
GAS SERVICE 1 to 4 Outlets
30.00
5.00
Ea. Add'l Outlet 1.00
Repair or Replace Gas Piping 5.00
Oum-Bdld.r lrcdr.ibn
I hereby attrrm lhal I am exempt trom the Conlractor's Lrcense Law lor lhe lollowrng reason (Ss
T03l5.BusrnessandPro16sronsCode Anyotyorcountywhrchrequrresape.mrttoconstruct.
alter, rmprove. demolrsh, or reparr any slructure, pilor lo rts rssuance, also requrres the applrcanl
for such pormrt lo trle a srgned slalemenl that he rs [censed pursuanl lo the provrsrons ol lhe
Conlraclor's Lrcense Law (Chapler 9 (commencing wath Selron 7@0) ol Divrsion 3 ol the
Busrness and Prol6srons Code) or thal he rs exempl the.efrom and the basrs lor the alleged
eremptron AnyvrolatronofSectron70315byanyapplrcanltorapermrtsublectstheapp[canlto
a crvrl penalty ol not more than five hundred dollars ($5O0)
O SetronZO4A l.asownerollheproperiy.ormyemployeswrthwagsaslherrsolecompen-
salron. wrll do the mrt. and lhe struclure rs nol Inlended or ollered lor sale
E Sel'on 70448 l. as owne. ot lhe property, am exclusrvely conlractrng wrth lrcensad
contracloB lo conslrucl lhe p,otrcl
Oste
------__-
Owner {Sr9 )
-
Temporary Gas Service
Water Heater - Electric or Gas
100.00
5.00
ConlI*-toE l,t. Only
Water Piping Ea. 100'10.00
Paclflc VenturesCONTRACTOREagle '19f-tzzz Bain Water Piping (buried) Ea. 100'8.00
Water Softner 4.00AOORESSP.O. Box 11388
Alt. or Repair ol Drainage - Vent Piping 10.00
Costa Mesa
CITY STATE/ZIPeA 92627 Lawn Sprinkler i 6.00 | 6.OC
10.00
8.00
5.00
I hereby al,rrm that I am lrcensd under the provrsions ol Chapter 9.
Prol6sions Code. and my lrcense 6 rn lull ldce and
L,cense No 4-29611- crass2l ts leo
ol the Busrness and
9109
(S'g )
3.00
10.00
5.00
1.00
5.00
10.00
Rain System - Per Drain
Deck Drain System - Per Drain
Repair/Alt. Drainage or Venl
Backflow Device 2" or Less
Water Service Ea. 100'
lnd. Waste lnterceptor
Pool Traps
Vacuum Breakers 1-5
Over 5
Over 2"
10.00
Subtotal
I lEreby altrm that I havo a certiridto ot conssnt lo sll-insure.
person rn any manner so as lo b*ome subiecl lo
Calrlornia
tlo[c. To ADellcil:
lf afier makrnq lhrs Certrfrcale ol Exemplron. you should bsome subiel lo lhe Worker's Compen-
satron provrsrons ol lhe Labor Code. you musl lorlhwrlh comply wrlh such provrsions or lhrs
permrt shall be demed revoked
a cadilicale
2lLs le0 Applicant (Sr9 )
trled the
I certrfy thal rn the performance ol lhe work
Worker's Com-
Date
Oale Applicant (S9 )
Worltr! Comp.rutbn O6lIallon
gensatron Insurance Cstrtied coov rsoere 4l9O
Exprres
-
Vwilied By
Penalty Fee (when applicable)
(50.00)Violation Fee
Plan Check 650/o ol subtotal (minimum 20.00)
Receipt No.Pc#Date
Plan Check (Adjustment)
Erdr.ton
This p€rmit shall expiro by limitetion and become null end void al th€ work authorizod by this
permil i3 nol commencad within lE0dayg lrom the data ol lhis p€rmit or itwork 8ulhdiz6d bylhis
,Ermil is suspondad or abandonod at any tima ellsr th€ work i9 commoncrd tor 8 period ol IEO
days. A now pormil shsll b€ oblaaned lirsl b€tore such work can b€ racommanced.
ArDIc.nl'. D.d.r.odr
I certrty lhal I have .ead this spplicaton and stale thal the
lulhorized ropr€a6nlslion ol this cily to onler upon
pu7po3a3.
I agrtr to
hergbycomply wrlh all oly ordinancB and state las
or," LJ)!!LO Appr.anr or Aeant
lssuance Fee
TOTAL PERMIT FEE
DATE
(minimum
PERMIT NO.
TOTAL
each fixture/trap
Dental Unit or Medical Gases
SEWER
1st 100'+Conn.
GAS PIPING
MISCELLANEOUS
10.00
0
BurLorNG \L6.1 \-) 1 PL PERMIT ISSUEO BY (Sig.)
P. Lomeli
A11 fees paid M-1r585 CL . l1r/r- L-/{ - I n
vALroATroN (oFFtcE USE ONLY)
(ACCOUNT r1!-412)
Drslnbution. I lnspector Copy 2 Frls Copy 3 Fr Copy 4 Applrcanl Copy
cs-61 1
,5.0O
IUJgI
1
t
o I
PLUMBING INSPECTION RECORDS
R6markg
Ground Work (Soil)
Ground Work (Wateo
Water Service (Ground)
Gas Service and Underground
Lawn Sprinklers
Waste lnterceptor
Pool Traps
Sewer
Boof Drains
Water Heaters
Water Soltner
Rental or Medical Gases
Rough Plumbing
Final Plumbing
Temporary Gas Service
Notes
Drtc lnrpecto? Approval
(Slgnlturo)
/%a J..4r- -,