HomeMy WebLinkAbout3700-3710 S Raitt St - Misc. Permit (7)APPLICATION AND
PLUMBING PERMIT
(TYPEWRITE OR PRINT IN INK)
a o CITY OF SANTA ANA
206 W. 4th Street
667-2738 Itr*
APPLICANT FILL !AREA BELOW
@g-Iz
ootmoo
o0J
Ir#r
n lndustrial ! Commercialfflesidential NO.EACH TOTAL3710 S. Sanra Fe VlllageJOB AOORESS
fixrunes
Sunfloser Assoclates
OWNER PHONE
each plumbing flxture/trap 5.00
Dental Unit or Medical Gases 10.00
MAILING.}ODBESS
3315 fatrview Rd.
SEWERCITY
Costa Mesa
STATE/ZIPcA 92626 1 st 1 00' + Conn.15.00
Ea. Add'l Conn.5.00
Ea. Add'l 100' or Fraclion 5.00
Oxn r-&rLr.r lr.dftbn
I hereby 8ltarm lhal I am exmpt trom the Contracto/3 Lacense Law lor the tollowang rea3on (S€c
7031 5. Busrn$s and Prot6srons Code. Any cdy or county which requireg a permit to construct.
alter, rmprovs. demolish, or repaar any structurg, prior to its issuanc6, also requires the applicant
,or $ch permd to tile I sqned 3tat6menl lhat he as licons€d puEuanl lo th€ provi3ions ol the
Conlractor's Licens Law (Chapter 9 (commsncing with Section 7m0) o, Division 3 ot tho
Business and Prolasions @de) or that ho is exempl theieliom and the basis lor lhe allegod
sxemption AnyviolalronotSaclionT03l.5byanyapplianltorap€rmilsubitrlsthespplicantto
a civil p€mlty ot not more than liv€ hundr€d (bllars ($5m):
E S*t,on 7Oa4A l. as owner ot the properly. or myemployes wrth wage6 s lhoar sle comp6n-
Sation. will do the wort, and the slructure is nol intmded or ollsed lor sale
E S*tion 70448 l. as owner o, the property. am sxclusavely contractang wilh lacens6d
contrrctoG to construct the proiec,l.
Oate Owrer (Srg )
Conlrrcton [r.. Only
"o""flogl" Pacif ic ventures PHONE75t-3222
P.O. Box 11388
ADORESS
Costa Mesa
CITY STATE/ZIPcA 92627
I heroby sllirm that I 8m licensd under the provisions ol Chaptor 9, Oivision 3 ot the Busin6s and
Prol6sions Code, md my lrcense rs
Lic.nse No 420651 c,*.9
or]c 2l L5 I g0conrracro, (s,e )
andin tull lore
c-2
Sorf a't Com9arlaf bo Daclrr0on
I h€rcby st irm thet I haw s cartilietc o, @nsl to slf-insurs. or a cdtilicateol Wbrlq's Com-
I certrly thsl rn lhe perrormancaollhe work lorwhach this Fnrmit is rssued. I
p€r8on in any mlnner 3o B to bocome subiact to tha Work6/B Componsalion Lils ot
Caliromia
t{otlc. To AP9llcrl:
ll atter makrng lhrs Certrficale o, Eremptron, you should become sublst to the Worker's Compen-
salron provrsrons of lhe Labor Code, you musl lorlhwrth comply wrlh such provrsrons or thrs
pe.mrt shall be demed revoked
pensatron lnsurance Certrled copy is frled the building
notemployany
Veflfied By
d6partment
P:;?", 419_0
Dare 2 / 15 l90 orrr,canr (s,s )
Dato
-
Applienl (Sig.)
Erparrdon
This permit shall expire by limitatim and bocome null and void it the work aulhorizod by thig
p€.mit is nol @mmsnced within tEO dsys lrom th€ dsla ot thb pgimil or it wort suthoriz6d by this
p€rmil is susp€nd€d or abandoned al any tim6 stler lhe wort is commencod lor 8 period ol 1E0
days. A nil pormil lhall be obtsined ,iBt bolora $ch worl en b€ @mmn@d.
Applbrrill O.dr.[dr
I cerlily thet I have rsd this application and state that lha abov6
@mply with all cily ordinancB and st8l6 laws rglating to
aulhoiized rapraentation ol this cily lo 6nld upon thc
purpos€s.
as
Applicant o, Agenl (Sig.
lor inspeclion
end haroby
I ag.e lo
o.," 2/15/go
Alt. or Repair of Drainage - Vent Piping
30.00
I 6.00
25.00
Private Sewage Disp. System
Water Service Ea. 100'
Over 2"
Backflow Device 2" or Less
Over 5
Vacuum Breakers 1-5
Repair/Alt. Drainage or Vent
Deck Drain System - Per Drain
Pool Traps
lnd. Waste lnterceptor
Rain System - Per Drain
Lawn Sprinkler
Water Softner
Rain Water Piping (buried) Ea. 1@'
Water Piping Ea. 100'
Water Heater - Electric or Gas
MISCELLANEOUS
Temporary Gas Service
Repair or Replace Gas Piping
Ea. Add'l Outlet
GAS SERVICE 1 to 4 Outlets
PIPING
5.00
100.00
1.00
5.00
5.00
10.00
10.00
10.00
8.00
5.00
4.00
1.00
10.00
5.00
6.00
10.00
10.00
3.00
8.00
5.00
Subtotal
Penalty Fee (when applicable)
Violation Fee
Plan Check 650/o of subtotal
lssuance Fee
TOTAL PERMIT FEE
DATE
(50.00)
Date
(minimum 20.00)
(minimum $35.00)
PERMIT NO.
Receipt No.Pc#
EurLorNG 54627-33
PERMIT No VERIF|EO BY (Sig )
PL
PERMIT ISSUEO BY (S'g )
P. Lom6Li
-?0
(ACCOUNT t-1121
Oislnbulron: I lnspoctor Copy 2 File Cogy 3 Fanance 4 Applrcant Copy
CS-61 1
Plan Check (Adiustment)
.15 t
10.00__0-
I
1,
A11 fees paid M-1L585 C/L.
I a
PLUMBING INSPECTION RECORDS
Romaik3
Ground Work (Soil)
Ground Work (Waler)
Water Service (Ground)
Gas Service and Underground
Lawn Spranklers
Waste lnterceptor
Pool Traps
Sewer
Boo, Drains
waler Heaters
Water Softner
Rental or Medical Gases
Rough Plumbing
Final Plumbing
Temporary Gas Service
Noles
O!tc lnrpactor ApproYal
(Slgn!turc)
ftra 7