HomeMy WebLinkAbout3700-3710 S Raitt St - Misc. Permit (6)APPLICATION AND
PLUMBING PERMIT
(TYPEWRITE OR PRINT IN INK)
e o CITY OF SANTA ANA
206 W. 4th Street
667-2738
APPLICANT FILL IN AREA BELOW lhd
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3708 S. Santa Fe VlllageJOB AOORESS
OWNER
Sunflower Associates
PFiONE
MAILING ADDRESS3315 Falrview Rd.
crrY Costa Mesa YN'''9zoz6
NO.EACH TOTALD lndustrial D Commercial
Repair or Replace Gas Piping
Ea. Add'l Outlet
GAS SERVICE 1 to 4 Outlets
each fixture/trap
Dental Unit or Medical Gases
SEWER
1st 100'+Conn.
Ea. Add'l Conn.
Ea. Add'l 100' or Fraction
Private Sewage Disp. System
PIPING
5.00
10.00
30.00
5.00
5.00
5.00
5.00
1.00
Temporary Gas Service 100.00
Om.r-BulkLr O.drdbn
I hereby altirm thal I am exempt lrom the Contractor's License Law for the tollowing rsason (S*
7031 5. Busrness and Prot6srons Code Any crty or county whrch requires a p€rmit to construct.
alter, rmprove, demol€h, or repair any slructure, prior lo its isuance. d$ requires tha spplicant
lor such psrmrt to tile a srgn€d slatement that h€ rs lic€nsed puBuant to lhe piovisions Ol the
Conlractor's Lrcenss Law (Chapler 9 (commenong wrth Strtron 7@O) o, Oivasion 3 of the
Busine$ and Prolessions Code) or that he is exempt thererrom and lhe bsis lor the slleged
exemplron Any vroletron ol Seclron 7031.5 by any applicsnt lor a permit subj@ls the applacsnt lo
a crvrl p€nalty ol not more lhan trve hundred dollars (t50O)
E S*tion ZOala l. as own6r ol lhe property. or my €mployees wrlh wages as therr sole compen-
salion, will do the rcrt. and th€ structure rs nol rntondad or ollsod tor sale
E] S*tion 7O4,lB l. 8s owner ot the property. sm exclusively contrtrting with licensod
conlract06 to construcl lhe proi*t
Oale .- Owner (Srg )MISCELLANEOUS
Conli-lor t r. Only
CONTRACTOB
Eagle Pacific Ventures 75t-3222
PHONE
P.O. Box 11388
AOOR€SS
CITY Costa Mesa
STATE/ZIPcA 92627
I he,eby allirm that I am ficensed under the provisions ol 3olthe Businssand
15
9.
9
2 9 0*n,r"",o. 1a,n.1
, and my
2065
tnis fullIcenseProtessronsCode.
4,1 C-
ClassLrcense No
Oale
Alt. or Repair of Drainage - Vent Piping
1 6.00
10.00
10.00
8.00
10.00
4.00
5.00
10.00
'r.00
6.00
5.00
10.00
10.00
8.00
3.00
5.00
Water Piping Ea. 100'
Water Service Ea. 100'
Rain Water Piping (buried) Ea. 100'
Owr2"
Water Soltner
Backflow Device 2" or Less
Orcr5
Lawn Sprinkler
Vacuum Breakers 1-5
Rain System - Per Drain
Repair/Alt. Drainage or Vent
lnd. Waste lnterceptor
Deck Drain System - Per Drain
Pool Traps
Subtotal
TOTAL PERMIT FEE
Fenalty Fee (when applicable)
lssuance Fee
Violation Fee
Plan Check (Adjustmenl)
Plan Check 65% ol subtotal
(50.00)
Date
(minimum 20.00)
10.00
tx0
Receipt No.Pc#
Uo.tan Coipanaalbn Oaclrrlton
I hereby arlirm that I hav6 I cortiradlo ot onsat to *ll-insre, or a cdlilacate ot Woatr's Com-
tao$c. lo ADPlbil:
ll alter makrng lhrs Cerlricate Ol Exemptron. yOU shOUld become SUbltrt lO the Worke/S COmpen-
salron provrsrons of lhe Labor Code. you must forlhwrth comply wtlh such provisions or lhis
permrl shall be demed revoked
Olpp,,"rnt 1S,9.12lLs lgOale
employ any
Laws ol
wrth lhe
rs rssued I
sub,scl lo the Worke/s
Dale
-
Applio.nt (Sig.)
p€nsatron lnsuralce Cdtrlied copy rs tilsdDare 4l9OExprre3 - Verified By (Sig )
I cerrit thai in tho tE tormancsolthe work
pe6m ln any mnnor $ 6 to b6ome
Calitornia
Erplratlon
Thrs p€rmrl shall exprre by lamitalton and bocome null and void il th€ wort authorazod by this
p€rmit is not commnced within t80 days lrom the dalo ol this permit d il rcrk aulhtrized by lhis
IErmit is suspandod or abandoned al any timo atler lha worl is commnced lor I period ol 18O
days. A new permrt shall be obtarned ti6t b€lore such work can b€ recommenced.
AFlcrnt.. O.d.ratdr
I cerlity that I hava r*d this applicatron and statg that the ebova
authoflzed rep16€ntatron ot thts city to enler upon lhe
e"'e""n 2/15/90
to
and
Dale
to
Applicanl or Agent (Sig.)
@mply wth 8ll cily ordinancG and stete lrws
EurLorNG 54622-26
PERMIT No VERIFIEO BY (Siq }
PL P. Lomel-iPERMIT ISSUED BY (Sig,)
r1 1-t112)A11 fees paid M-l1585 e,
Dislnbulion I lnspeclor Copy 2 File Copy 3. Frnance Copy Applrcant Copy
CS-61I
FIXTURES
15.00
Water Heater - Electric or Gas 5.00
(
25.00
(minimum $35.00)
1 9:.t I
O I
PLUMBING INSPECTION RECORDS
Romaiki
Ground Work (Soil)
Ground Work (Water)
Water Service (Ground)
Gas Service and Underground
Lawn Sprinklers
Waste lnterceptor
Pool Traps
Sewer
Rool Drains
Water Healers
Waler Soltner
Rental or Medical Gases
Rough Plumbing
Final Plumbing
Temporary Gas Service
Noles
Ortc Inrpactor Appioval
(Slgnrturc)
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